Total Diet Approach to Communicating Food and Nutrition Information

from the association ADA REPORTSPosition of the American Dietetic Association: TotalDiet Approach to Communicating Food and NutritionInformationABSTRACTIt is the position of the American DieteticAssociation that the total dietor overall pattern of food eaten is themost important focus of a healthfuleating style. All foods can fit withinthis pattern, if consumed in moderationwith appropriate portion size andcombined with regular physical activity.The American Dietetic Associationstrives to communicate healthfuleating messages to the public thatemphasize a balance of foods, ratherthan any one food or meal.Public policies that support the totaldiet approach include the DietaryGuidelines for Americans, MyPyramid,the DASH Diet (Dietary Approachesto Stop Hypertension), DietaryReference Intakes, andnutrition labeling. The value of a foodshould be determined within the contextof the total diet because classifyingfoods as “good” or “bad” may fosterunhealthful eating behaviors. Alternativeapproaches may be necessaryin some health conditions. Eatingpractices are dynamic and influencedby many factors, including taste andfood preferences, weight concerns,physiology, lifestyle, time challenges,economics, environment, attitudesand beliefs, social/cultural influences,media, food technology, and foodproduct safety. To increase the effectivenessof nutrition education in promotingsensible food choices, food andnutrition professionals should utilizeappropriate behavioral theory and evidence-basedstrategies. A focus onmoderation and proportionality in thecontext of a healthful lifestyle, ratherthan specific nutrients or foods, canhelp reduce consumer confusion. Proactive,empowering, and practical0002-8223/07/10707-0021$32.00/0doi: 10.1016/j.jada.2007.05.025messages that emphasize the totaldiet approach promote positive lifestylechanges.J Am Diet Assoc. 2007;107:1224-1232.POSITION STATEMENTIt is the position of the American DieteticAssociation that the total diet oroverall pattern of food eaten is themost important focus of a healthfuleating style. All foods can fit withinthis pattern, if consumed in moderationwith appropriate portion size andcombined with regular physical activity.The American Dietetic Associationstrives to communicate healthful eatingmessages to the public that emphasizea balance of foods, ratherthan any one food or meal.Over the past 4 decades, Americanshave become more consciousof diet and nutrition (1).Although nearly all consumers believethat body weight, diet, and physicalactivity influence health, diet surveyssuggest that their food habitsare not always commensurate withknowledge and beliefs (2). Only halfdescribe their diet as healthful, and14% eat five or more servings of fruitsand vegetables per day. One thirdclassify themselves as sedentary anddo not engage in physical activity.Even though more than half of consumerssay they are making dietarychanges to improve their health, approximatelytwo thirds are overweightor obese. It is clear that practicalguidance by food and nutritionprofessionals is needed to promotepositive lifestyle changes that aresustainable.According to the Shopping forHealth 2004 study, nearly six in 10consumers are trying hard to eathealthfully so they can avoid healthproblems later in life (3). More thanhalf of food shoppers strongly agreethat eating healthfully is a better wayto manage illness than medication.Unfortunately, this trend toward increasingawareness has been accompaniedby widespread confusion withcomplaints that nutrition educationis focused on what NOT to eat, insteadof what TO eat (1). These conflictingmessages make it difficult toknow what to do.Eating is an important source ofpleasure. As food and nutrition professionalsstrive to improve the qualityof Americans’ dietary and lifestylechoices, challenges are exacerbatedby the widespread perception that individualsmust choose between goodtaste and nutritional quality. In fact,no single food or type of food ensuresgood health, just as no single food ortype of food is necessarily detrimentalto health. Rather, the consistent excessof food, or absence of a type offood over time, may diminish the likelihoodof a healthful diet. For example,habitual, excessive consumptionof energy-dense foods may promoteweight gain and mask possible underconsumptionof essential nutrients.Yet small quantities of energy-densefoods on special occasions have no discernibleinfluence on health.In most situations, nutrition messagesare more effective when focusedon positive ways to make healthfulfood choices over time, rather thanindividual foods to be avoided (4,5).Unfortunately, the current mix of reliableand unreliable information ondiet and nutrition from a variety ofsources is confusing to the public andelicits negative feelings such as guilt,worry, helplessness, anger, fear, andinaction.The total diet approach is based onoverall eating patterns that have importantbenefits and health consequencesand that provide adequate1224 Journal of the AMERICAN DIETETIC ASSOCIATION © 2007 by the American Dietetic Association

