Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change
The individual is at the innermost core of the social-ecological model. In order for policy recommendations such as the Dietary Guidelines for Americans to be fully implemented, motivating and facilitating behavioral change at the individual level is required. The collective work presented in this chapter suggests a number of promising behavior change strategies that can be used to favorably impact a range of health related outcomes and to enhance the effectiveness of interventions. These include reducing screen time, reducing the frequency of eating out at fast- food restaurants, increasing frequency of family shared meals, and self-monitoring of diet and body weight as well as effective food labeling to target healthier food choices. These strategies complement comprehensive lifestyle interventions and nutrition counseling by qualified nutrition professionals. Timely feedback from registered dietitians/nutritionists and other qualified health professionals and engagement of the individual as appropriate in individual and group counseling will enhance outcomes. For this approach to work, it will be essential for the food environments where low-income individuals live to facilitate access to the selection of healthy food choices that respect their cultural preferences. Likewise, food and calorie label education should be designed to be understood for low literacy audiences some of which may have additional English language fluency limitations. While viable approaches are available now, additional research is necessary to improve the scientific foundation for more effective guidelines on individual level behavior change for all individuals living in the United States, taking into account the social, economic and cultural environments in which they live.
The evidence reviewed in this chapter indicates that the social, economic, and cultural context in which individuals live may facilitate or hinder their ability to choose and consume dietary patterns that are consistent with the Dietary Guidelines. Specifically household food insecurity hinders the access to healthy diets for millions of Americans. Also, immigrants are at high risk of losing the healthier dietary patterns characteristic of their cultural background as they acculturate into mainstream America. Furthermore, preventive nutrition services that take into account the social determinants of health are largely unavailable in our health system to systematically address the nutrition-related health problems of Americans including overweight and obesity, CVD, type 2 diabetes, and other chronic diseases. In summary, this chapter calls for: a) continuous support of Federal programs to help alleviate the consequences of household food insecurity, b) food and nutrition assistance programs to take into account the risk that immigrants have of giving up their healthier dietary habits soon after arriving in the United States, and c) efforts to provide all individuals living in the United States with the environments, knowledge, and tools needed to implement effective individual- or family-level behavioral change strategies to improve the quality of their diets and reduce sedentary behaviors. As indicated in Part D Chapter 4: Food Environment and Settings and Part D Chapter 5: Food Sustainability and Safety, achieving these goals will require changes at all levels of the social-ecological model through coordinated efforts among health care and social and food systems from the national to the local level.