Nutrition and Health

1. I’m sceptical….what are you?

   Published on Thursday, July 15th, 2010

   New Scientist ran an interesting series of articles about denial in May this year.

   It got me thinking that scepticism vs denialism is another way of describing a theme often addressed in this blog.  I consider myself a sceptic – meaning that I take an objective approach to the evaluation of claims - but I also find that a bit of commonsense goes a long way.  Deniers, on the other hand, have a position (or end goal) staked out in advance, and sort through the data employing “confirmation bias”.  This is defined by New Scientist as “the tendency to look for and find confirmatory evidence for pre-existing beliefs and ignore or dismiss the rest”.  Whether sceptics agree or disagree, we can debate the issues like grown ups.  Dealing with denialism feels more like trying to rationalise with a toddler having a tantrum.

   It’s easy to think of denialism as an old fashioned notion, driven by zealots such as anti-evolutionary theorists or those who believed the Earth was flat.  But no – denialism is alive and well in our modern world.  We’ve all heard of climate change and vaccination deniers.  New Scientist provides useful perspectives on these examples, as well as deniers of the ill health effects of tobacco, the existence of AIDs and those who believe pandemics such as swine ‘flu are developed and released by pharmaceutical companies.  I can add more examples to this list based on personal experience in the food and health area.  Those who are convinced that:

   • obesity is caused by single foods or beverages (and that this is a conspiracy of global food companies).
   • anti-tobacco tactics directed to certain foods are the best option to combat obesity.
   • specific approved food additives or ingredients cause illnesses ranging from autism to cancer (and that this is a conspiracy of both food companies and food safety organisations).
   • there are no adverse health effects of high salt diets at a population level.
   • it’s acceptable to deliberately design research studies to prove a point or handpick research results to suits their means, rather than taking a more objective view.

   Your typical denier often has the public’s sympathy because they’re the “underdogs, fighting the corrupt elite”.  They often occupy the moral high ground for this reason.   And the media love the extreme viewpoint they offer so they have a natural public stage.  Regulators, businesses and governmental organisations do not have the luxury of being able to handpick evidence to suit.  They have to be objective, so they often come off looking non-committal, or at worst, defensive, when facing denialists in public.

   In my digging around for material on this subject I also found this delightful quote by Richard Asher, published in The Lancet in 1959.

   “It is important to realise that ideas are much easier to believe if they are comforting and that many clinical notions are accepted because they are comforting rather than because there is any evidence to support them. Just as we swallow food because we like it, not because of its nutritional content, so do we swallow ideas because we like them and not because of their rational content.”

   I believe this rings especially true today and I’d love to hear some more examples of denialism that you’ve come across.

   

2. All hail the cheese roll

   Published on Thursday, June 17th, 2010

   They’re celebrating and exploring the science of the cheese roll in Dunedin this month.  I love cheese rolls, and reading about this makes me want to rush home and cook up a batch of these warming winter treats.

   Winter food is all about comfort, warmth and sustenance.  Soup is a great example of this (and a perfect food match to those cheese rolls!).  All those great staple classics like lasagna, shepherds pie, macaroni cheese and casseroles come into their own at this time of the year.

   For those from the southern end of New Zealand, the humble cheese roll is so much more than a tasty snack.  It’s part of our heritage.  It’s about memories of Grandma and family times.  It’s about sharing with friends and social occasions.  And for those north of the cheese roll divide, there are other food favourites which fulfill this role in life.

   The powerful social role of food cannot be underestimated.  Recently I read some consumer research showing that the majority of people prioritise good nutrition when choosing what to eat at home or in routine situations.  But unsurprisingly when asked the same question in relation to times when they’re socialising or eating with friends, good nutrition became less of a priority.

   When communicating about food and nutrition the power of food’s traditional social role in our lives cannot be underestimated.  These messages mean very little if they fail to acknowledge people’s behaviour and feelings around food, especially in social settings.  Excellent nutrition communication needs to provide ways and means of achieving the same warm fuzzy feelings around healthy eating.

   And for those of you who’re dying to experience the magic of the Southland Cheese Roll to warm you up this winter, here’s a great recipe.

   

3. Navigating the food and nutrition communications highway

   Published on Thursday, May 27th, 2010

   Navigating the communications highway can easily lead you into a spaghetti junction. Perhaps never more so than in the area of food and nutrition communications. Central to successful navigation is weighing up the evidence, listening, and understanding the views of others before choosing the path to follow.

