Food Info

Well done Michelle Obama.  I commend her “Let’s Move” public awareness campaign to help stem the tide of childhood obesity in the US, launched on February 9th and outlined in the NZ Herald.

A critical success factor is that this campaign appears to stem from Michelle’s own personal family learnings and experience prior to entering the White House.  And now that she’s mother of the nation it makes sense to bring these learnings to her new, wider family.  It’s a PR dream.

The four campaign pillars are: helping parents make better food choices, serving healthier food in school vending machines and lunch lines, making healthy food more available and affordable, and encouraging children to exercise more.

Yes, it is ambitious – but what I like is that it’s multifaceted - like obesity itself.  The true causes of obesity in a population are highly complex, because they vary so much from person to person, so no single approach will ever be successful.  What’s needed for prevention is a multifaceted approach across the population, to allow for this individual variation.

Within “Let’s Move” there are specific plans to work with the food industry on developing easily understood food labels, encouraging doctors to better identify and work with those children at risk, serving healthier food in schools, offering tax breaks to improve access to healthier food in specific areas, consumer education programmes providing tips and resources, and encouraging at least 60 minutes of exercise daily.

All really good common sense stuff, that’s pulled together as one campaign with one clear goal, by a powerful, talented and nurturing figurehead.  As discussed on Rebecca Scritchfield’s US healthcare blog, recognition of the fact that governments alone will not solve the challenge of obesity is another critical success factor of Let’s Move.  Surely it’s the sort of approach our own government should be taking?  Why then abolish the progress made on making school food here healthier?  Why take the view that education on its own doesn’t work, so stop marketing and producing healthy eating education and resources?  Why stop programmes already working to improve access to healthier foods in communities?  Why not commend food companies for the progress they’ve already voluntarily made (for example labelling foods with %DI information to help consumers plan their food and beverage intake)?

Our government seems to be focusing on exercise as a silver bullet.  What do you think?  Who would our Let’s Move figurehead be?  Would people believe this of Bronagh?

(PS – these questions aren’t rhetorical.  I’d really like to hear your views!)

In olden day cowboy movies the do-gooder cowboy heros wore white hats.  Recently the term “white hat bias” was coined to describe bias in scientific research on obesity (the subject of much nutrition research at present) which leads to “distortion of the published information in the service of what may be perceived as righteous ends”.

A commentary in this month’s International Journal of Obesity discusses this phenomenon and analyses examples.  Particular bias on topics related to weight, nutrition and the food industry were shown, especially a tendency to distort information about products such as sugar-sweetened beverages or practices like breastfeeding, regardless of the facts, when the distortions are perceived to serve good ends.

The authors examined the areas of citation bias, publication bias miscommunications in press releases and the inappropriate or questionable inclusion of information.  Analysis of specific research papers in the areas of reporting effects of sugar-sweetened beverages on body weight and the protective effects of breastfeeding were included.

The analysis showed that less than one-third of the papers citing the beverage studies accurately reported the overall findings, and more than two-thirds exaggerated evidence that reducing sugar-sweetened drink consumption reduced weight or obesity. The researchers also found several examples in breastfeeding studies in which the white hat authors selectively included some data and discarded other research to support the theory that breastfeeding decreases the risk of obesity.

For both the beverage and breastfeeding research, the resulting data was more likely to be published when it showed statistically significant outcomes. Studies with outcomes that did not show sugar-sweetened drinks to be bad and breastfeeding to be good were less likely to be published.

Notably, this bias appeared in studies not funded by industry, raising questions as to the motivation on non-industry funded research.  Interesting; since for many years health lobbyists have also sought to disqualify the results of industry-funded research.

Some researchers like to demonise certain products or defend practices with a kind of righteous zeal.  Whether this is intentional or unintentional, it’s simply wrong to stray from truthfulness in research reporting.

So, perhaps with the best of intentions, scientists are actually distorting the available evidence and losing sight of what science is about – the disciplined, objective observation, collection and documentation of findings.  The authors refer to white hat bias as “eroding the foundation of scientific discipline”.

