|No change after three decades of dietary advice|
|Tuesday, 16 November 2010|
Do dietary guidelines serve any useful function? Are they little more than a vague mission statement, aspirational yet irrelevant? Do they influence only the eating habits of the most-informed, most health-conscious consumers? It is an unavoidable and uncomfortable fact that in the 30-odd years since the dietary guidelines first appeared our diet and health appears not to have improved but to have got worse.
First published in New Nutrition Business, July 2010 Newsletter, by Julian Mellentin
The last three decades has seen continuously rising rates of overweight and obesity and diet-related diseases in most countries.
When the preliminary 2010 Dietary Guidelines for Americans were released in June the guideline committees chair Linda Van Horn wrote: "The single most sobering aspect of this Report is the recognition that we are addressing an overweight and obese American population. Everything within this Report is presented through the filter of an obesegenic environment in critical need of change."
That the environment is in critical need of change is undisputed. But what is also being argued by some nutrition scientists, as well as industry and media commentators, is that the dietary guidelines have done nothing to help improve the situation.
The US Dietary Guidelines are revised every five years in order to reflect changes in nutrition knowledge over time. The 2010 draft guidelines to be finalised later this year contain no surprises and nothing new. In fact they trot out old answers to the continuing question of how to improve diet. As expected, they recommend a reduction in maximum sodium intake from 2,300mg a day to 1,500mg; Americans average intake remains about 3,500mg a day.
As anyone knows who has tried to motivate anyone to do anything differently, setting a target that people see as unattainable does not help you succeed and may even stop people from trying at all.
Other recommendations include reducing saturated fat intake to no more than 7% of calories, and eating two servings of seafood a week, contributing an average of 250mg per day of omega-3 fatty acids. Despite the abundant science on the benefits of marine omega-3s, the Committee says that only moderate evidence shows 250mg of long-chain fatty acids per day can reduce death from coronary heart disease. And to the disappointment of supplement companies and suppliers of omega-3 oils, supplementation is not mentioned as a means of delivery, rather: Increased consumption of seafood will require efficient and ecologically-friendly strategies be developed to allow for greater consumption of seafood that is high in EPA and DHA, and low in environmental pollutants such as methyl mercury.
In summary, the guidelines say that Americans should reduce calorie intake and get more exercise; shift toward a more plantbased diet; eat more seafood and low-fat dairy; eat fewer foods containing added sugar and solid fats; and reduce intake of sodium and refined grains.
Food industry responsibilities
The report also tackles the issue of availability, suggesting that healthy foods should be made more affordable, and saying, as the nutrition community always does, that the food industry should be encouraged to produce foods with lower levels of solid fats, added sugar and refined grains, and that processed foods should be offered in smaller portions.
As readers will know, reducing sodium, fats and sugars is and has been for 10 years a key part of every responsible company's product development strategy and most food and beverage companies, large and small, are engaged in a process of incrementally lowering these three bad ingredients each year incrementally because, as some have learnt the hard way, if you (for example) reduce sodium levels too quickly people simply stop buying your foods.
Industry gets little credit for the social responsibility it demonstrates by setting itself ever-higher goals. In the US, for example, General Mills recently announced that it would reduce sodium by 20% across multiple product categories by 2015, on top of its across-the-board sodium reductions of recent years, such as a 16% sodium reduction in its leading breakfast cereals brands and more than 25% in its Progresso soups.
In Australia, the leading cereal companies Kelloggs, Sanitarium, Cereal Partners Worldwide have all made new commitments to reduce the sodium content of breakfast cereals containing more than 400mg per 100g by 15% over the next four years; 70% of cereals have already met the target.
The American dietary guidelines and those of most countries have not changed very much in their essence since the 1980s. The problem is that people choose not to follow them, despite a massive increase in health communications and healthy eating advice over the same period of time. The past 30 years have seen an explosion in the amount of nutrition education and on-pack information to help people make healthier choices - a food marketer from the 1980s, transported to today would be astonished at how much information companies cram onto their packages.
But the hard fact is that the increasing availability of nutrition information and the public health education have failed and for the academic and health professional community to call for yet more is to simply pursue a failed strategy.
5-A-Day: a high-profile failure
One of the best examples of the failure of nutrition education to make any difference to people's choices is the 5-A-Day For Better Health Program, to encourage more consumption of fruit and vegetables. Launched in 1991, it was America's largest public-private nutrition education initiative. A collaborative effort of many groups, including government agencies, private companies, state coordinators, and educators, its main goal was to increase fruit and vegetable consumption to at least five servings per day for 75% of Americans by 2010.
