Thursday, December 14, 2006

The Guidelines Not Followed: MyPyramid’s Failure of Presence, Practicality, and Possibility to the Obese Consumer – Johanna Vostok

Introduction

Obesity has reached epidemic proportions in the United States. A study in 1999 indicated that 27 percent of adults in the US were obese and an additional 34 percent were overweight. Obesity is ranked the second leading cause of preventable death in the US, resulting in 300,000 deaths each year. Obesity increases the risk of illness for about 30 serious medical conditions including cardiovascular disease, type-2 diabetes, and hypertension (1). In addition to its health effects, obesity also has economic consequences; in 2000, the economic cost of obesity was $117 billion. (1)

Obesity is a complex, multifaceted disease that is caused by environmental, genetic, physiological, metabolic, behavioral and psychological factors. The Surgeon General has acknowledged that behavioral and environmental factors are large contributors to obesity, and therefore offer the greatest opportunity for intervention to take place (1). As the epidemic has risen over the past 20 years, the government has made numerous attempts to intervene. Most recently, these interventions have included actions such as President Bush’s HealthierUS initiative launched in June 2002, the FDA’s development of the Obesity Working Group (OWG) in August 2003, the FDA’s Calories Count education campaign in March 2004, and the National Cancer Institute’s 5 A Day program among many others (2). However, despite these most recent efforts, the number of overweight and obese Americans has continued to steadily increase.

The resource that underlies many of these interventions is the United States’ federal nutrition policy. This policy is represented by the Dietary Guidelines for Americans, a publication developed in 1980 and updated every five years by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) (3). In 1992, the Food Guide Pyramid was developed as an educational tool to assist Americans in selecting healthful foods for a nutritious diet. The pyramid translated the government’s nutritional recommendations into the day-to-day terminology of what and how much to eat. In April 2005, the original Food Guide Pyramid was replaced by a new food guidance system dubbed “MyPyramid”. The purpose of this revision was to improve the Food Guide Pyramid’s effectiveness in motivating consumers to make healthy food choices and to ensure that it reflected the most up to date nutritional science. Along with the revision came the hope that the new pyramid would provide more specific, consumer-oriented advice individualized to each consumer. This was done by developing not one but twelve calorie levels based on a consumer’s age, sex, and activity level. With the catchy slogan “steps to a healthier you,” MyPyramid has become an attractive, colorful symbol intended to serve as a reminder for Americans to make healthy food choices. To promote health and wellbeing in its entirety, the new pyramid also encourages consumers to incorporate activity into their daily routine. This is creatively integrated into the symbol by a person climbing up steps along the side of the pyramid.

In contrast to the original pyramid which featured a diagramed breakdown of the five food groups along with the number of recommended daily servings, the new pyramid presents the ideas of proportionality, variety, and moderation through colored vertical bands. The new pyramid is intended to serve as a symbol to remind consumers to make healthy decisions rather than a guide to follow. In order to learn more about the concepts diagrammed, the consumer must go online to the pyramid’s website, www.MyPyramid.gov.

The MyPyramid website provides consumers with individualized pyramids specific to their age, sex, and activity level because “one size doesn’t fit all.” Similar to the old version of the food guide pyramid, the MyPyramid website outlines how much of each of the five food groups should be consumed each day. The site also provides a plethora of additional information and tools including tips for meeting daily requirements, food safety tips, Meal Tracking Worksheets, tips for eating out, and a sample menu. At first glance, the MyPyramid website appears to have it all. It provides an abundance of information, educational resources, and advice on how to live and eat healthy. Despite how good it looks on the computer monitor, MyPyramid falls short of being an adequate intervention. First, the new pyramid has failed to be properly disseminated among consumers. Second, the pyramid fails to recognize that environments directly affect dietary behaviors and thereby play a large role in a consumer’s ability to carry out interventions. Finally, the pyramid undermines consumers’ self-efficacy by not providing adequate tools for individuals to implement the guidelines.

Distribution and accessibility to MyPyramid

By providing nearly all of its information online, MyPyramid has failed to be accessible to all consumers. The number of households with computers has increased dramatically in the past 20 years; in August of 2000, the U.S. Commerce Department’s Census Department found that 51% of the nation’s households had at least once computer. However, this increase has not been equal across income levels: while nearly 90 percent of households with an income of $75,000 or more have internet access, only 20 percent with incomes below $25,000 have access. (4) This leaves those at lower income levels without access to MyPyramid’s guidelines.

The first step an individual needs to take to better their health using MyPyramid is to look at their individualized guidelines online. For individuals without household internet access, this poses an immediate problem. Therefore, from the get go MyPyramid fails low-income consumers by challenging their ability to access the necessary information. This is especially alarming considering that the highest rates of obesity are among those of low income (5). Therefore, the individuals who are known to have higher rates of obesity and who are in greatest need of learning about healthy diets are the least able to access these educational resources.

MyPyramid’s website provides little to no information on how it is being distributed to consumers. Although the website provides resources for “educators” including downloadable posters as well as a power point presentation, there is no insight as to whom these “educators” are. There is no indication that teachers or health professionals are being encouraged, never mind required, to relay this information to consumers. Therefore, MyPyramid fails ergonomically in its distribution to consumers.

Environment’s affect on dietary behaviors

The development of MyPyramid failed to take into account elements of the social ecological model which acknowledges that environments directly affect public health. The factors in the environment that affect public health can be multilevel, multistructural, multifactorial, and multi-institutional in character (6). These factors can include everything from nations to neighborhoods, socioeconomic status to social status, physical activity to emotional stress, and local government to immediate family. Understandably, it is difficult to address every factor that contributes to obesity in the US. However, some factors do call for more attention than others. One significant factor that has been neglected by the pyramid is socioeconomic status.