ADA REPORTSsituation such as a tempting food (eg,a cookie), loss of control may occur,depending on the individual’s emotionalstate, interpersonal conflict,and social pressure (23).In this scenario, a cookie would beregarded as a forbidden food and adieter who yields to a desire for acookie would tend to say, “I ate thecookie. I have blown my diet. I mightas well finish the rest of the box.” Thispessimistic approach becomes selffulfilling,as the subject believes thatthere is not much that can be doneonce a loss of control occurs (24). Askilled nutrition counselor might reducethe probability of relapse by increasingawareness of nutrition(knowledge), teaching coping skills(alternative behaviors), incorporatingpersonal favorites in individualizedeating patterns, and promoting acceptanceof personal responsibilityand choice (“I can refuse to eat it” or “Ican occasionally enjoy a small portion”).The option of providing simple,one-size-fits-all decision rules may bean expedient approach to educationand counseling, but it often misleadsconsumers into thinking that a giventype of food is always a positive ornegative addition to the diet. The alternativeof offering more comprehensiveand targeted education involvescontext-based judgment. This type ofeducational message is more difficultto address in language that is easy tounderstand and apply, but it is morelikely to help the consumer to makewell-reasoned food choices and adoptbehavior patterns that are sustainableover time (17).All-Good or All-Bad Foods? Problems occurwhen a food or food component isoversimplified as all good or all bad.The increased risks for cardiovasculardisease associated with ingestionof trans fat produced during processingof foods might lead to the classificationof all trans fat as bad. However,a type of trans fat that occursnaturally from ruminant animalsources (dairy and meat), conjugatedlinoleic acid, has far different effectson metabolic function, genetic regulation,and physiological outcomes (25).In contrast to the atherogenic natureof most synthetic forms of trans fat,conjugated linoleic acid has beenshown to have beneficial effects oncardiovascular disease, diabetes, immuneresponse, energy distribution,and growth. To avoid this confusion,the Food and Drug Administrationhas excluded the naturally occurringtrans fat that is in a conjugated systemfrom its definition of trans fat fornutritional labeling (26).Conversely, even foods associatedwith a healthful diet such as eggwhites and soybeans should not beoversimplified as being perfect. Eggwhites are low in cholesterol and highin protein, yet they are also so low inzinc that they can induce a zinc-deficiencywhen used as a primary or solesource of protein in the diet (27). Similarly,soybeans have n-3 fatty acids,flavonoids, and phytoestrogens withhealth-promoting properties, but soyalso contains phytates that diminishabsorption of zinc and iron (28,29)and the health benefits of adding soyto the diet have not been consistentlysupported by research (30). For example,animal studies in which soy intakewas higher than that found inAsian diets found an increase in tumorgrowth (31). Thus, foods such asegg white and soy cannot be classifiedas completely good or bad, but rathertheir value is determined within thecontext of the total diet. Furthermore,lists of good and bad foods were consideredone of the “Ten Red Flags ofJunk Science” by the Food and NutritionScience Alliance, a collaborationof seven scientific professional organizations(5).With over 45,000 food items in theaverage supermarket (32) and an infinitearray of recipe combinations,the futility of attempting to sort allfood items into dichotomous categoriesbecomes evident, leading to confusionand frustration. Thus, the totaldiet approach, with its emphasis onlong-term eating habits and a contextualapproach to food judgments suchas discretionary calories, providesmore useful information to guidelong-term food choices.CONTROVERSIES WITH THE TOTAL DIETAPPROACHOne concern with the total diet approachis that it may be viewed aspermitting unlimited inclusion of lownutrient-densityfoods and beveragesor encouraging overconsumption offoods with marginal nutritionalvalue. In a study using a DietaryGuidelines index as a measure ofhealthful diet quality, heavy consumptionof savory, high-fat snackswas associated with poor diet quality(33). In addition, three national surveysof the US population have documentedthat portion sizes and energyintakes have increased substantiallyover time both inside and outside thehousehold (34). Nutrition education iscritical because individuals tend toeat more calories when served largeportions of foods, especially energydensefoods (35). Yet foods low in nutrientdensity can fit as part of thetotal diet, if these foods are consumedas discretionary calories in combinationwith appropriate quantities