According to my twitter feed I seem to be the only person who thinks the recent announcement* should be celebrated. As for the rest of you- all I hear is cynicism and complaining.

The Health Star Rating (HSR) system uses a star rating scale, like the energy stars on appliances, to help shoppers make informed and healthier food choices. Given how much people struggle to interpret food labels surely this is a step in the right direction?

Yeah, I hear you critics. Your points have merit- I’d just like to put them in perspective.

Firstly, yes there are anomalies. There always will be- no labelling system is perfect. Nope, not the Heart Foundation’s Tick nor the UK’s traffic lights. As a dietitian who has worked in food industry I have trialed a variety of nutrition-scoring systems and whenever you think you’ve found one that works you’ll stumble across another curve-ball product that damages the integrity of the system.

Secondly, food industry was involved in the advisory group. The calibre of this group, and the associated collaboration around this table is actually what I think should be celebrated the most. The majority of the group was made up of nutrition experts working in public health, academia and government. Five of the 11 members were from ‘food industry’.  I should hope that industry was involved. After all, they are the ones who work day in day out with product development, regulation and labelling. Their involvement gives me faith that the system is actually practical for companies to implement.

Thirdly, the system is currently voluntary. If you think all (if any) food companies are rolling in money you are delusional. Labeling changes are expensive and are done as infrequently as possible. Given that food companies are the ones footing the bill, not government; it is fair that companies should choose when and how they roll out the labelling changes.  Again, for those up in arms about the industry involvement in the advisory group, the fact that some of our biggest food companies are supportive of the system in a great start. Nestlé and Sanitarium have already publically pledged their support. Give them the chance to step up to the plate.

Don’t get me wrong- I have apprehensions about how it is all going to work, and what effect it will actually have on health outcomes.  But can we all just take a moment to acknowledge that with a little collaboration and faith we may have taken an extremely positive step.

* On 27 June 2014 the Minister for Food Safety, Nikki Kaye, announced that the Government will be joining with Australia’s (voluntary) Front of Pack Nutrition Labelling system. More information available here.

While there is a lot of great material in their call for action document Stop the Heartbreak 2014, I chose to speak about the three closest to my heart – which unsurprisingly are related to the food and nutrition space.

They are:

-  objective, good quality data

-  facilitation more communication and collaboration

-  addressing inequity.

My first point addresses the paucity of ongoing good quality data on what New Zealanders are eating and drinking. How can the government possibly form rational and evidence-based policy, programmes and guidelines on food and nutrition when they don’t have quality information about the food supply and what we’re actually eating? This lack of authoritative data has created a space that’s ripe for anecdotal evidence and opinion.

For example: We did once have nutrition surveys that collected gold standard information about our diet – comparable with the best national surveys internationally such as NHANES in the US and the NDNS series in the UK.  Sadly these have been replaced with comparitively inaccurate health and lifestyle questionnaires within the health survey which cannot possibly assess the complete nutritional status of the participants. If you want good quality policy, you must invest in good quality evidence gathering.

Which brings me to my second point of facilitating communication and collaboration.

Part of good leadership is to ensure everyone’s aligned, on the same page, and moving forward as one, to address an issue in the most efficient way possible.  This saves various unaligned factions from wasting time and doubling up on resources – or even worse – working against each other and ultimately achieving nothing.  Sadly the latter is often the case when you consider work being done by the food sector and health sector in New Zealand.

Health officials should have the mandate to communicate and engage with all stakeholders in the food and nutrition area.  In my view, food manufacturers and their suppliers, retailers and food outlets are key stakeholders in determining the food environment and thereby, to some degree, the nutritional health of the population.  But health officials do not communicate with this sector.

This precludes them from impartially recognising important areas of mutual agreement with which to facilitate genuine cross-sectorial engagement and action.  Already, some food manufacturers are driving some impressive health-related change with the programmes they’re implementing: breakfast programmes in schools, workplace health programmes, targeted lifestyle, activity and cooking skills programmes, and reformulation initiatives around nutritional content or serve size.

These types of initiatives shouldn’t occur in isolated pockets – they could be facilitated, coordinated and even partnered with academics and NGOs and other stakeholders to deliver maximum benefits to the population, with a combination of funding sources.

Of course the Heart Foundation are one of the few agencies facilitating some sterling work in this space with food companies, through inititiaves such as HeartSAFE and Fuelled 4 Life. But there’s a huge amount more scope for this type of activity.  In fact there is some promising signs that the Government also recognise this in their initial material regarding the proposed Healthy Families Programme.

