“Fixing America’s Eating Habits” in Food Stores

The fix is in press this week for our terrible eating habits. In Nature Medicine, Pao-Hwa Lin and Crystal Tyson review a new RCT of interventions in food stores that they believe point the way to “fixing America’s eating habits.” They write:

“Today, more than half of all adults in the USA have one or more diet-related chronic diseases and health conditions, including obesity and diabetes, and the situation is worsening.

“Food manufacturers and retailers can prosper by growing a loyal customer base, doing right by their customers in the way that they manufacture and sell healthy food, and providing tools to support customers’ healthy eating habits.”

A Daunting Challenge

The ambition here is good. But the authors tell us correctly that the challenge is daunting. “Deciphering diet information and translating it into advice for their patients” is so frustrating that clinicians don’t engage in it.

So the idea here is to engage with stakeholders in broader systems that shape the food environment. In the case of the present study, this was food retailers and their dietitians.

Short-Term Changes for a Long-Term Goal

Dylan Steen and colleagues designed their RCT to test dietary interventions delivered in the setting of a supermarket. They collaborated with Kroger and randomized people into three arms – a control group and two strategies for dietary education in stores and on the web:

“Both Strategies 1 and 2 included individualized, in-person, dietitian-led, purchasing data-guided interventions. Strategy 2 also included online tools for shopping, home delivery, selection of healthier purchases, meal planning and healthy recipes.”

For this study, the measure of healthy eating habits was a DASH score for adherence to the DASH diet. When Steen et al combined the two intervention groups, they found that eating habits improved versus the control group after three months. But three months later, after the intervention was over, they could find no effect. Furthermore, they found no effect on measures blood pressure or BMI.

Individual Coaching for Population Health?

Clearly, dietary coaching can be quite helpful for some individuals. Lin and Tyson seem to think that it’s a promising strategy for population health. “The lack of sustained, long-term success up to now should not discourage us from delivering interventions at food retailers,” they write.

But it’s hard to imagine that a wide swath of the population will engage sufficiently to move the needle on dietary health. It could be that more systemic changes are necessary for fixing the eating habits that shape our health. Very likely, we will need to reshape our food systems that in turn shape our dietary habits.

Click here for the study and here for the commentary.

Workman Sitting on a Basket Cutting Bread, lithograph by Vincent van Gogh / WikiArt

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December 6, 2022