Abundance of food and beverage choices complicates healthy eating. 

Now more than ever consumers are finding themselves faced with an over-abundance of food product choices. The market of alternative foods and beverages is becoming more crowded and competitive, with a growing diversity of products within the food groups. The “selling of absence,” or valuing foods for components they lack (e.g., sugar-free, low-sodium, non-GMO, and cage-free) is also causing overcrowding on market shelves. 

Food and beverage options that address the needs of those with food allergies and sensitivities, whether perceived or actual, are becoming a norm, and restaurants are changing their menus to reflect these evolving demands. Animal welfare, sustainability and social responsibility are some of the sought-after attributes, and food producers and manufacturers are responding to these demands by developing more options to satisfy consumers. Nutrition can get lost in all of these choices.

While the increase of choices in the food environment holds many benefits, especially for those with specific needs, it can also lead to unintended health consequences. New buzzwords and labels intended to help consumers find products that match their values or health conditions, can also lead to confusion or displace important food groups and nutrients necessary for optimal health and chronic disease prevention. 

This is of concern especially when making choices for children and meeting their nutritional needs for growth and development. Fear of specific components of foods, driven by “free from” labels, may turn parents away from foods that play an important role in the health of their children, and certain nutrients such as protein, essential fatty acids, calcium, vitamin D and iron may be under-consumed.

Skills in critical thinking and decision-making are necessary for consumers to navigate through the increasingly competitive food market, and nutrition education needs to focus on building these skills. Research supports multi-component interventions to improve food choices. Nutrition education that includes hands-on activities such as cooking, food tastings and gardening are engaging and build critical thinking skills. 

Health professionals can promote critical thinking and decision-making skills to help consumers assess the food environment and make the best choices that meet individual nutrient needs and lifestyles.

Research continues to support the inclusion of dairy in plant-based eating patterns, however dairy is often overlooked in general recommendations. 

Plant-based eating patterns are often held as the gold-standard for promoting optimal health, which is reflected in the three eating patterns recommended by the Dietary Guidelines for Americans (DGA). The body of consensus science which informs the DGA recommendations emphasize consumption of vegetables, fruit, whole grains, legumes and dairy. However, health messages to the public often define plant-based as plant only, or vegan. Also, these messages do not take into consideration the different nutrient needs of children, the elderly, and other vulnerable groups within the population. If poorly planned, vegan and vegetarian diets may be deficient in protein, calcium, vitamin B12 and iron, all important nutrients for health and well-being. 

While a move toward plant-based eating patterns are well founded, diet advice and consumer messages that do not comprehensively reflect the body of science could result in a missed opportunity for optimal nutrition. For example, research supports that a well-balanced, healthy eating pattern that contains both dairy foods and healthy, plant-based foods could help close the nutrient gaps that exist among Americans of all ages.¹ Additionally, studies have shown fermented dairy foods such as cheese and yogurt can reduce risk for cardiovascular disease and type 2 diabetes.² Despite growing research suggesting that dairy has a nutrient matrix uniquely different than other animal sources of protein, dairy is often omitted when discussing plant-based eating patterns. Excluding dairy from children’s diets may have a detrimental effect. Canadian dietitians and pediatricians have released a joint statement discouraging plant-based beverages as the main choice of beverage for infants and young children, stating that the dietary shift could result in inadequate intake of important nutrients and protein necessary for growth and development.³ 

Eating patterns that are plant-based and include a wide variety of dairy, fruits and vegetables, whole grains, and protein are supported by science for long-term health and well-being and can be adopted to meet individual needs. 

Health professionals should keep abreast of all of the latest research on optimal, healthy eating patterns and help guide patients to make the best food choices for themselves and their families. It is important to help clients understand that plant-based doesn’t mean exclusively plants, and that milk and dairy foods play an important role in healthy eating patterns especially for children and their families.

Disruption to agriculture could change the future food supply.

Farmers and agricultural professionals are facing mounting pressures from a multitude of sources, from unpredictable weather patterns to consumer expectations of environmental stewardship to tighter, more costly regulations. These factors create challenges that aren’t going away in the foreseeable future, and farmers are looking for ways to innovate while balancing financial needs. 

In 2017, U.S. farms decreased by one million acres from the previous year, according to U.S. Department of Agriculture (USDA) data, leaving less land in food production. At the same time, the average farm size increased by two acres as farms consolidated.⁴ In California, where dairy is the leading agricultural commodity⁵, dairy farms and processing plants are closing. Limited water supply is causing some farms to change the crops they’ve traditionally grown. As consumers expect more from their food, farmers and food companies are leading the way to address these growing demands. 

As agriculture continues to evolve toward a more sustainable food system, there needs to be increased awareness among the public around the real financial and regulatory pressures farmers and food companies are facing.

Environmental impact is not the only factor that makes diets sustainable; foods need to be nutritionally adequate to feed a population, affordable and culturally acceptable. Animal welfare and the livelihoods of those who work in agriculture are equally important. As communities become further removed from farms, there is a growing need for education on agriculture. 

