Scientific Research

1. 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).

    

    

   

2. 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. 

    

   

3. en•gage•ment (in-geidj-mint)

   Published on Thursday, October 28th, 2010

   n.
   1. The act of engaging or the state of being engaged.
   2. Betrothal.
   3. Something that serves to engage; a pledge.
   4. A promise or agreement to be at a particular place at a particular time.
   5. a. Employment, especially for a specified time.
   b. A specific, often limited, period of employment.
   6. A hostile encounter; a battle.
   7. The condition of being in gear.
   Synonyms: engagement, appointment, assignation, date1, rendezvous, tryst
   These nouns denote a commitment to appear at a certain time and place: a business engagement; a dental appointment; a secret assignation; a date to play tennis; a rendezvous of agents at the border; a lovers’ tryst.

   I do believe after many years of courtship and conflict, the various groups of stakeholders in the ever-expanding waistlines of New Zealanders are finally approaching engagement.  There’s not a lot of tangible evidence of productive engagement yet, but the scene is set.

   [The cynic in me is bearing in mind that using the above definition, engagement can mean both betrothal and battle...]

   Last week I attended the popular Edgar Centre for Diabetes Research and Prior Policy Centre’s Who Cares About New Zealand’s Waistline? seminar held in Wellington.

   Much of the discussion was not new – but the format was.

   As Professor Jim Mann explains here, the event was designed to portray evidence and practice from several of the key “actor groups” previously identified by the United Nations as influencing the health of populations.  The “actor groups” chosen to contribute at this event were Food Industry, Government, Civil Society Organisations, Schools & Families, Media and Workplace.

   Researchers were asked to present the case for evidence-based action in each sector and each sector was asked to respond with what has been and what could be done in New Zealand.

   I was particularly struck by the lack of hard evidence for any one intervention within each “actor group” having a major impact on obesity rates (with the exception of better town and transport planning).  Although every group demonstrated tangible evidence that they’re doing their bit – some better than others – within each area.  And no-one can deny that the combined effect of many coordinated interventions involving many different actor groups would likely be substantial, if any such research project existed to provide the hard evidence.  Presently it’s an ambitious dream, but monitoring action and research in this way on an annual basis will hopefully show progress.

   Tariana Turia impressed us all with her personal and compassionate concern for the issues.  You can read her speech here.

   Professor Grant Schofield from AUT was bold enough to admit that people don’t want to hear public health messages.  He suggested we need to re-frame the problem/issues into solutions/benefits/outcomes our audiences can relate to.  This was also backed up by sentiments expressed in the media session by Lorelei Mason and Jim Tully about what consumers want.

   Re-framing the issue is something done particularly well by the private sector.  Engaging in marketing and business tactics used successfully by the private sector are exactly what could make the difference to public sector campaigns.  In a recent inspirational TED presentation by Melinda Gates, she stated (of the need for aspirational marketing in health) “…<health agencies> assume when people need something we don’t have to make them want it”. It’s very true.

   Which brings me back to the need for real engagement between all actor groups to engage New Zealanders in the issues.  The main point I took from the research outcomes presented was that working away diligently in silos is not likely to trim our waistlines one iota.

   Well done to Professor Jim Mann and his team – who did a lot of the legwork to pull together the programme.  It was a refreshing approach.

   

4. No wonder people are confused about nutrition

   Published on Thursday, August 19th, 2010

   A friend once said to me that the opening phrase of a media article most feared by nutritionists is: “a new study now proves that ….”.  She’s right.

   The interface between science and journalistic endeavour is an area of constant tension. Rarely does a singular study change the course of knowledge. This comes about by the gradual accumulation of a body of evidence, each study with its own strengths and flaws.  And for every five studies that prove a point there are bound to be at least four which disprove it, or vice versa.

   It’s an unfortunate truth that cumulative evidence over long periods of time is just not attention-grabbing material.  Nevertheless that’s what forms the basis of evidence-based recommendations such as the food and nutrition guidelines.

   Meanwhile it’s frequently opinion, and our propensity for storytelling which creates human interest and media attention.  Regrettably at times it is presented as fact.

   By way of example, I’d like to share a recent frustration with one of our daily papers.  A few weeks ago there was a large, well-meaning, colourful feature about the sugar content of popular children’s breakfast cereals.  The headline  described them as junk food.  My concerns about this article were multiple:
   1.    The sugar content of cereals is hardly news, when every single packet, by law, displays the sugar content per 100g.
   2.    The sugar content per 100g is really only useful when comparing between cereals in the supermarket.  It does not equate to the sugar content per serve, which in this particular case would have been about a third of that colourfully highlighted.
   3.    A public health advisor contributed: “cereal manufacturers use layers of sugar on fat on salt on more sugar to get people hooked on the product”.  So,  you could be forgiven for thinking that breakfast cereal – surely a good product to develop a life long habit for – is less preferable than sending little Johnny off to school on an empty stomach, or with a belly full of bacon and eggs.
   4.    There wasn’t any information which would help the average person to put the sugar content of these possible breakfast options into context with other possible breakfast options.  I don’t know any children who’d be happy to eat weetbix or porridge without sugar or fruit, which would essentially render either of these options equivalent in total sugar to most of the cereals listed in the article.  Unfortunately the other recommended option,  “homemade bircher muesli” requires a luxury of time that most of us don’t have, not to mention it being made with fruit juice, grated apple and yoghurt, adding a substantial amount of sugar.

   So the average Mum (household shopper) is left feeling guilty (yet again) for feeding her children something they will actually eat for breakfast, and has no idea what she should replace it with.

   But she only has to wait a week before another article from the same paper gives her a solution.  This extols the health benefits of maple syrup and encourages parents to drizzle it over their children’s breakfasts for “nutritive value”.

   And we wonder why people get confused….

   If you have any similar examples to share I’d love to hear them! Just submit a comment below.

   

5. 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.

   

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.