ofother recommended foods (36).Another controversy with the totaldiet approach is the emphasis on variety.Choosing a variety of foods hasbeen a cornerstone principle in theDietary Guidelines for Americans, butthat emphasis has changed fromoverall variety to varying choiceswithin the food groups. Choosing avariety of nutrient-dense foods helpsto ensure adequate intakes of morethan 50 nutrients that are needed forgrowth, repair, and maintenance ofgood health. However, an increase infood availability and variety in foodchoices may be a cause of overeating,especially when applied to energydensefoods (37). For example, themultitude of choices at a buffet andthe temptation to taste each food canresult in a greater intake of caloriesthan from a plated or family-stylemeal. When McCrory and colleagues(38) analyzed 1999 food consumptiondata, increases in energy intakes andbody fatness were associated with ingestionof a high variety of sweets,snacks, condiments, entrees, and carbohydratefoods, coupled with a limitedvariety of vegetables. Krebs-Smith and colleagues (39) observedthat a variety of foods was associatedwith nutrient adequacy to a point, beyondwhich there was no improvement.When nutrient needs are satisfied,eating additional foods providesexcess calories without added healthbenefits.WHY WE EAT WHAT WE DOConvenience, Cost, and ConfusionAlthough 87% of consumers reportedbeing very or somewhat concernedabout nutrition, widespread improvementsin dietary changes have notoccurred (2). Shoppers say healthful1226 July 2007 Volume 107 Number 7

ADA REPORTSeconomic factors were the most importantissue facing this country; by1999, only 12% held this belief (59). Inindividuals with lower incomes, convenienceis rated as a more importantinfluence on food choices as comparedwith those with higher incomes (62),reflecting limitations in transportation,cooking facilities, food preparationskills, grocery store locations,and availability of healthful foodchoices (63,64). However, financial issueswere associated with limitedcompliance with dietary guidelines ina recent study of low-income women(65).Environmental FactorsAttitudes and Beliefs. Attitudes and beliefsabout foods tend to reflect culturalvalues, but they change morequickly with time (66). For example,perceptions, attitudes, and beliefsabout fat have shifted in the last halfof this century, much of it because ofsocial trends and marketing campaigns.Also, the typical “meat andpotatoes” plates have been replacedby varying cuisines and preparationtechniques (67). An illustration is a1950s restaurant meal of beef steak,fried onion rings, lettuce wedge withThousand Island dressing, and bakedpotatoes with butter, cheese, and sourcream. Today, meals might be lowerin fat and reflect changing tastes,such as pasta with chicken, sun-driedtomatoes, and roasted vegetables, accompaniedby a salad of mixed fieldgreens, dried cranberries, and balsamicdressing.Social Influences. Social factors substantiallyinfluence eating behaviors.For example, the presence of a friend(but not a stranger) while eating increasesenergy intake by 18%. Thisstudy suggested that social facilitationof eating is caused by an impairedability to self-monitor (68). Ina study of why cardiac patients do notfollow nutritional advice, 86% reportedthat social and work situationspresented challenges, in addition tofinancial barriers to change and difficultywith restraint when facing largeamounts of food (69).Media. The media is a powerful forceinfluencing the food choices of Americans.In 2004 approximately $11 billionwas spent for food, beverage, andrestaurant advertising in magazines,newspapers, television, and radio (70).When Kellogg’s high-fiber cerealsfirst added health claims about cancerprevention and dietary fiber totheir package label, sales escalated47% within the first 6 months (71).Trade association programs have promotedgeneric advertising, such asthe one for fluid milk (“Got Milk?”),which featured celebrities wearingmilk mustaches. Remarkably, thesecampaigns slowed or stopped the decliningtrend of milk consumptionand 47 lb of milk were purchased foreach advertising dollar spent (72).Thus, consumers can change theirperceptions of foods and food choiceswhen given repeated and positive nutritionmessages.Product Safety. Concerns about productsafety can affect food choices profoundly.For example, the 1988 scareof Alar (Chemtura Corporation,Middlebury, CT) in apples resulted innear hysteria among mothers whothought they had fed their childrentainted foods. Apple sales plummetedas a result, even though the researchbehind the scare was controversial.When Alar (a plant growth regulator)was removed from use in some statesand the perceived risk of cancer minimized,consumers returned to eatingapples as in the past (73). Although itis essential to acknowledge that trulyunsafe foods are never good foodchoices, in this case, positive messagesabout the benefits of diets withplenty of fruits and vegetables helprestore balance in