Contextual factors and healthy eating patterns

As previously described, the Social-Ecological Model provides a framework for how individuals make food and physical activity choices (where, what, when, why, and how much) each day. Understanding individual choices and motivators and the context that affects them can help professionals identify which strategies are most likely to be effective to promote healthy choices aligned with the Dietary Guidelines.

The scientific literature has described a number of specific circumstances that can limit an individual’s or family’s capacity to choose a healthy diet. These contextual factors—food access, household food insecurity, and acculturation—are particularly important for millions of individuals living in the United States. As appropriate, professionals can consider these critical factors when developing strategies and providing education to enhance interventions.

The social Ecological

Consistent evidence shows that implementing multiple changes at various levels of the Social-Ecological Model is effective in improving eating and physical activity behaviors. For example, strong evidence from studies with varying designs and generally consistent findings demonstrates that school policies designed to enhance the school food setting leads to improvements in the purchasing behavior of children, resulting in higher dietary quality of the food consumed during the school day. For adults, moderate evidence indicates that worksite nutrition policies can improve dietary intake, and approaches targeting dietary intake and physical activity can favorably affect weight-related outcomes. These examples demonstrate how support and active engagement from various segments of society are needed to help individuals change their eating and physical activity behaviors and achieve positive outcomes. Approaches like these have the potential to improve population health if they can be incorporated into existing organizational structures and maintained over time. Among the components of the Social-Ecological Model, sectors and settings influence change at the population level and are addressed first in this discussion.

Key elements of Healthy Eating Patterns

The components of healthy eating patterns recommended in this edition of the Dietary Guidelines were developed by integrating findings from systematic reviews of scientific research, food pattern modeling, and analyses of current intake of the U.S. population:

  • Systematic reviews of scientific research examine relationships between the overall diet, including its constituent foods, beverages, and nutrients, and health outcomes.
  • Food pattern modeling assesses how well various combinations and amounts of foods from all food groups would result in healthy eating patterns that meet nutrient needs and accommodate limits, such as those for saturated fats, added sugars, and sodium.
  • Analyses of current intakes identify areas of potential public health concern.

Together, these complementary approaches provide a robust evidence base for healthy eating patterns that both reduce risk of diet-related chronic disease and ensure nutrient adequacy.

Scientific evidence supporting dietary guidance has grown and evolved over the decades. Previous editions of the Dietary Guidelines relied on the evidence of relationships between individual nutrients, foods, and food groups and health outcomes. Although this evidence base continues to be substantial, foods are not consumed in isolation, but rather in various combinations over time—an “eating pattern.” As previously noted, dietary components of an eating pattern can have interactive, synergistic, and potentially cumulative relationships, such that the eating pattern may be more predictive of overall health status and disease risk than individual foods or nutrients. However, each identified component of an eating pattern does not necessarily have the same independent relationship to health outcomes as the total eating pattern, and each identified component may not equally contribute (or may be a marker for other factors) to the associated health outcome. An evidence base is now available that evaluates overall eating patterns and various health outcomes.

Key elements of healthy eating

Over the course of any given day, week, or year, individuals consume foods and beverages[1] in combination—an eating pattern. An eating pattern is more than the sum of its parts; it represents the totality of what individuals habitually eat and drink, and these dietary components act synergistically in relation to health. As a result, the eating pattern may be more predictive of overall health status and disease risk than individual foods or nutrients. Thus, eating patterns, and their food and nutrient components, are at the core of the 2015-2020 Dietary Guidelines for Americans. The goal of the Dietary Guidelines is for individuals throughout all stages of the lifespan to have eating patterns that promote overall health and help prevent chronic disease.

Food and Nutrition

Food and nutrition play a crucial role in health promotion and chronic disease prevention. Every 5 years, HHS and USDA publish the Dietary Guidelines for Americans, the Nation’s go-to source for nutrition advice. The latest edition of the Dietary Guidelines reflects the current body of nutrition science, helps health professionals and policymakers guide Americans to make healthy food and beverage choices, and serves as the science-based foundation for vital nutrition policies and programs across the United States.

Stage 1: Review of Current Scientific Evidence

In the first stage, the Secretaries of HHS and of USDA appoint an external Dietary Guidelines Advisory Committee (Advisory Committee). The use of a Federal advisory committee is to ensure the Federal Government is seeking sound external scientific advice to inform policy decisions. Nominations from the public were sought for candidates to serve on the 2015 Advisory Committee. The 15 members of the 2015 Advisory Committee are prestigious researchers in the fields of nutrition, health, and medicine. Their role was to provide advice and recommendations to the Federal Government on the current state of scientific evidence on nutrition and health. Per Federal Advisory Committee Act rules, Advisory Committee members were thoroughly vetted for conflicts of interest before they were appointed to their positions and were required to submit a financial disclosure form annually.

The 2015 Advisory Committee was charged with reviewing the 2010 edition of the Dietary Guidelinesto determine the topics for which new scientific evidence was likely to be available, and to review that evidence to inform the development of the 2015-2020 edition. The Advisory Committee was asked to place primary emphasis on evidence published since the 2010 Advisory Committee completed its work and on evidence to support the development of food-based recommendations that are of public health importance for Americans ages 2 years and older. It met in public meetings to discuss its findings and develop its recommendations. The public was invited to submit written comments to the Advisory Committee throughout the entirety of its work as well as oral comments at a public meeting.

The 2015 Advisory Committee used four state-of-the-art approaches to review and analyze the available evidence: original systematic reviews; existing systematic reviews, meta-analyses, and reports by Federal agencies or leading scientific organizations; data analyses; and food pattern modeling analyses. Most of its conclusion statements on nutrition and health were informed by systematic reviews, which are a gold standard for informing clinical practice guidelines and public health policies worldwide. The Dietary Reference Intakes (DRIs), as set by the Institute of Medicine (IOM), also serve as a source of evidence for the Advisory Report and the Dietary Guidelines. This multifaceted approach allowed the Advisory Committee to ask and answer scientific questions about the relationship of diet and health to systematically, objectively, and transparently synthesize research findings and to limit bias in its evaluation of the totality of the evidence for the topics it reviewed. This approach also allowed one or more methods to be used that were best suited to comprehensively answer each question. These methods are described below.