DISCLOSURE: UC Food Observer editor Rose Hayden-Smith agreed to submit questions for review to the USDA in advance of her Q&A with Angela Tagtow. The final transcript was also reviewed by the USDA prior to publication. Hayden-Smith and Tagtow have known each other for eight years, since participating together in the W.K. Kellogg Foundation-funded Food and Society Policy fellows program in 2008-2009. This is the first of a two-part series. The second part of the series discusses the process for adopting the 2015 Dietary Guidelines, the shift to more holistic “eating patterns” and the backlash against suggestions to include environmental sustainability.
“Making sure that kids are healthy and ensuring that kids have access to healthful food is a priority of the administration, Agriculture Secretary Tom Vilsack and throughout USDA. There is a dedication to this; vision by leadership is truly in alignment. From the agency level, to the Agriculture Secretary, to the President and the First Lady…the alignment is probably historical. And the engagement by the public on these issues is unprecedented. Again…we recognize that this is an historic time.”
– Angela Tagtow
About Angela Tagtow: Angela (“Angie”) Tagtow has served as the Executive Director for the Center for Nutrition Policy and Promotion (CNPP) at the U.S. Department of Agriculture (USDA) in Washington, D.C. since July 2014.
The CNPP is the smallest USDA agency and focuses on improving American health. It is probably best known for its work in developing and promoting the Dietary Guidelines (in partnership with the Department of Health and Human Services). These guidelines are reviewed every five years.
Tagtow is a registered dietitian who is nationally known for her expertise in nutrition research and advocacy. She has extensive experience working on issues related to the USDA’s food programs. Tagtow worked in a leadership position with the Iowa Department of Public Health’s (IDPH) Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Program.
She has served in a variety of leadership positions within the Academy of Nutrition and Dietetics, Iowa Academy of Nutrition and Dietetics, Society for Nutrition Education and Behavior and the American Public Health Association. Her research has been extensively published. She launched and was the managing editor of the Journal of Hunger & Environmental Nutrition and also served on the editorial board of the Childhood Obesity Journal. She co-founded a statewide non-profit focused on health and food systems.
Tagtow recently served as an Endowed Chair, Senior Fellow at the University of Minnesota, College of Food, Agricultural and Natural Resource Sciences. Previously, she was a Food and Society Policy Fellow with the University of Missouri, Thomas Jefferson Institute and the Institute for Agriculture and Trade Policy (programs funded by the W.K. Kellogg Foundation). She is a graduate of the University of Northern Iowa and Iowa State University.
Q: You were appointed as the Executive Director for the Center for Nutrition Policy and Promotion (CNPP) in July 2014. CNPP is often recognized for the Dietary Guidelines and MyPlate. What other initiatives do you work on?
Ms. Tagtow: When I came to the CNPP, I sat down with every staff person to learn about the work each does, the structure of their job and what excites them about our work. It was the best orientation ever. After doing this for a couple of months, I found that there were essentially three tenets, or core functions: science, policy and impact. Everything we do fits into one of these core functions. Science is the foundation of everything we do at CNPP.
We do extensive nutrition and economic analytics at CNPP. One example is the annual Expenditures on Children by Families report, also known as the “Cost of Raising a Child.” This report sets child support and foster care payments for states and is widely used; people want to know how much it costs to raise a child to age 18. We also provide analytics on the nutrient content of the U.S. food supply and have over 100 years of data. It’s impressive.
CNPP also produces the U.S. Food Plans. There are four different food plans that are used by other federal agencies, such as the Department of Defense. The food plan that ties us to USDA’s Food and Nutrition Service (FNS) is the Thrifty Food Plan which determines benefits for the Supplemental Nutrition Assistance Program (SNAP).
The Healthy Eating Index, which provides a measure of the average healthy diet in the nation, is another CNPP responsibility. By using this data, we can determine trends in diet quality…and we are seeing our trends move ever so slightly in a positive direction – but we have a long way to go to move Americans closer to eating according to the Dietary Guidelines.
We are responsible for the USDA Food Patterns, which tie into the Dietary Guidelines. The 2014 Agricultural Act charged us and HHS to develop dietary guidance for infants up to age 2 and pregnant women, which is to be integrated into the 2020 Dietary Guidelines for Americans. This has resulted in our teams working on simultaneous dietary guidance initiatives.
