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The Value of Nutrition Obesity Research Centers: As Told by Dr. David Allison

Doctor David B. Allison is the current dean, distinguished professor, and provost professor at the Indiana University School of Public Health-Bloomington. Prior to Indiana University, Allison was a distinguished professor, Quetelet Endowed Professor, and director of the NIH-funded Nutrition Obesity Research Center (NORC) at the University of Alabama at Birmingham (UAB). Allison was appointed director of the NORC in 2003 and served until 2017. Allison has published more than 500 scientific papers with research interests including obesity and nutrition, quantitative genetics, clinical trials, statistical and research methodology, and research rigor and integrity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NORCs are “intended to integrate, coordinate, and foster interdisciplinary basic, clinical, translational, and public health research by a group of established investigators actively conducting programs of important, high-quality research that is related to research specific to NIDDK’s mission.”

There are currently twelve university-based NORCs across the United States from New York to Washington State. These centers are funded by P30 Center Core Grants from the NIDDK to bring together investigators who are conducting research in nutrition and obesity and improve the quality of research by promoting multidisciplinary work and sharing access to specialized technical resources and expertise. These centers allow for cost-effective collaboration between groups of investigators at the same institution. The NORC at UAB currently has 159 investigators from 58 different academic units – a manifestation of the center’s multidisciplinary approach.

Allison’s 14-year appointment as director of UAB’s NORC makes him an ideal individual to speak with about the successes of the initiative since its inception in 1999. Allison was gracious enough to answer several questions about his tenure as director and about NORCs more broadly.

What role do you see NORCs playing on university campuses?

NORCs are enormously helpful, and it is valuable to consider them in a historical context. The first NORC – before they were even called NORCs – was the New York Obesity Research Center at Columbia University and, at the time, Rockefeller University. It was the first and for many years only federally funded obesity research center in the United States. The NIDDK subsequently decided to call all the clinical nutrition research units and obesity nutrition research centers “NORCs,” and there are now twelve under this designation.

The New York center is where I started my career as an obesity researcher during my second postdoc. It was a lot of fun there. The NY Obesity Research Center was the mecca of obesity research. If you were an obesity researcher, and if you wanted to get trained, you knew where the mecca was. If you wanted to make a pilgrimage, you could see what the great leaders of the field were doing. You could go there and meet esteemed individuals such as Ted VanItallie, Xavier Pi-Sunyer, and Steven Heymsfield.

You sort of knew where the leadership was – where the intelligentsia and cognoscenti were. There were certainly other places in the world that were powerhouses in obesity, but in the United States, the NY Obesity Research Center served as a galvanizing force. It also served as a great training ground at the time – and NORCs still do. It is one of the things that makes NORCs special: they are multidisciplinary, and they are focused on a topic.

What you sometimes see in the field of obesity, which is probably true in other fields as well, is that there are a lot of instances of people making mistakes that I refer to as “errors in interdisciplinarity.” This is an error which one makes because one is completely unaware of something that would be basic and fundamental to someone in another discipline – but you as a member of a different discipline aren’t aware of it.

A simple example would be if you are a social scientist and you know that physical activity matters for obesity, and you make an assessment that some program will have an important effect, but you don’t know anything about body mass or energetics. You then project the amount of weight change that could occur because of the physical activity intervention without understanding the physics, the mechanics, or the energetics. This is an error of interdisciplinarity.  We see these things regularly.

When I was “growing up” in the NY Obesity Research Center, these kinds of things would become the fodder of your education as a young person. So if you piped up and raised your hand in a seminar and said, “What about this?” it may reveal that you didn’t understand a basic concept in statistics, psychology, physiology, or anatomy. Then the more senior people around, who were experts in those things, would say to you, “Come on over here, kid, let’s explain to you that’s not how that works.” You got it drilled into your head, an emphasis of interdisciplinarity – the idea of real expertise – and avoiding these simplistic mistakes that you still see so often now in people who are focused on obesity research. That is one very valuable part of it: bringing together an interdisciplinary cadre of experts on the topic who then educate young people to be an expert in a topic, and not just get caught up in their own discipline.

The second thing that is extremely valuable is the idea of the NORC as provocateurs of people’s interests. The total amount of money in the NORCs per se is not much – around $750k/year in direct costs – not much bigger than one or two R01s. What is important is not the total cash value, but the way the value is delivered through a leader on campus, who then uses the funds as a lever, at the right points to provoke activity, and provoke interests.

