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Start Living Healthy

Start Living Healthy. Seiji Yamada, MD, MPH. Nutrition and Your Health: Dietary Guidelines for Americans 2005 Dietary Guidelines Advisory Committee Report *Healthy Hawai‘i Initiative Provider Training. Nine Key Messages. Consume a variety of food Control calorie intake to manage body weight

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Start Living Healthy

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  1. Start Living Healthy Seiji Yamada, MD, MPH

  2. Nutrition and Your Health:Dietary Guidelines for Americans2005 Dietary Guidelines Advisory Committee Report*Healthy Hawai‘i Initiative Provider Training

  3. Nine Key Messages • Consume a variety of food • Control calorie intake to manage body weight • Be physically active every day • Fruits/vegetables/whole grains/low-fat milk • Choose fats wisely • Choose carbohydrates wisely • Cut down on salt • If you drink, use alcohol in moderation • Keep food safe to eat

  4. 1. Consume a variety of foods • within and among the basic food groups • while staying within energy needs • Promote intake of vitamin E, calcium, magnesium, potassium, and fiber by children and adults • Promote intake of vitamins A and C by adults

  5. 2. Control calorie intake to manage body weight • Calories do count - not the proportion of carbohydrates, fat, and protein in diet*NEJM 2003 May 22 • A calorie deficit of 50 to 100 calories a day allows weight maintenance in adults • Monitor weight regularly • Limit portion size

  6. 3. Be physically active every day • Moderate physical activity at least 30 mins. every day reduces risk of obesity, HTN, DM, CAD*Start Living Healthy message: 30 minutes, most days. • Many adults need up to 60 mins. to prevent weight gain • 60 to 90 minutes to prevent weight regain • Children and adolescents need 60 mins. on most days *role for pedometers?

  7. 4. Choose fats wisely • Limit animal fats & cholesterol • Limit trans fats (partially hydrogenated vegetable oils) • Reduced risk of sudden/CHD death associated with 2 servings of fish/week (pregnant, lactating women, children need to avoid mercury)

  8. 5. Choose carbohydrates wisely • Choose whole fruits rather than juices • Choose whole grains rather than refined grains • Reduce added sugars, especially sugar-sweetened beverages

  9. 6. Fruits & vegetables, whole grains, reduced-fat milk products • 2½ to 6½ cups of fruits and vegetables daily *Provider Training: children 5 servings, adult women 7, adult men 9 • Brown rice over white rice • Whole wheat over white bread • Adults: 3 cups skim or low-fat milk per day (Ca, Mg, K, vit D)

  10. 7. Choose and prepare foods with little salt • to lower blood pressure • Potassium-rich diets blunts effect of salt • Goal: < 2,300 mg sodium per day

  11. 8. If you drink alcohol, do so in moderation • Mortality reduction primarily seen in • Men > 45 years • Women > 55 years • Moderation • Men: up to two drinks per day • Women: up to one drink per day • Beer 12 oz., wine 5 oz., spirits 1.5 oz.

  12. 9. Keep food safe to eat • Foodborne diseases yearly toll in U.S. • 76 M illnesses • 325,000 hospitalizations • 5,000 deaths

  13. Putting it all together • Dietary Approaches to Stop Hypertension DASH diet (N Engl J Med. 1997 Apr 17;336(16):1117-24) • High fruits and vegetables • High in low-fat dairy • In hypertensives, reduced systolic BP by 11.4 mm Hg and diastolic BP by 5.5 mm Hg • DASH Sodium: Low salt • + 30 mins. physical activity

  14. *Idaho Plate Method • Healthy meal: 9 inch plate: • 1/2 vegetables • 1/4 carbohydrates • 1/4 protein • fruit and dairy on the side For Type 2 DM, for low-literacy, ESL

  15. Microeconomics • diets based on refined grains, added sugars, and added fats are more affordable • diets based on lean meats, fish, fresh vegetables, and fruit are not • Drewnowski A. Obesity and the food environment. Am J Prev Med 2004;27(3S):154–162.

  16. Control of lives is related to control of land, systems of productions, and the formal political and legal structures in which lives are embedded. -Paul Farmer. Infections and Inequalities.

  17. Microconomics • Supersizing phenomenon • Main cost of fast-food industry: labor • Marginal cost of additional food insignificant • Consumer feels he’s getting a better deal

  18. Economics • 3,800 calories of food a day produced for every American • 500 calories more than 30 years ago • Drives agribusiness imperative to induce consumers to eat more

  19. The Supply Side • Meat-packing plants: Nebraska; Greeley, Colorado • Migrant workers • Work conditions reminiscent of The Jungle • Marshallese: agribusiness in Oklahoma, chicken processing in Arkansas

  20. Marketing the Product • Marketing to children • McDonald’s Playlands • A good parent gives his children what they like • School cafeterias & vending machines

  21. Future directions • Limits on advertising to children • Junk food, soda machines out of schools • Shift government subsidies • from sugar and grain production • to fruits and vegetables • Discounted health insurance for workplace wellness programs • Focus on built communities

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