I am in the midst of a project in grad school to come up with a new way to save money and provide better health to the elderly - by way of implementing a new information system. This is in conjunction with following the requirements set forth in the "Health Care Innovation Challenge", run by the Center for Medicare & Medicaid Innovation (CMI), within the Centers for Medicare & Medicaid Services (CMS), under the umbrella of the Department of Health and Human Services.
I plan on getting blasted for my remarks, as the professor is most likely highly ingrained in the current health paradigms. I will find out shortly.
My intent is to shed light on the fact that if you simply try and push a new information system, without first reforming dietary guidelines, general health suggestions and other preventative measures, success will be limited. The majority of health improvements for the elderly - and cost savings associated with it will be seen if such ideas are successfully addressed and implemented. I realize this would never happen, especially in such an organization as the CMS, however it is important to point out.
Here is the short section which is simply a quick breakdown of the reasoning behind the necessary re-thinking of these dietary guidelines:
Science-Based Dietary Health Program
Before deciding on specifics regarding the proposed system, there is salient issue that merits addressing. With regard to health, the United States of America is on the brink of disaster. In 1985, no state in America had over 15% of its population labeled as obese (that is BMI equal to or greater than 30). [7] This is still a high amount, yet nothing compared to the 2010 data showing all states averaging around a 30% obesity rate, one state as high as 34%. [7] Even more startling is the fact that “Nearly 70 percent of men and women are either considered overweight or obese….and 32 percent of children ages 2 to 19 are considered overweight or obese.” [8]
Why do we have such an epidemic of obese and overweight Americans? The US Government has produced the MyPlate program [9] after the Food Guide Pyramid failed to get America into a healthy state. Children were informed by the government to increase their daily exercise routine to keep obesity at bay with the Let’s Move program. From the Food Guide Pyramid, MyPlate program and the Let’s Move program:
“1. Ensuring students are offered both fruits and vegetables every day of the week
2. Substantially increasing offerings of whole grain-rich foods
3. Offering only fat-free or low-fat milk varieties
4. Limiting calories based on the age of children being served to ensure proper portion size
5. Increasing the focus on reducing the amounts of saturated fat, trans fats and sodium.” [10]
Most of the recommendations made above are not science-based dietary guidelines. These dietary guidelines are based on a food nutrition paradigm shift that began several decades ago, pushed by both the United States government and food industries. In the 1970s, the United State Select Committee on Nutrition and Human Needs, chaired by Senator George McGovern, created the Dietary Goals for the United States in response to a number of health conditions facing the U.S. The recommendations put forth were to avoid fat, cholesterol, eat less meat and ingest whole grains, fruits and “complex” carbohydrates. We can see that the MyPlate program almost forty years later mirror these same guidelines. The Committee’s dietary outline conflicted with many scientists at the time, due to the fact the suggestions and recommendations were indeed not based on reliable scientific data. Indeed the American Medical Association protested along with many other large organizations. [11] Yet, in 1977 the dietary guidelines were set and have been in place ever since.
The dietary plan found its way into school lunches, the Women, Infants and Children program and almost every facet of society involving food distribution. For example, with the WIC program, the USDA touts research into the program from 2004: “…WIC participation is associated with improved diets…reduces intake of fat as a percentage of energy, increases the intake of carbohydrates as a percentage of food energy…” [13]
Essentially, through fat’s demonization, it has been removed or lowered in just about every food item and replaced with carbohydrate. This replacement of fat with carbohydrate gives a much longer shelf life to food items and is also cheaper to produce, due to crop subsidization. As a result, nearly every meal children eat is filled with carbohydrates. Fat is avoided as it is seen as artery-clogging and the reason one gets fat. Babies drink formula which is extremely high in carbohydrates, school-aged children typically ingest cereal, sandwiches, pasta, chips, juice and more every day.
A continually surfacing theme in current scientific study is the hypothesis that weight gain is merely an effect of a larger metabolic disorder, directly related to insulin resistance. The highest degree of impact on rapidly increasing insulin resistance is sustained blood-glucose levels. This is turn is a direct result of a large level of carbohydrate ingestion. There are also major clinical studies which completely discredit much of what is still touted as science derived from the Dietary Goals formulated decades ago.
When one looks at the Let’s Move program [10], we see many of the major unscientific dietary information surfacing. Counter to the five points made previously with regard to this program, scientific data include the fact that whole grains and bread in general is a fattening food; fat ingestion does not increase fat accumulation; saturated fat does not clog arteries or increase cardiovascular risk; sodium ingestion has little to no effect on health; dietary cholesterol intake has no bearing on cholesterol count; attacking cholesterol is misguided; and calorie restriction has many negative consequences for the human body.
The current dietary guidelines have produced 100 million individuals in the United States with either pre-diabetes or type II diabetes. This represents over one quarter of the entire population. As the American Diabetes Association states, “Before people develop type 2 diabetes, they most always have “prediabetes” – blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes…Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes.” [12] However, even the ADA suggests eating “healthy” which in turn points to the aforementioned unscientific dietary guidelines. What should be suggested is eliminating the main cause for insulin spikes. Those who have full blown type II diabetes that have followed the scientific dietary guidelines have eliminated all medication and symptoms associated with this potentially devastating metabolic disorder.
Implementing an information system to save money is important. However, to truly and drastically also improve health care for the elderly, adopting scientifically-based dietary health guidelines is paramount. Allowing this type of access in the home will further improve health and cost.
That is it, so far. Interesting from the Dallas Morning News (1977) regarding the dietary committee:
Oh, but it was accepted.
