1. Start Living Healthy Seiji Yamada, MD, MPH

2. Nutrition and Your Health: Dietary Guidelines for Americans Nutrition and Your Health: Dietary Guidelines for Americans 2005 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)

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

10. 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)

11. 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

12. 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.

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

14. 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

15. *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

16. 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.

17. 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.

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

19. 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

20. 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

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

22. 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