And lastly, the absolute MOST important thing which the Government could and should do to stop the Heartbreak is to seriously address the health inequity in our society.  Inequity refers to the uneven distribution of health determinants which may be unnecessary and avoidable as well as unjust and unfair.

Sadly it’s no longer affordable to eat what’s recommended for many people in this country.  While academics argue over whether 5+ or 7+ fruit and veg a day are better for you, people struggle to achieve anything close to 5+ a day. Regardless of Government advice, the main reason why most shoppers don’t pick healthy foods is that they are more expensive.  They’re also often harder to access in some areas.

To buy fruit and vegetables for a family of four costs thousands of dollars more per year than more convenient (and potentially less good for you) food options. When faced with the option of buying apples or sausages for the family within a very limited budget, it’s not surprising that the more filling sausages make it into the trolley.  Good intentions evaporate when faced with the option of paying the electricity bill or having another bag of frozen peas this week so that another serving of vegetables can be part of each meal.

Importantly though, I wouldn’t blame the sausage makers or the electricity companies for that.  Instead I’d question why people are forced to make this decision at all, since all items are necessary for health.

The Government need to intervene, to mobilise communities and make healthy eating more affordable and accessible to those who are faced with unfair choices.

In a country where someone dies from heart disease every 90 minutes – we could all do more to stop the heartbreak.

My surprise deepened at their “relief” that it was allegedly the water that caused the bacterial outbreak, and they expected to have their raw milk back on the “shelves” this week.  Problem solved, all clear, never mind.

I expect that other food industry players were aghast, particularly the poultry industry which has, for a long time, been the country’s fall guy for campylobacter, and not so gently prodded over the issue by a range of academics.

Why, then, is it such a non-issue when raw milk is the campylobacter culprit?  It’s because the people affected by the bacteria are also its biggest advocates.  You have to suspect then, how often issues with raw milk go unreported. Interestingly raw milk advocates (who are not generally big advocates of other more processed foods), are probably the most likely to find such failures in other food systems inexcusable.

There is hypocrisy here because every food supplier works hard to prepare and offer safe food, yet raw milk is inherently risky. If any producer was going to offer a processed food with the same risk profile, the authorities would represent a substantial barrier.  What’s clear is that other food categories need to work harder to cultivate their “advocates” to be half as passionate and supportive!  If raw milk advocates don’t draw the line at potentially lethal bacteria, then how would they feel about glass and heavy metals?

One irony is that for many advocates of raw milk the attraction is the fact that it is not pasteurised, but MPI is advising producers to tell their customers to heat the milk to 70°C for one minute (i.e. self-pasteurise it to reduce the risk of bacterial infection). Good luck with that.

Food companies exist solely to make money, so they will sell whatever people will buy. Healthy food provides smaller margins, so they fill their food with cheap processed ingredients that lack nutrition.  And then they market these foods to appeal especially to the most vulnerable (eg, children).  This has caused the ‘toxic’ food environment and high rates of obesity and diabetes.

When you view the world through this lens, it’s certainly easy to find examples to illustrate it.  For example:

• It’s hard to find a reasonably priced wholemeal salad sandwich amongst the shelves of confectionery and chips at a convenience store or a petrol station.
• A sausage roll and fries is much cheaper than a chicken salad at most cafes.
• How many times have you been trapped behind a ‘back of the bus’ promotion for the latest lolly and cream-filled frappé offering? (It always happens to me when I’m driving a carload of hungry children, so I know the effect these ads have on kids.)

It’s true: healthy choices are often difficult choices – especially for those most stretched for time and money.  They often go against the yummiest or the cheapest option – and we all know that taste and price are the major drivers to purchase.

Regulation, marketing restrictions and taxes on foods and beverages are being proposed by some as the means to change this.  I propose they won’t change this because they won’t achieve the fundamental societal shift that’s needed to encourage people to willingly adopt the harder option.

There are many aspects of life in which the right choice is not the easiest choice, but regulations are not the best answer:

• Most people find it easier to spend money than to save it.  Does that mean we should all be denied access to retail outlets on certain days of the week?
• It is easier for parents to let children watch TV for entertainment rather creating more sociable entertainment, or ensuring the homework is done instead.  Does that mean parents should not be allowed to have television sets?

Why is food and health any different?