diet and healthgoals.COMPLEXITIES OF CHANGING EATINGBEHAVIORSThe impact of nutrition informationon promoting healthful lifestyles dependson how effectively nutritionmessages are communicated to consumers.Nutrition information mustbe presented with sufficient context toprovide consumers with a broader understandingof the issues and to determinewhether it applies to theirunique needs (4). Communicationsand educational programs must emphasizethe importance of consideringa food or meal in terms of its contributionsto the total diet. This type ofcommunication can be more effectivewhen educators use appropriate theoriesand models of factors related tohuman behavior (18). Although providinginformation can be effective inpromoting healthful behaviors, communicationsdesigned to build skillsor help learners master more complexconcepts usually benefit from the inclusionof principles from health-behaviortheories and models (Figure).Adapting Behavior-Oriented Theories forFood and Nutrition CommunicationKnowledge-Attitude-Beliefs. One of thesimplest models for food and nutritioncommunication is the Knowledge-Attitude-Beliefsapproach, which is basedon the often-mistaken assumption thatthe person who is exposed to new informationwill attend to it, gain newknowledge, change attitude, and improvedietary patterns (20). This approachcan be effective if the individualis already motivated and the new informationis easy to follow. For example, alist of foods that are high in iron may bea successful trigger to dietary improvementfor someone concerned over a recentdiagnosis of anemia. However,without such a “teachable moment,” increasedknowledge, such as a memorizedlist of high-iron foods, often failsto result in changed behavior. This istrue especially if following the advice isnot convenient or congruent with personaltaste preferences.Health-Belief Model. The Health-BeliefModel is one of the most widely usedtheories in health education (74). Anexample is the promotion of foodshigh in folate to reduce the risk ofcertain birth defects. This model explainshuman behavior and readinessto act via four main constructs: perceivedsusceptibility (“How likely amI to get heart disease and how soon?”),severity (“How bad would it be tohave heart disease?”), benefits (“WillI feel better if I change the fats thatI eat?”), and barriers (“How hard willit be to make these changes in myfat intake?”). A recent addition to theHealth-Belief Model is the concept ofself-efficacy (“How confident am I thatI can succeed in changing the fatsthat I eat?”). The Health-BeliefModel is useful when the target audienceperceives a problem behavioror condition in terms of health motivation.Yet many consumers “tuneout” repeated messages of gloomand doom for habits that seem commonand without immediate negativeconsequences.1228 July 2007 Volume 107 Number 7

ADA REPORTSI realize that eating whole fruit is a good way to help me increase my intakeof fruits and vegetables each day. I also realize that I have been gettingmost of my fruit in the form of juice. I will start buying more whole fruit andless juice the next time I go to the supermarket.Stages and processes of changeTranstheoretical ModelIf the vending machines at my office have fruit, I will be more likely toselect it as a snack.Reciprocal determinismSocial Cognitive TheorySocial Cognitive Theory/Transtheoretical Theory.When problem behaviors areclosely tied to social or economic motivations,more comprehensive theoriesand models may be effective toolsfor planning nutrition interventions(75). For instance, if an educatorneeds to promote milk-based foods assources of dietary calcium, SocialCognitive (Social Learning) Theorywould support an educational interventionaddressing behavioral capability(knowledge and skills needed toselect and prepare milk-based foods),11I know that I can eat more fruit and less juice by learning which fruits are inseason and putting those fruits on my weekly shopping list.Self-efficacySocial Learning Theory, Transtheoretical, and Health-Belief Models1Whole fruits have fiber that helps me feel full. If I drink juice instead ofeating whole fruit, I would get less fiber and have a harder time managingmy calorie intake. That could lead to gaining excess weight which wouldmake me feel less attractive. However, I may not be able to eat whole fruitas often as I want to because it is easier to find fruit juice when I needsomething that’s fast and easy from a vending machine or a conveniencestore.Perceived benefits, threats, and barriersHealth-Belief ModelCalorie per calorie, whole fruit has more dietary fiber than fruit juice.Health informationKnowledge-Attitude-Behavior1Figure. Example of how behavioral models can be used to provide positive nutrition messagesfor increasing consumption of fruit (eg, eating whole fruit more often than juice). Each level addsimportant concepts to factors addressed by models on the levels below it.reciprocal determinism (availabilityof milk-based foods in vending machinesand