Diet Improvements Primarily Seen Among White Americans

White, middle-class, and upper-class Americans tend to receive the best nutrition, new study results suggest.

Despite considerable public education about the benefits of a healthy diet, a study recently published inJAMAdetermined that nearly half of all Americans still make poor food choices, and less than 1% consume a diet the American Heart Association (AHA) would consider ideal.

The study used the AHA’s 2020 Strategic Goals as a yardstick for healthy nutrition, measuring participants’ self-reported consumption of the AHA’s 5 primary metrics: fruits and vegetables, whole grains, fish and shellfish, drinks with added sugar, and sodium. Another 3 AHA secondary metrics—nuts, seeds, and legumes; processed meats; and saturated fat—were also included in the analysis. Each metric prescribes an average daily diet target the AHA has identified to improve cardiovascular health and reduce cardiovascular disease and stroke-related deaths in the United States.

According to the US Population Reference Bureau, dietary factors account for more than 650,000 deaths each year and 14% of all disability-adjusted life-years lost.

Between 2000 and 2012, the percentage of Americans with a poor diet dropped 10%, from 56% to 46%. However, the percentage of those with ideal diets remained low, hovering between 1% and 2%.

Although the American diet remains suboptimal, modest improvements were observed in certain age cohorts. For example, Americans older than 20 years seem to have cut their soda-drinking habits in half. Meanwhile, the same group almost doubled its servings of whole grains and introduced more nuts, seeds, fish, and other seafood.

Notably, when the researchers controlled for race/ethnicity, and education and income levels, they observed much weaker dietary improvements. In fact, the dietary habits of those with lower incomes appear to have worsened. About twice as many white individuals had significantly improved their diets within the study period, compared with black and Latino individuals.

Among African- and Mexican-American minority groups, only 10% had improved from the “poor” to “intermediate” diet category from 2000 to 2012. In contrast, 1 in 5 white individuals had made the same improvement.

In an accompanying editorial, endocrinologist and general internist Margo Denke, MD, pointed out that “even with the best education and intensive training,” health care providers “struggle to influence the lifestyles of their patients and produce long-term change.”

Most literature on healthy eating and weight maintenance focuses on the need for patient counseling and achievable goals, which Dr. Denke acknowledges are “significant, challenging tasks to accomplish in an office visit.”

Retail clinicians are uniquely positioned to provide weight-loss counseling and promote healthy eating habits for all patients regardless of race/ethnicity and socioeconomic status, but the study findings can “inform discussions on emerging successes, areas for greater attention, and corresponding opportunities to improve the diets of individuals living in the United States,” the authors wrote