At the core of our Nutrition Guidance and Analytics team is the Nutrition Evidence Library (NEL). The NEL provides the systematic review methodology of the nutrition research which serves as the foundation of the Dietary Guidelines. NEL is an ever-growing repository; it houses the research and what the bodies of nutrition science really say. The scientific integrity behind this methodology is world class.
In the policy domain, the pinnacle initiative for CNPP is the Dietary Guidelines. They are updated every five years in partnership with the Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. The 2015 Dietary Guidelines were released in January. It’s proven to be a great turning point for us to move from the development phase of the Guidelines to the implementation phase and to apply them in a variety of ways.
In terms of impact, the Dietary Guidelines are significant. By mandate, federal food and nutrition programs use these guidelines. The Food and Nutrition Services (FNS), which oversees fifteen food and nutrition programs, uses them. Specifically, the Dietary Guidelines inform the National School Lunch and School Breakfast programs, WIC and the Child and Adult Care Food programs. The Departments of Defense, Veterans Affairs and Health and Human Services also use them. Our charge is to assure the Dietary Guidelines are being applied across the federal family.
Our third domain is impact. CNPP helps translate the guidelines so that they can be applied and used in a variety of ways. The Dietary Guidelines are designed to be used by professionals, who then apply them to programs, practices or to shape policies. Because they are not written for a consumer audience, CNPP translates the Dietary Guidelines into actionable messages and tools for consumers. In that way, MyPlate (launched in 2011, a year after the 2010 guidelines were released) is a direct reflection of the Dietary Guidelines.
The 2015 Dietary Guidelines are better aligned with the image of MyPlate. This reflects more of an eating pattern and the totality of what we eat. Consumers and professionals alike can visit the MyPlate portal for all the great pieces. I’m really proud of CNPP’s interactive tools team and of the tools themselves. Tools like SuperTracker are free to help individuals monitor, track and reach their eating and physical activity goals. The underpinning of these tools is science-based as they are backed by the Dietary Guidelines. The team that develops these tools is unique. The individuals have nutrition backgrounds but are working in the IT world; it’s a brilliant group.
We’ve also partnered with FNS on a recipe repository called What’s Cooking? We’ve consolidated all the recipes from all of the FNS programs. These are tested recipes with nutrient analysis. We’re moving forward with better connectivity between SuperTracker and What’s Cooking? to create a seamless set of tools for individuals and families to track and monitor what they eat; their physical activity behaviors; to provide help in planning menus, including recipes, and even assemble a cookbook and shopping lists.
I’m proud of the outstanding work CNPP is doing, and I’d like to provide some perspective about our size…we’re the smallest agency in the USDA – both in funding and staffing. Based on the snapshot of functions we manage in CNPP, I find it remarkable the volume and quality of work we do on a shoestring budget.
The 2014 Farm Bill requires us to develop dietary guidance for the birth to 24 month and pregnant women populations; this is also an unfunded mandate. So, we’re developing simultaneous tracks of Dietary Guidelines. I applaud the very skilled, high-capacity staff we have, that work so hard to deliver on all these mandates with no Congressional support financially to do so. The team at CNPP has a keen eye for scientific integrity and is constantly employing continuous quality advancement strategies to their work. They are remarkable.
Q: What is concerning you about America’s health?
Ms. Tagtow: As a public health dietitian, my entire career has been about promoting healthy eating and physical activity. It’s always been the focus of my efforts. Coming to the USDA has provided an opportunity to truly be at the forefront of efforts to drive change to improve the health of this country. The one thing that is so concerning is that nutrition remains one of the most powerful tools at our disposal to make an immediate and direct impact on diet-related chronic disease – and subsequent health care costs – in this country, yet we struggle to do so. That is my biggest concern.
Over the last thirty years, diet-related chronic diseases have continued to rise. We know that diet is a direct cause of these diseases – Americans are not eating according to the Dietary Guidelines, yet we can’t seem to find that tipping point. There are many influences on the food system that are preventing us from achieving that tipping point. Now, I do have hope and have seen changes with our approaches in addressing overweight and obesity, and other diet-related chronic diseases. These approaches expand beyond direct interventions. Diet interventions are very helpful with individuals, but it takes much more of a comprehensive systems approach to looking at food settings, food policies, investing in programs – whether government or other programs – to assure that healthy food is always the easy choice. USDA has made great strides on this front with healthier school meals, a revised WIC food package and significant expansion of farm-to-school efforts. Systemic changes as to be part of the formula.
