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Strategies to Reduce Sodium Intake in the United States
challenged by limited data. Conjecture and reaching beyond the data should be avoided, but several hypotheses can be outlined.
The consumer message that sodium is linked with hypertension has been consistent throughout the years. However, messages on who should reduce sodium, and best methods for reducing intake have shifted. Initially, messages most strongly encouraged higher-risk groups (e.g., African Americans and older adults) to reduce sodium, and use of salt at the table and during cooking was emphasized. As in most areas of emerging scientific research, as evidence became stronger that sodium should be a concern throughout the lifespan and as new data emerged on major sources of intake, messages were adjusted to include the entire population, and to encourage consumers to consume processed and restaurant/foodservice foods that were lower in sodium. It is reasonable to expect some consumers to be confused by—or even dismissive of—the slight change in messaging or to never adopt the revised message. This may have limited some consumer interest in reducing intake or in seeking information about how to best accomplish reductions.
Motivation may have also been a challenge. Some consumers may see hypertension as a commonplace, treatable condition in our society, and not recognize the serious ramifications of excess sodium intake. The low levels at which consumers recognize the potential for sodium intake to influence risk of heart disease, speak to this point. The channels used for dispersing sodium messages may have also been insufficient. In addition, it is possible that a portion of the population may simply be uninterested in health messages, and no amount of consumer messaging will motivate behavior change.
Sustainability of consumer interest and concern is another obvious problem. Although early public health initiatives increased awareness, concern levels, and intentions to alter sodium intake, these levels of awareness and concern subsequently declined. Competing messages in the food environment about the importance of a range of nutrients are likely to impact the sustainability of consumer interest and concern over sodium. The problem of public health messages competing for consumer attention is not unique to sodium.
The above mentioned factors cannot be documented and are largely hypotheses, but it seems apparent that even those personally concerned about sodium were also unable to reduce intake. The food supply undoubtedly played a key role in challenging such consumers, but it is also likely that consumer skills for interpreting the sodium content of their diet may have been lacking. Further, while the food industry did make a number of efforts to introduce lower sodium foods during the long history of sodium initiatives, many low-sodium products failed in the marketplace. Likely reasons for these failures were detailed further and include the lack of satisfactory