Health Promotion

1. Who’s to blame? Time to try something different

   Published on Monday, March 4th, 2013

   We all know about the world’s obesity epidemic and the serious health consequences ahead of us.  But we seem to be stuck in a blame game, rather than really committing to effective, collaborative solutions.

   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?

   

2. Food Addiction

   Published on Friday, September 21st, 2012

   Are we using the term “addiction” too freely these days?  Headlines portray a range of human weaknesses from social media “addiction” to shoe shopping “addiction”.  We’ve long known about the serious nature of alcohol, nicotine and narcotic addictions, and the severe consequences they have on our society.  But a relative newcomer is the term “food addiction”, discussed yesterday at an Australasian psychiatry conference in Wellington, and promoting this
   rather odd  Stuff poll.  (Last time I looked at the poll results the category “something else” was in the lead.  Not really surprising since chocolate does not have its own category – clearly the poll was written by a man!)

   Is food addiction the ever-elusive single cause of the obesity epidemic?  As a slightly pedantic sceptic, I must admit to finding this term somewhat illogical.

   The official definition of addiction is: a persistent, compulsive dependence on a behaviour or substance.  To some degree aren’t we all persistently, compulsively dependent on food?  After all, unlike nicotine, gambling, alcohol and narcotics, we cannot live without it.  Preferably we need it at least three times a day, every day, for our whole lives.  Yet only a third of the population are supposedly at risk of having “food addiction”.   If broccoli was your preference, would that be labelled an addiction?

   Don’t get me wrong – I’m not trying to belittle the justifiably valid concerns of those who feel completely out of control around food, and who legitimately see this as a reason for their own weight problems – I just don’t see these people being in the majority.  I was intrigued when I recently saw a notice on a bus advertising an Overeaters Anonymous meeting.  Perhaps this is something we will see more of, and hopefully, as with AA, it will be a very helpful framework for individuals in order to work though common issues towards recovery.

   But does this loss of control around food (or more correctly, specific types of food) occur in isolation?  I’m no psychiatrist, but it would seem to me that underlying reasons for this type of behaviour would be multifactorial and complex.  Overeating is therefore a symptom, which sadly results in symptoms of its own, exacerbating a cycle of health problems.

   I don’t think the complete loss of control around food, with a continuous drive to eat more and more around the clock is solely responsible for the obesity epidemic we face.  Most of us eat a little too much on a regular basis and are too inactive to balance
   this intake of calories.  Over time this leads to a gradual increase in the waistline, until we are in a situation where more people are overweight than are normal weight within the population, and nearly the same proportion are obese.

   If it helps people to examine what they’re eating and how active their lifestyle is to label themselves as a “food addict”, then so be it.  The only outcome I’m interested in is people getting healthier.  This involves solutions that enable all of us to take more ownership of our health and make wiser choices about what foods and drinks we choose to buy and consume, in what amounts, and how much we sit being inactive.  What do you think?

   

3. Canned foods get a thumbs-up for sound nutrition and affordability

   Published on Wednesday, June 13th, 2012

   

   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.

   

4. Sugar – since when did the facts get in the way of a good story?

   Published on Monday, June 11th, 2012

   Last night’s Sunday programme on sugary soft drinks (TVNZ 10 June, 7pm) promised yet another “expose” of the type our current affairs love to hype up to get our eyeballs and ears on their screens at the right time.  Previous shows from the US and Australia clearly paved the way for our own home-grown version of another chapter in the great obesity debate.

   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.

   

5. Blind men and an elephant

   Published on Thursday, March 15th, 2012

   There’s an old Indian tale about giving a group of blind men an elephant to describe through feel.  As each of them is feeling different parts of the elephant, they end up squabbling as none can agree on how to describe it as a whole.  Each sticks fervently to their version of the truth, without communicating effectively and realising that all of their “truths” in harmony describe the total picture.

