Adoption and Design of Emerging Dietary Policies to Improve Cardiometabolic Health in the US
Purpose of Review
Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains—food prices, reformulation, marketing, labeling, and government food assistance programs—appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design.
Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base.
These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.
KeywordsDiet Nutrition Policy Tax Subsidy Labeling
The authors thank all of the collaborators and advisory groups in the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) project (https://www.food-price.org).
Ms. Huang and Dr. Micha had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Huang, Mozaffarian, Micha.
Acquisition, analysis, or interpretation of data: all authors.
Drafting of the manuscript: Huang, Micha.
Critical revision of the manuscript for important intellectual content: All authors.
Obtained funding: Micha.
Administrative, technical, or material support: Huang.
Study supervision: Micha.
This research was supported by the NIH, NHLBI (R01 HL130735, PI Micha). The funding agency did not contribute to design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Compliance with Ethical Standards
Conflict of Interest
Ms. Huang, Drs. Pomeranz, Wilde, Capewell, Gaziano, Kersh, O’Flaherty, Mozaffarian, and Micha report grants from NIH during the conduct of the study. Dr. Whitsel serves as the Director of Policy Research for the American Heart Association. In addition, Dr. Micha reports personal fees from the World Bank, Bunge, and Dr. Mozaffarian from Astra Zeneca, Acasti Pharma, GOED, DSM, Haas Avocado Board, Nutrition Impact, Pollock Communications, Boston Heart Diagnostics, Bunge, and UpToDate, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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