As a dietitian working with a range of food companies, I also see things through a different lens.  It is easy to paint food companies as faceless, profit-hungry global entities who don’t give a damn about the health of the planet or their consumers, and to blame the current food environment on them (and the government for letting them do it).  But the burden of proof placed on those companies to demonstrate how fictitious this is, is often too high to scale, especially considering the lack of reason and objectivity that exists in the debate around “Big Food”.

Food companies – and especially the global ones in my experience – take their obligations to their communities, employees, consumers, environment, suppliers, stakeholders and shareholders equally seriously.  That is how they succeed.  A company who purposefully harms the health of their consumers is not sustainably commercially successful.  So no: commercial success does not equal public health failure because true commercial success requires public health gain.

Unlike the tobacco industry, the food industry is able to produce and promote healthier food and portion options – something many companies have been actively working on for decades.  Increasing the momentum of this change depends on consumer demand, and this is influenced by a huge range of societal influences, in which we all have a significant part to play. What do you think you could do?

The reason our supermarket foods don’t carry more foods with the label, “Product of New Zealand”, is that they don’t exist. Basically the reasons boil down to the inability to grow many ingredients, a tiny domestic market, and a lack of  investment which results in a lack of scale and an inability to meet competition from imports.

Strange as it may sound, it is the consumer who’s in the driving seat when it comes to determining the origin of their food products through purchasing power, irrespective of what growers can produce and food companies might make.  This is aside from items that we simply  or don’t grow on a commercial scale, like one of the largest selling fruits, bananas.

Consumers make their choices about what they buy in a supermarket, and price plays a major part on their decision making.  It’s true that brand and taste still figure very prominently in the purchasing equation, but for more and more consumers, price is the deal maker. We’ve seen this recently in Australia where local production  lost out to less expensive imports.

The reality is that in a tiny domestic market like New Zealand, very few companies have the scale to buy ingredients and prepare foods that are price competitive with imported food products, which now more than ever have the benefit of a high New Zealand dollar.

For a product on the supermarket shelf to be competitively priced, means that the ingredients have to be competitively priced and production has to be cost efficient.  So it is not only a question of whether an ingredient is available in New Zealand, but whether it is available on a commercial scale and at price that allows the finished product to be competitive.  This includes flour for commercial scale bread making.

Some try to fight imports by maligning the country of origin, because they have the mistaken belief that everything grown and produced in New Zealand is safe, and everything grown elsewhere is not. More important is the guardian or brand of the food, and the reality is, regardless of whether a food item is made locally or imported, it must meet the very same strict standards of food safety.

Likewise, some are confused  by the labelling of foods with “made from local and imported ingredients”. Often this is without any thoughts as to what those ingredients are. Take Wattie’s Baked Beans. Despite a number of attempts over many years Wattie’s has not been able to establish a local supply of navy beans.  There has been no lack of willing, it is a matter of having the right bean for local conditions. Again, take Wattie’s Spaghetti. The spaghetti pasta is actually made Hastings, but the flour is imported because there is not a viable local supply for this product.

There are many food products that include ingredients not available in New Zealand. For instance, all our sugar and rice is imported because there are simply no local supplies.  The same with many herbs, spices and oils.  The reality is that neither home cooks or food manufacturers would use pricey gourmet olive oil, such as NZ produces, every time oil is required in a recipe.

Week after week books are published and media reports are issued focussing on finger pointing.  For the past six months in particular all fingers have been pointed at the food industry – in particular the “food giants” – for manipulating and addicting consumers to their products.  Prior to that – at least in New Zealand – experts have pointed to Government, for their lack of investment in preventative health and unwillingness to introduce regulatory taxes, bans and restrictions for certain foods and food marketing.  And any health-related association or sports group is now being criticised for working collaboratively with food companies because of the fear that food companies only associate with health-related associations as a fluffy PR exercise. It is not known what foundation there is for such fear, but it’s enough to make food companies throw in the towel on their numerous attempts to introduce healthier options and reformulate existing products, and just start doing exactly what they’re being accused of (if people are determined to think that anyway).

In the meantime is the population any better off?  When the average person spends less than a second deliberating over their supermarket choices and juggles food provision for their families with all of the other priorities in our busy lives, what is all this finger pointing achieving for them?