Years ago, early in the NORC’s history at UAB, it became clear to me that using more invertebrate models for obesity was important, that genomics was upon us, and that we should have people working with Drosophila and C. elegans. I was able to use different pieces of the NORC to provoke that. For example, I would bring in speakers through our seminar series who worked on those topics. We had funding for pilot grants that could be used on that research. There were extra discretionary funds from institutional matching, so I could use those funds to recruit some younger people to work on these topics. All those things came together so that people were writing and getting R01s to do research involving those organisms.

There are other things that are important for the NORC in terms of sense of identity.  People are excited to be at an NORC because they feel that they are at one of “the” places. The dollar amount of the NORC isn’t that great, but the prestige value is high. It serves to create an identity to get people excited – to pull them together to work together on things. Those are some of the big values of the NORCs today.

You were director of the NORC at the University of Alabama at Birmingham for nearly 15 years. How have you seen the effect of NORCs change over that time?

I think we have seen a couple of changes. In general, science has changed, and the NORC science has changed with it. Science has become more molecular, more genetic, and the NORCs keep up with the trends of general science. Other things I have seen in NORCs is this idea of leveraging the amount of money. Not only is the amount of money provided by the direct costs of the NORC not large, especially compared to diabetes centers, cancer centers, and other NIH centers that receive much more than NORCs, but it’s been flatlined for over 20 years. If you compared the NORC funds in real dollars to the dollars from 20 years ago, the current funds are much smaller.

NORCs have become these engines – at their best – where creative leaders use the P30 grants as the nucleating site around which to build other stuff. You go to your institution and get a match in funds, and then you get some T32 grants. You say, “Isn’t this great we have an NORC, so we can do great training. Please give us a postdoctoral and predoctoral T32 in obesity, and then why don’t you give us an R5 to do a national short course in obesity?” … You keep adding those things on. We at UAB were very strong on that. Many other institutions are as well, and that is one way you have seen the NORCs change. They have become these multi-infrastructure grant organizations.

When speaking with other NORC directors and center administrators, what are some of the advances and successes that have stood out to you?

I think probably more than anything, the successes and advances that I hear the NORC directors take the greatest pride in is the young people who they help get started, and that is especially true for those NORCs that go on to get T32s, which many have. How I got my own start was on a T32 while in New York. That is also how I learned to write T32s, by being thrown into it by my old boss at the NORC. He said, “Here’s my old folder. I’m going on a trip out of the country. I will be back after this thing is due. Good luck,” and I said “…okay,” and so I learned how to write a T32 grant.

I think when people are successful in getting those T32 grants, as well as in getting young people involved, however they do it, bringing new people into the field, and helping those new people achieve, it is a great success. You can look at many of us and say that we are products of the NORC systems themselves. Myself, Doctors Dympna Gallagher, Tim Nagy, Barbara Gower, Michael Goran, and many others, are all the products of these centers, brought in as postdocs at the beginning of a center. Many who are NORC directors now got their start there.

How do NORCs help cultivate the future generation of nutrition and obesity researchers?

To reiterate, the interdisciplinarity: training people so they are not just a public health person that says, “Yeah I get it, people, they eat too much and exercise too little, what else do I need to know about obesity. Now I just need to talk about the policies that will make people eat less and exercise more.” Well, maybe it would be good to know a little more than that. NORCs bring up people with a more robust knowledge of this. The NORCs also draw people into the field, give them a sense of identity and belonging and an enthusiasm for being in the field.

You have been critical of the rigor at which obesity and nutrition research is performed. Do you think that NORCs have been able to increase the quality of research in the field?

I think that NORCs do increase the quality of research in the field, and they lead by example. I am critical of the rigor and quality of the research everywhere, including in my own research. That is important for us to do as scientists – to be critical of the rigor and the quality of research – and to make it better. I think there are particular concerns raised in the field of obesity, and some of those concerns in my mind came out in the mid-90s when obesity began to be seen as a public health crisis.

Instead of obesity research being driven to a greater extent by people who were fully involved in it for a long time, and involved with others in getting this interdisciplinary background, it became more that anybody felt that they can jump in. Any economist, any public health official, jumped in with zealous passion, which much of the time wasn’t matched with rigorous background knowledge. This has led to some of the more questionable research we have seen. It’s not everything, but just one factor. NORCs are helping by providing training for people, by putting out good research, and by leading by example.

