What do you think about when you hear the series of numbers 4 - 4 - 3 - 2? Say them aloud to yourself—four, four, three and two. Hmmmmm . . . ring a bell?
If you were in elementary or secondary school between the late 1950s and the 1980s, you received this nutrition education communication from a variety of sources in school, the media and advertising, and on food packages.
Many Americans associate this series of numbers with the Basic Four Food Groups—fruits and vegetables, breads and cereals, dairy and meat-first published by the U.S. Department of Agriculture (USDA) in the 1957 publication, Essentials of an Adequate Diet.
Making the Basic 4 Better (and Actionable)
While food guides date back to the early 1900s, over the years they have been increasingly used for nutrition education, food purchasing advice, prevention of malnutrition and preparedness for the nation's troops during wartime.
How did the public become so familiar with the Basic Four? One way was through public-private partnerships and private organizations extending the reach of nutrition education messages.
Partnerships between government, not-for-profits and industry are very useful for communicating with one voice about important public health and safety issues. Think of it as dropping a pebble in a calm pond and watching the ripples radiate from the center. As the ripples move, they reach out to all corners of the pond. Through collaborations, there is substantial amplification of key health messages that add to the success of campaigns for all involved in the partnership. And, more importantly, the consumer is the one who benefits the most from the extensive reach of essential and timely messages.
In 1958, the National Dairy Council revised its Guide to Good Eating publication to conform to the USDA's Basic Four concept. As a nutrition education tool, the Basic Four quickly became the centerpiece for communicating basic dietary guidance to the public.
Over the years, scientific views have changed as a result of new research findings, and nutrition and dietary recommendations have moved away from preventing nutrient deficiencies to "wellness"-promoting health and preventing chronic diseases. As a result, recommendations began to focus on both choices and quantity of food to achieve a healthful balance.
The Basic Four was replaced in 1992 by the Food Guide Pyramid, jointly published by the USDA and the U.S. Department of Health and Human Services (DHHS). The next time you are in the grocery store or you reach into your pantry, you will probably find a food product that includes the pyramid on the package for nutrition education purposes.
At the same time that the Food Guide Pyramid was being developed, private groups and food companies were using other diet and health messages. A frequent source of these messages was the Dietary Guidelines for Americans, seven recommendations for nutrition and health that were published by the USDA and DHHS. The Guidelines have been used extensively in health education communications by private entities and by health organizations such as The American Dietetic Association, American Heart Association and American Cancer Society. Although the basis of the messages—the Guidelines—was the same, the messages were not very actionable for consumers.
As a result, research indicated that consumers were becoming more confused about the flood of nutrition and food information. Prior to the release of the 1995 Dietary Guidelines, the guidelines were tested with consumers to see how well they could be put into practice. Testing clearly showed that consumers felt the messages needed to be more actionable and add linkages to physical activity and healthful lifestyles.
To tackle the task of turning the dietary guidelines into action-oriented messages that could be understood by consumers, a group of 13 food, nutrition and health, consumer and government organizations formed the Dietary Guidelines Alliance. Their goal-to expand the reach of the Dietary Guidelines with "It's All About You" consumer messages (see Summer 1996 and March/April 1997 Food Insight).
"Our goal is to have the same level of recognition for these new messages that merge nutrition, physical activity and healthful behaviors, as there was for the Basic Four," stated Eileen Kennedy, D.Sc., R.D., director of USDA's Center for Nutrition Policy and Promotion and liaison to the Alliance.
Eating Your Way to Better Health Another excellent example of partnerships is the collaboration between the National Cancer Institute (NCI) and Produce for Better Health in the 5 A Day campaign to increase Americans' fruit and vegetable consumption. This highly-targeted public health campaign for dietary change is producing substantial results among Americans. You would be hard pressed to find a fresh vegetable aisle, can of fruit or bag of frozen vegetables without the 5 A Day logo. The program's success is evident by nutrition and food surveys that show many consumers hear and understand this message. USDA data from early spring 1997 show that Americans are a step closer to reaching the 5 A Day goal. Since 1991, when the 5 A Day program began, fruit and vegetable consumption for adults rose from 3.9 servings a day to 4.4. Although a one-half serving increase per average adult does not seem like much, it adds up to a lot of extra fruits and vegetables-approximately 35.5 billion
more servings a year. "We have made big strides to raise public awareness of the need to eat five or more servings of fruits and vegetables," said Peter Greenwald, M.D., Dr.P.H., Director of NCI's Division of Cancer Prevention and Control. "The next critical—and often more difficult—step is for people to actually do it."
In this unprecedented national public-private partnership, NCI, as the program's official health authority, has granted Produce for Better Health, representing the fruit and vegetable industry, a license to sub-license the use of program materials to industry participants. Produce for Better Health has authorized approximately 1,000 industry participants, including retailers, foodservice providers, growers, shippers, packagers, merchandisers, commodity boards, trade associations, branded products and others to conduct 5 A Day efforts. "NCI provides health information based on sound science and Produce for Better Health provides that information to consumers through a network of 35,000 grocery retailers nationwide," said Elizabeth Pivonka, Produce for Better Health president. Through this partnership, average consumption of fruits and vegetables is on the rise toward everyone eating "5 A Day" in the year 2000.
