Promoting Healthy Eating: An Investment in the Future

A Report to Congress

EXECUTIVE SUMMARY

This report fulfills a Congressional request for the Food and Nutrition Service (FNS) to report on "a comprehensive, integrated approach to nutrition education as a complement to the various nutrition assistance programs." FNS reviewed its current nutrition education efforts, and consulted with a wide range of nutrition education experts and stakeholders.

Our findings are clear: While the nation’s investment in nutrition assistance is a vitally-important and effective tool in fighting hunger, food insecurity, and related health problems, improving the quality of the American diet remains a major challenge. The prevalence of poor nutrition and lack of physical activity in the FNS target populations exacts a heavy toll in morbidity, mortality, and economic costs due to disease and lost productivity.

Fortunately, nutrition education holds great potential to promote good health and prevent disease. Research confirms that well-designed, behavior-focused interventions can effectively improve diets and nutrition-related behaviors. Federal nutrition assistance programs offer a special opportunity to deliver nutrition and healthy lifestyle messages to those they serve, particularly children. However, critical changes are needed to make program-based nutrition education fully effective in improving nutrition and promoting good health.

Our review of the current state of nutrition education in FNS programs identified the following barriers and opportunities to change that will enhance effectiveness:

Authority and funding levels for nutrition education vary widely by program. Each FNS program has a different nutrition education legislative authority and funding stream. It is important to make nutrition education an integral benefit of all FNS programs.

Flexible authority and a dependable funding stream for nutrition education are needed to support planning, program delivery, integration of services and the ability of the Federal government to provide leadership and technical support.

State and local infrastructures must be developed to deliver integrated, comprehensive programs. The long-term success of Team Nutrition depends on a stable infrastructure for nutrition education delivery; this infrastructure was provided by the Nutrition Education and Training Program (NET) before its funding was eliminated. More generally, there is no assurance of a central coordinating point at the State level for nutrition education across and among FNS programs; such coordination is vital for long-term development of an integrated approach.

The evaluation system for FNS nutrition education is fragmented and minimal, and lacks outcome measures. Adequate and reliable data to determine which program components are successful in improving nutrition and food behaviors and related outcomes is essential to permit FNS and its partners to plan effective nutrition education interventions.

The external environment has a fundamental impact on efforts to influence diet-related behavior. Advertising and fast food enterprises, coupled with financial and time constraints in family life, have a powerful effect on the eating and physical activity habits of the American population. It is unrealistic to expect consumer behavior to be consistent with healthy eating goals in an environment that promotes the opposite, unless positive nutrition messages are communicated using similarly effective approaches.

Dietary behaviors are complex, and are motivated by the combined influence of many factors, including personal factors (attitudes and values) and environmental influences (family, workplace, school, grocery stores, community and mass media). Nutrition interventions must deal with the full range of these complex influences. In addition, nutrition education, like other kinds of education, requires a commitment to sustained, consistent and reinforcing messages that can be delivered in multiple ways to an audience over the long term, and with sufficient breadth and depth to compete effectively with countervailing messages and influences.

FNS is working toward a comprehensive nutrition education approach that fulfills its objective of nutrition education that "is fully integrated into all FNS Programs and provides consistent nutrition messages that encourage and motivate target groups to make healthy food and nutrition-related choices throughout the life cycle."

Stakeholders who provided input for this report identified WIC nutrition education, Food Stamp matching grants to States, and Team Nutrition as promising pieces of this approach. However, they clearly indicated that NET or a NET-like State program must be fully and consistently funded in order to provide the infrastructure that makes Team Nutrition effective at the local level. The internal review and external input highlight the value of a strengthened policy foundation for nutrition education, and more sustained resource commitments for nutrition education throughout all programs. These discussions identified:

1. Develop a Funding Mechanism that Supports Sustained Nutrition Education for All Programs. Adequate infrastructure and capacity is critical to equip Federal, State and local agencies to plan, develop and implement effective interventions. One component of an adequate funding structure is to restore the appropriation for NET, and increase its authorization level to reflect inflation since the 1977 authorization.
   
   
2. Authorize Funding for Cross-Program Coordination. By using a small portion of Federal program resources for cross-program initiatives, FNS could better reach target populations. This flexibility would give FNS an opportunity to structure a cross-program effort to motivate partners to maintain high-quality, better coordinated nutrition education across FNS programs. Grants to State agencies should be used to support development of long-term nutrition education plans and foster better national, state, and local coordination.
   
   
3. Clearly authorize use of FNS program nutrition education funds for efforts directed to FNS target populations. Eligible individuals cycle in and out of program participation, making sustained efforts offered to participants alone problematic. FNS should be authorized to use some funding for nutrition education directed at the FNS target population, rather than restrict efforts to active program participants.
   
   
4. Expand Reach of Nutrition Education by Offering State Incentives. Federal-State-local funding partnerships can increase investment in nutrition education and spur private contributions. FNS should be permitted to provide incentives to expand nutrition education services, and to reach FNS target populations.
   
   
5. Authorize Grants for Nutrition Education Focusing on Special Populations. While integrated cross-program strategies are necessary to improve diets across eligible populations, some populations, such as Native Americans, face dietary problems and needs that require more specialized intervention; special investments are required in these areas.
   
   
6. Leverage Federal Resources with Public-Private Partnerships. With the authority to enter into financial partnerships with business and private non-profit entities, FNS can take advantage of the potential connections between encouraging healthy dietary behaviors and such efforts as promotion of American agricultural products, mutually reinforcing both endeavors.
   
   
7. Invest in Improved Evaluation and Reporting for Nutrition Education. A system for routinely collecting useful data to improve the planning, management, and outcomes of nutrition education activities should be developed and implemented. USDA should also make ongoing investment in studies to supplement this reporting, and should evaluate social marketing strategies and nutrition education outcomes.
   
   
8. Invest in Nutrition Education for the General Population. FNS’ target populations are unlikely to improve their nutritional lifestyle if the general population is not also making improvements. Federal structures, in particular USDA’s Center for Nutrition Policy and Promotion (CNPP), the Human Nutrition Coordinating Committee, and HHS’s Nutrition Policy Board, are in place to provide leadership; funding should be adequate to ensure that these efforts make an impact in the context of broad environmental influences on nutrition and physical activity.

Enhancing the nation’s investment in nutrition education represents a prime opportunity to improve diets and promote good health. The needed changes in nutrition behaviors can best be achieved through a sustained, integrated, long-term nutrition education effort that:

• ensures program infrastructure and capacity to support delivery of ongoing and multifaceted nutrition education to program constituencies;
  
  
• makes nutrition education an integral component of all FNS programs; and
  
  
• allows flexibility for integrated, cross-program interventions.

December 1999