What's Wrong With the American Diet?

What's wrong with the typical American diet? This is what the experts have to say:

"Too many calories," says Marion Nestle, PhD, MPH, Professor of Nutrition and Food Studies at New York University.

"Too many calories," asserts Melanie Polk, registered dietitian and former director of nutrition education for the American Institute of Cancer Research.

Barbara Gollman, a registered dietitian who used to be the spokesperson for the American Dietetic Association, weighs in with her own theory: "Too many calories."

Perhaps it's time to stop talking about fatty foods and admit that we simply eat too many calories. Twenty-five years ago, the average American consumed about 1,850 calories each day. Since then, our daily diet has grown by 304 calories (roughly the equivalent of two cans of soda). That's theoretically enough to add an extra 31 pounds to each person every year. Judging from the ongoing obesity epidemic, many Americans are gaining those pounds -- and then some.

Take the latest national surveys on weight. More than 68 percent of all Americans are considered overweight or obese, according to the Centers for Disease Control and Prevention. (This means they have a body mass index greater than 25.)

But calories don't tell the whole story. To truly understand what's wrong with the American diet, you have to know how we manage to consume all those calories. There are two possible ways to go overboard: You can eat too many calorie-dense foods, or you can eat too much food or beverages in general. Many people choose to do both.

Our fondness for fast food is taking a particularly heavy toll. Although the federal government recommends that we have at least two to five cups of fruits and vegetables a day, for example, surveys show that the average American eats only three servings a day, and 42 percent eat fewer than two servings a day.

Here's a closer look at our love affair with calories -- and the health crisis it has created.

The carnival mirror

Of course, there is no single American diet. We all have our individual tastes, quirks, and habits. Still, experts see clear patterns in our food choices. In fact, most American diets fall into one of two broad categories: "Western" or "prudent."

The prudent diet is a nutritionist's dream. People in this category tend to eat relatively large amounts of fish, poultry, cruciferous vegetables (i.e. cabbage and broccoli), greens, tomatoes, legumes, fresh fruits, and whole grains. They also skimp on fatty or calorie-rich foods such as red meats, eggs, high-fat dairy products, french fries, pizza, mayonnaise, candy, and desserts.

The Western diet is the prudent diet reflected in a carnival mirror. Everything is backwards: Red meat and other fatty foods take the forefront, while fruits, vegetables, and whole grains are pushed aside. In addition to fat and calories, the Western diet is loaded with cholesterol, salt, and sugar. If that weren't bad enough, it's critically short on dietary fiber and many nutrients -- as well as plant-based substances (phytochemicals) that help protect the heart and ward off cancer.

Put it all together and you have a recipe for disaster. In a 12-year study of more than 69,000 women, published in the Archives of Internal Medicine, a Western diet was found to significantly raise the risk of coronary heart disease. Other studies have shown that a high-fat, low-nutrient diet increases the likelihood of colon cancer, diabetes, and a host of other ailments.

Portion distortion

The Western diet is nothing new. The typical American family in the 1950s was more likely than we are to sit down to a meal of pork chops and mashed potatoes than stir-fried tofu and broccoli. So why has the obesity epidemic exploded in the last 20 years? It's a matter of size. "Twenty years ago, the diet wasn't as varied as it is today, and people didn't eat nearly enough fruits and vegetables," Gollman says. "But the portions were more in line with what people really need."

From bagel shops to family restaurants to vending machines to movie theater concession stands to the dining room table, our meals and snacks are taking on gargantuan proportions. "Everyone in the food industry decided they had to make portions larger to stay competitive, and people got used to large sizes very quickly," Nestle says. "Today, normal sizes seem skimpy."

The hyperinflation of our diet is especially obvious away from home. "Look through the window of any of the big chain restaurants, and you'll see huge platters of food coming out of the kitchen," Polk says. One of those platters could easily pack 2,000 calories, enough to last most people all day.

Convenience culture

Despite our national obsession with weight loss, the obesity epidemic continues to be a national health concern. The human craving for fats and sweets will never go away, and it's getting easier than ever to satisfy those cravings. With 170,000 fast-food restaurants and 3 million soft-drink vending machines spread across the country, huge doses of calories are never far away -- especially when those soda machines are sitting right in the middle of public schools.