restaurants), expectations(beliefs about osteoporosis as a consequenceof avoiding milk-based foods),self-efficacy (confidence in one’s abilityto use more milk-based foods), observationallearning or modeling (seeingpeers and other role modelsdrinking milk), and reinforcement(positive or negative feelings that occurwhen milk drinking is practiced).The Transtheoretical Model/Stageof Change (76) describes learners interms of their progress through a seriesof behavioral stages (stages ofchange). It also includes related dimensionssuch as processes of change,self-efficacy, and decisional balance(pros/cons) and allows educators totailor educational messages to learners’needs and readiness for behavioralchange.Social Marketing. Social marketing is abehaviorally focused process thatadapts commercial marketing techniquesto programs designed to influencethe behavior of target audiencesto improve their well-being. Socialmarketers work to create and maintainexchanges of target audience resources,such as money or time, forperceived benefits such as feeling betteror having more independence.Just as educators may use a range oftheoretical concepts to design effectiveinterventions, marketing campaignsalso may be more effectivewhen important determinants of behaviorare identified and used in amedia campaign (77).The Fruits and Veggies: More Matterscampaign and its predecessor,the 5-A-Day for Better Health campaign,are examples that adapt marketingtheory to food and nutritioncommunication (78). Designers ofthese campaigns studied the preferencesand habits of various audiencesegments; developed messages thatwould be perceived as relevant, comprehensible,and actionable; and thendistributed these to consumers in settingssuch as supermarkets, restaurants,and the Internet (79). The effectivenessof these campaigns inincreasing Americans’ consumptionof fruits and vegetables is wellknown.Regardless of the theoretical basisof communications, messages must beconsistent with an emphasis on a totaldietary pattern that is balancedand moderate, and guard against inadvertentuse of oversimplified messagessuch as good/bad foods. Otherwise,communicators may not beeffective in achieving their educationalgoals (80).The Socio-Ecological DimensionIn addition to programs that targetbehavioral practices and dietaryknowledge/skills of individuals andfamilies, it is often appropriate to promotebehavioral changes and dietaryJuly 2007 ● Journal of the AMERICAN DIETETIC ASSOCIATION 1229

ADA REPORTSimprovements at the broader organizationalor societal levels. A socio-ecologicalmodel has been developed toguide programs that facilitate choicesof targeted systems, environment,and public policy change within organizationsat the community and statelevels (81).REDUCING NUTRITION CONFUSIONTo reduce confusion from the highvolume and apparent inconsistenciesof nutrition advice, the followingshould be considered when designingnutrition education for the public:● Promote variety, proportionality,moderation, and gradual improvement.Variety refers to an eatingpattern that includes foods from allMyPyramid food groups and subgroups.Proportionality, or balance,means eating more of some foods(fruits, vegetables, whole grains,fat-free or low-fat milk products),and less of others (foods high in saturatedor trans fats, added sugars,cholesterol, salt, and alcohol). Moderationmay be accomplishedthrough advice to consumers tolimit overall portion size and tochoose foods that will limit intake ofsaturated or trans fats, added sugars,cholesterol, salt, and alcohol.To make gradual improvement, individualscan take small steps toimprove their diet and lifestyleeach day (16).● Emphasize food patterns, ratherthan individual nutrients or individualfoods, as key considerationsin evaluating and planning one’sfood choices. Be aware of the social,cultural, economic, and emotionalmeanings that may be attached tosome foods and allow for flexibilitywhenever possible. Understandthat social and cultural aspects offood consumption are essential forplanning educational programs tohelp correct nutritional problems ofindividuals and population groups(82).● Acknowledge the importance of obtainingnutrients from foods, ratherthan relying on nutrients from supplementsor fortified foods. Althoughnutrient modifications arerecommended when food intake isinadequate to meet specific needs(eg, iron, folic acid, vitamins B-12and D for some population groups),it is important to stress that a dietbased on a wide variety of foods remainsthe preferred overall sourceof nutrients (83). Numerous bioactivecompounds in foods such asphytochemicals and ultra trace elementshave been identified thathave potential health benefits. Yetthe precise role, dietary requirements,influence on other nutrients,and toxicity levels of these dietarycomponents are still unclear. Furthermore,foods may contain additionalnutritional substances thathave not yet been discovered. Thus,appropriate food choices, ratherthan supplements, should be thefoundation for achieving nutritionaladequacy (7).