What are some fond memories from your time at UABs NORC

Well, pulling together on things in general. Part of what makes a great center great is people working together as a center. In fact, one of the things that attracted me to come down to UAB was in fact its centeredness. I had other offers before heading to UAB, and some were at institutions that were more attractive in some ways, but what I liked about UAB and the NORC was the feeling that this was a group of people that worked together, and only a slight exaggeration, but it was a sense of a family. I really liked that. To me, a lot of my fondest memories were pulling together with Tim Nagy, Barbara Gower, José Fernández, Tim Garvey, the late Roland Weinsier, Stephen Barnes, Steve Austad, Kevin Fontaine, Julie Locher, Gary Hunter, and I am sure I’ve missed many important people, but the ability to pull together through tough challenges, working hard, overcoming obstacles – doing things together which none of us could have done alone.

 

This is part two of a two-part interview with Dr. David Allison.

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Submit Your Comments on the 2020-2025 Dietary Guidelines

2020-2025 Dietary Guidelines for Americans

The U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) are seeking public comments on topics and supporting scientific questions to inform the development of the 2020-2025 Dietary Guidelines for Americans. This is a new step in the development process. View the Federal Register Notice here.

Topics and questions proposed by USDA and HHS are based on four criteria: relevance, importance, potential federal impact, and avoiding duplication. The topics for 2020-2025 Dietary Guidelines are within a life stages approach, focusing on priority scientific questions from birth through older adulthood. In addition, the topics reflect a continued focus on patterns of what we eat and drink as a whole, on average and over time.

Learn more on the development of the dietary guidelines hereSubmit your comments here.

Listed below are the five life stages with proposed topics and scientific questions. The guidelines will also describe current dietary patterns, including intakes of food groups and nutrients, for each stage of life.

Infants and toddlers from birth to 24 months (healthy, full-term infants)

Topic Question(s)
Recommended duration of exclusive human milk or infant formula feeding What is the relationship between the duration of exclusive human milk or infant formula consumption and 1) growth, size, and body composition; 2) food allergies and other atopic allergic diseases; and 3) long-term health outcomes?
Frequency and volume of human milk and/or infant formula feeding What is the relationship between the frequency and volume of human milk and/or infant formula consumption and 1) micronutrient status; and 2) growth, size, and body composition?
Dietary supplements (e.g., iron, vitamin D, vitamin B12) What is the relationship between specific micronutrient supplements for infants fed human milk and/or infant formula and 1) micronutrient status; and 2) growth, size, and body composition?
Complementary foods and beverages*: Timing of introduction, types, and amounts

*Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives)

What is the relationship between complementary feeding and 1) micronutrient status; 2) growth, size, and body composition; 3) developmental milestones; 4) food allergies and other atopic allergic disease; and 5) bone health?

What is the relationship between complementary feeding, including foods and beverages, and achieving nutrient and food group recommendations of infants and toddlers?

Note: Evidence related to dietary patterns (including beverage patterns) consumed during the complementary feeding period will be considered as part of these questions.

 

Children and adolescents, ages 2-18 years old (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health and normal growth and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed during childhood and adolescence and 1) growth, size, and body composition; and 2) bone health?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for children and adolescents?

Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during childhood and adolescence and achieving nutrient and food group recommendations?
Added sugars What is the relationship between added sugars consumption during childhood and adolescence and achieving nutrient and food group recommendations?

How much added sugars can be accommodated in a healthy diet during childhood and adolescence while still meeting food group and nutrient needs?

 

Adults, ages 19-64 years old (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health, prevent disease, and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed during adulthood and 1) body weight or obesity; 2) risk of cardiovascular disease; 3) risk of type 2 diabetes; and 4) risk of certain types of cancer?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for adults?

Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during adulthood and achieving nutrient and food group recommendations?
Added sugars What is the relationship between added sugars consumption during adulthood and achieving nutrient and food group recommendations?

How much added sugars can be accommodated in a healthy diet during adulthood while still meeting food group and nutrient needs?

Saturated fats What is the relationship between saturated fats consumption (types and amounts) during adulthood and risk of cardiovascular disease?

 

Pregnancy and lactation

Topic Question(s)
How additional calorie needs should be met during pregnancy and lactation What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed among women who are pregnant and 1) risk of gestational diabetes; 2) risk of hypertensive disorders during pregnancy; 3) gestational age at birth; and 4) birth weight standardized for gestational age and sex?

What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed among women who are lactating and human milk composition and quantity?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for women who are pregnant or lactating?

