johanna dwyer, d.sc,rd office of dietary supplements ... do... · office of dietary supplements...
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Why Do Americans Use Dietary
Supplements?Motivations for Dietary Supplement Use
Johanna Dwyer, D.Sc,RDOffice of Dietary SupplementsNational Institutes of Health
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Agenda
USEHow do people vary in dietary supplement use?
MOTIVATIONSDo people think they are “deficient”?Do motivations for use vary by
person (demographics, health status, readiness)supplement (nutrient vs herbal/botanical)
Are some people more ready to use than others?
IMPLICATIONS for dietitians
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DemographicsDemographics
MotivationMotivation UseUse
AttitudesAttitudes
N=2002 nationally representativegrocery shoppers,in 2003
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MotivationsMotivations
AgeAgeSexSexIncomeIncomeEducationEducationEthnicityEthnicity
Concerns aboutConcerns aboutNutrient deficienciesNutrient deficiencies
Health statusHealth status
Readiness to engageReadiness to engageIn preventive behaviorsIn preventive behaviors
AttitudesAttitudesAttitudesAttitudes
DemographicsDemographics
UseUse
Nutrient vs NonNutrient vs Non--nutrientnutrientSpecific productsSpecific products
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Population
Representative sample Primary grocery shoppers/heads of household in USA, 2003 N=2002Surveyed by National Family Opinion for The Natural Marketing Institute (NMI)
16 page mail-home questionnaire of Health and WellnessSecondary data analysis funded by ODS, NIH
Results nationally projectable within 2%
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Methods
Motivations and useGeneralFor specific conditions/purposes
weight lossmanaging chronic conditions others
RespondentsDemographics
Age SexIncomeEducationEthnicity
Current health statusType of supplement used
nutrient vs nonnutrient
Readiness to use DS
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Methods
Respondent characteristics Demographics
Age SexIncomeEducationEthnicity
Current health statusDS useMotivations
Supplement characteristicsType (nutrient vs herbal and other) Category (MVM, single nutrient, condition-specific)
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How do people vary in DS use?
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Most Popular Nutrient DS 2003
0 20 40 60 80 100
MVM
Ca
E
C
B complex
Herbals
Mg
Antox
Folic
Glucosamine
% daily
Percent Using Daily
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Lately herbal DS decreasing andcondition-specific DS increasing!
Condition-SpecificCondition-Specific Condition-Specific Condition-Specific
Herbals HerbalsHerbals Herbals
Minerals MineralsMinerals Minerals
Vitamins Vitamins Vitamins Vitamins
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003
Condition-Specific Herbals Minerals Vitamins
Percent Used Last Year
Use past 12 months
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Factors affecting use
DemographicsMore with age especially if feeling poorlyF>MW> B or Hispanic
More with poor current health status
Supplement type and category also affect
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Use of some DS very common past year
0 20 40 60 80 100
Vitamins
Rx Drugs
OTC
Minerals
Herbals
Condition-Specific DS
Weight loss DS
HRT
Homeopathic Remedies
DS Other therapies
%
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People use DS in various ways
Use DS & alternativehealthcare first
Use combo DS,RX&OTC drugssimultaneouslyUse Rx drugs first
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Implications for Dietitians
With patients undergoing medical treatment
If prescription drugs are prescribed, encourage their use as directed first
Ask about DS use since it is common among the ill
Counsel to avoid possible adverse interactions
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Implications for Dietitians
People at special riskUse DS first for treatmentUse DS, conventional medical therapies and CAM all at the same time for disease treatment
Need to note to avoid interactions and failure to apply better tested treatments
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Herbals going down over time;condition-specific DS up!
0
20
40
60
80
100
2000 2001 2002 2003
Condition-Specific
Herbals
Minerals
Vitamins
Condition-Specific Herbals Minerals Vitamins
Use past 12 months
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Motivations
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Do people think they are “deficient”?
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Concerned about “deficiencies” in foods, ingredients, and nutrients
0
25
50
75
100
Soy p
roteinFiber
Soy I
soflav
ones
Whole Grains
Protein
PercentWhich do you consider deficient in your current diet?
%
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What are consumer perceptions of nutrient/food deficiencies ?
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Implications
Consumers mix up poor food choices and true nutrient deficiencies
Some think that eating less of a food than recommendations is “deficiency”
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Implications
Consumer and medical views of deficiency differ
Consumers interpret phrase as :“not getting enough in diet”
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Concerned about “deficiencies”
0 20 40 60 80 100
Antiox
C
K
Lutein
E
Folic acid
Mg
Protein
PercentWhich do you consider deficient in your current diet?
%
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Validity of dietary deficiency concerns varies
Some evidence for low intakes in subgroups in forSome nutrients: folic acid ,calcium , soy, fiber, potassiumSome foods: Whole grains
But little evidence for othersSoy protein and isoflavonesWaterOmega 3’s?
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Concerned about “deficiencies”
0 20 40 60 80 100
Calcium
Fiber
Omege 3
Water
Iron
PercentWhich do you consider deficient in your current diet?
%
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Implications
Sizable minority think they have nutrient deficiencies
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Those reporting feeling poorly reported more perceived nutrient deficiencies
However, perceived deficiencies of nutrients & foods not associated with use of DS
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Implications
People who report a “deficiency” more likely to also report health problems
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Why do people use supplements?