   Lessons from this ancient fable are just as relevant today when we evaluate how various scientific experts approach the totality of scientific evidence.  Recently we had a good example of this when one prominent scientist published his professional (and somewhat extreme) opinion on sugar in Nature, resulting in a media storm and “expert” slanging match across the globe.  Personally I thought Dr Arya Sharma’s commentary on this was one of the better ones.

   The very essence of scientific endeavour is to prove or disprove hypotheses, and since research often raises more questions than it answers, further research is usually justified.  So individual researchers passionately chase logic down the path where their research leads them.  It’s hardly surprising that when they come up for air and see what other “descriptions of the elephant” exist, debates can get heated. People who “describe the animal in the same way” comfortably reference each other’s material, while desparately trying to disprove the findings of others who might describe the animal differently.  Hence many highly esteemed experts fight it out in the media and the general public become more confused and disenchanted than ever.

   In the world of nutrition science nothing is black and white, as everything is highly dependent on a complex web of lifestyle variables and genetic make-up.  It is therefore difficult to make clear and meaningful recommendations on a population basis, and no wonder really that we usually wind up back at use-your-common-sense messages, such as “eat a variety of foods” and “a balanced diet” which can be waffly and confusing for people.

   White hat scientists (and there are a lot of them), tend to take the approach that it won’t do anyone any harm , rather than the evidence-based approach.  There is an increasing school of thought that goes; since it takes so long to prove or disprove scientific theories on nutrition, we should just make recommendations which may not be effective but can’t do any harm.  The American Heart Association clearly states in its position paper on sugar that “research tools thus far have been insufficient to confirm a direct link” [between added sugar intake and weight gain]. Then they go ahead and make  prudent recommendations anyway.

   Sadly this well-intended advice often serves to confuse and alienate the public further, as they reach for another chocolate bar and vow never to listen to another expert.  Judging by the comments on TVNZ’s Breakfast facebook page (Feb 24th) this is certainly what happened when the NZMJ published a viewpoint article listing 49 foods for obese people to avoid, and the media made a complete meal of it.  Yet again, the dietitians among us come out of it looking like the food police.

   So, can we win?  Is practical, meaningful and evidence-based dietary advice the ever-elusive holy grail?  I’d love your views on this.

   

6. Motivating the imperfect, irrational human being

   Published on Monday, October 3rd, 2011

   At the Dietitians NZ Conference in Nelson this year I attended a memorable workshop by Melbourne-based Psycoholgist John Boyle, on making changes and breaking habits.

   Lightbulbs went on in my head throughout the workshop, appropriately titled A conversation around compliance, motivation and the imperfect, irrational human being. Often health professionals wonder why people come to them for help, only to fail to follow the advice or treatment plan that’s provided.

   This nonsensicality begins to make sense when  the complexity of our brain, emotions and thought-patterns are accessed (and when you bear in mind that to some extent, we are in fact all imperfect, irrational human beings).

   As many of  us know breaking an old habit, is remarkably difficult. Of course there are cases where people have turned their lives around in an instant, but these are far outweighed by those of us who have tried every way to leave behind a habit, and still struggle to achieve lasting results. In fact often we can end up worse off than when we started.

   But don’t despair – some helpful tips, gleaned from John’s workshop on this topic, included:

   • When encouraging change, we must first ensure that in doing so, we don’t increase resistance to change. If we are confronted, a natural instinct is to resist, demonstrate reluctance or react. Often, objective, logical evidence is dismissed and any attempt to use logic and scientific argument can have the opposite effect that’s intended.
   • We as humans are wired to loss aversion – meaning if you told me I need to give up chocolate biscuits, I may work to avoid this. Instead it is important to focus on what I would gain from giving up that box of chocolate biscuits each day.
   • We have a commitment to our beliefs which is often difficult to terminate, even when things aren’t working. Evidence in support of a belief (such as, “no I don’t believe I need to exercise in order to lose weight”) may be lacking, but this belief has the power to create an immoveable force, leading us back to our old habits.
   • Motivational interviewing is a common and effective technique used in all forms of counselling, including dietary counseling. Instead of confronting or persuading someone to change, this technique focuses on helping a person to mobilise their values and goals so that change becomes the bi-product of this. This is done using tactics such as practicing reflective listening, open-ended questioning, and summarising – then being able to identify and act on ‘change statements’ – i.e. acting when a person is actually ready to change. Changes statements include those which; recognise a problem, show concern, show an intent to change, or show optimism about changing.

