New ACS guidelines stress importance of social and physical environments

Proposals for community action accompany each major recommendation

Updated guidelines on nutrition and physical activity for cancer prevention from the American Cancer Society stress the importance of creating social and physical environments that support healthy behaviors. The report includes updated recommendations for individual choices regarding diet and physical activity patterns, but emphasizes that those choices occur within a community context that can either help or hinder healthy behaviors.

The updated guidelines include recommendations for community action to accompany the four major recommendations for individual choices to reduce cancer risk, saying a supportive social and physical environment is indispensable if all Americans are to have genuine opportunities to choose and maintain healthy behaviors.

The American Cancer Society publishes its Guidelines on Nutrition and Physical Activity for Cancer Prevention to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. The guidelines, published about every five years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. They were last updated in 2006.

The guidelines include four major recommendations, each of which includes several supporting recommendations.

Achieve and maintain a healthy weight throughout life

• Be as lean as possible throughout life without being underweight.
• Avoid excess weight gain at all ages. For those who are currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
• Engage in regular physical activity and limit consumption of high-calorie foods and beverages as key strategies for maintaining a healthy weight.

Adopt a physically active lifestyle

• Adults should engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week, or an equivalent combination, preferably spread throughout the week.
• Children and adolescents should engage in at least 1 hour of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week.
• Limit sedentary behavior such as sitting, lying down and watching television, and other forms of screen-based entertainment.
• Doing some physical activity above usual activities, no matter what one's level of activity, can have many health benefits.

Consume a healthy diet, with an emphasis on plant foods

• Choose foods and beverages in amounts that help achieve and maintain a healthy weight.
• Limit consumption of processed meat and red meat.
• Eat at least 2.5 cups of vegetables and fruits each day.
• Choose whole grains instead of refined grain products.

If you drink alcoholic beverages, limit consumption

• Drink no more than 1 drink per day for women or 2 per day for men.

The authors of the report say the tobacco control experience showed that policy and environmental changes at national, state and local levels are critical to achieving changes in individual behavior. They say similar purposeful changes in public policy and in the community environment are required to help individuals maintain a healthy body weight and remain physically active throughout life. In that vein, the Guidelines also include recommendations for community action:

Public, private, and community organizations should work collaboratively at national, state, and local levels to implement policy and environmental changes that:

• Increase access to affordable, healthy foods in communities, worksites, and schools, and decrease access to and marketing of foods and beverages of low nutritional value, particularly to youth.
• Provide safe, enjoyable, and accessible environments for physical activity in schools and worksites, and for transportation and recreation in communities.

"Our guidelines have always stressed what people can do themselves to lower their risk of cancer, and that's important," said Colleen Doyle, MS, RD, director of nutrition and physical activity, and co-author of the report. "But we must also take public action to make those behaviors easier for all Americans. We can't just tell people to eat more fruits and vegetables and get more exercise when there are so many forces working against them being able to do that easily, and on a regular basis.

"We've got to work together to ensure that worksites and schools have healthy food options; that our neighborhoods are designed so that our children can safely ride their bikes or walk to school; that people have the information they need to help them make healthier food choices, whether at the grocery store or when eating out.

"The environments in which we live, work, learn and play have a tremendous impact on our ability to make and sustain healthy lifestyle choices. So if we're not working to change those environments so that the healthier choice is the easier choice, we're missing the boat."

The report also reviews the evidence on diet and physical activity factors that affect risks for select cancers, as well as a section on common questions about diet, physical activity and cancer; from coffee and dietary supplements to garlic, fiber, and irradiated foods.