Last week I went to a seminar in Wellington which discussed similarities between the food industry and tobacco industry, and was reminded of the potential dangers of White Hat bias being used here in New Zealand.

Recently I had the privilege of hearing one of my all time dietetic gurus, Linda Tapsell from Wollongong University, speak about how we relate to beverages.  Alongside her, Claire Richards from Coca-Cola Oceania shared some fascinating insights into New Zealander’s attitudes to drinking.  And Caryn Zinn expertly summarised issues on hydration in sport.

When it comes to successfully encouraging people to make healthier beverage choices, each and every speaker stressed the importance of working with individuals, rather than making broad general recommendations such as “drink water and low fat milk”.

What people expect and need from different beverages is extremely varied, which explained to me why it’s unrealistic to expect people to switch from one set of beverages (with similar attributes) to another set of beverages (with completely different attributes in the mind of the consumer). 

For example, if you’re out for a good time with your mates you’re about as likely to order a glass of milk as you are to be wearing pyjamas.  What you want is a beverage that’s associated with socialising, not one that’s associated with, say health and nutrition.  There is a time and place for everything.

Those underlying needs associated with certain life situations don’t change, but moving to a healthier option which addresses the same underlying need within the same situation is far more likely to work.  For example in the scenario described above, recommending that people order a diet soft drink if they’re watching their calorie intake, rather than a sugar containing soft drink, might actually be likely to work.

That would be fine, were it not for another shocking fact I picked up at the same seminar: New Zealanders drink mostly tap water (nothing shocking in that), but the second most widely consumed beverage in New Zealanders (ranging from 12-69 years of age) is …wait for it….beer!  So in fact, most people in the above scenario will opt for a beer anyway!  Diet beer anyone?

This sets my mind reeling at the calories we Kiwis must consume from alcohol.  It baffles me why all dietary energy sources do not require nutrition labelling and packaged alcoholic drinks are a long overdue candidate for this. 

Thanks to the NZ Nutrition Foundation and Coca-Cola Oceania for making this event possible.  Linda and Caryn’s presentations should both be up on the Nutrition Foundation’s website shortly.

We both claim to have invented the pavlova, but when it comes to everyday food are we very different from our Australian cousins?  Ask any New Zealander and they’ll say yes.  But most Australians, it seems, think of us as being the same.

A new colleague of mine, freshly off the plane from Oz and now working as a dietitian in New Zealand, has been blown away by the differences.  Having worked in trans-Tasman roles for years based in Sydney, she admits it’s taken a move to NZ to see the extent of the differences between our two countries.  Refreshingly , she’s also now saying of her Aussie colleagues : “They just don’t get it!”

So what are some obvious differences?

• We know what’s in season and, what’s more, we often get quite excited about seasonal food changes.  Apparently most Australians are less aware of their food’s seasonality.

• We eat spuds, while rice is more of a staple in Australia.

• We drink tea.  In Australia it’s more likely to be coffee and maybe iced tea.

• While Mediterranean foods are certainly available here, they’re not really as main stream as Australia.  It’s more common to find a New Zealander describing ricotta as “posh cottage cheese”, but not so the Australians.

• Awareness of the Glycaemic Index of foods.  In Australia, food manufacturers pay for most low GI foods to bear the “approved low GI” symbol from the GI Foundation of Australia.  It’s as common as the Heart Foundation tick is here.  New Zealanders don’t really understand what all the low GI fuss is all about.  This is surprising in a way, since we have a higher rate of diabetes than they do in Australia – especially in our minority population groups.

• Most New Zealanders will have tried food prepared in a traditional Māori way, such as a boil-up or hāngī.  I’m not sure how many Australians would have tried traditional Aboriginal food.

I’d love to hear about other food differences anyone out there has observed between us and our large “West Island”.  Please add a comment to the blog to share.

As with any country, our food is a key part of what makes us distinctive as a culture.  To know us is to eat with us.  Our food culture has perplexed many trans-Tasman food marketers.  Those who acknowledge, even embrace, those differences are likely to be more successful at making a meaningful connection with ‘us kiwis’.

