The food and substances we put into our bodies can either facilitate healing and wellness or increase risk for harm and deterioration. Improper nutrition is a leading risk factor for chronic disease, obesity, and early death. The opposite of this concept is also widely supported by research. Focused studies as well as analysis of recorded data regarding diet and health support the idea that high quality nutrition is correlated with significantly decreased risk of chronic disease and early mortality. Healthy nutrition is also linked with better quality of life in general, including improved physical, mental, and emotional well-being.
What is considered proper nutrition?
Dietary Guidelines for Americans for 2020-2025 presented by the United States Department of Agriculture (USDA) and the United States Department of Health and Human Services (HHS) define healthy nutrition as a diet high in fruits and vegetables, whole grains, unsaturated fats such as plant oils that are liquid at room temperature, and healthy sources of protein such as plants, fish, seafood, lean meat, and low-fat or fat-free dairy. The guidelines also recommend limiting intake of highly processed foods, saturated fats such as those derived from animal sources, salt, sugar, and alcohol.
A meta-analysis conducted by the American College of Lifestyle Medicine published in 2023 reviewed evidence-based dietary recommendations created by governments, major medical professional organizations, and large stakeholder associations between 2010 and 2022. The review consisted of 78 different sets of dietary standards. These guidelines focused on prevention and treatment of chronic conditions including cardiovascular disease, hypertension, autoimmune disorders, digestive disorders, diabetes, metabolic syndrome, cancer, and obesity as well as guidelines for general health promotion. This review showed consistency in recommendations to eat abundant fruits and vegetables and limit processed foods, saturated fat, sugar, and salt.
The American College of Lifestyle Medicine published a study in 2023 which reported that unhealthy diet is responsible for more deaths per year than any other modifiable lifestyle factor, including tobacco smoking. The Center for Disease Control and Prevention (CDC) reported in 2024 that an estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical management and treatment for chronic disease. Many of these illnesses can be prevented, managed, or in some cases even reversed through proper nutrition. The CDC published in 2024 that 42% of Americans (almost half!) have 2 or more chronic medical conditions and 12% have at least 5. The American Heart Association in 2023 estimated that about 90% of Americans eat less than the daily recommended amount of fruits and vegetables each day as given in the 2020-2025 Dietary Guidelines for Americans. The same report by AHA presented that the majority of Americans take in less than the recommended amount of whole grains and unsaturated fats while consuming much more than the suggested amount of saturated fat, sodium, hydrogenated fats, and sugar.
Why is healthy eating so challenging?
Although there is consistency in dietary recommendations across multiple organizations with authority and credibility regarding healthy nutrition, it is estimated that less than one eighth of Americans are following even the minimum requirements given in the guidelines. Why is this?
The American Heart Association suggested in their 2023 article addressing the Food is Medicine (FIM) program that challenges to eating healthy in America include access and affordability, the manner in which foods are marketed and advertised, and the common mindset challenge of immediate versus delayed gratification. In addition to this, there have been mixed ideas about what is considered “healthy” and for many years there had not been enough focused research with regard to these specific aspects of nutrition and their correlation to chronic disease and health for some of the recommendations to be considered evidence-based. Over the last five years study in this area has grown tremendously. Doctors and other health professionals have often neglected to discuss the topic of diet with patients, but as evidence grows to support specific nutritional interventions this is beginning to change.
Another significant challenge to eating healthy in America comes with the way that foods are produced. Our industrialized economy has favored maximized production at minimal cost with the longest shelf life possible. This has resulted in the production of highly processed foods with added sugars, salt, unhealthy fats, and other unnatural chemicals used as flavors, preservatives, and for enhancement of appearance and texture of the product. This conflicts with the recommendations for healthy diet which feature unprocessed foods, abundant fruits and vegetables, whole (not refined) grains, varied proteins, and only minimal to moderate dairy and meats in low-fat and fat-free forms.
An article published by the Harvard University School of Public Health in 2024 outlined the significance of the milling process and how that changes the nutritional quality of grains. In an effort to meet consumer demands and provide low-cost foods for the highest number of people possible roller mills were invented in the late 19th century. The outer casing of the grain is removed during the refining process as well as the inner core. This process strips away healthy fats, almost all of the natural fiber, B-vitamins, vitamin E, iron, copper, selenium, zinc, magnesium, antioxidants, and phytochemicals which are natural compounds in plants that have been researched for their role in disease prevention. The part that remains is high in carbohydrates, and without the outer coating and natural fiber has a much higher glycemic index. This means that the carbohydrate is absorbed into the body very abruptly causing a sudden spike in blood sugar. The milling process leaves the grain high in calories and low in nutritional content. Some of the nutrients are added back through fortification, although these forms are less usable to the body than the original and some highly nutritious components such as phytochemicals cannot be replaced. It is only in recent years that studies have illustrated the health impact of this process and indicated refined grains as less nutritious than whole grains, and even harmful in large amounts.