I applaud the USDA and HHS team on the production of graphics that convey complex information in the 2015 Dietary Guidelines. In particular, there is a graphic that shows current eating patterns. A bar graph shows where we are meeting the guidelines and where we aren’t…on almost every food group we’re not anywhere near meeting the Dietary Guidelines.
The other set of data that gives me concern is the Healthy Eating Index. On a scale of 1 to 100 – the current Healthy Eating Index – the average diet quality across the nation – is 59. That’s an increase of almost 10 index points, making a slight increase in the last 15 years with improving the American diet. Although this gives me hope, with that trajectory, we’re just not going to meet the Healthy People 2020 goals. We ALL need to do more.
[Editor’s Note: The graphic referred to is Figure 2:1; it appears in Chapter 2 of the Dietary Guidelines.]
Q: What do you think are the largest challenges Americans face in terms of achieving a healthy overall diet?
Ms. Tagtow: One of the single largest challenges Americans think they face probably relates to our perception of time. We think that it takes additional time or costs too much to eat healthfully. Perhaps that is true to an extent. I also think that the myriad of influences on our food decisions throughout our day – whether it’s the food setting where we purchase our food or the environment where we consume it – can sabotage healthy eating goals. There are so many opportunities to advance this work in behavioral design and behavioral economics and how they influence food and consumption choices. We need to continually strive to create settings and environments where healthy food is the easiest choice. And this can help erase the perception that it takes more time to eat healthfully. The setting can support our healthy eating goals.
Q: If you could get the average American to make one or two dietary changes, what would they be?
Ms. Tagtow: I keep coming back to our current consumption patterns. There are so many opportunities to make small changes and shifts in our eating choices.
That part is nearly limitless…each and every time you eat – or drink – you are making a decision and have an option of making a shift to a healthier choice. The easiest thing people can do – and the science is so strong here – is focusing on fruits and vegetables to make shifts. People can increase the amount consumed, or make a shift within groups, for example, from red and yellow to dark and leafy green vegetables.
A key is to identify things you can easily do and enjoy doing that would result in a change…and lead, perhaps, to a lifetime habit. And it’s about making small shifts over time…and realizing an optimal diet once you’ve met your goals.
Q: What is inspiring you?
Ms. Tagtow: The CNPP staff and how our work is making an impact. During National School Breakfast week I was working with our USDA office in Atlanta. We visited an elementary school and a high school. The high school has a phenomenal school garden; they are going to be doing garden to cafeteria soon. I was able to speak with kids who are eating school breakfasts, as well as meet with food service staff and the superintendent. What they are trying to achieve is built on what we do here. It was an “aha!” moment for me. The Dietary Guidelines are the basis for all school nutrition programs. MyPlate was very visible. And I had a realization that we are making an impact, whether through policies, individual awareness, or perhaps incorporated in the behavioral design – the food environment – of school systems. It’s fascinating and rewarding to see our work in action. I want more of our staff to be able to witness that.
Q: What are some of the best aspects of your current position?
Ms. Tagtow: It’s an interesting time in the Obama administration.
Making sure that kids are healthy and ensuring that kids have access to healthful food is a priority of the administration, Agriculture Secretary Tom Vilsack and throughout USDA. There is a dedication to this; vision by leadership is truly in alignment. From the agency level, to the Agriculture Secretary, to the President and the First Lady…the alignment is probably historical. And the engagement by the public on these issues is unprecedented. Again…we recognize that this is an historic time.
As an example, the Let’s Move! campaign has truly elevated the priority of healthy eating among children to an historic level. Leadership within the USDA has supported this work. The stars have aligned and given us a phenomenal opportunity to make substantial impacts on nutrition and public health in this country.
Q: What are some of the most challenging parts of your work?
Ms. Tagtow: The fact that we are time-limited. It’s March of 2016. There’s going to be a change in the administration very soon. This gives us a very narrow window of opportunity to institutionalize the great work being done here. We’re working against the clock. It’s exciting and rather stressful. We recognize that there is limited time to put down roots and institutionalize all the initiatives across the mission area and the entire department. Fortunately, the career staff at CNPP are very dedicated to advancing this work that I know much of it will continue after the Administration changes.
Stay tuned for Part 2 of our interview with Ms. Tagtow.
CNPP has recently released a series of videos, MyPlate, MyWins. The first one is below.