Dietary Goals of the United States

This extensive study found that: "The major health problems in the US are diet related."

Most all of the health problems underlying the leading causes of death in the United States could be modified by improvements in diet."
Dr. C. Edith Weir, Assistant Director, Human Nutrition Research Division, Agricultural Research Service, U.S. Department of Agriculture

We may be the best fed country in the world on the scale of quantity but we are among the worst on the scale of quality

Modern medicine is like a group of ambulances gathered at the bottom of a cliff picking up the battered bodies of those who fall. It would be simpler to go to the top of the cliff and repair fences.

Treating the symptoms of malnutrition with drugs, surgery or radiation will always yield less than satisfactory results!

95th Congress 1st Session Committee Print
Excerpts from Dietary Goals for the United States

DIETARY GOALS FOR THE UNITED STATES
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Original Document Printed for the use of the
Select Committee on Nutrition and Human Needs

The purpose of this report is to point out that the eating patterns of this century represent as critical a public health concern
as any now before us.

We must acknowledge and recognize that the public is confused about what to eat to maximize health. If we as a Government want to reduce health costs and maximize the quality of life for all Americans, we have an obligation to provide practical guidelines to the individual consumer as well as set national dietary goals for the country as a whole.

Such an effort is long over-due. Hopefully, this study will be a first major step in that direction.

I would like to thank Mr. Nick Mottern of the Committee staff for his extraordinary effort and the high degree of professionalism
he used in the preparation of this publication.

In addition, to acting as a practical guide to promote good eating habits, this report, hopefully, will also act as a catalyst for government and industry action to facilitate the achievement of the recommended dietary goals. Without Government and industry commitment to good nutrition, the American people will continue to eat themselves to poor health. Government and industry have a responsibility to respond to the findings of the report. Action is needed to determine how changes can be made regarding the content of nutritional information provided to the public; the kinds of foods produced; how foods are processed and advertised; and the selection of foods offered by eating establishments. Our national health depends on how well and how quickly Government and industry respond.

SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS
GEORGE McGOVERN, South Dakota, Chairman

HERMAN E. TALMADGE, Georgia
CHARLES H. PERCY, Illinois
EDWARD M. KENNEDY, Massachusetts
ROBERT DOLE, Kansas
GAYLORD NELSON, Wisconsin
HENRY BELLMON, Oklahoma
ALAN CRANSTON, California
RICHARD S. SCHWENKE, Pennsylvania
HUBERT H. HUMPHERY, Minnesota
MARK O. HATFIELD, Oregon
ALAN J. STONE, Staff Director
MARSHALL L. MATZ, General Counsel

[Press Conference, Friday, January 14, 1977, Room 457, Dirksen Office Building]

STATEMENT OF SENATOR GEORGE McGOVERN

ON THE PUBLICATION OF DIETARY GOALS FOR THE UNITED STATES

The purpose of this press conference is to release a Nutrition Committee study entitled Dietary Goals for the United States, and to explain why we need such a report.

I should note from the outset that this is the first comprehensive statement by any branch of the Federal Government on risk factors in the American diet.

The simple fact is that our diets have changed radically within the last 50 years, with great and often very harmful effects on our health. These dietary changes represent as great a threat to public health as smoking.

Too much fat, too much sugar or salt, can be and are linked directly to heart disease, cancer, obesity, and stroke, among other killer diseases. In all, six of the ten leading causes of death in the United States have been linked to our diet.

Those of us within the Government have an obligation to acknowledge this. The public wants some guidance, wants to know the truth, and hopefully today we can lay the cornerstone for the building of better health for all Americans, through better nutrition.

Last year every man, woman and child in the United States consumed 125 pounds of fat, and 100 pounds of sugar. As you can see from our displays that's a formidable amount of fat and sugar.

The consumption of soft drinks has more than doubled since 1960—displacing milk as the second most consumed beverage. In 1975, we drank an average of 295, 12 oz. cans of soda.

In the early 1900's, almost 40 percent of our caloric intake came from fruit, vegetables and grain products. Today (1977) only a little more than 20 percent of calories come from these sources.