Lately, having done a small amount of work with McDonald’s NZ, I’ve been pondering the place of takeaway foods in our diet.  Like them or loathe them, they’re here to stay.

A recent evaluation of the zoning strategy employed by authorities in Los Angeles, banning new fast food establishments in order to address the excessive obesity problem in South Los Angeles, indicates that strategies like this are unlikely to achieve their goals.  The main reasons for this failure are outlined at the end of this posting.

There is an assumption both in the US and NZ that so-called “toxic food environments” exist, in which poor and minority neighbourhoods are overrun with fast-food chains, causing higher obesity rates.

While the majority of fast food may not be nutrient dense, it is conceivably less obesogenic than food eaten at full-service, sit-down restaurants in the US.  This is because it is less calorie-dense, due to greater portion control and a shorter “food exposure time”.  In American sit-down restaurants the serving sizes were found to be 2-4 times greater than recommended, and in this environment people are more likely to also order dessert and be topped up with free sugary drinks throughout their stay.

There are some big differences between the US and NZ.  Most obviously, our much maligned intake of soft drinks does not come anywhere near the gallons consumed per capita in the US – especially by teenagers and young adults.

I propose that the great kiwi institution of fish and chips – still the country’s most eaten takeaway, is probably more obesogenic than many fast food chains.  A piece of battered fish and standard scoop of chips from one of these places is enough to feed my whole family – for several days sometimes!

But most importantly, as the L.A. study illustrates, we just have too much food around us all the time.  Establishments providing meals are only one small part of a food environment where it’s possible to indulge our taste buds ceaselessly if we so desire.  In my opinion it’s this constant nibbling (or scoffing) that’s by far the biggest problem – even more so than what’s being eaten.

Findings of the L.A. zoning evaluation study:

1.    Upon analysis there were actually fewer fast food outlets in South LA per capita than in other parts of L.A.
2.    There was a much higher density of small grocery stores (I guess similar to our dairies) in South L.A. compared to other parts of L.A., and a lower density of large supermarkets.
3.    Discretionary calorie intake, higher in South L.A. than other parts of L.A., was mainly from foods and beverages widely sold in non-food establishments as well (eg, vending machines, car washes, bookstores, laundromats, offices, etc).
4.    The proportion of the population having the recommended number of fruit and vegetable servings per day, or getting the recommended amount of exercise was no different in South L.A. compared with other parts of L.A.
5.    People in South L.A. were more likely to walk or take public transport to do food shopping, while this is unreported in other parts of L.A.

When we become parents there’s no instruction booklet on how to become perfect role models 24/7.  After all, we’re still only human.

All children are shaped and formed by good and bad experiences.  I was just reading an article about what issues most affect children.  Apparently it’s dissension between parents and money worries.

Children apparently also have very highly attuned BS detectors, so you won’t get away with trying to cover it up!

Our attitude and actions around food shapes our children’s understanding of food.  We often place a higher value on our children getting good nutrition, than on feeding ourselves well.  So children may quite rightly perceive this as a double standard. 

Have you ever found yourself trying to talk a child into eating a vegetable that you yourself detested as a child?  A few years ago Nestlé research showed that many parents hide a secret stash of chocolate to tuck into when the kids are out of sight.  And how many of us (after ensuring the kids eat well) revert to a pizza delivery for our own dinner more often than we’d like to admit? 

Recent research in the US indicates that adult shoppers most often refer to the Nutrition Facts Panel on food products when the food in question has been requested by a child – but not when it’s requested by another adult.

Not only do children pick up on things - they remember them.  Nine months ago our family had a serious car accident.  Our two year old (who was in the car at the time) hasn’t ever said much about the accident.  So I was surprised when she said to a near stranger just this week: “our car had a smash and Mummy and Daddy were covered in blood”.

This won’t come as any surprise to child psychologists, or to most parents when they sit down and really think about it.  But when parents are going through stressful times themselves they often find themselves doing or saying things that they’re not particularly proud of.  I’m not talking smacking, or verbal abuse, but perhaps simply raising our voices, over-reacting or doing quite the opposite of what we expect our children to do.

