Sunday, December 10, 2006

By reaching only a limited audience and by setting unattainable goals, the Food Guide Pyramid contributes to health disparities - Tina Seekri

In 1992 the US department of Agriculture (USDA) created the first food guide pyramid. The food guide pyramid was created as a dietary guideline that is represented graphically to help people implement the guidelines into their lives through better food choices, ultimately to promote overall health. This first food guide pyramid consisted of 4 levels grains, fruits and vegetables, dairy, and fats, they were accompanied by recommended daily servings as well. It was a very basic representation of the foods that are necessary for a healthy balanced diet. Through the evolution of nutrition the definition of healthy has changed over the years, as well as the lifestyle of Americans. This had prompted the USDA to create a new revised food guide pyramid that came out in 2005, named MyPyramid. MyPyramid is an interactive online resource that enables users to personalize their own pyramid with specific nutrition requirements based on age, sex and activity level. The Dietary Guidelines describe a healthy diet as one that Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; Includes lean meats, poultry, fish, beans, eggs, and nuts; and is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars (www.usda.gov). The full dietary guidelines report is an 80 page document that can be accessed from the USDA website. One important difference in the new pyramid is the fact that it accounts for activity level. This educational tool in theory is a good idea, but as a Public Health campaign Mypyramid is a failure for several reasons. For a campaign that has a target audience of the general American population, the first reason for the failure of this campaign addresses access to Mypyramid.

Access or exposure to this intervention is very limited to many people the intervention targets. Through the magic of the internet a healthy diet is just a mouse click away; for people who have a computer. In the year 2000 51% of households had a computer and only 41.5% had internet access (http://www.ntia.doc.gov/ntiahome/fttn00/chartI-1.htm). Therefore the campaign is at a disadvantage already, not having the potential to reach 60% of the population, and with Mypyramid being such an interactive campaign there are a lot of Americans that don’t even have the opportunity to use the website. This campaign can not expect to influence the behaviors of individuals who are never exposed. Therefore disparities in Health behaviors may exist between internet users and non users. Going beyond just internet and non internet users, this could mean disparities between young people and older people, those who are economically stable and those who aren’t. Many older Americans didn’t grow up in the computer age and therefore are reluctant to try new technologies. This puts an entire population at a disadvantage initially. In the same way many Americans can’t afford to buy a computer or internet access. A financial disparity could also potentially lead to other types of disparities. Those who cant afford internet access leads to a disparity in those exposed to the campaign which leads to a disparity in those exposed to the campaigns message then with an effective message there will be a disparity in the behaviors which eventually will lead to a disparity in Health. The campaign also doesn’t account for the fact that people may receive or view the campaign differently. Those who are generally healthy as well as those who are knowledgeable about nutrition may see find it more appealing when they see the images and information from Mypyramid and therefore respond to it more, than people who eat junk food and think of it more as a chore to “try” and eat healthy.

The contents of the campaign are also worth taking a look at. Many Public health campaigns are designed from Health behavioral change models. The Theory of Reasoned action or Theory of Planned behavior is of particular interest with a campaign such as Mypyramid. Mypyramid basically is prescribing health to people. If people don’t know why they need to eat the recommended daily allowances they aren’t going to. With the complete dietary guidelines being an 80 page document the campaign was doomed from the beginning. Health in many peoples mind is not though of until disease is present; therefore other needs come first. Basically people aren’t going to read an 80 page document for their health until it becomes an immediate threat. The theory of reasoned action focuses on 2 major determinants of health behavior. The first being a persons attitude towards the behavior, and the second is the perception of the social norm. This theory simply proposes that people who have an intention to do a behavior are more likely to do that behavior and the more positive their attitude the higher the intention (Baranowski et al. 30S). There are several limitations to this theory. It assumes that if a person intends to do something they do it; this is not often the case. It also put the decision making and control of the decision at the individual level. Many behaviors however are not under a persons control (healthier food option are not available at the store) and many of the successful public health campaigns from the past have taught us that these factors should be at a group level; an example this is public sanitation which was one of the most successful and important public health interventions. This theory doesn’t take into account the fundamental causes of why people aren’t eating healthier. It doesn’t indicate how the behavior changes or what variables are responsible for the changed behaviors (Baranowski et al. 30S).

Mypyramid recommends that people have 5 or more fruits and vegetables a day. This was also heavily promoted by the 5 a day for better health campaign. In 2003 the centers for disease control and prevention’s behavioral risk factor surveillance system (BRFSS) estimated that only 22.5% of adults ate 5 or more fruits and vegetables a day which has declined from 1999-2000 (Guenther et al 1372). One reason for this is that the goals set by the authors of Mypyramid and Public health Practitioner are unattainable for the general population. For many it is rather difficult for them to obtain many of the items on the food guide pyramid, for instance fruits and vegetables may be harder to find in some cities compared to more affluent towns that have big produce markets with 80 different varieties of apples. Or they may be very expensive. Perhaps the fruits and vegetables that are available may just not be very appealing. For many fast food is too readily available, with a restaurant on every corner and the food is inexpensive. The choice is very simple for a family that can’t afford to by fresh produce or doesn’t have good produce available to them nearby.

In general people need to feel like they can achieve something for them to have the intention to do something. Social Learning Theory suggests that self-efficacy is necessary as well as the positivity or negativity of the outcome expectancies of the behavior for people to change adopt that behavior (Baranowski et al 30S). Self efficacy is a big contribution to the factors that lead to intention of a behavior. If the bar is set too high many people feel that if they can not reach the goal they fail and they shouldn’t bother at all, which actually works against the campaign in the end.

Mypyramid, although it has many interesting fact, and scientifically and medically it is very informative it has failed in swaying the general population to change their eating habits. Prescribing health to people doesn’t work it never has. Giving people the information is only the first step; the entire campaign shouldn’t rely exclusively on the information, if they want people to change their behavior. Public health practitioners need to think about the risk factors for being at risk. What fundamental factors are going to persuade people to change the way they eat so they can avoid disease and live healthier lives. Mypyramid relies too much on individuals; practitioners are trying to reach a “group” of people, but they are putting the responsibility in each individual’s hands. There are so many limitations to this Public health campaign and to remedy them the Public Health community needs to find out why people change their behaviors from the people themselves and design their campaigns around what they learn.


Works Cited
1. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are Current Health Behavioral Change Models Helpful in Guiding prevention of Weight Gain Efforts? Obesity Research. 2003;11:23S-38S
2. Guenther PM, Dodd KW, Reedy J, Kriebs-Smith SM. Most Americans Eat Much less than Recommended Amounts of Fruits and Vegetables. Journal of the AMERICAN DIATETIC ASSOCIATION. 2006:106:9:1371-1379
3. (http://www.ntia.doc.gov/ntiahome/fttn00/chartI-1.htm
4. www.USDA.gov

1 Comments:

Anonymous Anonymous said...

Tina-
Awesome job. You took a topic that I previously found kind of boring and made it interesting. I actually read yout paper word for word and I have no attention span. Nice.
-Heidi

10:01 AM  

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