1.4: Nutrition and Population Health
By the end of this section, you should be able to:
- 1.3.1 Identify the roles that government agencies and nonprofit organizations play in the creation, implementation, and enforcement of nutritional regulations.
- 1.3.2 Describe current USDA dietary guidelines, including MyPlate.
- 1.3.3 Analyze the primary sources of consumer nutrition information.
- 1.3.4 Assess the importance of client education for promoting healthy nutritional habits.
The U.S. Department of Agriculture
It is difficult to separate an individual from the community when assessing personal ability to meet nutritional needs. Factors such as food accessibility, ability to prepare foods, and traditional dietary preferences play a role in how a client can adopt a dietary lifestyle conducive to health and wellness. Government regulations and programs and the availability of appropriate consumer nutritional education can influence these factors.
The USDA leads 29 agencies that oversee food production and consumption. The USDA (n.d.) recognizes poor nutrition as a substantial factor in illness in the U.S.—poor nutrition is linked to diabetes, obesity, and heart disease. These illnesses impact the nation more broadly by decreasing productivity and increasing health care costs. To foster health, the USDA promotes research to build support and collaboration to provide all Americans equitable access to healthy foods. The USDA’s Food and Nutrition Service works to address food insecurity and provide evidence-based nutritional guidance to consumers (USDA Food and Nutrition Service, n.d.).
As part of the USDA’s commitment to connecting all Americans with access to affordable, healthy food, the USDA manages programs designed to provide Americans of limited income or with special needs with healthy food. For example, the Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides a monthly allotment for enrollees to purchase certain nutrient-dense foods. The National School Lunch Program (NSLP) provides nutritional, low-cost or free lunches to eligible school-age children. Table 1.5 lists food assistance programs available through the USDA for qualified individuals.
| Program | Website |
|---|---|
| Supplemental Nutrition Program for Women, Infants, and Children (WIC) | https://www.fns.usda.gov/wic |
| Farmers Market Nutrition Program (FNMP) | https://www.fns.usda.gov/fmnp/wic-farmers-market-nutrition-program |
| Fresh Fruit and Vegetable Program (FFVP) | https://www.fns.usda.gov/ffvp/fresh-fruit-and-vegetable-program |
| Supplemental Nutrition Assistance Program (SNAP) | https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/ |
| Farmers Market Grant Program administered jointly with the National Association of Farmers Market Nutrition Programs (NAFMNP) | https://www.fns.usda.gov/snap/farmer-producer/farmers-market-grant-program |
| Healthy Fluid Milk Incentives (HFMI) | https://www.fns.usda.gov/snap/healthy-fluid-milk-incentive |
| The Emergency Food Assistance Program (TEFAP) | https://www.fns.usda.gov/tefap/emergency-food-assistance-program |
|
National School Lunch Program
(NSLP)
School Breakfast Program (SBP) Special Milk Program (SMP) Child and Adult Care Food Program (CACFP) Summer Food Service Program (SFSP) Team Nutrition The Patrick Leahy Farm to School Program |
https://www.fns.usda.gov/cn |
The USDA also plays an essential role in regulating food production and distribution to ensure food quality and safety. The Food Safety and Inspection Service is the primary USDA agency that enforces safe processing and packing regulations of meat, poultry, and egg products.
The USDA actively promotes nutrition through educational materials. From the provision of curricula available for school-age children in both English and Spanish, Team Nutrition—an initiative to support child nutrition—utilizes visually appealing materials to promote nutrition various ways.
The Dietary Guidelines for Americans 2020-2025 are designed for policymakers and health professionals to assist in their efforts to promote a healthy, nutritious diet (USDA & USHHS, 2020). MyPlate , a resource directed towards consumers and based on the Guidelines , provides practical information on nutritious foods for consumers to use daily. The MyPlate campaign uses the image of a plate colorfully sectioned into recommended proportions of food for a nutritious meal. Fruits and vegetables comprise half of the plate, grains are approximately one-fourth of the plate, and protein occupies the remaining section. Low-fat or fat-free dairy is represented by a glass next to the plate. The MyPlate website encourages everyone to “start simple with MyPlate” and “make every bite count” (USDA, n.d.).