Dietary supplements (e.g., iron, folate, vitamin D) What is the relationship between micronutrient supplements consumed during pregnancy and lactation and 1) micronutrient status; 2) birth outcomes; and 3) human milk composition and quantity?
Diet during pregnancy and lactation and risk of food allergy in the infant What is the relationship between maternal diet during pregnancy and lactation and risk of infant allergies and other atopic allergic disease?
Seafood What is the relationship between seafood consumption during pregnancy and lactation and neurocognitive development of the infant?
Beverages (cow’s milk, water, 100% fruit juice, sugar-sweetened beverages, milk alternatives, caffeinated beverages) What is the relationship between beverage consumption during pregnancy and lactation and 1) achieving nutrient and food group recommendations; 2) birth outcomes; and 3) human milk composition and quantity?
Alcoholic beverages What is the relationship between maternal alcohol consumption during lactation and human milk composition and quantity?

 

Older adults, ages 65 years and older (with data reviewed by age group)

Topic Question(s)
Dietary patterns to promote health, prevent disease, and meet nutrient needs What is the relationship between specific dietary patterns (Dietary Guidelines-related, Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH), vegetarian/vegan, and low-carbohydrate diets) consumed across the lifespan and 1) body weight or obesity; 2) risk of cardiovascular disease; 3) risk of type 2 diabetes; 4) risk of certain types of cancer; and 5) risk of osteoporosis?

What modifications to dietary patterns are effective in preventing or reversing declines in muscle mass or bone density in older adults?

Are changes to the USDA Food Patterns needed based on the relationships identified? If so, how well do USDA Food Pattern variations meet nutrient recommendations for older adults, age 65-80 years and those age 81+ years?

Specific nutritional needs related to older adults What modifications to food and beverage choices promote meeting nutrient needs in older adults with impaired dentition, dry mouth, or other aspects of aging that interfere with food and beverage consumption?

Comments are accepted through March 30, 2018. If you have a new topic or question to suggest, provide a brief summary including information pertaining to the four prioritization criteria. After the review of comments and finalization of topics and supporting questions, USDA and HHS will post a public call for the Dietary Guidelines Advisory Committee nominations.

Read more about the Dietary Guidelines here.

If you have any suggestions to inform ASN’s comments please reach out to Sarah Ohlhorst, Senior Director of Advocacy and Science Policy, at sohlhorst@nutrition.org or 240-428-3647.

 

 

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National Nutrition Month

March is National Nutrition Month. The campaign promotes healthy eating habits and nutrition education, and it celebrates the people who promote these healthy habits. In 2018, the theme is “Go Further with Food”, highlighting that food decisions make an impact on your overall health.

Members of the American Society for Nutrition (ASN) are diverse. We study nutrition as a science, reporting on the physiological and biological aspects of foods and nutrients. We are also the nutrition educators and practitioners who get the latest nutrition science into the hands of those who need it: policymakers, dietitians, medical doctors, nurses and allied health professionals, and consumers. To celebrate National Nutrition Month and ASN’s impact on enhancing the knowledge of nutrition and quality of life, we will be highlighting some of our programs and activities that ultimately influence public health and how we can “go further with food.”

NUTRITION 2018 – American Society for Nutrition’s Annual Meeting

Nutrition 2018 LogoThis year ASN kicks off a new annual meeting that will focus on the multidisciplinary field of nutrition science. The meeting will bring together basic, translational, clinical, and population scientists and practitioners. The meeting will be held in Boston June 9-12 and registration is open now!

Some hot nutrition topics at the meeting:

  • Role of Anti-inflammatory Nutrition Strategies
  • Pediatric Nutrition
  • Nutrition and the Environment
  • Precision Nutrition
  • Science of Breastfeeding
  • Food Allergies

These are only a few topics that are included in the 4-day nutrition meeting. Our NUTRITION 2018 schedule is now open so please refer to it for the latest sessions.

Stay tuned for more news and a special membership offer for dietitians and nutritionists during National Nutrition Month.

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How can we implement better health behaviors in cancer survivors?

Lifestyle interventions targeted at obtaining/maintaining a healthy body weight and/or incorporating physical activity and healthy eating habits have great potential in improving outcomes in cancer survivors. Cancer diagnosis is a “teachable moment” wherein many patients are highly motivated to make changes (1). Furthermore, a balanced diet and moderate exercise can improve prognosis, quality of life, physical function, and survival across the cancer continuum. As such, groups such as the Amercian Cancer Society, National Comprehensive Cancer Network and the American College of Sports Medicine have released lifestyle guidelines for cancer survivors.