   While motivational interviewing is widely used by health professionals, I believe it can be applied to many areas of our day to day lives, and the way we communicate with each other. Without knowing it, I was constantly using this technique quite successfully when employed as a nanny. When the children resisted eating their vegetables, I would focus on what they’d immediately gain from eating them – which was having the freedom to leave the table and go and play on the trampoline again. And to a 12 year old this prospect was irresistible.

   I’d be interested in hearing your thoughts on where you think this could be applied, whether it be with your children or partner, or even with colleagues or business associates.

    

   

7. The expansion of New Zealand waistlines

   Published on Friday, September 23rd, 2011

   With the release of the 2008/09 nutrition survey summary report last week, I was heartened to read that diet-wise, New Zealand adults seem to be starting to make the right choices.  According to the survey, since 1997 we’ve reduced our overall energy fat, saturated fat and sugar intakes.  We’re eating more healthy fats and protein, fruit and selenium.  We also have lower total cholesterol levels with a better total:HDL-cholesterol ratio, potentially due to these dietary changes, but more likely due to higher rates of statin use.  A couple of interesting findings were the drop in our intakes of vitamin A, iron and zinc; possibly resulting from cutting down on full cream dairy products and red meat.

   But the real kicker is what’s happened to our waistlines, despite all this apparent healthy change.  There’s no doubt about it – we’re all getting fatter.  Sadly, as is often the case, this trend disproportionately affects certain groups in the population, with obesity rates amongst Maori and Pacific peoples in particular, starting to scale to dizzying proportions.

   While everyone agrees the reasons are multifaceted, a number of experts have provided commentary in the past week as to why this dichotomy is being seen, including (and I’m paraphrasing for the sake of brevity):

   1. “It’s because people under-report what they eat in surveys” (Rod Jackson)

   Yes, this has been documented in the literature, but in comparing like methodology with like methodology are we really likely to be recording our food intake any less accurately now than we were in 1997?  Even with an interviewer in our homes and going through our cupboards?  I’m not sure this is the only explanation.

   2. It’s partly because we’re less active than ever before and the survey did not assess activity levels.

   Certainly the basic energy in: energy out equation loop isn’t completed without an assessment of physical activity levels.  There is no question that sedentary behaviour is the elephant in the room with respect to obesity.  No matter how much we idolise our sporting heroes as a nation, the majority of us are more likely to sit on our backsides for most of the day.  Every day.  But, are we likely to be even more sedentary now than we were in 1997?  The 2006/07 NZ Health Survey found no change in regular physical activity between 2002/03 and 2006/07.  However, according to Professor Grant Schofield, our levels of sedentary behaviour are likely to be on the increase, with more hours of TV viewing, more sedentary jobs and greater car ownership/distance travelled by car in the last 15 years.  I don’t think we’ve heard the last on just how dangerous sitting can be for our health.

   3. “It’s because our environment is too jammed with easily available high fat, salt and sugar foods” Robyn Toomath.

   This is where we start to go around in circles, because the dietary intake data on the whole indicate we’re actually eating less fat and sugar.  In fact the only source of sugar which is growing in our diets seems to be fruit.  And in our fear of fat we seem to be switching to low fat dairy at the expense of retinol intakes and cutting out red meat to the expense of our zinc and iron intakes.  So are we reporting our intakes correctly? (… and the circular nature of this dicussion goes on).