The USDA recognizes the importance of incorporating cultural food traditions when planning a healthy diet. The Dietary Guidelines for Americans 2020–2025 are meant to be a framework for individuals to use to plan meals that are nutritious yet reflective of their culture/ethnic food preferences. To assist with educating clients from diverse backgrounds, MyPlate educational materials are available in many different languages.
The U.S. Food and Drug Administration
One of the oldest U.S. government agencies is the FDA , which has been the driving force behind labeling. Earlier versions of food labels focused solely on listing accurate ingredients. In recent years, labels have evolved to provide more detailed nutritional information to consumers. The FDA recently updated the Nutrition Facts label on packaged food and drinks to incorporate current research and public input (Figure 1.2). The changes were designed to make it easier for consumers to make good food choices to improve health and wellness. In addition to the new changes, the FDA also engaged in a campaign to strategically support consumer education to decrease poor nutrition that contributes to disease and death.
This is a 30-second “commercial” designed to highlight key changes in the new Nutrition Facts label. Watch the new nutrition facts label video to see how nutrition information can be presented in an entertaining format.
Learn more about the FDA’s new Nutrition Facts label using this interactive resource: Interactive Nutrition Facts Label . Select different label components to learn more about each one and how each appears on the new label. Then, test your knowledge of the new label by taking a brief quiz.
In addition to consumer education, the FDA offers professional continuing education on the new Nutrition Facts label. Visit Healthcare Professionals | FDA to access educational materials designed to help health care professionals understand the new label and how to incorporate it into their practice.
U.S. Nonprofit Organizations
Nonprofit organizations work to advance good nutrition through advocacy for pro-nutrition policies and by providing consumer education and wellness promotion. These organizations may focus solely on nutrition or on reducing the effects of illness and disease. For example, in 2006, the American Heart Association promoted health via nutrition by presenting the Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction. These guidelines, reviewed and updated in 2021, recommend the following nutritional recommendations as part of a comprehensive plan to decrease the risk of cardiovascular disease:
- A variety of fruits and vegetables
- Whole grains
- Healthy sources of protein (mostly plants, nuts, fish and seafood, low-fat or nonfat dairy, and lean unprocessed meat and poultry)
- Liquid non-tropical vegetable oils
- Minimally processed foods
- Minimal added sugar intake
- Foods prepared with little or no salt
- Limited or preferably no alcohol intake (AHA, 2023)
Health care organizations also provide free nutritional resources. For example, Johns Hopkins Medicine offers Health, a vast online resource discussing healthy eating, vitamin use, diets for specific illnesses, and consumer tips. Table 1.6 lists nonprofit websites to explore available information related to nutrition, health, and wellness.
| Organization | Website |
|---|---|
| Action for Healthy Kids | https://www.actionforhealthykids.org/ |
| American Diabetes Association | https://diabetes.org/healthy-living/recipes-nutrition/healthy-food-choices-made-easy |
| American Heart Association | https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics |
| Johns Hopkins Medicine | https://www.hopkinsmedicine.org/health/wellness-and-prevention/food-and-nutrition |
| Mayo Clinic | www.mayoclinic.org/healthy-lifestyle |
| Meals on Wheels America | https://www.mealsonwheelsamerica.org/ |
| National Alliance for Nutrition and Activity | https://www.cspinet.org/protecting-our-health/nutrition/national-alliance-nutrition-and-activity |
Consumer Health Information
The trend toward consumer awareness and personal responsibility has dramatically affected how food and nutrition are currently promoted. Nurses can use the wealth of available resources to promote a healthy relationship with food for individuals, families, and populations.
Consumer health information is widely available through the Internet and other media sources (television, podcasts, magazines, etc.). When using consumer health resources, first assess the scientific validity of the information (North Dakota State University, 2019). For all media sources, the author or speaker should be qualified to write or speak on the topic, and the research sources supporting the material should be clearly identified. Online information should come from a reputable website. Government websites (ending in .gov), educational organization websites (ending in .edu), and nonprofit agencies (ending in .org) are considered the most reliable sources of online information.
