Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real April 28, 2010

1. Implementing Dietary Recommendations for Heart Health: Moving from Ideal to RealApril 28, 2010 Presenters: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Lisa Cooper, MS, RD – Senior Research Dietitian, Rippe Lifestyle Institute Moderator: Barbara J. Ivens, MS, RD, FADA – Senior Nutrition Director, ConAgra Foods SELECT SUMMARY SLIDES FOR DEVELOPING STAND ALONE PRESENTATIONS

2. Nutri-Bitessm Webinar Summary Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real • Current landscape of authoritative recommendations for heart health converging on the need for a preventative approach. • Understanding influences on, and barriers to, heart healthy eating provides opportunities for developing effective strategies to help individuals make recommendations ‘real’ in their everyday lives. • Individualize the interventions; use Vital Signs of Cardiovascular Health to open counseling conversation; target those most receptive to dietary changes for heart health.

3. Prevention: THE Focus of Future Guidelines Nutrition and dietary patterns play a major role in the promotion of health and prevention of disease. Diet is not “one factor but a complex constellation of multiple factors.” These facts and observations of how they play out in lives of Americans are shaping new goals, guidelines and strategies for change. “Health is a broader more positive construct than just the absence of clinically evident disease.” “It makes sense that the avoidance of adverse levels of risk factors in the first place may be the most effective means for avoiding clinical events during the remaining lifespan.” AHA 2020 Strategic Impact Goals

4. A Welcome Step Lifestyle medicine practitioners and research scientists have promoted for over two decades Part of the objectives of Dietary Guidelines for Americans An objective of 2008 Guidelines for Physical Activity The approach of professional organizations such as the American Dietetic Association (www.eatright.org), Preventive Cardiovascular Nurses Association (www.pcna.net) and others have championed This approach to prevention is well-established.

5. Basics of Human Food Behaviors Convenience Variety and choice (The option of) Value Food taste or palatability also plays an important role in food choices. Research suggests that there are three principles of human behavior that cannot be changed. These relate to food choices and other choices. As individuals and consumers we seek: Sources: Brian Wansink. Marketing Nutrition: Soy, Functional Foods, Biotechnology and Obesity. Urbana and Chicago: University of Illinois Press, 2005. pp.86-87. 2) Dr. Wansink’s presentation to DGAC 2010. www.dietaryguidelines.gov

6. Many Influences on Food Choices Answer why nutritional guidelines have not had as great an impact on individual food choices and public health as intended and hoped. Develop more effective strategies  how  to promote individual and population change and adherence to healthful food choices and eating patterns. • Beyond internal determinants of food behaviors, a growing body of research suggests that a complex mix of environmental factors influence individual food choices. • Better understanding of these factors may help us:

7. Hierarchy of Factors that Influence Food Choice Adapted from AHA Scientific Statement: Implementing American Heart Association Pediatric and Adult Nutrition Guidelines. Circulation 2009;119:1161-1175.

8. Guidelines Continue Evolving . . . Moving from nutrients and components to emphasize whole foods and eating patterns Providing simple messages about food Eat more fruits, vegetables and whole grains Get two fish meals weekly; eat healthy fats Limit sodium Positive messages when possible – “Do” rather than “Don’t” Linking nutrition and physical activity to Meet the Challenges

9. Strategies for Change Start with the individual client (or focused group) Assess client readiness to change Assess barriers that may block success Use counseling techniques that foster clients making their own decisions and choosing steps for change Motivational interviewing Five A’s: Assess, Advise, Agree, Assist, Arrange Provide tools for change Provide support What do we know works? Goal: Empower client  self efficacy Giddings et al. Circulation 2009; Martins & McNeil. CliinPsychRev 2009; Searight, AmFamPhys 2009; Henson et al. Appetite 2010

10. Vital Signs of Heart Healthy Diet – AHA Healthy Diet Score Vital Signs of Obesity Vital Signs of Physical Activity Use Vital Signs of Heart Health 2000 kcal/day basis  Weight  BMI  Waist circumference Stanford Brief Activity Survey (SBAS) or other brief, validated checklist. • Taking each vital sign provides a cost-effective opportunity to discuss heart healthy behaviors and strategies for change.

11. Resource Links on Implementing Heart Health Recommendations American Heart Association www.americanheart.org Vital Signs of Heart Healthy Diet - Lloyd-Jones et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. Circulation 2010; epub Jan 10, 2010, Abstract. Vital Signs of Obesity - de Koning L et al. Eur Heart J. 2007 Apr;28(7):850-6. Epub 2007 Abstract; Craigie AM et al. Obes Facts. 2009;2(3):150-156. Abstract; Dunkley AJ et al. Obes. Facts 2009, Abstract; Ness-Abramof R, Apovian CM. Nutr Clin Pract. 2008 Aug-Sep;23(4):397-404, Abstract; Lemieux I, et al. Can J Cardiol. 2007 Oct;23 Suppl B:23B-31B Abstract; Schneider HJ et al. J Clin Endocrinol Metab 2010, Abstract. Vital Signs of Physical Activity - Pate et al. AJLM 2010 Abstract; Dunn AL. AJLM 2009 Abstract; Taylor-Piliae et al. J Cardio Rehabil Prev 2007, Abstract; Taylor-Piliae et al. J Phys Act Health. 2010, Abstract.

12. Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real Original recording of April 28, 2010 webinar and PDF download of PowerPoint available at: www.startmakingchoices.com/health-professionals