CLEVELAND — By now, virtually every American has heard that COVID-19 disproportionately affects minority communities. But many don’t realize why.
The health disparities between minorities and whites often result from a preventable cause — poor nutrition. Inadequate diets increase the risk of developing Type 2 diabetes, obesity, and heart disease. These ailments weaken the immune system, making individuals with at least one diet-related condition 12 times more likely to die from COVID-related complications.
As the first female African-American surgeon to practice at the Cleveland Clinic, I’ve seen the devastating long-term consequences of poor nutrition — especially among minority groups. Many of my patients suffer from diet-related conditions, ranging from hypertension to obesity. These health problems make operating far riskier.
Treating the symptoms of these diseases with drugs and surgery feels like slapping a Band-aid on a much larger wound. It’d be smarter to prevent these problems from developing in the first place. Given that minority Americans particularly struggle to access nutritious foods and eat well, that requires increasing the quantity of straightforward and reliable dietary advice in these communities.
It’s understandable that minorities have a hard time buying healthy foods. Black Americans are more likely than whites to live in urban food deserts — where one-third or more of the local population lives at least one mile from a supermarket. Minority Americans also tend to live in neighborhoods packed with fast-food restaurants that mostly sell highly processed foods full of refined grains, salt, and sugar.
These disadvantages result in poor nutrition — and poor health. Four out of ten Black Americans suffer from high blood pressure. Seventy percent of Black men and 80% of Black women are overweight or obese.
But, there’s another reason why these Americans struggle with nutrition. The government’s official blueprint for healthy eating — the Dietary Guidelines for Americans, or DGA — has ignored minorities’ unique health care needs and distributed contradictory information.
The DGA influences billions in public spending, including nutrition education, food stamps, and the National School Lunch Program. The next iteration is due out by the end of this year.
Some of the guidelines are common sense — eat fruits and vegetables, engage in physical activity, maintain a healthy weight, and avoid sugary drinks. But the rest aren’t as straightforward. They don’t meet the government standards for all essential nutrients. Even if Americans follow the guidelines perfectly, they will still not meet recommended amounts of iron, vitamin D, vitamin E, choline, and folate.
Even more problematic is that the guidelines are targeted only at healthy Americans, even though 60% of U.S. adults — and an even higher share of minorities — have one or more chronic diseases. For example, the DGA recommends six servings of grains per day and allows up to 12 teaspoons of added sugar. That means that cans of soda — like Coke and Mountain Dew, each with roughly nine to 11 teaspoons of sugar — can theoretically be served as part of school lunch programs.
Those recommendations are catastrophic for Americans with diseases like diabetes and hypertension. Yet the guidelines give scant guidance to these patients. The National Academies of Sciences, Engineering, and Medicine warned in a 2017 report that, without further changes, “present and future dietary guidance will not be applicable to a large majority of the general population.”
Our government is failing to provide Americans with the nutritional advice they need. Fortunately, there’s an opportunity for change. There’s still time for the next version of the guidelines to reflect our demographic realities. That means providing minority Americans with advice that’s sensitive to their health and access challenges. More inclusive guidelines would help ensure that every American has the tools to lead healthy lives.
Dr. Linda D. Bradley is a professor of obstetrics, gynecology, and reproductive biology at the Cleveland Clinic. The views expressed are her own.
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