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The light is pouring in A new study analyzing two decades’ worth of nutrition data paints a dark picture for America’s fight against malnutrition and its associated health problems.
“The good news is that Americans are starting to hear the nutrition message and some companies and restaurants are starting to make healthier products, so we’re seeing some improvement,” said Dr. Dariush Mozaffarian, a cardiologist and director of the Food and Medicine Institute at Tufts University in Boston and the study’s lead author.
But most of the improvements occurred between 1999 and 2010, and no progress has been made in nutrition since then, he added.
“We’re at a crossroads as a nation, and this doesn’t bode well for our health,” Mozaffarian said. “If I were to rate the American diet, I’d give it a D, slightly above an F.”
Between 1999 and 2020, the number of US adults who had an unhealthy diet fell 11.4%, from about 49% to just over 37%, while the number who had a somewhat nutritionally good diet increased 10.5%, according to the study.
An unhealthy diet is defined as one that is high in refined grains, processed meats, sugary drinks including fruit juice, and ultra-processed foods that are high in added sugars, salt and fat, and is low in healthy options like fruits and vegetables.
“Fruit and vegetable intake has not increased at all in the last 20 years, which is quite surprising,” Mozaffarian said.
An ideal diet includes at least the daily recommended amounts of fruits and vegetables, plus legumes, whole grains, nuts and seeds. Dietary guidelines such as those from the American Heart Association recommend eating 4 to 5 cups of canned, fresh or frozen fruit and the same amount of vegetables per day.
The nutritionally ideal diet also contained low amounts of sugary drinks, processed meats, refined grains and ultra-processed foods, which are often high in added sugars, fats and salt, according to the study.
Unfortunately, the number of people who consumed an ideal diet that included nine cups of fruits and vegetables increased by less than 1%, the study found.
“A question I often get asked is, ‘Why are obesity and diabetes still on the rise when diets are slowly improving?’ They’re increasing because only 1.58 percent of Americans are eating an ideal diet. We still have a long way to go,” Mozaffarian said.
According to the U.S. Food and Drug Administration, more than one million Americans die each year from diet-related diseases, including obesity, cancer, heart disease and type 2 diabetes, while unhealthy diets and food insecurity cost the United States an estimated $1.1 trillion annually in health care costs and lost productivity.
“I think it’s fair to emphasize that the quality of our diet in the United States remains dismal, and it’s clear why Americans are experiencing epidemics of obesity and diabetes and declining life expectancy,” Dr. Walter Willett, a professor of epidemiology and nutrition at the Harvard School of Public Health in Boston, who was not involved in the study, said in an email.
The study, published Monday in the Annals of Internal Medicine, analyzed dietary information from nearly 52,000 U.S. adults who participated in the National Health and Nutrition Examination Survey (NHANES).
The greatest nutritional gains were made among women, young adults, Hispanic adults, those with higher education and income, and those with private health insurance. Less progress was made among men, blacks, older adults, those with lower incomes, less education, those without private health insurance, and those who are food insecure.
“Demographic disparities based on education, income, race and ethnicity have remained constant or, in some cases, worsened,” Mozaffarian said.
The study found that low-income people saw a 5% improvement in nutrition quality, while high-income people saw a 16% improvement in nutrition scores.
“We need to avoid blaming only the victims of America’s dysfunctional food system for the poor dietary habits documented in the study,” Willett said. “We are not educating students about nutrition in schools and we are feeding them unhealthy meals.”
“Our health care system is almost completely dysfunctional; it allows advertising to tempt our children with junk food and drinks that lead to premature death; and it indirectly subsidizes unhealthy foods in a variety of ways, making healthy options relatively expensive and inaccessible to low-income Americans,” he said.
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Experts say there’s a simple way to change your diet from D to A.
Experts say there are simple steps you can take to make your diet more nutritious.
Cook at home as often as possible. “My number one suggestion would be to do as much shopping as possible at grocery stores instead of eating at coffee shops, sandwich shops or fast food restaurants,” Mozaffarian said.
Even if you eat at a full-service restaurant, He added that people should limit their eating out at restaurants: Previous research by Mozaffarian and his team found that about 80% of the food Americans consume in restaurants is of poor quality.
“Surprisingly, there was no dramatic difference in quality between fast food and sit-down restaurants,” he said.
Instead, choose minimally processed foods that you cook at home and avoid the heat-and-eat convenience foods commonly found at grocery stores. Bring your own lunch and snacks to work.
Don’t drink sugar. While Americans are becoming more aware that sugary sodas are unhealthy, they still don’t realize the link between sugary energy drinks, sports drinks and caffeinated beverages that are also loaded with sugar, Mozaffarian said.
“Energy drinks, pre-sweetened iced teas, and specialty coffee drinks can contain more sugar than soda,” he says. “You see people getting drinks from coffee shops with whipped cream on top; don’t drink sugar.”
But excluding sugary drinks, just 6 percent of the nation’s calories come from added sugars in food, Mozaffarian said. “By contrast, about 35 percent of the nation’s calories come from refined grains and starches.”
Limit refined grains. Overall, refined grains are the biggest culprit in Americans’ poor diets, consuming 5.2 servings per day. “Refined grains, including refined bread, refined rice, crackers, chips and other ultra-processed foods, amount to nearly two servings per meal,” Mozaffarian said.
Whole grains contain the bran and germ and are a nutritional powerhouse packed with healthy fats. It contains antioxidants, minerals, and vitamins E and B. Whole grains take longer to digest, don’t raise blood sugar as much as refined grains, and are high in dietary fiber, which may help reduce the risk of chronic disease, promote weight loss, and improve digestion.
According to the USDA website My Plate, “Examples of whole grains include barley, bulgur, farro, millet, quinoa, black rice, brown rice, red rice, wild rice, oatmeal, and popcorn.”
Refined grains like white flour, corn grits, white bread and white rice have been milled to remove the bran and germ to give them a finer texture and a longer shelf life. Milling also removes nutrients like fiber, iron and vitamins. Refined grains are found in almost all ultra-processed foods, including breakfast cereals, desserts, pastries, breads and crackers.
“Instead of refined grains, feed your gut microbiome with fruits, vegetables, beans, nuts and seeds, and minimally processed whole grains,” Mozaffarian says, adding that fermented foods like yogurt, sauerkraut, and kimchi also support gut microbiome.