The programme reached far and wide to improve public awareness. Media campaigns, community-level interventions, point-of-purchase programmes and industry partnerships worked to get the message out. But even after spending roughly $50 million (40.7 million) per year in marketing efforts to get people to strive for five, fruit and vegetable consumption rates did not budge, according to Elizabeth Pivonka, president and CEO of the Produce for Better Health Foundation.
An article in the American Journal of Preventive Medicine assessed adult trends in fruit and vegetable consumption between 1988 and 2002 and found that 89% of Americans failed to meet the Dietary Guidelines during that time. Furthermore, there was no change in fruit consumption over these years, and vegetable intake actually decreased. The 5-a-Day campaign was phased out in 2008.
Europeans have done no better. Europe's fruit consumption is static and fresh vegetable consumption continues to fall, with a 14.2% reduction in 2008 compared to the average of the previous five years.
Traffic lights dont work either
The idea that health education and more information will make a difference to people's choices is disproved again and again. After the failure of 5-a-Day, another spectacular example is the failure of traffic light labelling.
Much favoured by academics, it ranks a food's nutritional content against a set of good and bad criteria and awards it a green (healthy), amber (consume occasionally) or red (consume infrequently) traffic light to be carried prominently on the front of the package to guide people in making healthier choices.
But a study based on hard sales data, published earlier this year in the World Health Organisation's journal Health Promotion International, found that traffic lights do not persuade people to make healthier choices. Researchers tracked ready meal and sandwich sales at an unnamed UK retailer for a month before and a month after the introduction of the labelling, and found no significant difference; indeed, the healthiest two sandwiches experienced the sharpest sales drop of any product.
This study found the introduction of a system of traffic light labels had no discernible effect on the relative healthiness of consumer purchases, said the study. The reports co-author, Professor Mike Rayner of Oxford University's public health department, was previously an advocate of traffic light labelling.
If the usefulness of flagging up healthier foods with a crude mechanism such as traffic lights has been shown to be a myth, so too is the mantra that "if only the food industry makes healthier foods more available, the people will buy them". Many food companies have experienced the frustration of making healthier foods available only to find that people do not choose them.
One leading company even switched all of its noodles from fried to baked only to find that sales actually fell 20% as consumers rejected the taste of the healthier option. And anyone who buys into the myth that having more fruit available makes it easier for people to choose should read a study1 that looked at fruit and vegetable consumption of nearly 200,000 people in developing countries, which found that even in traditional cultures with traditional diets, when fruits and vegetables are abundant and easily accessible, people don't necessarily eat them.
Lead author Spencer Moore and his colleagues looked at data from 196,373 adults in 52 mainly low- and middle-income countries. They found that:
Most people, regardless of the country that they live in, simply do not meet the recommended guidelines for adequate fruit and vegetable consumption, said Hall, adding that the overall prevalence of low fruit and vegetable consumption is remarkably high across the globe.
What dietary guidelines might do, some researchers speculate, is provide information on which only the most health-conscious, most-informed (and therefore higher income) consumers act. For example, among the major recommendations of the last US dietary guidelines, issued in 2005, were that Americans consume more wholegrains, fruits and vegetables. Consumption of these foods some argue has not risen across the board, rather it has gone up among people who are already health-conscious, the same 25% who are already the most-motivated to buy healthier foods. Which raises the possibility that dietary guidelines and health promotion might just have the unintended consequence of helping to widen dietary inequalities by providing information that is only acted on by a small and receptive group.
None of this is to say that dietary guidelines are useless, but how they can be made to work for the benefit of the population at large is a question to which no one has the answer.
1. Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.
About New Nutrition Business
New Nutrition Business is a London-based research, publishing and consulting company which specialises in researching, analysing and forecasting developments in the business of food, nutrition and health around the world.
The strategies and success factors it has identified in the 1990s have become the benchmarks for strategy development and brand positioning in the worldwide nutrition business. It works with companies all around the world, from the United States to Australia and from Sweden to South Africa.
New Nutrition Business is headed by executive director Julian Mellentin, one of the worlds very few global specialists in the business of food, nutrition and health.
He is the editor-in-chief of New Nutrition Business and Kids Nutrition Report, the only industry journal in the world on the rapidly developing kids nutritional marketplace.