I would venture to say it’s doing more harm than good.  It’s causing even more confusion.  The bottom line is people have to eat and drink something to stay alive.  Dietary experts and food and nutrition guidelines largely make recommendations based on the four food groups, which actually don’t relate well to what the average person has to choose from when they’re in the supermarket or eating out these days. People also don’t have the lifestyles or incomes that enable them to grow their own foods or shop at farmers markets (wonderful as they are).  They simply buy and eat what they like/can afford/are familiar with – in that order.  So achieving the shift that motivates them to also vitally include in the purchasing mix “know is healthy for them” requires the following:

- Unity and clarity in scientific advice from Government and academics which relates to the current food supply, not the foods which Nana had to choose from when she shopped for her family back in the 1960s.

- No more contradictory, confusing, subjective and unsubstantiated messages or blanket statements which only result in people giving up and going back to what they know and like.

- Support and endorsement from the scientific/health community when food companies make positive nutritional changes, so that there is actually a demand for healthier products from the population.

- Dropping the blame game.  Truly collaborative implementation of solutions is the only way forward to deliver real benefits to the population.  This will involve significant compromise for all parties, who must commit to concrete actions and be held accountable to those in the long term.

Can’t we just get on with it?

Image thanks to FreeDigitalPhotos.net

The universal call to increase the consumption of fruits, vegetables, higher fibre foods and seafood, coupled with tightening family budgets, means that a study published recently in the Journal for Nutrition and Food Sciences is highly relevant.

The study looked at the nutritional qualities and relative cost of canned foods, and reassuringly found that canned foods provide sound nutrition at an affordable price, in a convenient format.  Specifically much-needed key nutrients, such as fibre, protein, folate, vitamin C, and vitamin A were shown to be significantly preserved in a range of canned foods.

The nutritional findings are in line with research undertaken here in New Zealand about 10 years ago, but the latest study went an extra step by evaluating affordability on a price-per-serve basis against fresh, frozen and dried counterparts.  The affordability measures took into account preparing and cooking time, and also energy usage.

The study looked specifically at canned beans, corn, mushrooms, peas, pumpkin, spinach, tomatoes, peaches, pears and tuna; comparing then with their fresh counterparts.

Two examples of the findings were:

• Tomatoes – It is nearly 60 percent more expensive to obtain dietary fibre from fresh tomatoes as from the same portion of canned tomatoes.
• Corn – When looking at purchase price alone, fresh corn is less expensive than canned or frozen. However, when the cost of waste (most notably the cob) is factored in, as well as time to prepare, canned corn offers the same amount of dietary fibre with a 25 percent cost saving compared to fresh and the same amount of folate with a 75 percent cost saving compared to fresh.

The NZ Nutrition Foundation (NZNF) commented on the relevance of the findings, as they come at a time when many families are struggling to put healthy food on the table because of limited budgets. It also makes the point that canned foods ensure essential nutrients are more accessible to consumers, particularly those with limited storage, preparation facilities, limited time, skill or interest in preparing fresh foods.

I find this heartening, at a time when so many of our current foodie programmes put great emphasis on the use of fresh fruit and vegetables.  I fear this may be setting the bar too high for many kiwi families who are struggling to make ends meet.  We now know that canned foods do deliver the goods nutritionally and needn’t shy away from the limelight, in the informed kitchen.

It was a great opportunity to show what is happening in NZ and how we as a nation are faring in these tricky times and what the food industry and health sector are doing to address a global issue.

Not surprisingly, but no less disappointingly the piece was fairly one dimensional and single-mindedly focused on sugar and soft drinks.  What it did highlight, once again, was the limited lens through which so many people choose to examine the link between food and health, or rather food and disease as appears to be the main focus.

While I commend Sunday for attempting to help New Zealanders think about what they choose to eat (or in this case drink), the facts do not warrant the dramatic way in which this, and many other stories are presented.

It certainly makes for good TV to show a wheelbarrow full of sugar to represent how much we each consume annually, but this is somewhat misleading.  Likewise we each consume several Olympic-sized swimming pools of water annually, which also looks frightening.  In fact on a daily basis our median intake of sucrose when last measured in 2008/09 was just 48g.  And it’s on the decline (it was 53g in 1997).

Also, only 5% of our energy (as measured in 2008/09) came from non-alcoholic beverages.  And just 1.4% of energy was contributed by the sucrose in all non-alcoholic beverages (only part of which is sugary soft drink).  The rest, presumably, is contributed by fat, lactose, fructose, glucose and protein (remembering this group includes all non-alcoholic beverages other than plain milk).  So are the other foods and drinks which contribute 98-99% of our energy intake unimportant?  I think not.

In New Zealand, our intake of sugar (and particularly sugary soft drinks) differs significantly from countries like the United States, where much of the concern about sugar intakes stems from.