Depends on person’s characteristics
Also on type of supplement
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Personal characteristics
SexBig differences by sex on type of DS used
Poor reported health statusMore use of herbal, condition-specific DSLess of vitamin minerals
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Poor Reported Health StatusThose in poor physical, emotional or mental health used DS for specific health conditions more
ImplicationBe sure to check DS use in ill
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DemographicsWomen more mentions of
“MD recommended”“Good for me and family”
Implication: Women often traffic cops for DS use in families; enlist their help when DS needed
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Why Vitamin Mineral DS important to me
0 20 40 60 80 100
Overall health/wellness
Performance/energy
Px specific health problem
MD rec
good for me,family
nutrition
Tx specific health issue
lifestyle changes
Vitamins and Minerals
Many drivers
%
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Reasons for first using vitamin mineral DS
Percent
0
10
20
30
40
50
60
70
80
90
100
Overa
ll He
alth/
wellne
ssPe
rform
ance
/ene
rgy
Prev
ent
Doct
or R
xBe
tter f
or m
e& fa
milyNut
rition
al Co
nten
t
Trea
t
Lifes
tyle
Chan
geVitamin/Minerals
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Why Herbal DS are important to me
0 20 40 60 80 100
Overall health/wellness
Performance/energy
Px specific health problem
MD rec
good for me,family
nutrition
Tx specific health issue
lifestyle changes
Herbals
Many drivers
%
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Reasons for first using DSPercent
0
10
20
30
40
50
60
70
80
90
100
Overa
ll He
alth/
wellne
ssPe
rform
ance
/ene
rgy
Prev
ent
Doct
or R
xBe
tter f
or m
e& fa
milyNut
rition
al Co
nten
t
Trea
t
Lifes
tyle
Chan
geHerbals
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Why DS are important to me
0 20 40 60 80 100
Overall health/wellness
Performance/energy
Px specific health problem
MD rec
good for me,family
nutrition
Tx specific health issue
lifestyle changes
Vitamins and Minerals Herbals
Many drivers
%
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Reasons for first using DSPercent
0
10
20
30
40
50
60
70
80
90
100
Overa
ll He
alth/
wellne
ssPe
rform
ance
/ene
rgy
Prev
ent
Doct
or R
xBe
tter f
or m
e& fa
milyNut
rition
al Co
nten
t
Trea
t
Lifes
tyle
Chan
geVitamin/Minerals Herbals
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Implications
Many drivers for use
Differ only slightly by supplement type
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Why do people use dietary supplements???
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Authoritative Guidance
The Law:DSHEA 1995: DS are not for prevention or treatment of disease
ExpertsDS inappropriate as substitutes for evidence-based therapies prescribed by physicians
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Consumer view DS as helpful in Px and Tx of many conditions
0 20 40 60 80 100
arthritis
colds & flu
osteoporosis
lack energy
memory
cancer
TxPx
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Consmers view DS as helpful in Px and Tx of many conditions
0 20 40 60 80 100
hi BP
heart
vision
cholesterol
heartburn
stress
depression
TxPx
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0
10
20
30
40
50
60
70
80
Overall Health/wellness Prevention Treatment
Vitamin/Minerals Herbals
Agree that taking… is effective in …..(agree completely/somewhat)
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Consumers view DS as helpful in Px and Tx of many conditions
0 20 40 60 80 100
arthritiscolds & flu
osteoporosislack energy
memorycancer
hi BPheartvision
cholesterolheartburn
stress depression
obesitydiabetes
Chronic Fatigue
TxPx
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Implications
DS often used in ways differently than the law intends
Caution needed, especially if for treatment
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Are some people readier than others to use dietary supplements?
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Readiness for behavioral change
Prochaska: trans-theoretical model of readiness of behavioral change
Readiness varies by types of DS
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0
10
20
30
40
50
60
No Need Need haven'texplored
Explored for futureuse
Gatheredinformation and
evaluatingalternative
Useinfrequently<1yr
Use frequently>1yr
Vitamin/Minerals%
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0
10
20
30
40
50
60
No Need
Need haven't explored
Explored for future use
Gathered information and evaluating alternative
Use infrequently >1 yr
Use regularly,consistently >1 yr
Herbals
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0
10
20
30
40
50
60
No Need Need haven'texplored
Explored forfuture use
Gatheredinformation and
evaluatingalternative
Use regularlyconsistently 1
yr+
Useinfrequently>1
yr
Vitamin/Minerals Herbals
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How are motivations and use of DS related?
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Do motivations cause use?
Knowledge- Attitudes- Usemotivations
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Or do people develop motivations to justify use???
Use Attitudes-- Knowledgemotivations
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Are motivations the chicken ??
Motivations Use
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Or, are motivations the egg??
UseMotivations
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Implications for dietitians
Some people get in the habit and then find reasons for behavior
Often due to social influence
Others operate in a more deliberate manner
Consider both ways to influence behavior when collecting information about dietary supplement use!
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Case: Women in reproductive age group and folic acid DS
Some get into the habit of taking a folic acid supplement
Others use only after appealing to logic and attitudes
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Conclusions
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Conclusions
Motivations for dietary supplement use complex
Patterns of use vary depending on supplement
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Implications for dietitians
Many interactions between medications , drugs and dietary supplements
Check about interactions!
Put interactions in the chart!
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Implications for dietitians
Probe about dietary supplement use
To get total dietary intake must include nutrient containing dietary supplements!
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Acknowledgements
Funded by Office of Dietary Supplements, National Institutes of Health
http://Nutrition.govhttp://ods.od.nih.gov
DSID group
Thanks to Steve French and The Natural Marketing Institute (NMI) for analyses
www.NMIsolutions.com
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Conclusions
USEPeople vary greatly in dietary supplement use
MOTIVATIONSA substantial minority of people think they are “deficient”; either in foods or nutrients or bothMotivations for use vary by
person (demographics, health status, readiness)supplement (nutrient vs herbal/botanical)
Some people (nutrient supplement users) are more ready to use DS than others
IMPLICATIONS for dietitians:always ask about DS