   I would love to know what you make of all of this.  It would be great to get a discussion going.  Just insert a comment below (if there are no comments yet you need to click on the no comments box in order to make one).

    

    

   

8. When is a healthy recipe not a healthy recipe?

   Published on Tuesday, June 14th, 2011

   It has become the fashion for most, if not all, of our lifestyle magazines to present what they call “healthy recipes”.  This is a development that concerns me, not for the fact they are promoting healthy food, but because such recipes are generally devoid of any nutritional reference points.

   Perhaps there is an increasing demand by some for healthy, affordable meal ideas.  The unparalleled success of the Healthy Food Guide magazine would certainly indicate this. 

   As a result, everyone seems to have jumped on the bandwagon with ideas for “healthy” snacks, “healthy” pantry items and “healthy” meal ideas.  The problem is that most of these recipes do not stack up when put against real nutrition criteria, such as energy (kilojoule) content, fat content, sugar content, fibre content and salt content.  Healthy Food Guide pride themselves (rightly) on their rigorous nutritional criteria for recipes and as such, when they say “healthy”, they really do mean healthy.

   Some recent examples of other so-called “healthy” meals include anything vegetarian or gluten free, or anything our nana might have made.  While the use of a range of vegetables in vegetarian recipes is to be applauded, sadly when they are swimming in cream, oil or high fat cheeses their health benefits are somewhat offset.  One particular recent example of “healthy” has been a vegetable stack on a mashed potato base with parmesan wafers.  When analysed it was found to provide more than 75% of the daily energy requirement and more than 100% of the daily requirements of fat, saturated fat and sodium in just one serve.  The recommended serve size was also very large. 

   While there are regulations around using claims such as “low fat” on food labels, there are no such regulations covering the promotional headlines often seen on the covers of magazines.  Usually analysis of the supposedly “low fat” recipes reveals the promotional headline is outrageously misleading.

   Just as frustrating can be the use of terms such as “diet foods” – inferring healthy – but actually meaning for people (rightly or wrongly) trying to avoid particular food components such as gluten and lactose.  The recipes might be devoid of lactose or gluten, but they can make up for it with lashings of fat and sugar.

   I suspect that some of references to “healthy foods” are intended to mimick Healthy Food Guide magazine. However I suspect the success of that magazine is due not just to its strict nutrition criteria for recipes.  It’s also due to its “best friend” approach to its readership, in providing helpful, supportive ideas, while ensuring the information it provides is factually correct.   Contrast this with the claims of a recent article in a popular magazine, headlined “why sugar is making you old”.  It quotes a “celebrity dermatologist’s” theory about how sugar consumption affects the elasticity of the skin.  Any objective analysis of the published research in this field would find the evidence for such claims to be shaky, at best. 

   I have discussed this “healthy recipe” trend with other dietitians. They agree there’s a role for Dietitians NZ to provide some guidance on this, so watch this space for more information. 

    

   

9. Food Week dishes up popular cooking tips

   Published on Friday, May 13th, 2011

   There’s only 2 more days to go in the inaugural New Zealand Nutrition Foundation Food Week!

   Having completed 16 radio interviews and five interactive celebrity cooking demos with audiences of hundreds, and with 600 “likes” on the Food Week Facebook page, Sarah Hanrahan from the Nutrition Foundation is justifiably satisfied with progress so far.

   The approach of Just Cook – promoting positive, no stress cooking, with basic, inexpensive pantry essentials and just talking about food in a positive light has been received well by people so far.  “It’s so much more practical and well received than telling people what not to do”, said Sarah when we spoke to her today.

   With rising food prices and cost of living increasing, many families struggle to manage on an average New Zealand wage (as shown by Campbell Live reporter Tristram Clayton’s reality check in living on a budget), Just Cook, and its message “Just get in the kitchen and cook!” shows it’s absolutely still possible to make healthy, tasty meals in the home without breaking the budget.