My hope is that this report will perform a function similar to that of the Surgeon General's Report on smoking. Since that report, we haven't eliminated the hazards of smoking, nor have people stopped smoking because of it. But the cigarette industry has modified its products to reduce risk factors, and many people who otherwise be smoking have stopped because of it.

The same progress can and must be made in matters of nutritional health, and this report sets forth the necessary plan of action:

2. Simple buying guides are recommended to help consumers attain these goals; and

3. Recommendations are also made for action within Government and industry to better maximize nutritional health.

I hope this report will be useful to millions of Americans. In addition to providing simple and meaningful guidance in matters of diet, it should also encourage all those involved with growing, preparing and processing food to give new consideration to the impact of their decisions on the nation's health. There needs to be less confusion about what to eat and how our diet affects us.

With me this morning are three of the country's leading thinkers in the area of nutritional health. They have very graciously assisted the staff of the Select Committee in the preparation of this report. They will explain in greater detail its purpose and goals.

First, Dr. Mark Hegsted, Professor of Nutrition from the Harvard School of Public Health. Dr. Hegsted has a long and distinguished career in science, bringing conscience as well as great expertise to his work. Dr. Hegsted has worked very closely and patiently with the Committee staff on this report, devoting many hours to review and counseling. He feels very strongly about the need for public education in nutrition and the need to alert the public to the consequences of our dietary trends. He will discuss these trends and their connection with our most killing diseases.

Following his presentation, Dr. Beverly Winikoff of the Rockefeller Foundation will discuss the changes necessary in food marketing and advertising practices if the consumer is to make more healthful food choices. Dr. Winikoff, who with Dr. Hegsted and Dr. Lee testified at our hearings in July, has also been extremely helpful in assisting the committee staff in preparing this report.

Dr. Philip Lee, the Director of the Health Policy Program at the University of California in San Francisco, and a former Assistant Secretary for Health, will conclude our presentation with a discussing of the costs of our current dietary trends. Dr. Lee has also consulted with the committee staff on this report and has offered much encouragement.

Before Dr. Hegsted begins, I would also like to note that the staff has also received valuable assistance from Dr. Sheldon Margen, a nutritionist with the University of California in Berkeley, who is traveling outside the country today.

I want to thank each of these people personally for their help and spirited concern for the public interest.

The Committee will continue its investigation into the connection between diet and health on February 1 and 2, when hearings will be held concentrating on problems of diet and heart disease and obesity.

STATEMENT OF DR. D. M. HEGSTED, PROFESSOR OF NUTRITION,
HARVARD SCHOOL OF PUBLIC HEALTH, BOSTON, MASSACHUSETTS

The diet of the American people has become increasingly rich-rich in meat, other sources of saturated fat and cholesterol, and in sugar. There will be people who will contest this statement. It has been pointed out repeatedly that total sugar use has remained relatively constant for a number of years. We would emphasize, however, that our total food consumption has fallen even though we still eat too much relative to our needs. Thus, the proportion of the total diet contributed by fatty and cholesterol-rich foods and by refined foods has risen. We might be better able to tolerate this diet if we were much more active physically, but we are a sedentary people.

It should be emphasized that this diet which affluent people generally consume is everywhere associated with a similar disease pattern-high rates of ischemic heart disease, certain forms of cancer, diabetes, and obesity. These are the major causes of death and disability in the United States. These so-called degenerative diseases obviously become more important now that infectious diseases are, relatively speaking, under good control. I wish to emphasize that these diseases undoubtedly have a complex etiology. It is not correct, strictly speaking, to say that they are caused by malnutrition but rather that an inappropriate diet contributes to their causation. Our genetic makeup contributes-not all people are equally susceptible. Yet those who are genetically susceptible, most of us, are those who would profit most from an appropriate diet. Diet is one of the things we can change if we want to.

There will undoubtedly be many people who will say we have not proven our point; we have not yet demonstrated that the dietary modifications we recommend will yield the dividends expected. We would point out to these people that the diet we eat today was not planned or developed for any particular purpose. It is a happenstance related to our affluence, the productivity of our farmers and the activities of our food industry. The risks associated with eating this diet are demonstrably large.

The question to be asked therefore is not why should we change our diet, but why not? What are the risks associated with eating less meat, less fat, less saturated fat, less cholesterol, less sugar, less salt, and more fruits, vegetables, unsaturated fat, and cereal products-especially whole grain cereals. There are none that can be identified and important benefits can be expected.

