Nutritional Pearls: The Gap Between Daily and Healthy

Joey is a 43-year-old overweight man struggling to lose weight. While he has recently begun attempting to eat healthier, he tells you he has a hard time knowing how to “eat right” beyond simply cutting back on sugar and fat.

How do you advise your patient?
(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance. 

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, associate professor of medicine at Tulane University in New Orleans, faculty chair of the all-new Certified Culinary Medicine Specialist program, and co-chair of Cardiometabolic Risk Summit.

Now, for the first time, Dr. Gourmet is sharing nutritional pearls of wisdom with the Consultant360 audience. Sign up today to receive an update from the literature each week.

Answer: Many people do not have a good understanding of what a typical day's meals should look like within the context of a healthy diet.

There's more information available than ever regarding which foods are healthy and what constitutes a healthy diet. All that information, however, doesn't seem to be making much of a dent in the health issues related to obesity or a poor overall diet, such as diabetes, high blood pressure, heart disease, and stroke. This suggests that there's a disconnect between what people actually eat and what they probably know they should eat.

That much is obvious, you might say. But do people really know what a healthy diet looks like in practice? It's all very well to say, "Eat at least 3 servings of vegetables a day," but people might not know what counts as a vegetable (corn doesn't, for example), or how big a serving of vegetables is (about 4 ounces, or about 1 cup of sliced yellow squash or zucchini).

______________________________________________________________________________________________________________________________________________________________________ RELATED CONTENT
Study: Calcium Supplements Increase the Risk of Dementia in Elderly Women
Analyzing the Role of Dietary Fats, Supplements, and Meal Replacements in Diet
______________________________________________________________________________________________________________________________________________________________________

The Research

Researchers in Switzerland used a fake food buffet to gauge people's perceptions of a healthy diet. The authors presented a wide variety of foods commonly eaten in Switzerland, using highly realistic plastic representations of all perishable foods. The nearly 180 represented foods were carefully selected by dietitians to achieve a balance of healthy and unhealthy foods. Each of the 187 participants was asked to choose foods from the buffet that would represent all of the foods they would eat in a day and place those meals and snacks on an adjacent table for recording. Half the participants were asked to choose the foods they would themselves typically eat in a day, while the other half were asked to choose foods for "a healthy and balanced diet for themselves."

The authors could then estimate the number of calories each person would have (presumably) consumed, along with the amount of total fat, saturated fat, protein, carbohydrate, sugar, and fiber (among other nutrients). Before the start of the study the authors surveyed the 187 participants to determine each person's individual caloric requirements according to a formula that took into account height, weight, and activity level.

The Results

Generally speaking, all of the participants selected slightly fewer total calories than were required for their individual caloric needs. That said, those who were choosing foods for their usual diet tended to choose foods that were much higher in saturated fat and sodium while being far lower in fiber than the selections made by those who were choosing a healthy diet.

What was surprising, however, was both groups' choices were nearly 1.5 times higher in sodium than the Swiss government's recommendations for a healthy diet. Similarly, both groups' chosen foods were far higher in sugar. The Swiss government recommends that its citizens get less than 10% of their calories from sugar, but both groups' sugar intake was over 20% of total calories. The source of that sugar was different, however—the source of the sugar in the typical diet group was more from sweets and sugar-sweetened beverages, while the healthy diet group's sugar tended to come from fruits and fruit juice.

The good news is that participants choosing a healthy diet tended to choose fewer sweets, salty snacks, fast foods, flavored yogurts, sausages, and croissants than the typical diet group, and chose more nuts, olives, cheese, and salad dressings. Neither group, however, consumed the recommended 3 servings of vegetables per day.

The authors interpret these findings to mean that most people have a good idea of which foods are considered healthier choices. They do not, however, have a good understanding of what a typical day's meals should look like within the context of a healthy diet: 60% of the dietary recommendations that the Swiss government makes with respect to a balanced diet (think the US government's MyPlate or Food Pyramid guidelines) were not met by either group.

What’s the “Take-Home”?

It's a bit unrealistic to expect that a person will meet governmental guidelines for a healthy diet each and every single day. This is why, when we talk about a Mediterranean diet score, we talk about averages over the course of a week. That still means making healthy choices far more often than unhealthy ones, and doing that on a consistent basis for the long term.

Reference:

Mötteli S, Keller C, Siegrist M, Barbey J, Bucher T. Consumers’ practical understanding of healthy food choices: a fake food experiment. Br J Nutr. 2016;116(3):559-566.