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Dean Pomerleau

Americans Aren't That Clueless about Healthy/Unhealthy Foods

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All,
 
The New York Times has an article out yesterday title Where Americans and Nutritionists Disagree highlighting the results of a survey they conducted comparing what foods average Americans think are healthy/unhealthy vs. what a panel of 50 nutritionists thought about the same foods.
 
The upshot is best groked from the handy graph they provided, showing how the healthiness of foods was rated by average people (x-axis) vs. nutritionists (y-axis):
 
YyJSOZ3.png
 
 
 
Foods along the diagonal show agreement between the two groups. Foods above the diagonal are ones the nutritionists were more likely to rate as healthy compared with the public. Conversely, foods below the diagonal are ones the public in general though were healthier than the nutritionists. 
 
 As the title implies, the article focused on areas of disagreement - like granola, coconut oil and frozen yogurt, which the public thought were healthy but not nutritionists, and foods like quinoa, tofu and sushi which the experts rated healthy but not the public. But what was a bit surprising to me was how much agreement there was between the two groups. It appears in general the American public knows what's good and bad for them, they just don't or can't eat healthy based on that knowledge.
 
The other thing that surprised me was how high both groups (but especially nutritionists) rated chicken and turkey. These "white meats" have been traditionally thought of as healthy by well-informed people, but lately the link between chicken and obesity / diabetes has sullied their reputation. It appears nutritionists haven't yet gotten the memo...
 
--Dean

Edited by Dean Pomerleau
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Well, there isn't yet a memo. As you accurately say in your linked post,

 

while there is no smoking gun that Ad-36 [a chicken virus that seems to cause adiposity in them and that some evidence suggests may also be linked to obesity in humans] causes weight gain in humans, nor as far as I can tell is there direct evidence that you can get it by eating infected chicken (or how thoroughly you have to cook chicken to be sure you've killed the virus), the evidence is suggestive that chicken may not be the healthy white meat it was once thought to be.

Looking at the study Greger references for the "40% more obesogenic" claim, however, it's notable that this isn't the only such finding, nor is it unique to the USA, which has a higher reliance on chicken breeds that are selected for quick weight gain and thus might just be fattier and thus higher-Calorie (I recall a recent study showing that current marketed chicken is fatter and higher-Calorie than the "chicken" in the USDA database, which reflects a moving weighted average of decades of samples):

 

No association between total fresh meat consumption and prospective BMI change was observed ... Men with the highest intake of beef experienced a significantly lower increase in BMI after 6 and 14 y than those with the lowest intake ... After 14 y, a significantly higher increase in BMI was associated with higher intakes of pork in women (∆BMI change highest vs. lowest quintile: 0.47 kg/m2) and chicken in both sexes ... The results remained similar when stratifying on median baseline BMI, and age-stratified analyses yielded mixed results. ...

 

Our data suggest that men and women with the highest chicken consumption (>22.8 g/d) had a 0.19- and 0.53-kg/m2 higher increase in BMI after 14 y of follow-up, respectively, compared to those who consumed no chicken at all. This is in line with recent results from a Danish study showing that high consumption of chicken was associated with greater weight gain at the waist after 5 y of follow-up in women, but not in men (19). The EPIC-PANACEA study recently reported a strong positive association between prospective weight change and chicken consumption, but this was mainly driven by participants with previous illness or weight loss attempts that resulted in changes in diet (21). However, when we adjusted our analyses for special dieting habits (on doctor’s advice) in the 5 y preceding the baseline questionnaire or excluded participants who developed cancer during follow-up, the results did not appreciably change.

 

Back to your main subject: happily, a recent study finds the average American diet has improved significantly in this century:

 

Repeated cross-sectional investigation using 24-hour dietary recalls in nationally representative samples ... from 7 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2012) ... [were compared to] targets of the American Heart Association (AHA) 2020 continuous diet scores, AHA score components (primary: total fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium; secondary: nuts, seeds, and legumes, processed meat, and saturated fat), and other individual food groups and nutrients.

 

Results  Several overall dietary improvements were identified (P  < .01 for trend for each). The AHA primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). The AHA secondary diet score (maximum of 80 points) improved from 35.1 to 38.5 (an improvement of 9.7%). Changes were attributable to increased consumption between 1999-2000 and 2011-2012 of whole grains (0.43 servings/d; 95% CI, 0.34-0.53 servings/d) and nuts or seeds (0.25 servings/d; 95% CI, 0.18-0.34 servings/d) (fish and shellfish intake also increased slightly) and to decreased consumption of sugar-sweetened beverages (0.49 servings/d; 95% CI, 0.28-0.70 servings/d). ... Other dietary trends included increased consumption of whole fruit (0.15 servings/d; 95% CI, 0.05-0.26 servings/d) and decreased consumption of 100% fruit juice (0.11 servings/d; 95% CI, 0.04-0.18 servings/d). ... No significant trend was observed for other score components, including total fruits and vegetables, processed meat, saturated fat, or sodium.

 

The estimated percentage of US adults with poor diets (defined as <40% adherence to the primary AHA diet score components) declined from 55.9% to 45.6%, whereas the percentage with intermediate diets (defined as 40% to 79.9% adherence to the primary AHA diet score components) increased from 43.5% to 52.9%. ...

 

Disparities in diet quality were observed by race/ethnicity, education, and income level; for example, the estimated percentage of non-Hispanic white adults with a poor diet significantly declined (53.9% to 42.8%), whereas similar improvements were not observed for non-Hispanic black or Mexican American adults. There was little evidence of reductions in these disparities and some evidence of worsening by income level.(1)

 

I haven't seen the full text, but per a Washington Post story, "the share of American adults in or near poverty with poor diets declined from 68 percent in 2003 and 2004 to 61 percent in 2011 and 2012. Yet for affluent adults, the share eating poorly declined even more, from 50 percent to 36 percent over the same period."

 

Additionally, as a New York Magazine blog post aggregates and summarizes,

 

 

Soda sales have collapsed; packaged cereal sales have fallen 25 percent since 2000; frozen dinner sales fell 11 percent from 2007 to 2012; while fresh prepared foods have gone up 30 percent since 2009 [the Forum software forbids a direct link, but see http://storeDOTmintel.DOTcom/perimeter-of-the-store-us-june-2014-MR] , and among young adults and kids, eating fruits and veggies has grown 10 percent in the last five years.

Reference

1: Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary Intake Among US Adults, 1999-2012. JAMA. 2016 Jun 21;315(23):2542-53. doi: 10.1001/jama.2016.7491. PubMed PMID: 27327801.

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Recently I went to a cancer event at my local hospital. A dietitian was on the panel with a few cancer doctors. She recommended 9 servings of kale every day. A member in the audience asked one of the doctors, the director of the hospital's cancer treatment department, whether she followed that recommendation. She looked not very comfortable with this question. She admitted that eating those many servings of kale was either hard or impossible for her.

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