Posts Tagged ‘nutrition’

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. 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.

   

3. 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.

   

4. 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.

   

5. Helping kids buy from the school cafeteria – will ‘Big Brother’ tactics work?

   Published on Friday, August 21st, 2009

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

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

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

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

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

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

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

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

   

6. What to do when good research gives you a bad result?

   Published on Thursday, July 30th, 2009

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

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

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

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

   What?

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

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

   

7. “Just because it’s not in the targets doesn’t mean it’s not important”

   Published on Friday, May 8th, 2009

   As soon as I heard the Health Minister had announced the revised list of health targets, which exclude nutrition and obesity, I felt a blog coming on.  Especially since it kind of slipped in quietly, with the media otherwise occupied with shootings and ‘flu.

   While Tony Ryall argues that work in the areas dropped from the previous health targets is still important, I can only assume it’s not quite important enough to be a targeted priority.

   The way we eat affects our health as a nation enormously – and in more ways than just our physical health.  I don’t think anyone would disagree with that.  What seems to be up for debate is where the responsibility lies for what and how people eat.

   When Tony Ryall says that DHBs should not be held accountable for ensuring people eat their fruits and veggies, I tend to agree with him.  When public health experts say that people need a supportive environment to make healthy choices, I also agree with them.  Surely as a community we all need to play a part in creating a supportive environment, including the DHBs.  While the teams of experts within DHBs are doing a great job, they can’t achieve this on their own.

   Most major food manufacturers and marketers are voluntarily taking significant steps to improve the nutritional compositition of their products and are playing their part in recommending responsible dietary consumption.  Having said that, some food manufacturers and retailers could definitely focus more on improving the nutritional content of their offerings.  For example, my local café serves very indulgent meals to its regular customers and it’s hard to find a menu item that doesn’t provide more fat/salt and/or sugar than what is desirable on a regular basis.

   But people vote with their stomach when it comes to food choice, and those prioritising their physical health over everything else are sadly few and far between.  Making fruit and vegetables available, tasty, accessible, desirable, easy to prepare and affordable is the real task at hand, and no one should expect DHBs alone to be held accountable for this – just because they have to pick up the bill for obesity.  We all need to be accountable, but the Minister’s announcement may not help to underscore the importance of this.

   

8. Why should foodies participate in the on-line space?

   Published on Wednesday, April 29th, 2009

   A blog is just one of the many forms of social media that is having a profound influence on consumers’ attitudes, knowledge and ultimately consumption habits.  The more traditional mediums remain just as relevant and important but you ignore the on-line space and the new breed of influencers communicating within this space at your peril.

   Given the newness of this space to the business world and the rapid development of new social media platforms, the knowledge and skill level of people participating is wide and varied.  As qualified scientists, nutritionists and food industry experts we often find it challenging to accept the opinions of the new breed of influencers who are moving into this space.  But there is no question; their opinions are influential.

   It’s therefore even more important to jump in and get involved.  The on-line social media universe is really only in its adolescence and we know how difficult teenagers can be to understand. But when they do grow up into more mature adults the real benefits become apparent.

   There are also some new rules for interaction and for most people the best way to start out is simply to explore, participate, listen and learn.  I heard someone recently liken the rise of social media networks to the advent of the motor car.  When cars were new we all used to dress up and enjoy the journey, regardless of the destination.  Now that they’re an everyday necessity we see them as a means to an end.  So now’s the time to be enjoying your journey with social media – and you will be pleasantly surprised at what you discover.

   There are endless numbers of food-lovers blogs out there.  Some of the health and nutrition related ones we monitor regularly are listed on the blogroll to the right of the page, and some good local information sites can be found amongst the links.  Please feel free to post your own favourites in the comments box.  We’re especially keen to know more about other nutrition and health blog sites from within New Zealand.