Ischemic heart disease, cancer, diabetes and hypertension are the diseases that kill us. They are epidemic in our population. We cannot afford to temporize. We have an obligation to inform the public of the current state of knowledge and to assist the public in making the correct food choices. To do less is to avoid our responsibility.

The fact that the goals can be stated in nutritional terms first and then mirrored in a set of behavioral changes impels a closer look at why Americans eat the way they do. What people eat is affected not only by what scientists know, or by what doctors tell them, or even by what they themselves understand. It is affected by Government decisions in the area of agricultural policy, economic and tax policy, export and import policy, and involves questions of good production, transportation, processing, marketing, consumer choice, income and education, as well as food availability and palpability. Nutrition, then, is the end result of pushes and pulls in many directions, a response to the multiple forces creating the "national nutrition environment."

Even "personal dietary preferences" are not immutable but interact with other forces in the environment and are influenced by them. People learn the patterns of their diet not only from the family and its sociocultural background, but from what is available in the marketplace and what is promoted both formally through advertising and informally through general availability in schools, restaurants, supermarkets, workplaces, airports and so forth.

It is generally recognized with regard to the overall economic climate that both what the Government does do and what it does not do shape the arena in which other forces interact. This is also true with regards to nutrition. In determining the parameters of the socioeconomic system, Government also determines the nature of the national buffet. Government policy, then, must be made with full awareness of this responsibility.

It is increasingly obvious that if new knowledge is to result in new behaviors then people must be able to act, without undue obstacles, in accordance with the information that they learn. The problem of education for health as it has been practiced is that it has been in isolation, not to say oblivion, of the real pressures, expectations, and norms of society, which mold and constrain individual behavior. There must be some coordination between what people are taught to do and what they can do. Part of the responsibility for this coordination rests with the Government's evaluation and coordination of its own activities. Effective
education must be accompanied by Government policies which make it easier, indeed likely, that an individual will change his or her lifestyle in accordance with the information offered.

At present, we see a situation in which the opposite is often the case. Nutrition and health education are offered at the same time as barrages of commercials for soft drinks, sugary snacks, high-fat foods, cigarettes and alcohol. We put candy machines in our schools, serve high-fat lunches to our children, and place cigarette machines in our work places. The American marketplace provides easy access to sweet soft drinks, high-sugar cereals, candies, cakes, and high-fat beef, and more difficult access to foods likely to improve national nutritional health.

This trend can be reversed by specific agricultural policies, pricing policies, and marketing policies, as well as the recommendations outlined in these "Dietary Goals for the United States."

In general, Americans have quite accurate perceptions of sound nutritional principles, as was demonstrated recently by a Harris poll conducted for the Mount Sinai Hospital in Chicago. However, people do lack understanding of the consequences of nutrition-related diseases. There is a widespread and unfounded confidence in the ability of medical to cure or mitigate the effects of such diseases once they occur. Appropriate public education must emphasize the unfortunate but clear limitations of current medical practice in curing the common killing diseases. Once hypertension, diabetes, arteriosclerosis or heart disease are manifest, there is, in reality, very little that medical science can do to return a patient to normal physiological function. As awareness of this limitation increases, the importance of prevention will become all the more obvious.

But prevention is not possible solely through medical interventions. It is the responsibility of government at all levels to take the initiative in creating for Americans an appropriate nutritional atmosphere-one conducive to improvement in the health and quality of life of the American people.

STATEMENT OF DR. PHILIP LEE,
PROFESSOR OF SOCIAL MEDICINE AND DIRECTOR,
HEALTH POLICY PROGRAM, UNIVERSITY OF CALIFORNIA,
SAN FRANCISCO, CALIFORNIA

The publication of Dietary Goals for the United States by the Senate Select Committee on Nutrition and Human Needs is a major step forward in the development of a rational nutritional health policy. The public health problems related to what we eat are pointed out in Dietary Goals. More important, the steps that can and should be taken by individuals, families, educators, health
professions, industry and Government are made clear.