In 1978, for example, the typical teen-age boy in the United States drank about seven ounces of soda a day, according to Fast Food Nation author Eric Schlosser. Today, he drinks nearly three times that much, getting a whopping 9 percent of his daily calories from soda. Teenage girls are close behind.

Perhaps not surprisingly, studies show that childhood obesity has hit epidemic proportions over the last few decades. The main culprits, according to experts: high-fat foods, sodas, and too little exercise.

Taking control

Fatty, unbalanced, and oversized: That, in a nutshell, is the American diet. But it doesn't have to be your diet. "People think eating healthy is a difficult task, but small things make a big difference," Polk says. "You just have to employ some important strategies. It's called taking charge."

If you eat more than four meals away from home each week, you can start by making healthy choices as you dine. "As we eat at restaurants more and more, we have to take control of these outlandish meals," Polk says. Order foods that have been baked, steamed, or grilled instead of deep-fried. Have your salad dressing or other fatty toppings served on the side, and if mayonnaise isn't low-fat, skip it entirely. Consider ordering a salad and an appetizer instead of an entree. If you do order an entree, plan to take at least half of it home with you.

No matter where you eat, try to stick to a few basic guidelines. The amount you should eat depends on your age and activity level -- teenage boys and men need to eat more than young children, for example. Aim for three to eight ounces of bread, cereal, rice, or pasta each day, the more whole grains the better. This isn't quite as daunting as it sounds -- one cup of rice counts as two ounces, and a single slice of bread counts as one ounce. Two to five cups of fruits and vegetables each day will give you fiber and vital nutrients; if you're using a plate, try to cover half of it in produce. (One serving is a medium piece of fruit, a half cup of chopped fruit, a half cup of chopped vegetables, or a cup of fresh greens.) Taken together, fruits, vegetables, and grains can satisfy your hunger and fuel your body without blowing your calorie budget.

Meat isn't forbidden, but try to think of it as a complement to your meals, not the main attraction. According to the U.S. Department of Agriculture (USDA) food pyramid, you only need two servings (up to six and a half ounces) from the "meat group" each day. The group includes meat, poultry, fish, dry beans, eggs, and nuts. It goes without saying that six ounces of salmon, pinto beans, or chicken breast is preferable to six ounces of marbled steak (a serving of meat, by the way, should be about the size of a deck of cards).

Much of the advice can be boiled down to one word: moderation. By eating different foods from every part of the pyramid and watching your portion size, you can make your own personal American diet healthy and nutritious. We have more choices and more temptations than ever before, but ultimately, we also have the final say over what we eat. Take control, and enjoy.

Further Resources

If you want extra advice for planning your diet, there are many excellent resources to turn to.

For an in-depth review of a wholesome diet, read the U.S. Department of Agriculture's Dietary Guidelines for Americans .

For an interactive meal planner, see the National Heart, Lung, and Blood Institute (NHLBI) .

References

Flegal, KM et al. Prevalence and Trends in Obesity Among US Adults, 1999-2008 JAMA. 2010;303(3):235-241.

Interviews with Melanie Polk, registered dietitian and director of nutrition education for the American Institute of Cancer Research

Interview with Marion Nestle, Marion Nestle, PhD, MPH, Chair of the Department of Nutrition and Food Studies at New York University

Interview with Barbara Gollman, registered dietitian and spokesperson for the American Dietetic Association

Nestle, M. and M.F. Jacobson. Halting the obesity epidemic: A public health policy approach. Public Health Reports, January/February 2000. 115:12-24.

The American Institute for Cancer Research. The New American Plate: A timely approach to eating for healthy life and healthy weight.

Fung, T.T. et al. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. American Journal of Clinical Nutrition, January 2001. 73:61-67.

Centers for Disease Control. Overweight. April 2006. http://www.cdc.gov/nchs/fastats/overwt.htm

Alliance for a Healthier Generation. Alliance for a Healthier Generation Clinton Foundation and American Heart Association and Industry Leaders Set Healthy School Beverage Guidelines for US Schools. May 2006.

US Department of Agriculture. How much food from the meat and bans group is needed daily? http://www.mypyramid.gov/pyramid/meat_amount.aspx

Ogden, CL et al. High Body Mass Index for Age Among US Children and Adolescents, 2003-2006. Journal of the American Medical Association. 299(20):2401-2405. May 2008. http://jama.ama-assn.org/cgi/content/short/299/20/2401

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