Correcting Americans’ Eating Habits Through Effective Stakeholder Collaborations – Nature Medicine

Today, more than half of all adults in the United States have one or more chronic diseases and diet-related health conditions, including obesity and diabetes, and the situation is getting worse.¹. According to 2017-2018 data from the National Health and Nutrition Survey, more than half of the American adult population is obese or severely obese, and the prevalence continues to rise². The cost of this situation is enormous – influencing all aspects of the lives of those affected, their families and society. However, despite considerable efforts devoted to improving the quality of food in the United States³the eating habits of most American adults have not changed much in the past 20 years^4.5. So what new strategies are needed to improve the quality of Americans’ diets? A report by Steen et al.³ in this issue of natural medicine highlights a promising approach that the dietary intervention delivered in supermarkets improved the quality of shoppers’ diets.

An individual’s eating behavior can be influenced by many factors, including their own preferences and value systems, social circles, neighborhoods and communities, food environments (such as food retailers), societal infrastructure, government policies and even the global climate (Fig. 1). Improving diet quality requires not only consideration of all possible influencing factors on eating behaviors, but also effective collaboration among stakeholders. Each actor (individual or entity) can alone have a powerful and unique role in influencing eating behaviors; however, effective collaborations between stakeholders can maximize their impact and create new opportunities that would otherwise not exist.

Actors and factors influencing eating behaviors. Overview of the complexity of potential entities and factors that influence the eating behavior of individuals.

Steen et al.³ report a promising and innovative approach to addressing the challenges of improving diet quality, involving collaboration between researchers, food retailers and customers. They report the results of a randomized food intervention trial (SuperWIN, NCT03895580) conducted in supermarkets. The authors performed two active dietary interventions (strategies 1 and 2) and compared them to a control condition. Both active interventions offered individualized, in-person, dietitian-led medical nutrition therapy sessions tailored to the purchasing data of supermarket shoppers. Strategy 2 also included online tools for shopping, home delivery, selecting healthier shopping, meal planning and healthy recipes. The primary goal of each intervention was to help participants adopt the Dietary Approaches to Stop Hypertension (DASH) diet, an eating pattern recommended by the Dietary Guidelines for Americans.⁴.

Both active interventions significantly increased participants’ adherence to the DASH diet at 3 months. Although adherence was somewhat sustained at 6 months, the results were not statistically significant at this time. Previous research has shown similar short-term success in increasing fruit and vegetable intake, but no long-term success.⁵and a meta-analysis of in-store dietary interventions also showed mixed results⁶. However, the lack of sustained and long-term success so far should not deter us from intervening with food retailers. Steen et al.³ reported high participant engagement, suggesting that improving and refining the communication approach may be the key to long-term success. Using purchase data to guide interventions – including online tools and other strategies – also has the potential to improve the effectiveness of interventions.^seven. Indeed, the COVID-19 pandemic has indirectly increased the adoption and acceptance of online shopping tools, home delivery services and virtual information delivery. There are undoubtedly other undiscovered opportunities to create win-win collaborations between food retailers, customers, researchers, and other stakeholders with the goal of improving the diets of all Americans.⁸.

The trial reported by Steen et al.³ demonstrates an effective intervention using the supermarket food environment, data-driven dietitian consultation, and online tools in a free-living community population. It also demonstrates successful collaboration between academic researchers and food retailers in communicating healthy eating information to attendees, and it is crucial that such collaborations continue in order to improve and refine communication approaches of healthy eating information. Clearly, there is still a lot of work to be done, knowledge to be acquired, and perhaps drastic decisions to be made to improve Americans’ diets.⁹. We can start by learning success stories involving healthy and sustainable dietary change⁸. Food reformulation, such as the gradual reduction of salt content in food products, provides an example of a successful and collaborative strategy between government and food manufacturers in the UK that has led to significant health benefits.^ten. This strategy can and should be applied to other dietary habits to improve diet quality, but effective implementation will require clear and practical policies defined and monitored by government, with the voluntary collaboration of food manufacturers. . It is not an easy task; but it is worth pursuing because of the considerable health benefits the public has to gain.

Strategies are also needed to combat misinformation about food and nutrition and to effectively communicate factual information to health professionals as well as the general public. Clinicians face frustrating challenges deciphering diet information and translating it into advice for their patients, which can discourage them from engaging in such conversations. This highlights the need for collaboration between researchers, nutrition educators and clinicians to positively influence people’s eating habits.

Even within government agencies, there has been a call for an increased effort to coordinate the many food-related initiatives to improve their impact.¹¹. Learning from the success of taxing cigarette products to reduce smoking, taxing unhealthy foods such as soft drinks has been implemented in some US cities and has shown its effectiveness.¹². However, wider implementation of such a strategy requires more integrated collaboration among multiple stakeholders. “Doing well by doing good”, a philosophy attributed to Benjamin Franklin, applies here to create a mutually beneficial relationship between food manufacturers, retailers and their customers. Food manufacturers and retailers can thrive by developing a loyal customer base, respecting their customers in how they make and sell healthy foods, and providing tools to support customers’ healthy eating habits.

Only through integrated stakeholder collaboration and effective communication of evidence will we be able to improve the eating habits of the public and curb the increase in diet-related health problems.