Anna-leila Williams, PhD, MPH Frank H. Netter MD School of Medicine Quinnipiac University

1. Education Demonstration: the Influence of Socioeconomics, Industry, and Policy on Dietary Lipid Consumption Anna-leila Williams, PhD, MPH Frank H. Netter MD School of Medicine Quinnipiac University NCEAS Annual Conference, Chicago May 7, 2019

2. Workshop Overview

3. Curricular ContextYear 1 Medical school

4. Dietary Lipids: Who’s in Control? • 50-minute event [collaborative classroom or seminar] • Pre-event video [“voice over slides”] • 2 in class activities [we will experience today]

5. Pre-event Video Learning Objectives • Describe the interdependent relationships among basic science, health policy, the food industry, and health outcomes; • Review key recommendations from the National Dietary Guidelines; • Investigate the influence of socio-economics and environment on food access and dietary lipid consumption. In Class Activities

6. Pre-event video summary In seven slides

7. Dietary Lipids and Health Pre-event Video Summary • Healthy Fats: MUFA and PUFA • Saturated Fats, Trans Fats, and LDL • 600,000 deaths/year in US • Leading cause of death • $$$$ CDC.gov; Mozzafarian et al. Circulation. 2016;133:e38-e360.

8. Blood Cholesterol CHD Health Outcomes Lipid Metabolism Epidemiology Environment “Choice” Basic Science Behavior FDA Code of Federal Regulations Nutrition Guidelines Regulations/Industry Policy

9. http://health.gov/dietaryguidelines/2015/; Health.gov/dietaryguidelines/2015/guidelines/

10. Dietary Intake Compared to Recommendations Health.gov/dietaryguidelines/2015/guidelines/chaper-2 [Figure 2-1]

11. Recommendations criticized by nutrition community • vague • yielded to food industry pressures • World Health Organization’s classification • processed meat - CARCINOGEN • bacon, sausage, and hot dogs • red meat – PROBABLE CARCINOGEN • beef, pork, and lamb https://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf

12. McDonald’s $1.4 billion Pepsico $1.2 billion General Mills $866 million Nestle $819 million Hershey $745 million Kellogg $666 million Coca-Cola $664 million Kraft Heinz $569 million Dr. Pepper $414 million ConAgra $392 million Dunkin Donuts $382 million Wendy’s $347 million

13. Guidelines: “Support Healthy Eating Patterns for All” Food Access Food Insecurity http://www.freshtruck.org/ Acculturation https://nutrientsforlife.org/for-students/

14. Opening: “Any Questions about Pre-event video?” Move into first small group activity

15. Learners Small Group Work INTRO 1 A diet low in saturated fat helps reduce the risk of heart disease. Because much of the food consumed in the United States is processed, government regulations have been enacted to help people know the ingredients and nutritional content of what they are eating.

16. Learners Small Group Work [10 mins] see HANDOUT • Use the FDA – Code of Federal Regulations 101.75 Health Claims: Dietary Saturated Fat and Cholesterol and Risk of Coronary Heart Disease [Subpart E Requirements] https://www.ecfr.gov/cgi-bin/text-idx?SID=eaf8b05f4c36e7c40fabb0d8c089b05e&mc=true&node=pt21.2.101&rgn=div5#se21.2.101_175 • describe criteria for health claims and advertising related to dietary saturated fat and cholesterol; • discuss whether you think the criteria for labeling is sufficient for most people to make informed decisions about food purchase.

17. Health Claims

18. Educators What do you think of the content and andragogic approach used to investigate the Code of Federal Regulations ? Small Group Discussion [5 mins]

19. Educators Small Groups Report to All[5 mins]

20. Learners Small Group Work INTRO 2 “Food environment factors—such as store/restaurant proximity, food prices, nutrition assistance programs, and community characteristics—interact to influence food choices and diet quality. Researchers are beginning to document the complexity of these interactions, however, more research is needed to identify causal relationships and effective policy interventions. The Food Environment Atlas assembles statistics on food environment indicators, and provides a spatial overview of a community's ability to access healthy food and its success in doing so.”

21. Learners Small Group Work [15 mins] • Open the USDA ERS Food Environment Atlas: www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas.aspx SEE HANDOUT FOR INSTRUCTIONS

22. Develop a summary statement about the inter-relationship among economics, geographic location, food access, and health outcomes for the US county of your choice. Please include the following: • socioeconomic characteristics of the county’s population (include poverty rate; childhood poverty rate; percent of population who are WIC participants; percent of population who are National School Lunch Program and School Breakfast Program participants); • population’s access to a grocery store (include sub-populations - children, seniors); • county’s local food availability (farms, farmer’s markets, etc.); • county’s adult obesity rate; • county’s adult diabetes rate. • As a physician, how might you use these population-level data to improve the health of your patients?

23. Learners Small groups share summary statements with all[5 mins]

24. Educators What dO you think of the content and andragogic approach used to investigate the Food Environment Atlas and write the summary statement? Small Group Discussion [5 mins]

25. Educators Small Groups Report to All [10 mins]

26. Learners KEY SUMMARY POINTS • National Dietary Guidelines for Fats • Criteria for food labeling and advertising (dietary saturated fat and cholesterol) • Ways to use Food Environment Atlas data • Lobby government to assure access to quality food • Tailor patient nutrition education • Develop culturally and linguistically appropriate patient education materials • Advise school districts

27. KEY SUMMARY POINTS Educators Experiential Collaborative Integrated • Practical • Memorable • Perspective-taking Framework for lifelong learning for health professionals in understanding and addressing the social determinants of health.

28. Session Evaluation Thank you