No single bag of chips or bacon burger will kill you unless you choke on it. But in the big picture — the very big picture — how we Americans eat does often send us to earlier graves, and a new study out of Tufts University quantifies just how deadly our diets may be.
It estimates that over 318,000 deaths a year, or nearly half of American deaths from major "cardiometabolic" killers — heart disease, stroke and diabetes — were hastened by unhealthy eating.
I spoke with Renata Micha, an assistant research professor at Tufts and lead author on the paper just out in the journal JAMA. Our conversation, lightly edited:
What did your study do?
We developed a model that used national data on dietary habits and mortality, and used updated evidence of diet with cardiometabolic diseases to estimate how many deaths in the United States can be linked to poor nutrition. This enabled us to estimate deaths linked to poor dietary habits for the whole population, and also by age, sex, race and education.
And what did you find?
We estimated that nearly half of all deaths from heart disease, stroke and diabetes — collectively, cardiometabolic diseases — are linked to poor diet. And it wasn't just too much 'bad' in the American diet, it's also not enough 'good': Americans are not eating enough fruits, vegetables, nuts and seeds, whole grains vegetable oils or fish. Americans are overeating salt, processed meats and sugary-sweetened beverages. This is especially true of men, younger adults, blacks and Hispanics, and people with lower levels of education.
Is this a first in any way?
This study builds upon our earlier work and the work of other researchers. Instead of taking a microscopic view, we're zooming the lens way out to look at national patterns. In doing so, we hope to identify dietary changes that could benefit the greatest number of people. These results are representative of all Americans and help us identify what's most important in the American diet.
You found that high salt consumption is a particular threat — but isn't salt somewhat controversial?
There is a little bit of controversy about how low is low enough for sodium, but all major national and international organizations agree that we should be eating less sodium. Americans are still eating a lot of salt in their diets. And as you've mentioned, overeating salt, in our analysis, was linked to more deaths than any other food or nutrients
Among your findings, what was the worst news and the best news?
The bad news is that Americans are not eating healthy. The good news is: But we now understand which foods we need to target to prevent Americans from dying prematurely from cardiometabolic diseases. I'm actually still amazed at how people and policymakers tend to forget the simple yet vital truth: Eating healthy can and will prevent people from dying from premature heart disease, stroke and diabetes. If we remember that simple fact, most of us can have healthier and better lives.
"Preventing deaths through promoting healthy eating habits is the most timely and urgent priority of our time, from a health perspective."
What do your findings mean for policy?
There are tremendous policy implications to this. Instead of spending billions and billions of dollars on simply treating disease, we have an opportunity to focus on preventing disease. Doing so would improve productivity in the workforce, decrease health care costs, and improve the lives of millions of Americans and their families. Preventing deaths through promoting healthy eating habits is the most timely and urgent priority of our time, from a health perspective.
Are there a couple of things that could make the most difference?
Potential population strategies include, for example, economic incentives such as subsidies for more healthy foods, or taxation of less healthy foods; improvements to the Supplemental Nutrition Assistance Program; and incentivized or mandated product reformulation, such as to reduce additives such as sodium and trans fats.
For example, the present findings suggest that salt is a key target — population-wide salt reduction policies that include a strong government role to educate the public, and engage industry to gradually phase out or reduce salt content in processed foods, appear promising. In fact, the U.S. Food and Drug Administration has recently announced voluntary sodium reduction targets for the industry.
And at an individual level?
So simply as a take-home message of our findings: Try to eat more of the good and less of the bad. Basically, eat more fruits, vegetables, nuts and seeds, whole grains, vegetable oils and fish; and eat less salt, processed meats and sugary-sweetened beverages. Start by making one healthier choice each day and build on it.
Ultimately, for an individual, these findings are general results but don't mean, "If you eat badly, it will kill you," right?
Well, it definitely increases the risk of dying prematurely from these diseases. But of course, for any given individual there are other factors that will modify this risk, such as other dietary habits, their genetics or their physical activity. Just as with any medical or public health intervention, our findings should be considered as estimates of the average population.
Readers? Will knowing these latest big-picture stats affect your eating?