   Key equipment for us is scientific rigour combined with common sense.
   
   Last week our Food Group hosted a seminar on this topic.  The first half focused on collecting views and perspectives from many relevant sectors within the healthy eating debate, with presentations from Kate Porter (McDonalds NZ), Dr Robyn Toomath (Fight the Obesity Epidemic), Sarah Thomson (Child Cancer Foundation) and Katherine Rich (Food and Grocery Council).

   It was interesting to hear such diverse views on approaches to healthy eating within one session.  But the panel discussion highlighted promising areas of commonality towards a shared goal.  It’s effective communications which can achieve a WIIFM factor within such a wide spectrum of approaches.

   The second session focused on communicating what consumers think and want.  Our Food Group and Nutrition NZ analysed some recent large pieces of research looking at what consumers really think of food labelling – in particular food and nutrition information on food labels.  If you’d like a copy of my presentation I’d be happy to provide this.

   Then Cathy Arrow led us on a virtual tour of her sister’s fish pie via online media, highlighting the influence of various online media influences in effective communications.

   We ended up with a panel of “alpha mums” who were all asked questions by the attendees.  I think we could have carried on firing questions for at least another hour or two, as their insight was the true measure of all our communications efforts.

   For those who attended, what (if anything) did you learn?  What would you have liked to see more of?  Please post any comments on the event (good and bad) to this blog.

   

4. Has the world already reached Peak Health? If so, who’s to blame?

   Published on Monday, May 10th, 2010

   The concept of peak oil has spread into the health sector, with public health professionals now talking about peak health in the same vein.  This draws important parallels between our health as humans and the health of our planet – the two, as we have known for some time, being inextricably linked.

   So have we already reached peak health?  Are we therefore now heading down the slippery slope away from it?  If, as experts predict, today’s children will not live as long as their parents (due to increasing obesity and its ensuing chronic diseases), perhaps we are.

   And if we have surpassed peak health, who or what is to blame?  Having recently returned from a largely finger-pointing and teeth gnashing Public Health Association of Australia (PHAA) conference in Canberra where there was much discussion on peak health, I know that many believe the blame lies with food manufacturers and marketers.

   “How can they truly have the health of consumers as their main objective, when their main objective is to make a profit for their shareholders?”

   That old chestnut.

   In fact all organisations are constrained by financial realities, whether this involves making a profit, breaking even or maximising value for money.  The ever present clamour for public sector funding to undertake health research is but one example of how money makes the world go around in the public as well as the private sector. We all need to make a living to feed and house our families, but most of us feel better in our work if we know our employer genuinely cares about us and others.

   Actually what motivates businesses is far more basic than money.  It’s survival.

   At the NZ Food and Grocery Council’s half yearly meeting last week I was heartened by what John Doumani, General Manager for the Fonterra business in Australia and New Zealand said about how to build immortality into brands.  He suggested that unless companies prioritise their objectives in order of customers first, employees second and shareholders third, they will not survive.

   Looking after your customers means looking after their interests, in particular their health.  Same for employees; after all, no one enjoys work for a company which puts shareholders first above all else.  Ensuring customers are happy and healthy, and employees feel great about the company they work for will satisfy shareholders in the long term.  Any wise and sustainable food manufacturer knows this.

   Still, it seems that food manufacturers struggle to do anything right in the eyes of public health critics.  Even affordable foods, developed (at great expense) by food companies to provide high levels of the nutrients commonly missing from diets in developing countries, were criticised at the PHAA conference. It left me questioning what food companies could possibly ever do right for such critics.

   What do you think food manufacturers, and others can do to help us regain peak health?

   

5. Go First Lady!

   Published on Thursday, February 11th, 2010

   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!)

   

6. White Hat Scientists

   Published on Friday, December 18th, 2009

   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.

   

7. What’s driving us to drink….and what are we drinking?

   Published on Monday, November 30th, 2009

   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.

   

8. A seventh state of Australia – no way mate!

   Published on Thursday, October 29th, 2009

   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’.

   

9. If only it were that simple!

   Published on Thursday, October 8th, 2009

   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.

   

10. Do as I say but not as I do?

    Published on Tuesday, September 29th, 2009

    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!