Health professionals who educate themselves on the food system and farming practices by touring local farms or getting involved in Farm to School efforts can help their patients and clients understand how food choices are connected with agriculture. 

Dealing with childhood obesity and its comorbidities may require looking at prenatal and generational factors such as eating habits. 

Chronic diseases are impacting children at younger and younger ages. According to new research from Harvard University, a simulation of growth showed that 57 percent of today’s children will be obese by time they are age 35.6Obesity is strongly linked with chronic diseases such as type 2 diabetes and heart disease. When children develop these conditions, they are at risk for a lessened quality of life and a shorter life expectancy. The ability to prevent the onset of these diseases at a young age is of extreme importance. Researchers have identified that careful management of diet and lifestyle in pre- and perinatal periods could make considerable impact on the obesity epidemic for years to come. For example, a child’s risk for obesity is lowered if the mother consumes a healthful eating pattern and maintains a healthy weight during pregnancy. In addition, the American Academy of Pediatrics (AAP) has issued a new policy statement stressing that prenatal maternal nutrition and nutrition in the first two years of life are critical factors in a child’s lifelong neurodevelopment and mental health.7 

Exposing infants and toddlers to nutritious foods from the start plays a critical role in long-term health. The National Institutes of Health has developed a seven-year, $1.15 billion initiative named ECHO, Environmental Influences on Child Health Outcomes, to look more closely at the link between environmental exposures and pediatric health.8 The health care industry is also adjusting to focus on prevention and prioritize early childhood interventions. The AAP recommendations stress the importance for healthcare providers to connect families with existing nutritional services and advocate for positive food choices rather than the avoidance of unhealthy foods.

Establishing healthy eating patterns in young women of child bearing years, pregnant women, infants and young children is a key component of obesity prevention efforts. An increased focus on early prevention of obesity and chronic disease creates an opportunity for nutrition education that promotes healthy eating habits for growing families.

Rapid changes in technology and social media challenge health educators to remain relevant and engaging, yet also present increased opportunities for effective education. 

Technology has increased the sharing of information in more engaging ways than ever before. Videos, podcasts and live streaming on social media sites are just a few examples of communication channels being used and that are evolving at a rapid pace. Brands are now dependent on their social media and online presence and are seeking new and innovative ways to tell a story that is relevant and authentic. The majority of content shared on social media is by video; however, high quality, relevant videos differentiate those that reach viral status. Fast-paced advances in information sharing on social media platforms can become a challenge to nonprofit and public health organizations, which do not have the budgets to match large companies. One example of this was recently reflected in the USDA’s decision to discontinue its proprietary SuperTracker tool, an online diet tracking resource.

Advances in technology and social media platforms can also present an opportunity, particularly in education and healthcare. Technology advances are pushing forward health delivery models as seen by the growth and research in telehealth. Telehealth is the broad collection of technologies used to deliver virtual medical, health and education services.9 New studies continue to look at the effectiveness of telehealth and mobile-health technologies on education and behavior change, including health coaching via video, text messaging, wearable technology and peer support groups on Facebook and other channels, like apps. 

While the overall quality of current studies is weak and more research is needed,10 healthcare organizations are integrating telehealth, particularly as the need to reach rural communities becomes more pressing. Innovations in telehealth may become a crucial factor to prevent the growing health disparities seen in rural populations. 

Health organizations and professionals may find their efforts more effective by proactively seeking to understand the best communication channel for their audience. Being flexible in strategies could be critical since today’s hot new social media vehicle can be tomorrow’s outdated platform. Partnering with other organizations, universities or influencers may help smaller health organizations stay current in technological resources and innovation.

Millennials’ broad set of food preferences and values is influencing the way Americans eat. 

The millennial generation is moving into the roles of parents, caregivers, educators and health professionals placing them as key influencers of food decisions, not only for themselves, but for both younger and older generations. Millennials are uniquely different from the previous generations, and what has been considered traditional when it comes to eating and nutrition is not necessarily valued or desired. Growing up in the age of the internet and social media, millennials were reared with a wider lens to assess information. As a result, they have a broader set of food-related values, which impacts how they choose to feed themselves and their families.

When compared with their parents, millennials are more environmentally conscious, value natural labels, enjoy cultural flavors, and want transparency from food companies. They are less interested in dieting, calorie or fat-restriction than previous generations yet are open to newer trendy eating patterns. Functional and novel foods and beverages such as fermented drinks that tout gut health benefits continue to be popular with this generation. The presentation of foods has become just as important as taste and where they purchase foods is changing, too. Millennials support meal delivery services, online shopping and natural food stores while shunning big box, multipurpose grocery stores.11

Millennials are driving the values-based overabundance of food choices noted in trend number one. Additionally, millennials are crowdsourcing information and learning about new food products online. This creates opportunities for online nutrition education. Despite the impression that millennials have an affinity for natural, healthy foods and a desire to prepare meals themselves, USDA data show they are spending more grocery money on prepared foods, pasta, sugar and sweets than other generations, while devoting less of their budget to grocery stores.12 It is becoming more important that nutrition education and counseling align with the broad set of values and interests shared by millennials. 

