AHA Advisory Emphasizes Need for Food-System Innovation, and Proof That It Works

A scientific advisory statement from the American Heart Association (AHA) is emphasizing not only the need for change within the nation’s food system to promote better health outcomes but also the importance of evidence to show that different innovations actually work in creating sustainable change.

“There is a need for immediate action to promote and fund innovative food systems approaches and their evaluation, especially given recent debates in highly respected research journals, by prominent scientists, about the promises and pitfalls of nutrition research,” write Cheryl Anderson, PhD, MPH, MS (University of California, San Diego), and colleagues. “Innovation throughout all levels of the food system is necessary to see improvements in the public’s health.”

The AHA statement, published this week in Circulation, comes on the heels of the summary publication from the EAT–Lancet Commission that outlines the current state of malnourishment and poor food practices. Its authors conclude that “a global transformation of the food system is urgently needed.”

Andrew Freeman, MD (National Jewish Health, Denver, CO), who was not involved in either paper, told TCTMD that “the bottom line is there's an enormous amount of environmental pressure both from a health perspective, where we have this enormous burden of disease that we can't afford to pay for, and the truth is some of the environmental experts out there think that if we don't change the way we eat by 2050, we may not even have a planet that is habitable, so it won't even matter what we eat. . . . From an environmental standpoint or from a health standpoint, we've got to act.”

This paper has “a general message for healthcare practitioners, but particularly in the cardiovascular space because [heart disease is] the number one killer and we know that lifestyle has enormous impact on outcomes in cardiovascular disease. We should be some of the first practitioners that actively make these changes.”

Multilevel Engagement Needed

The AHA writing committee explains in their document that there are “multiple stakeholders that contribute to a health and sustainable food system,” including those in the food and agriculture industries, people involved with public health and medicine, policymakers, communities, as well as individuals and families.

Certain policy approaches like the banning of trans fats “could stimulate development of new food items containing fewer calories; food packaged or sold in smaller portion sizes; increases in vegetable and fruit consumption; and reductions in the consumption of sugar-sweetened beverages and other unhealthy foods and beverages,” they write. Within the private sector, marketing strategies, point-of-purchase interventions, and vegetable/fruit incentives have shown to increase healthy consumption, and public health interventions have also shown promise, though confirmatory evidence is needed.

Local approaches have also proven effective, Anderson and colleagues say. “For example, community organizations and school districts have implemented traffic light labels and choice architecture to increase healthy choices of food pantry customers and students,” they write. “Some schools have tested the effectiveness of increasing water availability and have shown that students increase consumption of water at school. There is growing interest in implementing and testing smart technologies, including nutrition and health applications (apps), wearable tracking and assessment devices, and gaming approaches, to improve healthy food choice behaviors among adults and children.”

The goal here is not so much just to live longer, but to live longer with better quality of life and less disease. Andrew Freeman

But it’s the multilevel strategies involving policymakers, the private sector, public health officials, health care workers, communities, and individuals that are likely to yield the most profound effects, Anderson told TCTMD. As for which players might be able to play a larger role, “at this stage, it’s hard to apply a sense of relativity,” she said. “The important message is that everyone can contribute. The amount that each of the stakeholders may be able to contribute may not be evenly split because of challenges that may go beyond their control. Importantly, I think we need to begin to have these conversations about what the contributions can be and if everyone made small changes toward this goal, we could start to make a shift in what the food system looks like.”

Future efforts in this field should focus on three areas, according to the writing committee. First, “evidence directly linking innovations to health outcomes is lacking,” they say, suggesting that partnerships are needed to publish sponsored research on prevention. Next, because of the “major gaps in the literature” on the effect of previous innovations by the food and agricultural industries, the AHA should work with to “promote transparency and availability of data regarding food products and consumption patterns.” Third, success in improving the health and sustainability of the food system can only be achieved if all stakeholders are engaged.

Future Action

Going forward, “we just need to constantly raise awareness, particularly among healthcare providers, that disease control is within our power,” Freeman emphasized. “We have to stand collectively together and make choices that sometimes are not going to be the most comfortable choices. . . . At the end of the day, the goal here is not so much just to live longer, but to live longer with better quality of life and less disease. I think when we can all see that uniformly together, that's where we're going to see the greatest impact on how we affect change.”

Specifically, Anderson recommended that cardiologists “consider the context in which [the] patient has to navigate” when giving nutritional advice.

“Credibility is enhanced when we’re able to approach a patient and say: 'Let’s talk about what it would take for you to be able to actually do this, and let’s talk about the environment that you're having to navigate to meet the requirements that I'm outlining for you.' It’s a more authentic conversation with a patient than ‘Here's the brochure. Just go do it,’” she advised.

Anderson said she looks forward to seeing data that show the impact of behavioral changes within the food system and on overall health. “People may actually increase their purchasing or they may have increased awareness, but we don’t actually know what it means for consumption,” she said. “So do these things actually change how people end up eating, and what does that then mean for their health outcomes?”