Addressing the epidemic of diet-related disease

January 5th, 2018 / By Steve Delaronde

The prevention and management of chronic health conditions will have the greatest impact on reducing healthcare costs, improving quality of life and reducing mortality.  A 2017 RAND study estimates that nearly 60 percent of American adults have at least one chronic condition and account for 90 percent of healthcare spending. Even more concerning is the 12 percent of Americans with 5 or more chronic conditions that account for 41 percent of healthcare spending.

Chronic conditions such as diabetes (12.6 percent of adults), cardiovascular disease (11.7 percent of adults) and cancer (4.8 percent survivors and 1.7 million new cases in 2017) account for the majority of morbidity and mortality in the United States and are interrelated. There are also known risk factors for these conditions, which in themselves have been classified as chronic conditions, including obesity (36.5 percent of adults), hypertension (33.3 percent of adults), and high cholesterol (29.8 percent of adults).

Heart disease, stroke and diabetes account for 31 percent of all deaths in the United States and have a significant impact on quality of life and healthcare costs. Therefore, identifying interventions that reduce risk factors for these conditions should be a priority. One of the primary risk factors associated with these chronic conditions is diet.

A March 2017 JAMA article provides an estimate of the mortality due to heart disease, stroke and diabetes that is associated with the suboptimal intake of 10 dietary factors. The authors estimate that 45.4 percent of all cardiometabolic deaths are associated with these factors (in descending order of importance)—sodium, nuts and seeds, processed meats, seafood omega-3 fats, vegetables, fruits, sugar-sweetened beverages, whole grains, polyunsaturated fats, and unprocessed red meats.

There are studies that also assess the impact of adherence to dietary guidelines and programs, such as the DASH (Dietary Approaches to Stop Hypertension) diet, the USDA Dietary Guidelines for Americans, and the Mediterranean diet. A 2017 study in the NEJM demonstrated a significant reduction in cardiovascular mortality associated with long-term adherence to any of these three diets.

The case for eating better to prevent, and even reverse, such conditions as obesity, hypertension, high cholesterol, cardiovascular disease, diabetes, and even some cancers is clear. The path to achieving better outcomes through an improved diet is still not clear. Perhaps one reason is that there are so many different interpretations of what it means to eat better, and even once an effective approach is ascertained, changing eating habits is incredibly difficult.

There is a growing consensus that the best diet is the one that is closest to what nature intended. This includes whole grains, legumes, fruit, vegetables, nuts and seeds. Michael Pollan may have summarized it most succinctly when he advised in his 2008 book, In Defense of Food: An Eater’s Manifesto, that we “Eat food. Not too much. Mostly plants.”

A whole food, plant-based (WFPB) diet is recommended by T. Colin Campbell (author of The China Study), Caldwell Esselstyn (author of Prevent and Reverse Heart Disease), Neal Barnard (founder of the Physicians Committee for Responsible Medicine), Dean Ornish, John McDougall, Michael Gregor and many other physicians and healthcare professionals for preventing and treating cardiometabolic conditions, as well as many types of cancer and auto-immune diseases. 

A review article entitled Cardio-Metabolic Benefits of Plant-Based Diets was published in August 2017 that summarizes the benefits of a plant-based diet. The appeal to this approach is its simplicity – eat plant-based foods, which include whole grains, legumes, fruit, vegetables, nuts and seeds. However, the challenge lies in changing lifelong behaviors and tastes – which means eliminating or at least drastically reducing the consumption of meat and dairy products, as well as processed foods, refined grains, and added sugar, oil and salt.

We can achieve better health outcomes at lower costs, but it won’t happen until we address the current chronic disease epidemic, whose victims account for 90 percent of our healthcare costs. While healthcare access, treatment, medication and patient compliance will help, we can’t ignore the poor diet and lifestyle choices we are making that contribute to diminished quality of life, higher healthcare costs, and death. Patients, physicians, hospitals, healthcare payers, government and industry all have a role to play. The United States achieved a decrease in smoking rates from 42 percent in 1964 to 15 percent in 2015 and the trend continues. Reducing obesity rates and diet-related disease should be the next priority.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.