Health professionals can have a role in helping guide decision-making skills that factor in optimal health given these value systems. Promoting online nutrition education tools is one way health professionals can meet millennials where they are at.

REFERENCES

1. DIETARY GUIDELINES FOR AMERICANS 2015-2020 EIGHT EDITION. HTTPS://HEALTH.GOV/DIETARYGUIDELINES/2015/GUIDELINES/. ACCESSED 20 FEBRUARY 2018. 

2. WU L, SUN D. CONSUMPTION OF YOGURT AND THE INCIDENT RISK OF CARDIOVASCULAR DISEASE: A META-ANALYSIS OF NINE COHORTSTUDIES. NUTRIENTS. 2017; 9(3):315. DOI: 10.3390/NU9030315

3. PLANT-BASED MILKS SHOULDN’T BE MAIN BEVERAGE FOR YOUNG CHILDREN, HEALTH EXPERTS SAY. THE CANADIAN PRESS. NOVEMBER 8, 2017. HTTP://WWW.CBC.CA/NEWS/HEALTH/PLANT-BASED-MILKS-FOR-KIDS-PEDIATRICIANS-DIETITIANS-1.4392857. ACCESSED JANUARY31, 2018.

4. FARMS AND LAND IN FARMS 2017 SUMMARY. USDA NATIONAL AGRICULTURAL STATISTICS SERVICE. HTTPS://WWW.NASS.USDA.GOV/PUBLICATIONS/TODAYS_REPORTS/REPORTS/FNLO0218.PDF. PUBLISHED FEBRUARY 2018. ACCESSED FEBRUARY 15, 2018.

5. CALIFORNIA AGRICULTURAL PRODUCTION STATISTICS: 2016 CROP YEAR REPORT. CALIFORNIA DEPARTMENT OF FOOD AND AGRICULTURE. HTTPS://WWW.CDFA.CA.GOV/STATISTICS/. ACCESSED FEBRUARY 14, 2018. 

6. WARD ZJ, LONG MW, RESCH SC, GILES CM, CRADOCK AL, GORTMAKER SL. SIMULATION OF GROWTH TRAJECTORIES OF CHILDHOODOBESITY INTO ADULTHOOD. N ENGL J MED. 2017; 377:2145-2153. DOI: 10.1056/NEJMOA1703860. ACCESSED FEBRUARY 15, 2018. 

7. SCHWARZENBERG SJ, GEORGIEFF MK. ADVOCACY FOR IMPROVING NUTRITION IN THE FIRST 1000 DAYS TO SUPPORT CHILDHOOD DEVELOPMENT AND ADULT HEALTH. PEDIATRICS. 2018;141(2):E20173716. DOI: HTTPS://DOI.ORG/10.1542/PEDS.2017-3716. ACCESSED FEBRUARY 13, 2018. 

8. SCHMIDT CW. GROWING A NEW STUDY: ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES. ENVIRON HEALTH PERSPECT. 2015; 123(10):261-263. DOI: 10.1289/EHP.123-A260. SCHMIDT C.W. ENVIRON HEALTH PERSPECT, 2015; DOI: 10.1289/EHP.123-A260.

9. WHAT IS TELEHEALTH? CENTER FOR CONNECTED HEALTH POLICY. HTTP://WWW.CCHPCA.ORG/WHAT-IS-TELEHEALTH. ACCESSED MARCH 5, 2018.

10. DARLING KE, SATO AF. SYSTEMATIC REVIEW AND META-ANALYSIS EXAMINING THE EFFECTIVENESS OF MOBILE HEALTH TECHNOLOGIES INUSING SELF-MONITORING FOR PEDIATRIC WEIGHT MANAGEMENT. CHILD OBES. 2017. 13(5):347-355. DOI: 10.1089/CHI.2017.0038

11. MILLENNIALS FOCUS ON FRESH, FITNESS AND FLAVOR. PREPARED FOODS WEBSITE. SEPTEMBER 28, 2017. HTTPS://WWW.PREPAREDFOODS.COM/ARTICLES/120418-MILLENNIALS-FOCUS-ON-FRESH-FITNESS-AND-FLAVOR. ACCESSED FEBRUARY 13, 2018.

12. KUHNS A, SAKSENA M. MILLENNIALS DEVOTE LARGER SHARES OF THEIR GROCERY SPENDING TO PREPARED FOODS, PASTA, AND SUGARAND SWEETS THAN OTHER GENERATIONS. USDA ECONOMIC RESEARCH SERVICE WEBSITE. DECEMBER 29, 2017. HTTPS://WWW.ERS.USDA.GOV/AMBER-WAVES/2017/DECEMBER/MILLENNIALS-DEVOTE-LARGER-SHARES-OF-THEIR-GROCERY-SPENDING-TO-PREPARED-FOODS-PASTA-AND-SUGAR-AND-SWEETS-THAN-OTHER-GENERATIONS/. ACCESSED FEBRUARY 12, 2018.