As a Nation we have come to believe that medicine and medical technology can solve our major health problems. The role of such important factors as diet in cancer and heart disease has long been obscured by the emphasis on the conquest of these diseases through the miracles of modern medicine. Treatment not prevention has been the order of the day.

The problems can never be solved merely by more and more medical care. The health of individuals and the health of the population is determined by a variety of biological (host), behavioral, sociocultural and environmental factors. None of these is or important than the food we eat. The simple fact and the importance of diet in health and disease is clearly recognized in Dietary Goals for the United States.

The Senate Select Committee on Nutrition and Human Needs has made four recommendations to encourage the achievement of the very sound dietary goals incorporated in the report. These are:

1. a large scale public nutrition education program involving the schools, food assistance programs, the Extension Service of the
Department of Agriculture and the mass media;

3. the development of improved food processing methods for institutional and home use; and

It is important that Dietary Goals for the United States be made widely available because it is the only publication of its kind and it will be an invaluable resource for parents, school teachers, public health nurses, health educators, nutritionists, physicians and others who are involved in providing people with information about the food they eat.

The recommendations, if acted upon promptly by the Congress, can help individuals, families and those responsible for institutional food services (schools, hospitals) be better informed about the consequences of present dietary habits and practices. Moreover, they provide a practical guide for action to improve the unhealthy situation that exists.

INTRODUCTION
During this century, the composition of the average diet in the United States has changed radically. Complex carbohydrates-fruit, vegetables and grain products-which were the mainstay of the diet, now play a minority role. At the same time, fat and sugar consumption have risen to the point where these two dietary elements alone now compromise at least 60 percent of total calorie intake, up from 50 percent in the early 1900's.1

1 Statistics from reports and testimony to the Select Committee's National Nutrition Policy hearings, June 1974, appearing in National Nutrition Policy Study, 1974, Pt. 6 June 21, 1974, heart disease, p. 2633, high blood pressure, p. 2529, diabetes, p. 2523.

In the view of doctors and nutritionists consulted by the Select Committee, these and other changes in the diet amount to a wave of malnutrition-of both over and under consumption-that may be as profoundly damaging to the Nation's health as the widespread contagious diseases of the early part of the century.

The over-consumption of fat, generally, and saturated fat in particular, as well as cholesterol, sugar, salt and alcohol have been related to six of the ten leading causes of death: Heart Disease, Cancer, Cerebrovascular Disease, Diabetes, Arteriosclerosis and Cirrhosis of the Liver.

In his testimony at the Select Committee's July 1976 hearings on the relationship of diet to disease, Dr. D. Mark Hegsted of Harvard School of Public Health, said:

"I wish to stress that there is a great deal of evidence and it continues to accumulate, which strongly implicates and, in some instances, proves that the major causes of death and disability in the United States are related to the diet we eat. I include coronary artery disease, which accounts for nearly half the deaths in the United States, several of the most important forms of cancer, hypertension, diabetes and obesity as well as other chronic diseases."

Even such a simple question as whether one should severely limit his consumption of butter and eggs can be a subject of endless scientific debate.

Faced with conflicting scientific opinions of this kind, it would be easy for health educators to sit on their hands; it certainly makes it easy for those who abuse their health to find a real "scientific" excuse.

But many of our health problems are sufficiently pressing that action has to be taken even if all scientific evidence is not in.

Based on (1) the Select Committee's July 1976 hearings on the relationship of diet to disease and its 1974 National Nutrition Policy hearings, (2) guidelines established by governmental and professional bodies in the United States and at least eight other nations, (Appendix)

B) and (3) a variety of expert opinions, the following dietary goals are recommended for the United States. Although genetic and other individual differences mean that these guidelines may not be applicable to all, there is substantial evidence indicating that they will be generally beneficial.

1. Increase carbohydrate consumption to account for 55 to 60 percent of the energy (caloric) intake.

2. Reduce overall fat consumption from approximately 40 to 30 percent of energy intake.

3. Reduce saturated fat consumption to account for about 10 percent of total energy intake; and balance that with poly-unsaturated and mono-unsaturated fats, which should account for about 10 percent of energy intake each.

5. Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.

