GOOD NUTRITION: WHATEVER HAPPENED TO "THREE SQUARE"?

Of equal importance is the recent change in the way our foods are consumed. It is a rare modern family that shares more than one meal a day.

Breakfast is a hit-or-miss affair. If any breakfast is eaten at all, more often than not it consists of presweetened cereal and milk or a vitamin-enriched breakfast bar (really a cookie in disguise) for the youngsters and juice, toast, and coffee for the adults. Three-quarters of American families do not eat breakfast together. In up to half the families, one or more persons regularly skip breakfast. And in 40 percent of families, the parents have nothing to do with the children's breakfast.

For lunch, nearly everyone is on his or her own. Mother, perhaps dieting, may skip it entirely or eat only yogurt. Father is usually in a restaurant or on a cafeteria line (have you ever noticed that these usually start with the desserts?). And the children who eat at school may trade or discard the contents of lunch boxes or shun the unappetizing meals in the school cafeteria. For many youngsters, lunch is a candy bar or bag of potato chips and soda pop from the school vending machine.

Supper is the one meal families are likely to eat together, and it is generally the largest meal of the day. Unfortunately, large amounts of caloric energy are least needed when the day's activities are nearly over. But even supper has become highly diluted in terms of nutritional control and content. In half the nation's households both parents work, and supper often consists of a heat-and-serve meal or something from the local take-out. Very few dinners are prepared "from scratch" with a single intelligence in charge of nutrients. Few cooks know the nutritional value of the prepared foods they use.

Eating out has become the American way of life, no longer reserved for "special occasions." By the mid-1970s, 25 percent of American meals were eaten outside the home. In this decade, experts predict that this percentage will double. By. 1980, restaurant meals accounted for 35 cents of every dollar Americans spent on food. And a quarter of those restaurant meals were eaten at fast-food establishments, where high-calorie, high-fat, and high-salt foods are offered. Even in "good" restaurants, diners have no way of knowing the nutrient content or ingredients used in the foods they order.

Snacking has become endemic. Children may get cookies and milk midmorning in school, with more of the same at home at three o'clock. Adults have morning and afternoon coffee breaks—liquid refreshment often accompanied by a sweet roll. After dinner in front of the TV, it's more snacks. Seventy-five percent of Americans have a snack before bed.

With so many people choosing such a large proportion of their daily calories on their own, sound nutritional knowledge has become vitally important. It is no longer enough that the "homemaker" know what's good to eat. Even in the "old days," such nutritional knowledge was limited. In a Maryland survey of homemakers and 4-H youths in 1971, most persons questioned did not know that vitamins and minerals have no calories; gelatin and meat do not have the same kind of protein; and hard mental work does not greatly increase caloric needs. In 1973, a Pillsbury Company survey revealed that only about half the housewives they interviewed could come close to describing a nutritionally balanced meal. Yet four out of five said they thought their families consumed adequate nutrients.

Even so, a significant number of Americans are changing their eating habits. Several recent surveys indicate that we have become more aware of what we're eating and have begun to change our consumption patterns. For example, in a Department of Agriculture survey of 1,400 representative households in 1976, in about half the homes, one or more persons said they were changing their diet due to health concerns.

Some of the dietary changes are reflected in current death statistics. Deaths from heart disease began to drop in the 1970s for the first time in our history. The age-adjusted death rate from all causes has also dropped, indicating that the decline in the proportion of heart deaths is not simply due to a relative increase in some other cause of death.

No one yet knows to what extent dietary changes have influenced the declining death rate, but there's every reason to believe they are an important factor.

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