Changing eating patterns versus adding nutrients to processed foods
Rosemary A Stanton
Med J Aust 2016; 204 (11): 398
Food-based dietary guidelines are necessary but the processed food industry prefers to concentrate on individual nutrients
Excess weight affects 70% of men, 56% of women and 25% of children in Australia,1 increasing the risk of type 2 diabetes, cardiovascular disease, some common cancers and musculoskeletal problems.
Genetic factors have an influence in obesity, but sedentary lifestyle and our eating patterns also contribute to the national girth. We move less and eat more, especially discretionary (junk) foods which now constitute 35% of adults’ and over 40% of children’s kilojoule intake.2 Plates, bowls, glasses and cups are bigger and contribute to greater consumption.3,4 Supermarkets and food outlets have extended hours. Eating home-cooked meals at the family table is often replaced with snacks and convenience foods, and children’s lunchboxes usually contain junk food “treats”.
There is no evidence that adding nutrients to poor food choices will fix this situation. In keeping with the World Health Organization recommendations since 1995,5 Australia’s 2013 dietary guidelines were based on evidence about whole foods rather than individual nutrients.2 This approach is not popular with the food industry, which opposes suggestions that we should eat less of any food,6 and prefers to improve diet quality by adding nutrients. This results in an increasing range of highly processed foods with added vitamins, minerals, protein concentrates, omega-3 fatty acids, prebiotics and probiotics, and various phytonutrients. Such foods cannot make up for the fact that just 5.5% of Australians have an adequate usual intake of vegetables and fruit,7 and most consume less than half the recommended quantity of wholegrains.2
The food industry does not necessarily object to the “eat less” advice applied to nutrients. Messages to consume less fat led to profitable low-fat foods. These have little value for weight control when the fat is replaced with sugar and refined starches. There is an industry backlash about reducing sugar (always one of Australia’s dietary guidelines), but innovative companies are producing high-fat, low-sugar products. However, there is no evidence that they help with weight control.
A nutrient-centred approach also suits supplement makers. Whole supermarket aisles are now piled with pills and powders containing nutrients and herbal concoctions in various combinations for different ages and stages of life. These products are also providing a profitable export market and many are also sold by gyms, fitness centres and pharmacies, often with endorsement from celebrity and sports stars. Again, there is no evidence that they assist with weight control.
Nutrient-enriched foods will not solve Australia’s weight problem. Adding vitamins and minerals to sugary cereals or chocolate-flavoured powders to stir into milk or sprinkle over ice cream is worse than useless. The subtle message accompanying such products is that it is safe to eat more. Messages to eat less go against the grain with those whose profits depend on us consuming more. Nutrient supplements are also problematic when advertised or used to balance a poor diet.
Food-based guidelines recommend whole foods and provide advice about which foods to restrict. They also provide guidance on cooking and eating patterns, and sustainable use of resources, including agricultural factors involved in production of livestock and crops for food and animal fodder. Highly processed foods do not fit well with food-based dietary guidelines. However, such foods, and the demise of more traditional cultural eating patterns, have accompanied the increasing incidence and prevalence of obesity.6
Worldwide, nutritionists are recommending changes in eating patterns rather than nutrient-enriched processed foods. In the United States, an advisory report on the 2015 dietary guidelines recommended a dietary pattern rich in vegetables, fruit, whole grains, seafood, legumes and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and beverages and refined grains.8 It also reported that a diet higher in plant foods and lower in calories and animal foods was associated with less environmental impact than the current US diet. Critics reacted. The US Congress passed a bill ensuring that sustainability issues were dropped. In 2016, the final guidelines did give more emphasis to eating patterns and reiterated the WHO call to limit sugar,9,10 but recommendations encouraging a more plant-based diet, opposed by meat producers, were ignored. The advisory committee’s call to limit exposure and marketing of foods and beverages high in added sugars and sodium was also dropped.8
The Nordic countries also emphasise the need to change eating patterns,11 and Brazil’s guidelines set a new bar.12 The Brazilian advice is to base the diet on natural or minimally processed foods; limit intake of processed foods and avoid those that are ultra-processed; eat regularly and carefully in appropriate environments (in company where possible); avoid fast food chains; and be wary of advertising and marketing.12 Following such direct guidelines could reduce consumption of junk food and help solve our obesity crisis.
Trying to fix poor food choices by adding extra nutrients avoids the real problem.