The nurse should instruct clients to review nutritional information with a questioning attitude. Clients should be wary of nutritional information that includes any of the following:
- Strategies that sound too good to be true
- Nutritional recommendations that are too simplistic or dramatic, and unlikely to be supported by scientific evidence
- Identifying specific foods as “good” or “bad”
- Nutritional guidance that is promoted by nonscience-based testimonials or celebrities or that has supporting research “underway”
- Guidance not supported by more than one study and not recommended by reputable scientific organizations (North Dakota State University, 2019).
Of course, even the most accurate information may not be appropriate for a particular client. The nurse should use clinical judgment to determine whether the nutritional information applies to the client’s situation. Additionally, the nurse should consider the client’s literacy level and ability to understand what is being explained.
Health Literacy
An essential factor in the effectiveness of labeling or any health education is the ability of the client to read and understand the information. Health literacy is the ability to “obtain, process, and understand basic health information and services needed to make appropriate health decisions” (USHHS, ODPHP, 2021). In 2010, the USHHS released a National Action Plan to Improve Health Literacy . Fundamental to this plan is the belief that all people have the right to make informed decisions and that health services should be delivered in ways that support this right. Services should be provided in ways that are easy to understand and that promote healthy living (USHHS, ODPHP, 2021). Accordingly, limited health literacy is linked to poor health outcomes (USHHS, ODPHP, 2021).
Helping clients communicate with the health care professionals they work with will improve their care and health-related outcomes. Encourage clients to use these strategies to promote good communication :
- Recommend the client write down or record information during their visit.
- Encourage the client to ask questions if something is not clear. Have the client confirm who to call if questions arise later.
- Advise the client to let the health care team know if the client does not understand what is being said. If the information is confusing or complicated, provide materials written in plain language that does not include medical terminology.
- Suggest that someone accompanies the client to their next appointment (if appropriate). This person can help take notes and ask questions. If the client does not speak the same language as the health care provider, an interpreter credentialed for health care services is needed. Family members should not be expected to act as medical interpreters. (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010)
Client Readiness to Learn and Client Teaching Strategies
Nurses should ensure clients have the skills and knowledge they need to participate effectively in their health care (Hendler, 2022). However, attempting to teach clients when they are not interested in learning is challenging. Accordingly, the nurse’s overall client assessment involves determining the client’s readiness to learn . The following questions can help the nurse identify cues relevant to learning readiness:
- Does the client express an interest in the subject?
- Does the client ask relevant questions?
- Is the client’s body language consistent with someone who is paying attention?
- Does the client appear distracted and disinterested?
To try to increase the client’s interest in learning, the nurse should take time to establish rapport. The nurse should ask the client questions to learn more about the client’s preferences and needs and explain the benefits of learning the material.
Assessing readiness to learn is part of a more extensive assessment that should occur when preparing to teach clients. Hendler (2022) summarizes an approach to effective teaching:
- Assess the client’s learning style.
- Determine the client’s strengths and weaknesses.
- Identify the client’s learning needs.
- Identify any relevant cultural or religious considerations.
During the teaching session the nurse should:
- Use appropriate resources for the client’s situation and literacy level. Obtain an interpreter who is credentialed in medical interpretation if needed.
- Involve family or close friends in the session when possible since they are involved in the client’s health care and daily living.
- Communicate using plain language that minimizes the use of medical jargon.
- If possible, teach the content over multiple sessions.
Evaluation of Effectiveness of Client Teaching
The nurse should evaluate client teaching to determine if the client has understood the information and applied it to their life. Most frequently, client teaching is evaluated using feedback from the client. This can be verbal feedback. For example, can the client answer relevant questions correctly? The nurse could have the client explain in their own words what the nurse has said; the nurse could also demonstrate the material taught, if applicable. If possible, the nurse should check in with the client later to monitor progress and answer any additional questions. Also, the nurse should monitor any relevant client outcomes. For example, have blood glucose levels or hemoglobin A1C (HbA1c) levels improved after instructing a client with newly diagnosed diabetes on diet management of the condition?
Holistic Assessment of Cultural Considerations
A client’s culture is intertwined with their health, requiring providers to continually learn more about their values, beliefs, and ways of life (Gbareen, Barnoy & Theilla, 2021). A cultural assessment involves more than identifying any language barriers. The nurse should seek to understand the client’s perspective, preferences, or social norms that are part of the client’s life and affect the client’s food preparation and consumption.