Nobody’s perfect, but being a great role model as a parent is about facing up to the tough things in life and achieving a positive balance which supports kids with real and meaningful actions – not just words.

Being a good role model is certainly not easy, but it undoubtedly pays countless dividends well into the future, probably in more ways than we know.  For me, it’s still a work in progress!

A new computer system telling parents what their child has bought in the school cafeteria that day is being used in some American schools. The idea is that parents can make sure their children are making appropriate choices and spending their money wisely.

In principle it sounds like a great idea but on the other hand, are we not depriving them of an opportunity to use their own decision making skills, in what would surely be a somewhat controlled environment?

As with most things I guess it depends on how we put it into practice.  Food police parents are likely to be pretty vigilant at home and will aim to encourage the same at school.  Many would argue that the school cafeterias should not be offering ‘inappropriate’ food choices anyway.  But those children who want to beat the system will always find a way, whether it’s at school or elsewhere.

At the other end of the scale there are the permissive parents who, given their more relaxed attitude are probably not going to worry too much anyway – at school or home.  And somewhere in the middle - my personal favourite - one hopes that common sense prevails.

For younger children I am sure that it could be a useful tool to help them learn about making healthy food choices.  But as they get older surely we need to offer them the chance to make their own decisions?  Yes there will be some downsides but with a good foundation they will eventually realise that eating only treat foods isn’t all that fulfilling.

I often wonder if parents of children who are growing rapidly are in fact offering sufficient high energy density foods to meet their needs.  A teenage boy for example can burn twice the energy of a sedentary adult male.  A desire for high energy snacks is just as likely to be due to a genuine need for energy in some as it is due to poor decision making in others.

On the other hand we know from the national nutrition surveys that as children get older and begin to exercise more free will, the overall nutrient intake changes – and not usually for the good. In particular consumption of dairy, fruit and vegetables goes down.

So what is the best way to encourage children to choose the right food and beverages at school?  Should we not be putting our energy into making sure what is on offer is appealing, tasty and good quality – nutritionally and aesthetically?

All good scientists know that the balance of evidence from objective, well designed research is the only sound basis for making recommendations. 

So what happens when we don’t like the results we get from research?  I was astounded to read recently about the Soil Association’s response to a piece of research which, added to existing research in this area, found that organic vegetables were not nutritionally superior to their standard counterparts.   Peter Melchett, policy director at the Soil Association, said:

“We are disappointed in the conclusions the researchers have reached. It doesn’t say organic food is not healthier, just that, according to the criteria they have adopted, there’s no proof that it is.”

Likewise, on last night’s TV3 6 o’clock news, after an article highlighting recent research findings on sunbeds and melanomas there was a comment by a man representing the sunbed industry.  He said people need to weigh up health risks such as this with all of the many health benefits to be gained from using sunbeds.

What?

As a busy person, getting to lie down and relax for 10-15 mins a couple of times a week might be good for my stress levels I guess.  Aside from that I cannot imagine what he means by health benefits – especially since what you’re weighing it against is a 75% greater risk of getting melanoma, if you’re under 30 years of age.

My point is that research is research.  While statistics can be manipulated to some extent, the balance of evidence is the balance of evidence.  If there is equivalent quality research to refute the findings and recommendations from other research this should be articulated.  If not, accept the facts for what they are.

The word nasty is a strong one that tends to elicit an involuntary feeling of discomfort in most of us – and people do say that your gut reaction is the most important.  According to one dictionary “nasty” means:

1.    Very ugly, or unpleasant to see, taste, smell, etc.
2.    Morally bad or improper.
3.    Harmful; painful; severe.
4.    Causing difficulty or danger.
5.    Angry or threatening.

So when a UK Supermarket decided to include Aspartame in its list of “nasties” as part of a marketing campaign it’s no surprise that Ajinomoto, the proud manufacturer of this well known sweetener, was more than a little insulted. They decided to take legal action, the outcome of which shows just how “judgemental” our interpretation of such words can be - even when there is clear evidence to the contrary - proving that gut reaction does indeed triumph over logic.