However, implementing changes in individuals and healthcare systems is challenging, to say the least. This is a recent topic covered by Karen Basen-Engquist and a number of colleagues as part of a special Issue of Obesity (Transdisciplinary Research on Energetics and Cancer)(2). Their article provides a 6-point agenda for translating research into clinical and community action, as follows:

  1. Increase the availability of different types of activities for weight management, nutrition counseling, and physical activity. One size will never fit all when it comes to improving health. Individual goals/preference, resources, and logistics all come into play, and cancer-specific programs may be needed.
  2. Improve screening and referral to lifestyle interventions. A system for evaluating and triaging patients for health programs should be developed. Importantly, an individual’s physical status, health needs, and goals should be considered.
  3. Improve the health care provider’s ability to screen, assess, and refer survivors for lifestyle programs. Oncology providers have a powerful role in helping cancer survivors; however, they often do not feel confident in screening, giving advice, or administering recommendations for lifestyle-related constructs. Implementation of processes such as the 5As (Ask, Advise, Assess, Assist, Arrange), which has been successful in tobacco cessation (3) and obesity management (4) might prove beneficial.
  4. Expand the support of oncology-specific professional training and certification. Professional organizations of dietitians, exercise professionals, psychiatrists, and physical therapists have additional certification programs for oncology or are working on developing one for its members. However, professionals with specific expertise in oncology are still greatly needed to address the unique needs of this population.
  5. Expand dissemination and implementation research. Many research programs do not address how a program could be implemented in a real-world setting (external validity). Dissemination of research findings with consideration of the sustainability and generalizability of programs is essential for broader impact.
  6. Advocate for health care policies that support lifestyle services for cancer survivors. Coverage for health programs is highly variable and often has barriers such as large co-payments, no coverage in grandfathered plans, and cost sharing. A potential solution could be incentivizing nutrition and exercise services, although more research is needed to determine the effectiveness of such actions.

As the authors eloquently articulate, the time has come to enable research into action for optimal healthcare in all cancer survivors.

References:

  1. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005;23:5814–30.
  2. Basen-Engquist K, Alfano CM, Maitin-Shepard M, Thomas CA, Schmitz KH, Pinto BM, et al. Agenda for Translating Physical Activity, Nutrition,and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity 2017; 25, S9-S22.
  3. Siu AL, Force USPST. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015;163:622-634.
  4. Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of Obesity Management framework on provider-patient interactions in primary care. Clin Obes 2013; 4, 39-44.

 

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Path to Policy: Interview with Angela Tagtow, Executive Director of the Center for Nutrition Policy

USDA Logo
By: R. Alex Coots, Student Blogger

The below interview is a continuation of an interview with Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA. Part 1 of this interview can be found here.

Tell me about the challenges of nutrition policy.

I imagine health policy falling into one of two categories, little-p policy (LPP) or big-p policy (BPP). LPP is a socioecological approach to policy, using individuals and organizations to make decisions to improve public health that don’t require an elected official. BPP requires elected officials to create broader, more top-down initiatives to improve public health. Both types of policy working in concert can create greater collective impact.

Many people see BPP as the primary driver of policy, but LPP can be very effective to improve community health. The Northeast Iowa Food and Fitness Initiative exemplifies the power of LPP. Through the initiative they recruited hundreds of community stakeholders to make commitments to improve public health whether that is at home, school, workplace or throughout the community. Starting the initiative was a slow process built on networking and strengthening relationships, but proved to make an impact in the lives of community members.

BPP also creates change, but has its own challenges. It can take several years for State or Federal programs to be fully implemented. For example, the Healthy Hunger-Free Kids Act was signed into law back in 2010, and we’re still seeing elements roll out. At the Federal level, Congress is another aspect that makes BPP challenging. Each Congressperson has a different perspective and set of values with respect to healthy food access, nutrition, public health. The ability to recognize their priorities and influencers is an important part of building support behind an initiative.

Given the number of different opinions and interests regarding public health, do you think there’s a way to make everyone happy?

There’s always going to be struggle. Every organization out there has a set of goals that are different from the next organization. Industry has an interest to protect its products and public health has an interest to keep people healthy. These goals are not always aligned, so there are challenges.

The media often reports on about industry trying to make changes to their offerings in the name of public health. Do you think these efforts are genuine?

Not all industry should be discounted. Some companies do consider how their products and services contribute to public health and are trying to make a difference. But for others, they need to evaluate whether they are doing all that they could be doing.

