Nutrition Trends: Implications for Diabetes Health Care Professionals

Since 1991, the American Dietetic Association has conducted nationwide consumer nutrition trend surveys (1991, 1995, 1997, 2000, 2002, and 2008). Results from the 2008 survey were presented at the association’s 2008 annual meeting, the Food & Nutrition Conference and Expo, in October 2008 in Chicago. Each of the six surveys conducted to date was designed to “measure people’s attitudes, knowledge, beliefs, and behaviors regarding food and nutrition; and to identify trends and understand how consumers’ attitudes and behavior have evolved over time.”1 From 25 February through 7 March 2008, the telephone survey, ~ 18 minutes in length, was carried out in a representative sample of the U.S. adult population (n = 783).1 The assumed standard deviation for each question is ± 3%, and results were projected to the 90% confidence interval.1 Public information releases and a PowerPoint presentation with details regarding the 2008 survey can be found at the association’s website (www.eatright.org/ trends2008).

Since 1991, the American Dietetic Association has conducted nationwide consumer nutrition trend surveys (1991, 1995, 1997, 2000, 2002, and 2008). Results from the 2008 survey were presented at the association's 2008 annual meeting, the Food & Nutrition Conference and Expo, in October 2008 in Chicago. Each of the six surveys conducted to date was designed to "measure people's attitudes, knowledge, beliefs, and behaviors regarding food and nutrition; and to identify trends and understand how consumers' attitudes and behavior have evolved over time." 1 From 25 February through 7 March 2008, the telephone survey, ~ 18 minutes in length, was carried out in a representative sample of the U.S. adult population (n = 783). 1 The assumed standard deviation for each question is ± 3%, and results were projected to the 90% confidence interval. 1 Public information releases and a PowerPoint presentation with details regarding the 2008 survey can be found at the association's website (www.eatright.org/ trends2008).

Importance of Diet, Nutrition, and Physical Activity
When asked about the importance of diet, nutrition, and physical activity, approximately three out of five consumer respondents answered that diet, nutrition, and physical activity are "very important" to them personally; women and people with college or post-graduate degrees were more likely to say that nutrition and diet are "very important." Less variation was observed in exercise and physical activity importance among sex, age-groups, and education levels. The majority of respondents in all groups considered exercise and physical activity "very important." In each survey since 1991, the American Dietetic Association has segmented participants into three consumer groups representative of their overall attitudes toward maintaining a healthy diet and getting regular exercise. The groups are labeled "I'm already doing it"(describing consumers who are concerned about nutrition and overall fitness who feel they are doing all they can to eat a healthy diet), "I know I should" (consumers who indicate importance but may not have taken significant action to eat a healthy diet), and "Don't bother me" (consumers who do not feel that diet and exercise are important to them and are the least concerned with nutrition and their overall fitness.
The The association reports that the "I'm already doing it" group has increased steadily in each survey, representing movement away from the "Don't bother me" group.

Top Reasons for Not Eating Better
The survey explored reasons why people are not doing more to improve their eating habits. It found that > 70% of adults do not do more to achieve balanced nutrition and a healthy diet because they report that they are satisfied with the way they eat, and they do not want to give up their favorite foods. The association states that "People like what they eat . . . and eat what they like." The major or minor reasons to not do more to change eating habits included: "I'm satisfied with the way I eat." • (79%) "I don't want to give up the foods • I like." (73%) "It takes too much time to keep • track of my diet." (54%) "I need more practical tips to help • me eat right." (52%) "I don't know or understand • guidelines for diet and nutrition." (41%)

Food Consumption, Knowledge, and Beliefs
Respondents were also asked about their intake of certain foods and nutrients and whether their consumption had increased, decreased, or stayed the same during the past 5 years. Overall, the top five foods that survey participants reported they had increased and the percentage of respondents reporting an increase were: When broken down by age-group, adults aged 18-34 years were the most likely to have increased their consumption of fruits, vegetables, and whole grains. Those ≥ 65 years of age were the least likely to have increased consumption of these Nutrition FYI foods. More than half of the respondents reported no change in their consumption of dairy foods, pork, low-carbohydrate foods, omega-3 fatty acids, low-sodium foods, and alternative sweeteners. By a large margin, foods containing trans fats were the most likely to have reduced consumption during the past 5 years. An average of 56% of all participants reported cutting back on these foods. Forty-one percent reported a decreased intake of beef, 33% cut back on pork, and 23% reduced dairy intake. Less than 20% of respondents had decreased their consumption of alternative sweeteners and low-carbohydrate products.
More than three in four respondents had heard "a lot" about health-related effects of low-fat foods, and 72% had heard about foods containing trans fats. Additionally, 94% of those surveyed said that they believe whole-grain bread is healthier than white bread. More than half of the respondents believed that organically grown fruits and vegetables are healthier than conventionally grown, 38% believed there was no difference, and 8% believed conventionally grown produce was healthier.