Despite aspartame being proven completely safe in more tests and studies than most other food ingredients added together, the High Court judge found in favour of the supermarket chain.

The Judge’s ruling stated that describing aspartame free foods as “containing no hidden nasties” did not mean that aspartame was potentially harmful or unhealthy, it was simply trying to convey the message “if you the consumer think that aspartame may be bad for you, or unpleasant to taste or consume, then this product is for you”.

It effectively says that despite the facts, if someone thinks aspartame may be bad for them, their false belief should be supported and encouraged.  Surely this defies logic?

Sadly some people automatically equate “natural” with “nice” and “manufactured” with “nasty”.  Before the manufacture of things like antibiotics and vaccines people died ‘naturally’, albeit horribly, in their millions.

There are also just as many natural nasties as there are goodies out there in foods, which can even have fatal effects.  Here are just a few toxins, naturally present in fruit and vegetables: amygdalin, ipomeamarone, furocoumarins, glycoalkaloids and oxalic acid.  Not to mention the whole range of food poisoning bacteria, also quite natural. And what about those natural food ingredients that contribute to overweight and chronic disease, which again is ultimately fatal? No manufactured “nasties” there.

Unfortunately despite the delicate nuances of the ruling, the general message to consumers is that aspartame is nasty.  This once again reinforces misconceptions based on emotion rather than reason.  I say challenge the nasty name callers with scientific facts and allow consumers the freedom to make their own informed choices.

Politics might be about people, but at the end of the day it is the fiscal health of our country and the impact an issue has on that health that is guaranteed to exercise the conscience and therefore policy direction of our government.

Obesity is the perfect example of this.  One of, if not the main reason obesity has become a major political issue during the past decade is the cost to New Zealand now and in the future.  But in identifying this problem what have we tangibly done to address it?

For almost a decade we have seen an enormous amount of time used in consulting, planning, lobbying and networking, in order to decide how we can help people overcome all of these issues that apparently are absolutely no fault of their own. Note the “how we can help”.

But are we really any further forward?  Do we have a decisive road map on how, in the medium and long-term, we can address these issues, or the very least the confidence in our convictions that we are making some in-roads?  Certainly there has been some progress but often these are specific and isolated outcomes.  I also know that the food industry (I freely admit my own involvement within the food industry) has done a huge amount to “assist”.

It now seems that our new Minister of Health is calling for greater focus on putting the money directly into fixing the problem and the word is that we want actions and outcomes not plans and pontification.  But what will this mean in the area of obesity?  Fat camps or social welfare benefits for people who are the right weight only?

If we look at our US counterparts who are also taking a fresh and very serious look at these matters there could be some lessons to be learnt.  A recent address by President Obama, to the annual American Medical Association conference highlights the key strategies needed to “fix” the US health system and if we listen carefully the situation really is dire.

Most interestingly President Obama specifically identifies greater investment in preventive care “so that we can avoid illness and disease in the first place” as the second most important focus for his administration in order to get the health system back on track.

It only comes second because the first area to tackle is that of a more efficient and integrated record keeping system. It seems that in America there is far greater success tracking a Fedex parcel than a person’s medical records.  It also results in significant cost blowouts right across the system.

The most refreshing aspect of his focus on preventive care is that it directly links to personal responsibility – listen to his words.

“That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.

“It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that’s a lesson that we should work with local school districts to incorporate into their school lunch programs.”

President Obama predicts that within a decade one of every five dollars earned will go towards health care.  In thirty years (when our own children will be working) one in three dollars will be spent on health care.  The future cost of health could potentially be the undoing of a modern society’s financial stability.

What I found particularly interesting was the fact that the US health system costs US$2 trillion every year and they apparently spend 50% more per person than the next most costly nation.  Despite that over 100,000 people a year die from medical misadventure.

So it is up to us as individuals to take responsibility for their health and the future health of their own children. To me it is a flash of the blinding obvious.

So to the question posed in the title.  Whose responsibility is it anyway?  Surely it is everyone’s?  So let’s park the blame game and get on with doing our bit.  But let’s do it for ourselves first!