 

What are some of the future goals for the USDA and the CNPP?

The CNPP does much more than just produce the Dietary Guidelines for Americans (DGA) and the iconic MyPlate. The Nutrition Evidence Library, a very rigorous review of the literature that directly informs the DGA. The CNPP also makes many tools and online resources available to assist individuals with eating and physical activity goals. ChooseMyPlate.gov and Supertracker.usda.gov are dynamic online resources for individual, families and professionals that put the Dietary Guidelines for Americans into action.

In the near term, the launch of the 2015 Dietary Guidelines for Americans and the Healthy Hunger-Free Kids Act are the top priorities. Some policymakers are challenging the validity of improving child health, and the House and Senate have inserted language in appropriation bills that will restrict USDA and HHS’s  abilities to create the Dietary Guidelines. It’s a very interesting political time regarding advancing the nutritional health of Americans.

Do you have any final advice for students?

Yes, be engaged. Having a good grasp of the content knowledge and political processes are good, but having contacts and networks is just as important. Knowing key people who create change and understanding how to work with them will allow you to be more effective in your endeavors. We need more people to get engaged with nutrition and public health efforts.

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Path to Policy: Interview with Angela Tagtow, Executive Director of the Center for Nutrition Policy

By: R. Alex Coots

The field of nutrition is diverse. Some nutrition researchers pursue their work to better understand human metabolism, while others seek to help people build healthy eating habits. Despite the different approaches in their research programs, nutrition researchersall aim to improve public health. But simply producing the information isn’t enough. The entirety of scientific knowledge must be evaluated and used to create effective policies to fully realize the benefits of nutrition research.

Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA, continues an illustrious career in health promotion at the USDA. She’s worked in nutrition, public health and food systems at levels ranging from local initiatives to international endeavors. She and I had a conversation about her career, her advice for students interested in policy, and her thoughts on the challenges of policy work.

How did you get your start in nutrition and policy?

Growing up, food and meals were very important in my family. We maintained a large garden which provided diverse foods for our day-to-day meals. In college I had an intense interest in health promotion, but clinical dietetics was focused on treatment rather than prevention of illness. Health promotion at the time was nascent but I saw the potential and oriented my life towards it.

After graduation from college I started work at the American Heart Association as a program director. This position helped build out my network and gave me my start in the health promotion world, however I quickly realized I’d need graduate-level training to take my career further. After graduate school I started work as a consultant in the WIC program at the Iowa Department of Public Health. Here I worked more broadly in the public health domain with a variety of groups such as the county boards of health and Title V Maternal and Child Health Services.

After 9 years, I decided to expand my areas of expertise to include food systems as well as public health and nutrition. I founded a consulting company where I provided education, informed policy, and developed communication tools around health, the environment, and food systems. After 9 years of consulting, I moved back to government to work at the CNPP.

What are the key lessons or skills that you took away from these endeavors?

Consulting work affords you a good deal of flexibility in the types of work that you take on. I was able to broaden my skillsets, increase my knowledge base, and diversify my network in ways that I wouldn’t have been afforded in government. Consulting does have a bit more uncertainty with respect to job security. A career in government is a much different experience. The scope of the work is more defined and the position is more secure compared to consulting, but it may be difficult to advance upward.

The key skillsets that today’s students should focus on are critical thinking, communication, and engagement. As dietitians and nutritionists, we need to feel comfortable being assertive and asking the difficult questions. Of these three skills, engagement and networking are the hardest to teach. Students should continually practice this skill throughout their careers. Networking is something that takes time and is an ongoing learning experience.

When creating nutrition policy, are particular data or data types more useful than others?

All of the different data types must be considered, especially systematic reviews and randomly controlled trials. We need to be looking at the preponderance of data to reach a conclusion, not create policy based on one particular study or study type, as each type of study has strengths and weaknesses. After evaluation of the data, we have to be able to translate the body of research into appropriate policy or interventions. Policy is like a puzzle and data are the pieces.

Do you feel that there’s siloing of academic fields, and that crosstalk can improve health outcomes?

There’s still some siloing of research topics, but there has been improvement. Some land grant institutions with great agricultural research programs focus on food production or food processing issues, but this work is not necessarily connected to the greater picture of human health. Some schools have recognized this issue and have started interdisciplinary programs aimed towards interconnectivity – programs in food systems is a good example. People have recognized the value of an integrated approach, but it’s a process that takes time to develop.

Part 2 of this interview will be posted in my next entry.