An article published by the National Institute of Health in 2023 evaluated the addictive quality of highly processed foods which often contain added sugar, artificial sweeteners, and other chemicals that initiate powerful responses within the brain. These are considered ultra-processed foods. Many of these foods not only damage the body, but are also often intentionally designed to be addictive for the purpose of drawing consumers to the product and boosting sales. Engineers in the process of the creation of these foods work to determine the “bliss point” which is the precise amount of sugar and chemicals that trigger the dopamine reward center in the brain and lead to reactions similar to those experienced by users of illicit drugs. In short, unhealthy foods fill the belly and trigger the brain providing a momentary “high” while healthier foods not only lack the addictive qualities provided by the sugar, salt, chemicals and added fat, but also require planning and additional time to prepare.
A study by a University of Michigan professor and colleagues used the criteria for substance use disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard for diagnosing mental health disorders, and applied them to food intake. These same criteria are titled the Yale Food Addiction Scale (YFAS) when used in the context of foods and include things like diminished control over intake, cravings, withdrawal, and continued use despite negative consequences. The analysis conducted by this research team estimated food addiction in 14% of adults in America and 12% of children. This is comparable to the rates of dependence on other substances that are known to be addictive such as alcohol and tobacco which are reported at rates of 14% and 18% in adults. The most striking difference between food addiction and the rates of addiction of other substances is the number of children affected. There is a disproportionate amount of children who meet the criteria indicating addiction to highly processed foods compared to other substances with addictive properties. At the same time childhood obesity is at an all time high with the CDC report from 2024 stating that 1 in 5 American children are obese, and more than 40% of school-aged children and adolescents have at least 1 chronic health condition.
How can we eat healthier?
As a nation we can move toward healthier eating by supporting programs like Food Is Medicine. FIM aims to improve population health through food and nutrition policy and programs. AHA presents FIM as one of several programs that are designed to provide nutritious food resources to the population in order to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. FIM and similar programs aim to improve access and affordability of nutritious foods to those in need as well as provide education to the public about nutrition and health.
Another step we can take on the societal level is advocate for policy that aims to regulate and properly label foods that are designed to be addictive and are harmful to health. In a similar situation, tobacco products (which contain some of the same highly addictive chemicals as some ultra-processed foods), when required to have visible labels of the health risk involved, significantly declined in popularity and use. Many Americans continue to consume ultra-processed foods regularly trusting that if it is sold to them as “food” in a grocery store then it must be nourishing and not harmful, and safe to give regularly to their children in the place of meals. Many addictive unhealthy foods are marketed specifically to kids with colorful packaging and catchy gimmicks. Requiring warning labels on the front of packages may cause people to take seriously the risks involved in consuming these products. In 20 different countries these types of labels have already been implemented. Studies are showing that the use of these labels leads to a decline in the sales and consumption of these foods which lack nutritional quality and carry significant negative health risks.
Another possible approach to guide society as a whole into healthier eating is to implement a tax on certain highly processed, addictive and health damaging foods. This is similar to other products that carry notable negative health risks and are consumed for pleasure like alcohol and tobacco. At least 103 countries have enforced taxes on sugar-sweetened beverages and some have also imposed taxes on ultra-processed foods. Studies indicate reduction in the sales and intake of these products estimated at 15-18%. In one country evidence supports that the implementation of these taxes is correlated with reduction in body mass index among teenage girls. Another study supports a correlation between these types of taxes and reduction of dental carries among members of the low-income population in a large city. The revenue generated by these taxes can be allocated to support programs like FIM that advocate for access and affordability of healthy foods to all members of the population.
As individuals we can recognize the influence that nutrition has on our health and make choices for ourselves and our families that facilitate the best physical, mental, and emotional well-being. We can prioritize meal planning and preparation and try to make meals with unprocessed or minimally processed ingredients whenever possible. Many of the meals we already enjoy can become healthier by swapping out some ingredients such as whole grains for refined grains, fresh or frozen vegetables and fruits rather than canned or processed, and using condiments and seasonings that are unprocessed or minimally processed and made with natural ingredients. This can be challenging, especially when it is new, but leads to great benefits in health and long-term versus immediate life satisfaction.
Progress not perfection
Although risk for many chronic diseases can be reduced through healthy nutrition this article does not intend to imply that diet is the only factor that contributes to these illnesses and conditions. Other factors are present in many cases that predispose individuals to different types of health conditions including age, gender, race, genetics, environmental factors, and significant life events or stressors. However in these cases individuals may still achieve a better quality of life and a more positive prognosis by working toward healthier nutrition. It is important to remember that people’s challenges are unique, health comes in different shapes and sizes, and becoming healthier is most often a progress and not perfection journey that happens one small step at a time. Even small changes can bring about benefits in health when done consistently. Working toward healthier eating does not mean that we can’t still enjoy a treat from time to time, it just means that those treats are outnumbered in our daily diet by natural, healthy, nutrient dense foods. When we work to build lifestyle habits that prioritize healthier nutrition we harness the power to lead ourselves toward better health one choice (and one bite) at a time.
Sources:
https://www.cdc.gov/healthyschools/chronicconditions.htm Assessed and Endorsed by the MedReport Medical Review Board