6. Reduce salt consumption by about 50 to 85 percent to approximately 3 grams a day.

1. Increase consumption of fruits and vegetables and whole grains.
2. Decrease consumption of meat and increase consumption of poultry and fish.
3. Decrease consumption of foods high in fat and partially substitute poly-unsaturated fat for saturated fat.
4. Substitute non-fat milk for whole milk.
5. Decrease consumption of butterfat, eggs and other high cholesterol sources.
6. Decrease consumption of sugar and foods high in sugar content.
7. Decrease consumption of salt and foods high in salt content.

This report is part of a study conducted at the direction of the Agricultural Research Policy Advisory Committee, U.S. Department of Agriculture. A joint task group representing the State Agricultural Experiment Stations and the U.S. Department of Agriculture was assigned the responsibility for making the study. Task group members were:

Dr. Virginia Trotter, co-chairman, dean, College of Home Economics, Univ. of Nebraska
Dr. Stephen C. King, co-chairman, associate director, Science and Education Staff, U.S. Department of Agriculture
Dr. Walter L. Fishel, assistant professor, Dept. Of Agriculture and Applied Economics, Univ. Of Minnesota
Dr. H. Wayne Bitting, program planning and evaluation staff, Agricultural Research Service, U.S. Department of Agriculture
Dr. C. Edith Weir, Assistant Director, Human Nutrition Research Division, Agricultural Research Service, U.S. Department of Agriculture

Better health, a longer active lifespan, and greater satisfaction from work, family and leisure time are among the benefits to be obtained from improved diets and nutrition.

Advances in nutrition knowledge and its application during recent decades have played a major role in reducing the number of infant and maternal deaths, deaths from infectious diseases, particularly among children, and in extending the productive lifespan and life expectancy. Significant benefits are possible both from new knowledge of nutrient and food needs and from more complete application of existing knowledge. Potential benefits may accrue from alleviating nutrition-related health problems, from increased individual performance and satisfactions and increased efficiency in food services. A vast reservoir of health and economical benefits can be available by research yet to be done on human nutrition.

Major health problems are diet related. Most all of the health problems underlying the leading causes of death in the United States could be modified by improvements in diet.

The relationship of diet to these health problems and others is discussed in greater detail later in the report. Death rates for many of these conditions are higher in the U.S. than in other countries of comparable economic development. Expenditures for health care in the U.S. are skyrocketing, accounting for 67.2 billion dollars in 1970-or7.0 percent of the entire U.S. gross national product.

The real potential from improved diet is preventative. - Existing evidence is inadequate for estimating potential benefits from improved diets in terms of health. Most nutritionists and clinicians feel that the real potential from improved diet is preventative in that they may defer or modify the development of a disease state so that a clinical condition does not develop. The major research thrust, nationwide, has been on the role of diet in treating health problems after they have developed. This approach has had limited success. USDA research emphasis has been placed on food needs of normal healthy persons and findings from this work have contributed much of the existing knowledge on their dietary requirements.

Benefits would be shared by all.-Benefits from better nutrition, made possible by improved diets, would be available to the entire population. Each age, sex, ethnic economic and geographic segment would be benefited. The lower economic population groups would benefit most from effective application of current knowledge.

These savings are only a small part of what might be accomplished for the entire population from research yet to be done. Some of the improvements can be expressed as dollar benefits to individuals or to the nation. The social and personal benefits are harder to quantify and describe.

It is difficult to place a dollar figure on the avoidance of pain or the loss of a family member; satisfactions from healthy, emotionally adjusted families; career achievement; and the opportunity to enjoy leisure time.

Major health benefits are long range. Predictions of the extent to which diet may be involved in the development of various health problems have been based on current knowledge of metabolic pathways of nutrients, but primarily of abnormal metabolic pathways developed by persons in advanced stages of disease. There is little understanding of when or why these metabolic changes take place. The human body is a complex and very adaptive mechanism. For most essential metabolic processes alternate pathways exist which can be utilized in response to physiological, dietary or other stress. Frequently, a series of adjustments take place and the ultimate result does not become apparent for a long time, even years, when a metabolite such as cholesterol accumulates. Early adjustment of diet could prevent the development of undesirable long-range effects. Minor changes in diet and food habits instituted at an early age might well avoid the need for major changes, difficult to adopt later in life.

The original document is over 70 pages. You may be able to find it in the stacks in the library of a large university.