● Stress that physical activity complementsthe total diet approachbecause it permits individuals tohelp manage weight and lowers therisk of premature diseases. Theminimum amount recommendedfor health benefits by MyPyramidand the Dietary Guidelines forAmericans is 30 minutes, preferablyeach day. To avoid weight gain,60 minutes per day may be necessary,and this may increase up to 90minutes to maintain weight loss.ROLE OF FOOD AND NUTRITIONPROFESSIONALSFood and nutrition professionals havea responsibility to communicate unbiasedfood and nutrition informationthat is culturally sensitive, scientificallyaccurate, medically appropriate,and feasible for the target audience.Some health and nutrition expertsand many “pseudo-experts” promotespecific foods or types of food to chooseor avoid in order to improve health. Amore responsible and effective approachis to help consumers understandand apply the principles ofhealthful diet and lifestyle choices.Unless there are extenuating circumstances(eg, individuals with severecognitive or physical limitations suchas dementia or renal failure), the totaldiet approach is preferred becauseit is more consistent with research oneffective communication and inclusiveof cultural/personal differences.To achieve this goal, the Board of theAmerican Dietetic Association approvedthe objective to focus nutritionmessages on total diet, not individualfoods (84).Effective Communication StrategiesTo be communicated effectively, educationalmessages and counseling interventionsshould:● focus on high-priority personaland/or public health needs;● provide a proactive, positive, andpractical approach;● promote an enjoyable pattern ofdiet and activity choices as part of along-term overall healthful lifestyle;● use successful educational strategiesbased on theories and modelsthat promote behavioral change;and● evaluate and share information oneffectiveness of food and nutritionprograms.As leaders in nutrition communication,food and nutrition professionalsneed to continue strengthening skills,updating competencies, and documentingoutcomes. Suggested techniquesto achieve these goals are:● build coalitions with industry, government,academia, and organizations;● use a full range of available andappropriate communication technologiesand take advantage of opportunitiesto communicate withprofessional colleagues and thepublic, such as giving presentationsand writing publications to influencesocial norms and public policy;● act as role models of active participationin local and professional associations;● maintain state-of-the-art knowledgethrough continuing education;and● take a professional and unbiasedapproach to promoting healthfuleating and physical activitypatterns.References1. American Dietetic Association. Nutritionand You: Trends 2002 Final Report of Findings.October 2002. Available at: http://www.eatright.org/cps/rde/xchq/ada/hs.xsl/media_1578_ENU_HTML.htm. Accessed June 10,2006.2. 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System, environmental, and policychanges: Using the social-ecological modelas a framework for evaluating nutritioneducation and social marketing programswith low-income audiences. J Nutr Educ Behav.2001;33(suppl 1):S4-S15.82. Devine CM, Sobal J, Bisogni CA Connors M.Food choices in three ethnic groups; interactionsof ideals, identities and roles. J NutrEduc. 1999;31:86-93.83. Committee on Dietary Reference Intakes.Dietary Reference Intakes for Vitamin C, VitaminE, Selenium, and Carotenoids. Washington,DC: National Academies Press;2000.84. Derelian D. President’s Page: Nutrition educationphilosophies—Why we do the thingswe do. J Am Diet Assoc. 1996;96:191.ADA position adopted by the House of Delegates Leadership Team onSeptember 13, 2001, and on June 30, 2005. This position is in effect untilDecember 31, 2011. The ADA authorizes republication of the position statement/supportpaper, in its entirety, provided full and proper credit is given.Requests to use portions of the position must be directed to ADA headquartersat 800/877-1600, ext. 4835, or ppapers@eatright.org.Authors: Susan Nitzke, PhD, RD (University of Wisconsin-Madison, Madison,WI) and Jeanne Freeland-Graves, PhD, RD (The University of Texas atAustin, Austin, TX).Reviewers: Mary Anne Burkman, MPH, RD (Dairy Council of California,Oakland, CA); Nutrition Education for the Public dietetics practice group(Laura Chalela, MPH, RD, Edelman Public Relations, Chicago, IL); SusanFinn, PhD, RD, FADA (Finn/Parks Associates, Columbus, OH); Jean M.Kerver, PhD, RD (Michigan State University, East Lansing, MI); LindaKnol, PhD, RD (University of Alabama, Tuscaloosa, AL); Mary Kay Meyer,PhD, RD (Alabama State Department of Education, Montgomery, AL); SusanM. Sanders, RN, MPH, RD (The Coca-Cola Company, Atlanta, GA).Association Positions Committee Workgroup: Dianne Polly, JD, RD (chair);Patricia Schaaf, MS, RD; Barbara Olendzki, MPH, RD (content advisor).1232 July 2007 Volume 107 Number 7