Gastroenterologists are called to arms in the battle against obesity

Gastroenterologists are being asked to step up to the plate in a battle to get Americans to put less on their plates. It’s really critical that gastroenterologists, dietitians and other healthcare professionals work together to help educate their patients about the new dietary guidelines for Americans. There needs to be a collective effort on the part of all healthcare professionals to use these guidelines if we want to have an impact on the obesity epidemic. The newly released Dietary Guidelines for Americans 2005 call on the medical community to spearhead nothing less than an overhaul of the dietary and exercise trends currently seen in the United States. The initiative from the United States Department of Agriculture (USDA) represents a major acknowledgement that the country’s obesity epidemic is out of control and will continue to get worse without dramatic changes to the lifestyles of most Americans.

This calls for a radical change in the way individuals incorporate exercise and let in to their lives. A USDA panel of nutrition experts came up with recommendations for healthy living based on a review of scientific evidence. The guidelines encourage Americans to eat fewer calories, to be more active and to make wiser food choices. Among the key recommendations, the guidelines call for Americans to:

• Engage in 60 minutes of moderate to vigorous exercise per day to maintain weight, and 90 minutes to sustain weight loss;

• Consume five and a half cups of fruits and vegetables per day, based on a 2,000 calorie intake;

• Eat three or more ounce-equivalents of whole grain products, with half of grains from whole grains;

• Consume three cups of fat-free or low-fat milk products;

• Limit saturated fats and transfats, and;

• Keep total fat intake to between 20 percent to 35 percent of calories.

If the nation had a collective mouth, it would hang open in astonishment. By all accounts, the guidelines have as much in common with the way most people carry out their daily lives as tofu and Twinkies. Ninety minutes of exercise a day? As if, five cups of fruits and vegetables? A lot of Americans go through Monday to Friday eating French fries as their only vegetable. A writer and former restaurant critic for The New York Times, spent four days trying to follow the guide. At the end, the new guidelines are not just health policy, they’re cultural policy, too. To comply fully, Americans will have to rethink their inherited notions of what makes a meal, and what makes a meal satisfying.

Nutritionists, gastroenterologists and national organizations, including the American Dietetic Association and the Center for Science in the Public Interest, applauded the guide for its strong stance on caloric control and physical exercise. The new guidelines are so much better than the old guidelines. There seems to be a lot more responsible science behind these. Since the 1980s, when the Centers for Disease Control and Prevention started tracking these things, obesity has swept this country like a plaque. We live in a world that wants use to be fat, and if you’re going to lose weight, you have to be different. Your behaviors, the way you eat and think and organize your life are going to be different than all your friends, because all your friends are on the train to Fatville, and we’re all on that train unless you make a deliberate decision to get off that train. These new guidelines are an attempt to redirect that train.

These are shock-and-awe tactics – much needed ones. These guidelines are well written, solid and based on the best available evidence. Because of that, they are going to be shocking to a lot of people. It’s night and day compared to how most people live, but that is what we need. If the guidelines are supposed to inspire a revolution, it’s going to be one that goes from the top down. Unlike previous editions of the guidelines, which are revised every five years, the 2005 version targets public policy makers, nutritionists and health educators. And unlike the familiar food pyramid of the 1980s and 1990s, the new guidelines go into very specific details about how clinicians should encourage people to change.

The goal is to get people to consume enough of seven essential nutrients – calcium, potassium, fiber, magnesium and vitamins A, C and E – to prevent disease, and to do so within a reasonable daily calorie limit, based on age, gender and size. Notably for gastroenterologists, the USDA flagged diverticular disease, osteoporosis, iron deficiency anemia, constipation and cancer, as well as a host of cardiovascular problems, and chronic health conditions that come along with poor diet. Nutrient imbalances affect chaos in the digestive tract – and it works vice versa: digestive diseases can impede the body’s ability to absorb certain nutrients from food.There needs to be a collective effort on the part of all healthcare professionals to use these guidelines if we want to have an impact on the obesity epidemic.