Caring About Cholesterol This September, you may have heard more about a healthy heart than usual because it was National Cholesterol Education Month. Since 1995, the National Cholesterol Education Program (NCEP), a project of the National Heart, Lung, and Blood Institute (NHLBI), has been supporting efforts to raise awareness and understanding about high blood cholesterol as a risk factor for coronary heart disease. The program also provides information to help the public lower its cholesterol. The NCEP was created because, although scientific studies had found a link between cholesterol and heart disease, surveys indicated that neither physicians nor the public were adequately informed of these findings. Through radio, television and print materials, the NCEP works to motivate the general public to "know your number," as well as increase awareness of the link between heart-healthy eating and lower blood cholesterol levels. The NCEP works in partnership with a wide range of organizations-government, professional, voluntary, community, private industry and educational-and the close involvement of all these parties ensures the continued development and expansion of programs. According to recent materials from NHLBI, the program is destined for continued success: "One goal for the year 2000—to reduce the prevalence of high blood cholesterol to no more than 20 percent in adults—has actually been achieved." The educational messages from the NCEP have very likely played a significant role in this healthful trend. Taking a Back Seat The momentum and effectiveness of public-private partnerships are not strangers to non-food and nutrition issues. Public-private partnerships have been extremely useful for message amplification and public understanding of other health and safety issues.
Take for example the recent campaign to encourage parents to have infants and children ride in the back seat of cars that have passenger airbags. This public service effort is sponsored by the National Highway Traffic Safety Administration, insurers, automakers and airbag suppliers.
"This easily understood message would not have reached millions of Americans without the partnership between the federal government and the automotive and insurance industries," noted John Graham, Ph.D., director of the Harvard Center for Risk Analysis. "This campaign to get 'kids in the rear seat' can only be successful through the joint resources of all of the partners." Millions of dollars have been contributed to this public education campaign to promote child health and safety. "Public education, new policies and reduced-risk technology can significantly impact public health and safety," he added.
In Europe, several countries adopted laws requiring children under 12 years of age to ride in the rear seat in the mid-1970s. That custom continues today, even though laws have changed. Today, fewer than 10 percent of children ride in the front seat in Germany and France, yet in the United States, between 30 and 50 percent of children are riding in the front seat. "Hopefully, collaborative communication efforts and policy changes will have a positive influence on where children ride, similar to increases in seat belt use over the past several decades," noted Dr. Graham.
The next time you look at a box of ready-to-eat cereal, can of fruit, or many other food products, you may be seeing the result of public-private partnerships in action. The Food Guide Pyramid, 5 A Day, "Every Heart Counts" and "It's All About You" messages reach consumers through the efforts of government and private educational efforts.
When you see or hear a public service announcement about a health or safety message, it is also most likely a result of a public-private partnership. "In a time of increasing clutter and shrinking resources there is both the opportunity and need to all work together," said Sylvia Rowe, president of the International Food Information Council. "Collective efforts allow us to reach more consumers effectively with positive, actionable information."
What Do Your Cholesterol Numbers Mean?
Every adult, age 20 and older, should have his or her blood cholesterol checked at least once every five years. Here's a quick look at the numbers and what they mean.
Total cholesterol. Your total cholesterol level falls into one of these categories:
Classification: Total and HDL-Cholesterol*
Total Cholesterol
Desirable Blood Cholesterol: less than 200 mg/dL
Borderline-High Blood Cholesterol: 200-239 mg/dL
High Blood Cholesterol: 240 mg/dL and above
HDL-Cholesterol
Low HDL Cholesterol - Less than 35 mg/dL
* These levels are for anyone 20 years of age or older
HDL-Cholesterol. Unlike total and LDL-Cholesterol, the lower your HDL, the higher your risk for heart disease. An HDL level less than 35 mg/dL is considered low and increases your risk for heart disease. The higher your HDL, the better. An HDL level of 60 mg/dL or above is high.
LDL-Cholesterol. Your doctor will likely check your LDL-cholesterol level if your:
- HDL-cholesterol level is low,
- total cholesterol is high,
OR
- total cholesterol is borderline-high, and you have two or more other risk factors for heart disease.
Source: National Heart, Lung, and Blood Institute
A Word on Triglycerides
Triglycerides in blood are derived from fats eaten in foods or made in the body from other energy sources, like carbohydrates. Unlike cholesterol, triglycerides are utilized by the body for energy. However, excess levels of triglycerides (hypertriglycerides) have been linked to heart disease.
The Second Expert Panel on the Detection, Evaluation and Treatment of High Blood Cholesterol in Adults defined hypertriglycerides as:
| Normal triglycerides |
Less than 200 mg/dL |
| Borderline high triglycerides |
200 to 400 mg/dL |
| High triglycerides |
400 to 1000 mg/dL |
| Very high triglycerides |
Greater than 1000 mg/dL |
