OTHER RECOMMENDATIONS

In addition to the recommendations for the content of the bulletin, the committee wishes to direct the attention of the Secretary of the Department of Agriculture and the Secretary of the Department of Health and Human Services to actions important to the use, implementation, and future development of the Dietary Guidelines.

The committee believes that the advice in the 1995 Guidelines, if followed, will lead to the improved health status of Americans and reduced health-sector costs. The committee recommends vigorous promotion of the Guidelines and their wide distribution made free of charge for use by health professionals, educators, and the media.

Prior to convening the 1990 committee, USDA conducted focus groups to determine consumer understanding of the messages in the 1985 Guidelines. The results of these studies were valuable in revising the Dietary Guidelines to convey a more meaningful message to consumers. To facilitate future revisions of the Guidelines, USDA and HHS are encouraged to continue to gather information similar to what is presently being collected through focus group testing.

There are significant barriers to consumer ability to implement the Guidelines, such as poverty, education, acculturation, and time. The committee recommends the development and publication of material giving practical advice on both family food management and congregant feeding. Particular attention should be given to the needs of the elderly.

Monitoring of food consumption and health indicators is essential to the development of the Dietary Guidelines. For example, survey data available to this committee show that the public is acting on the advice to reduce fat intake. Data also indicate, however, that consumption of key foods falls short of levels recommended in the 1990 edition and that the lower-fat diets tend to be less adequate in nutrients than those with more fat. This information was important in the committee's consideration of the Guidelines' revision. The committee strongly recommends continued support of national nutrition and health surveys, including the assessment of food consumption of individuals and families.

The 1990 and 1995 committees had the advantage of recently published documents such as the Surgeon General's Report on Nutrition and Health, the National Academy of Sciences report on Diet and Health and the Healthy People 2000 objectives to guide their deliberations (81,48,83). These documents provided insight about the major nutrition-related public health issues for the American public, as well as the current scientific base for dietary modifications appropriate to address these issues. Updating this knowledge is an essential part of the process to develop Dietary Guidelines.

While the committee recognizes that sound nutritional practices are important to good health at all life stages, the biology of growth and development make young children particularly vulnerable to poor nutrition and, conversely, also potentially the greatest beneficiaries of good nutrition. Similarly, the social and economic dependency of young children puts them at risk of poor nutritional practices. Exclusion of very young children from the guidelines is, therefore, inconsistent with both the important role of nutrition during that critical stage of growth and development and inconsistent with the programmatic roles played by local, state, and Federal governments in assuring the nutritional well-being of children.

The committee, therefore, strongly recommends the development of dietary guidelines for children, including those less than 2 years of age. To make this possible, a working group should be charged to develop provisional guidelines for children and supporting peer-reviewed documentation that is essential for this process. The lack of consensus documents focused on the needs of children has hampered the work of the present and past advisory committees.

Based on the experience of the 1995 committee, the agencies should consider some revisions to the process of developing the Guidelines. Several comments to the committee highlighted the difficulty of having a single bulletin address the needs of consumers, as well as policy makers and health professionals. A process that utilizes a two-step approach is encouraged. The first step would focus on determining the important nutrition-related public health issues and the dietary strategies that are most important. The second step would focus on effective communication messages to educate the public and achieve behavior modification. Such an approach would require that expertise in nutrition education as well as nutritional sciences be included in the committee or that a second committee with nutrition education expertise be appointed.

During its deliberation, some members of the current committee felt that there was a need to change the format of the Guidelines to be more effective in communicating current scientific thought. However, the implications of public misunderstanding of a change in format or key statements made it difficult to consider these modifications. To address this concern, issues regarding format and effective communication need to be a specific function of the next committee process.

The Dietary Guidelines form the basis of Federal policy related to nutrition and diet. Given this central role, it is essential that we build the knowledge base for these recommendations through continued research investment. For example, the deliberations of the committee emphasize the need for research to establish the relationship between fat consumption during childhood and long-term health outcome, the function and bioavailability of compounds in plant foods that are important for health, the implications for long-term health of body weight loss or maintenance or both, the association of food patterns and health outcomes, electrolyte balance and risk of hypertension, a better understanding of the physiological basis for the relationship between consumption of alcoholic beverages and cardiovascular disease, and the best ways to convey information about the role of diet and health to the public.

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