   

9. The ideal front-of-pack labelling scheme – yeah right

   Published on Thursday, March 5th, 2009

   In the great obesity debate front of pack nutrition labelling is often hailed as is the bold new hope to guide consumers towards healthier food options. The “traffic light” concept is the one most of us would be familiar with but actually there are a host of different options.

   Recent research* amongst food companies in New Zealand indicates that manufacturers are not keen on the adoption of a standardised front of pack nutrition labelling system and would only do so if it was mandatory.

   The preferred (though not universally preferred) option is “percent dietary intake” labelling, with many companies having already adopted it. The same system is being adopted by our Aussie counterparts and a quick scan of any supermarket will show you that it is relatively common. As a system, this option regards single foods as part of an overall diet, letting people select foods and beverages according to their own individual intake. By contrast the traffic light system is thought to rather inflexibly label foods as good or bad.

   A criticism of the traffic light and other similar schemes such as ‘Pick the Tick’ is that they are interpretive schemes, which do place a nutritional value judgment on individual foods and beverages, without a total diet approach. In fact one of the pitfalls of the traffic light system is that if people only ate foods with green labels they would run the risk of not meeting their daily requirements for some nutrients – possibly protein, calcium and iron in particular.

   If a traffic light system is made mandatory it will be impossible to apply it in the same way across all of the food and beverage offerings available in our supermarkets. It is likely that it would need to be complicatedly calibrated by sector (as with the current Pick the Tick scheme), which often leads to confusion and complaint. For example how would you compare the nutritional value of a sausage with the nutritional value of peanut butter?

   The research, undertaken last year on behalf of the New Zealand Food Safety Authority (NZFSA), canvassed the views of 16 major New Zealand food companies (including one retail chain) about front of pack nutrition labelling. The research report is publicly available on the NZFSA website. The people interviewed represented 17 separate categories within the diverse food and beverage industry. These are all people who know their products and their consumers very well, and by trial and error over the years as well as through experience, they know what encourages people to buy products, and what doesn’t.

   Consumer research undertaken in Europe last year where versions of traffic light labelling have been in place for a while, shows that consumers are confused about traffic light labelling. They know what green means, but not what red means, mistakenly thinking these products should be avoided completely. In comparison, they understand better the concept of “guideline daily amounts” – the equivalent of our “percent dietary intake” labels.

   Manufacturers in New Zealand are not just pushing back on traffic light labelling for the sake of it. They agree with health authorities that New Zealanders should eat more healthfully and they want their customers to eat well. The research also found that our major food and beverage manufacturers are actually doing incredible amounts of work behind the scenes to make foods healthier without consumers knowing about it. The last thing they want is for consumers to know the food is getting healthier, because then people wont buy it! It seems an odd sort of logic, but years of experience has proven this to be true.

   Food and beverage manufacturers have been developing and marketing healthier products for some time now, but sadly consumers often don’t flock to buy these products. More often than not, it is the brave new healthier product that sits on supermarket shelves and is eventually de-listed – leaving the manufacturing company with another expensive product development and marketing “experience” to add to the stockpile.

   Common sense, and any market research will tell you - price and taste remain the main determinants of any consumer food and beverage choice. Only a small proportion of the population will buy products with health as their primary motivator. As a dietitian married to a doctor, our weekly family shopping is probably more motivated by health than most’s, but I have to say we don’t buy healthy foods unless they are likely to taste good, be accepted by the kids and are not likely to be thrown in the bin at the end of the week. Occasionally I do buy a treat, and when I do I want the real thing, not a “healthified” version.

   The Food Regulation Standing Committee (FRSC) for Australia and New Zealand has drafted a set of policy guidelines on front of pack labelling for the Ministerial Council to consider in May 2009. The draft guidelines are currently open for public consultation with comment due by 24th March. I would urge all to make comment if you have views on this matter.

   * Declaration of interest: I was part of the research team for the NZFSA research referred to in this article.
   A special thanks goes out to the many Foodtalk readers who took part in this research.