   Research shows the biggest barriers to cooking at home are time, money and knowledge. Just Cook provides practical tips on how to address these barriers, such as knowing where to add a tin of beans or a cup of oats or to make meals go further for a fraction of the cost, adding good nutrition without compromising taste. The Food List  – a handy list of pantry, fridge and freezer foods to keep on hand at all times – is a great guide of kitchen essentials that can help those shopping on a budget prioritise what’s needed. And the Just Cook interactive kitchen houses easy, affordable, tried and tested recipes that cater to any combination of ingredients commonly held in NZ pantries.

   The programme also has a schools component for year 10 pupils which will be followed and evaluated in the coming weeks. Students are challenged to produce a recipe on a budget to feed a family of five, using items in the pantry list and a few extra dollars.

   As I write this, Sarah is just packing up from the final celebrity chef cooking demo in Britomart, where Masterchef finalist Nadia Lim cooked up a storm from the Food List in the fabulous kitchen provided by Fisher & Paykel. 

   You can access the celebrity chef recipes here, proof that some of our top foodies have great ideas for inexpensive food!

   We welcome any of your favourite recipe ideas or comments for making meals go further on a budget – please post these in the comments section below.

   

10. Finding new ways to bridge the food labelling debate

    Published on Tuesday, April 5th, 2011

    A new front of pack labelling system was put forward by Sanitarium today “in order to advance the discussion of front-of-pack labelling tools in the interests of promoting better public health”.

    While public health experts call for traffic light labelling (TL) and food manufacturers prefer percent dietary intake (%DI) labelling, there is no doubt that both systems have limitations.  Sanitarium is to be commended for developing an alternative concept and putting it out for discussion.  It would certainly be an extremely wonderful thing to have one system, agreed to by industry, public health and government alike.

    A brief report, outlining the system developed by Sanitarium is available.  It is clear that they have some public health heavyweights on board, with the report’s supportive foreword written by Michael Moore, CEO of the Public Health Association of Australia.

    Certainly examples of food manufacturers, public health experts and other sectors working together need to become more commonplace in order to improve the health of our communities.  It infuriates me that truly collaborative approaches are not very common (at least in New Zealand), but that’s a matter for another blog…

    It’s also very encouraging that online Australian consumer research shows that consumers find the concept easier to understand than both TL and %DI labelling.  It’s not clear whether that’s due to the single traffic light colour for each food, the fact that positive food components are included, or something else.

    Clearly the details (categories of products, nutrients included, criteria and terminologies) are still up for discussion and debate, but it’s really great to have a starting point from which to potentially develop an agreed joint approach.

    What seems to have been overlooked by the Blewett report, and others, including Sanitarium, is the well researched and comprehensive e-mark labelling system, also a viable alternative to TL or %DI labelling.  In fact the e-mark encompasses more nutritional information, is more scientifically accurate and yet is presented to consumers in a more simple way.  It also has the advantage of being less judgmental, avoiding the classic traffic light colours.  Though somehow the e-mark is just not taken seriously.  Potentially because it is not known about in Australia?   Is it the cost?  Certainly the idea of a universal system involving no fees for use, such as that put forward by Sanitarium, is advantageous.

    My fundamental concern remains with finding ways for improved knowledge to drive actual behaviour.  Internationally we are yet to see a front of pack labelling system which drives healthy food consumption.  Sadly this is because comprehension of healthy eating messages doesn’t influence actual eating behaviour.  If that were true all dietitians would have a BMI between 19 and 23 (we certainly don’t) and we would never let a morsel of “eat sparingly” food/beverage pass our lips (we certainly do, more frequently than we’d like to think).  We’re only human, and the way we all live our lives and interact with food is exceptionally complicated.

    I’d love to read your opinions about the new proposed labelling approach and any thoughts you might have about encouraging people to prioritise health over all else.  Post a comment below.