Nutrition: Essential to Whole Person Health

Most people think about health as how they feel, or by the results of lab tests and other measurements. These might include blood pressure, pulse, body temperature, and weight. For decades, health providers have referred to these as “vital signs.” But are there other signs that are also vital to our overall health? Definitely.

Instinctively, we know that health is about much more than what’s going on inside our bodies. Health is a dynamic construct reflecting not only biology and genetics – but also our physical, social, and psychological environments. Health is also about the choices we make, some of which are in our control but many of which are not – including those based upon social determinants of health and other external factors like food systems and climate change.

This more expansive and multidimensional view of health is known as whole person health. It’s an ecological view reflecting not only the state of an individual but also the environment of people, places, and things with which that individual interacts. Readers of this blog may think this sounds familiar, and it should. As I’ve written about before, I view nutrition as a complex ecology of internal and external inputs and outputs that relate to both human biology and the external world. Nutrition ecology fits well within the concept of whole person health: supporting the concept of the Nutrition Continuum – a framework that recognizes the multiple networks and relationships between food and health throughout the lifespan.

We are in good company! Since becoming ONR Director last year, I’ve had the privilege of working closely with leadership from NIH’s National Center for Complementary and Integrative Health (NCCIH), National Institute of Nursing Research (NINR), and Office of Dietary Supplements (ODS). We are all onboard with the need for a research roadmap that considers nutrition as central to whole person health, across the life course from the first to last days of life, as well as across generations.

The Nutrition Continuum relates food systems to food constituents (i.e., ingredients) to food-related behaviors. Recognizing this complicated network of ins and outs and in-betweens – from birth to old age – inspires new research to untangle it all. 

There are many unanswered questions about nutritional ecology that can be addressed with a whole person health lens. Importantly, all these research questions look different based upon individual and population characteristics: in particular, age and geography. The research questions are numerous and will require a whole of government (i.e., NIH and other federal partners like the USDA), whole of society (i.e., citizen scientists, academics, societies, and foundations), and multi-disciplinary (i.e., “team science”) approach to address them. But answering them is paramount and needed to improve public health and reduce health disparities. We can do it – I know we can! 

Here are just a few areas of study worth mentioning:

• Food production: Restoring healthy soil will require understanding the flow of organic matter, including microbes, that may benefit the health of both humans and plants. 
• Food distribution and marketing: We need to know what policy, system, and environmental changes can help people of all ages more easily make healthy food choices. 
• Food delivery: Community-based research could help identify effective and equitable models that make sense to specific populations and localities. 
• Dietary supplements: What effects do these substances – consumed by more than half of Americans – have on overall diet, lifestyle, and health?
• Brain-body interactions: Elucidating the interactions between hunger and other sensory cues, including brain-based reward circuits, may help inform what and when we eat. 
• Cooking: Understanding the near- and long-term impact of teaching kitchens and nutrition education programs within our communities and how they could guide implementation of successful nutrition strategies. 
• Public perception: Communications research may inform how people find and consume information about diet and guide the development of realistic, accessible nutrition educational strategies for the wide range of individuals and communities across America.
• Personalized nutrition: Wearable technologies and artificial intelligence analytic tools could give us access to real-time data that have been elusive to nutrition scientists until relatively recently.

Human physiology, nutritional needs, and behaviors change a lot throughout life, as do life exposures – with varied effects on nutritional health. Learning how to cook at an early age affects nutrition-related behavior for years to come. Middle-aged adults, as members of the ‘sandwich generation’ caring for their own children and aging parents, face challenges juggling multiple roles that can affect paying attention to personal nutritional needs. For older adults, good nutrition is often complicated by co-occurring health issues and social isolation.

As I approach my one-year anniversary as ONR Director, I continue to be honored and humbled to serve in this position. One of my goals during my first year was to begin to rebrand nutrition’s identity as “an expansive, vibrant, and multifaceted ecosystem” – and we have made good progress through interactions and listening sessions throughout NIH, across the government, and with our partners. Our office strives to coordinate nutrition science efforts across all sectors and provide service and technical assistance. This energizes me, and I love what I do. And on most days, this invokes a flood of energy and ideas. But following through on grand plans takes a dedicated team and extensive collaborations, for which I am grateful. 

Raising awareness of the Nutrition Continuum doesn’t start or end with this blog post! Work is already underway, and it’s exciting! We are at a special moment in time and have the opportunity to revolutionize how the study of nutrition is perceived and conducted. This is our time, so let’s seize the moment to embrace the complexities of a nutritional ecology and a whole person approach to health and work together, creatively and holistically, toward a better future for all. 

If you agree that a whole person health lens is the most accurate and realistic way to approach nutrition research – or any research for that matter – I invite you to call upon your colleagues to broaden their scope to contextualize individuals and populations as they live in the real world. This will not only enhance the rigor and reproducibility of the science that provides the evidence base for programs, practices, and policies, but also move the needle toward improving public health.

As always, I welcome comments, feedback, and suggested new directions for nutrition science research. Until next time, please visit the ONR website to get office-related information and consider signing up to the ONR Updates list to receive monthly emails (including the Drew’s Views blog and the ONR Director’s Updates newsletter).

Nutrition Is Who We Are!

Drew Bremer