Sources of Food and Nutrition Information
The nutrition trends survey indicates that Americans get most of their food and nutrition information from television and magazines ( Figure 1). However, the most popular sources are not necessarily considered the most credible sources of nutrition information by survey participants.
Although television remains the top source of nutrition and food information at 63%, it is down from 72% in 2002. Magazines have also declined from 58% in 2002 to 45% in the current survey. In 2008, 24% of participants named the Internet as a source of nutrition and food information. This figure surpassed that for newspapers and is nearly double the number of people who identified the Internet as a source in 2002. Reports of using the Internet as a source for nutrition information vary widely among age-groups: 42% of those aged 25-34 years use the Internet, while only 5% of those ≥ 65 years of age use the Internet to find nutrition information.
In addition to identifying where they get their nutrition information, participants were asked to read a list of sources and rate the credibility of each. At 78%, registered dietitians (RDs) and nutritionists topped the "very credible" list. Eight-six percent of participants have heard of RDs. By a three-to-one margin, respondents indicated that there is a difference between an RD and a nutritionist. The top 10 "very credi-ble" sources of nutrition information and the percentages of respondents reporting this were: RD

Implications for Diabetes Health Care Professionals
According to the survey, an increasing number of adults in the United States are conscious of nutrition and exercise and are taking steps to eat more healthfully and engage in regular physical activity. This is good news for diabetes health care professionals. Positive lifestyle changes, including meal planning and physical activity, aid in improving diabetes control and promoting healthy weight. 3 More than 24 million Americans have diabetes, and many more are at risk. 4 The challenge for diabetes health care professionals is to assist people with diabetes in moving from the "I know I should" category to the "I am already doing it" group. To facilitate this behavior change, it is important to encourage regular physical activity and healthful food choices at each encounter with patients or clients.
At times, it can be a daunting task to share all the information needed to successfully manage diabetes in a meaningful way. As a result, the message of physical activity may be minimized or left out entirely. Potential benefits of regular exercise are many, including improved blood glucose control, reduction of cardiovascular risk factors, promotion of weight loss, and an enhanced sense of well-being. 5 It is generally accepted to recommend ~ 150 minutes of moderate-intensity exercise per week for people with diabetes. 5 People with diabetes, like those in the general population, are encouraged to choose a variety of fiber-containing foods, including whole grains, legumes, fruits, and

Figure 1. Top five sources of nutrition information in 2008. 2
Department Nutrition FYI vegetables. 3 More than half of the respondents had increased their intake of whole-grain foods, and approximately half had increased their fruit and vegetable intake. Continuing to promote the favorable message of increasing consumption of these foods is beneficial for people with diabetes.
The nutrition trends survey also reported that respondents had decreased their intake of foods containing trans fats and increased their consumption of low-fat foods, the same nutrition messages that they reported they had heard "a lot" about. This indicates that the messages are being heard, and consumers are responding. For people with diabetes, the primary goal with respect to dietary fat remains limiting intake of saturated fatty acids, trans fatty acids, and cholesterol to reduce the risk for cardiovascular disease. 3 Diabetes health care professionals can assist people with diabetes by translating the science of health-ful eating and regular exercise into practical action steps so that the information may be used in a beneficial way. Traditional methods of communicating these messages are face-to-face with clients in groups or individual sessions. Combining the public's most popular nutrition information sources with the credibility of diabetes health care professionals can extend the reach of the message beyond traditional settings.
Although being interviewed for the media or writing for consumer print articles may seem overwhelming, the message from these activities can make a difference. Television and magazines remain the most common sources of nutrition information, with the Internet gaining in popularity. Diabetes health care professionals are encouraged to promote positive, credible nutrition and physical activity messages through these popular information sources to reach more people with diabetes.