Studies have shown that disparities exist in the prevalence of obesity based on socioeconomic status. Obesity has been shown to be disproportionately higher among groups with low income and low education, as well as in lower-income states and districts. (5) Individuals who are low income have less money to spend on food. Having less money to spend means purchasing foods that are low in cost, and most often low in quality. Although this thought process is fairly simple, it was not taken into consideration in the development of MyPyramid. Looking at the typical neighborhood convenience store, the lowest-cost foods are the ones highest in added sugars and fats and lowest in nutritional value. Unfortunately, added sugars and fats aren’t even given a band of color on the new food pyramid.

Although not part of the pyramid, MyPyramid does acknowledge added sugars and fats under the title of “discretionary calories.” According to MyPyramid’s “food guidance system,” these are the 100 to 300 calories allotted for foods and beverages that contain little to no nutritional value such as those high in added sugars and fats. The system fails to acknowledge that the most palatable, abundant, convenient, and low-cost foods are those highest in added sugars and fats (7).

While it is necessary to educate consumers that added sugars and fats aren’t nutritious, it is unrealistic to provide guidelines stating that they can only account for 100 to 300 calories a day. The American diet currently derives nearly 40% of its daily energy from added sugars and fats. Not only does MyPyramid fail to recognize the extent of sugar and fat consumption by Americans, but it fails to provide a minimally attractive, affordable, convenient, or practical alternative. Americans are not going to change their health behaviors until the environment is able to provide healthy, practical, and affordable alternatives to the current high-sugar and high-fat options.

Self-efficacy and MyPyramid

MyPyramid has failed to take into consideration Albert Bandura’s Social Learning Theory. In this theory, Bandura presents the idea of self-efficacy, a concept which states that unless people believe that their actions can result in desirable outcomes, they have little incentive to take action or persevere should difficulties arise (8). MyPyramid has ignored this concept by providing health recommendations in the form of strict, unrealistic guidelines that undermines an individual’s belief in their ability to carry them out.

MyPyramid provides consumers with dietary recommendations in the form of cups and ounces. For example, an individual on a 2,000-calorie diet needs 5 ½ ounces of meats and beans per day. Without further information, it is unclear how much 5 ½ ounces is. Even for something more familiar like cups, it is not traditional to think of fruit and vegetable quantities in this measurement. In order for MyPyramid’s health information to be of use, the consumer must believe that he or she can accommodate the guidelines into their lifestyle. If the consumer cannot understand or conceptualize the guidelines themselves, they are less likely to even attempt to adapt the recommended guidelines.

To assist consumers, the MyPyramid website has provided a sample week-long menu to demonstrate how to adapt the food guidelines into everyday meals. However, every meal suggestion offered contains at least 5 ingredients. For example, a suggested lunch menu includes a roast beef sandwich (1 whole grain sandwich bun, 3 ounces lean roast beef, 2 slices tomato, ¼ cup shredded romaine lettuce, 1/8 cup sautéed mushrooms in 1 tsp oil, 1 ½ ounce part-skim mozzarella cheese, 1 tsp yellow mustard), ¾ cup baked potato wedges with 1 tablespoon ketchup, and an unsweetened beverage. This challenges consumers to spend extra time, money, and effort preparing these healthy meals as well as their ability to access these items. Additionally, the meal suggestions do not take into consideration the well-established habits of Americans: although 54 percent of Americans drink coffee everyday and another 25 percent drinks it occasionally, the sample menu does not include coffee (9). Without taking into consideration such tendencies as drinking coffee, MyPyramid is challenging consumers not only to alter their daily dietary habits but to change them completely. Such a drastic change is daunting, and therefore it is much more easily dismissed entirely than attempted partially.

Conclusion

When the food guide pyramid was revamped in 2005 it was stripped of its symbols and words, and in many ways its meaning, to consumers. The new pyramid, MyPyramid, failed to ameliorate many of the original problems but did succeed in becoming even more useless to consumers. MyPyramid failed consumers, particularly those who are obese, by its poor distribution and limited access. It failed again by not taking into consideration the environment of the consumer and how it effects their ability to abide by the guidelines. Finally, MyPyramid failed by providing high expectations that undermine consumers’ self-efficacy. Obesity is a rapidly growing problem in the United States that is in desperate need of insight and practical tools; unfortunately, MyPyramid is not one of them.


References

1. Department of Health and Human Services. Overweight and Obesity: At a Glance. http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_glance.htm

2. Department of Health and Human Services, Food and Drug Administration. “Statement by Lester M Crawford, D.V.M, Ph.D. Acting Commissioner of Food and Drugs Department of Health and Human Services Before The Committee on Governement Reform United States House of Representatives June 3, 2004.” http://www.fda.gov/ola/2004/obesity0603.html

3. Department of Health and Human Services, Department of Agriculture. “Dietary Guidelines for Americans 2005.” January 12, 2005. http://www.healthierus.gov/dietaryguidelines/

4. Pastore, Michael. “Computer, Net Access Standard for Many Americans.” September 6, 2001. ClickZ Stats. http://www.clickz.com/showPage.html?page=879441

5. Drewnowski, A. & Darmon, N. (2005) Food Choices and Diet Costs: an economic analysis. Journal of Nutrition. 135:900-904.

6. Baranowski, T. et al. (2003) Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts? Obesity Research. 11: 23S-43S.

7. Drewnowski, A. (2003) Fat and Sugar: An Economic Analysis. Journal of Nutrition. 133:838-840.

8. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84: 191-215.

9. Cofeeresearch.org. Consumption in the United States. http://www.coffeeresearch.org/market/usa.htm

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