I don’t wish to trivialise the issue, as clearly the above figures are population medians, and some New Zealanders do over-consume.  I would like to propose however, that these individuals are unlikely to be over-consuming on sugary soft drinks alone, and are more likely to be part of the growing number of food-illiterate people who don’t understand what over-consumption is.

To Professor Rush’s point, there is some evidence that we feel less satiated when we drink kilojoules, compared with when we eat them (because our stomachs empty more quickly), but I think the issue of satiation is far broader than just blaming drinks for our obesity problem.  More and more New Zealanders seem to have become so accustomed to constant grazing on food and drink, to the point that many do not recognise the feeling of satiation, let alone the feeling of hunger.

What drives us to this?  Economic, cultural and social issues that shape the environment we live in and the choices we make.  Recently I read some research which found that most people no longer know what a calorie/kilojoule is.  Yes, sugar and sugary drinks provide kilojoules, but so does everything we eat.  In order to improve our health as a nation, individuals need a basic understanding of their own diet and how it relates to their own health; they need tools to help them make the best choices for them individually and they need to accept some individual responsibility for what they feed themselves and their families on a daily basis.

Yes, I do provide independent nutrition advice to a range of food companies, including NZ Sugar and Coca-Cola Oceania, so you may think my opinion is biased.  As a result though, I’ve been following this issue closely and am aware of the evidence, plus lack of evidence, surrounding it.  In my experience, it’s hard to get those without a vested interest in this issue to speak up – at least in New Zealand.  My personal view is to stick to the facts, and to address all of the issues with practical solutions, rather than pinpoint one possible contributor alone.  If there was a single silver bullet to address obesity, we would have found it my now, and we’d all be an ideal BMI.

As a nutrition communicator I spend much of my time trawling the pages of PubMed, tapping away on the computer, laptop, iPhone or iPad, using social media and other electronic networks to share balanced, evidence-based food and nutrition information.  It was actually quite a relief to rest my thumbs for a few days and use my own voice and ears instead.  So much so that I now sound like a pack-a-day smoker!

Together with Sarah (a colleague from the NZ Nutrition Foundation) we presented a social media workshop for dietitians at the conference, and while we were very successful in convincing New Zealand dietitians to jump onto the blogosphere, I was surprised at how much the experience reminded me that social media is only useful in-between times of face-to-face contact.  In fact when I think about it, the dietitians I interact most with via social media networks are the ones I’ve actually met in person.

Is it a generational thing? Being someone who grew up without the internet, who can even remember what working-life was like prior to email, perhaps I’m biased?  Are you more likely to respond to questions and take part in social media discussions about professional issues when you’ve actually met the person seeking input?  I guess I’ll get my answer from your comments below…

Food costs are rising and hunger is a heart-breaking reality for some people.But selecting an out of season fruit to highlight the issue of food prices won’t change that.Nor does it actually help people.Where has the age-old advice to buy in season and also to use nutritionally-similar frozen and canned as an alternative gone?

Is the price of milk yet another example of consumer expectations being formed by media to generate interest in a story that is now considered a major issue?Is the way this issue is being played out also telling people that milk should be cheaper than soft drinks?

Because so few people actually understand the food manufacturing process, it is not well understood that milk – a high nutritional value fresh protein food – costs far more to produce (think livestock management, cool chain processing, packaging, handling and storage).And because shelf stable soft drinks are simpler and cheaper to produce, their makers are frequently chastised by suggestions they are enticing people to put soft drinks in their trolley in place of milk.

The commentators who see a good story idea with some opportunity to link it to an issue of public good, often don’t present the full picture, and as a result the public’s interest isn’t served because attention to one aspect ignores potentially bigger issues. Perhaps they think people are too simple to understand a more complicated analysis of society?

Now a new dimension has emerged, with media commentators offering their own personal opinion on subjects others have had to spend years studying at university.A weekly food product analysis in a certain weekend paper is a case in point.While it offers some interesting observations on what’s in foods, and clearly scrutiny of food composition is important, the naivety of some of the comments would embarrass a new food technology graduate.And certainly frustrate most nutritionists.

Surely for this and other examples, there should be some level of accuracy and expert input to ensure a better degree of accuracy and perspective?That, to my mind would serve the public good a whole lot better.

Even Shortland Street has medical experts advising them on accuracy and we all know this is fictitious in the extreme.Credibility and impact of the media can only be eroded over time if these sorts of issues are not addressed. Then they really will be unable to protect and defend the interest of the public they represent.