Misguided approach to diets

The public are the losers in the foolhardy fat fight among public health experts and campaigners, says Nick Hughes.

Making healthy food choices is hard enough at the best of times, such is the onslaught of messaging imploring us to choose one product over another. But when even public health professionals can’t agree on the most basic of nutritional guidance you can forgive the public for giving up and going home to phone their local takeaway.

Make no mistake: the big losers from the unseemly row between the newly established Public Health Collaboration and Public Health England over the role of fat in the diet are members of the public who have to navigate their way through another bombardment of sensationalist (and in some cases deliberately disingenuous) headlines.

“Get fat to get fit”, declared the Sun; “Eat more fat to stay healthy”, screamed the Daily Express. Even the Telegraph couldn’t resist wading in with an overblown “Eat fat to get thin” headline of its own.

Whatever the validity of the argument that current national dietary guidelines, in their demonisation of fat and promotion of low-fat alternatives, have been fuelling the obesity epidemic for years, the result of the Public Health Collaboration’s controversial report has simply been to add a further barrier to the effective communication of dietary information to the public.

The tabloid press in particular has form for reporting the latest piece of dietary research as fact without putting it in the context of the whole weight of evidence. Bacon, red wine and chocolate are just a handful of products that are regularly subjected to hysterical and contradictory headlines. But public health professionals who choose to fight their battles through the medium of national newspapers must take their fair share of the blame for the confusion and apathy that such headlines engender among the population at large.

While it’s legitimate for doctors and academics to disagree, it serves nobody’s interests for their disagreements to be played out in the full media glare, particularly when the research conflicts with dietary advice that has only just been updated and disseminated. To be genuinely acting in the interests of the public, health professionals should do their utmost to publicly present a united front and do their squabbling and horse-trading behind closed doors.

One of the saddest facets of the whole episode is that the row over fat has obscured areas where both the Public Health Collaboration and Public Health England agree – for example, that fruit and vegetables should account for the bulk of the diet. In a country that gets nowhere close to hitting its five-a-day fruit and veg target, we should be shouting such advice from the rooftops.

As it is, the public are left scratching their heads wondering whether they can have that second slice of cheese on their burger after all.

A postscript to the row is that elsewhere in the world, countries such as Sweden, Germany and Brazil are looking ahead to future food system challenges by incorporating sustainability into their dietary guidelines (see “Flying the flag for sustainability”). In the context of such progressive thinking, the UK’s obsessive wrangling over individual nutrients seems even more foolhardy and backward.

Flying the flag for sustainability

Just four countries – Sweden, Germany, Qatar and Brazil – out of 215 include sustainability criteria in their dietary guidelines, according to new research published in May by the UN’s Food and Agriculture Organisation (FAO) and the University of Oxford’s Food Climate Research Network (FCRN).

This is a “missed opportunity”, noted the authors of “Plates, Pyramids, Planet”, given “ample evidence” showing that a healthy diet tends to be a green one too. The UK is amongst those struggling to put the two together.

Indeed, the latest iteration of dietary guidelines, the Eatwell Guide (see main story) has a lower environmental impact than its predecessor, the Eatwell Plate, and a far lower one than current consumption patterns. But analysis by the Carbon Trust shows it won’t take us anywhere near the kinds of greenhouse gas cuts required to meet the commitments within the Climate Change Act.

“Progress on healthy sustainable diets “has been intermittent and there has been a lack of continuity related to changes in government”, the authors noted in a section focused on the UK, as they highlighted how specialists groups have been formed and dissolved at an alarming rate.

The Sustainable Development Commission and the Council of Food Policy Advisors were both dissolved in 2010, while the Green Food Project initiated by the coalition government has disappeared without trace.

The GFP offered a glimmer of hope (as reported by Footprint). A lot
of the focus during the working groups was on meat consumption
– whether we should be looking at all meats and how to phrase the change needed, “moderation” or “reduction”. Perhaps the whole thing is too controversial? From the outset, DEFRA pitched its role firmly as “enabler” rather than “owner” of the principles that emerged (one of which was to moderate meat intake).

FCRN’s experts picked up similar ambiguity even in the four pioneers of food-based dietary guidelines. The advice given on meat often lacks specificity,” they noted.

Sweden is one country that has taken things to another level, however. Its April 2015 update embraces environmental considerations from
the outset, said FCRN, highlighting this statement: “What you eat isn’t just important to your own personal wellbeing; it’s important to the environment as well.”

And then there’s the detail. The Swedish National Food Agency (NFA) sets out nine themes and for each there are recommended actions, ways to achieve them, and then the health and environmental implications.

The advice ends with a “one minute advice” section, but there’s plenty of detail too, with the NFA even tackling some of the more nuanced advice, including the “positive environmental impacts of free range beef and lamb” and the lower environmental impact of high fibre vegetables compared to salad greens.

The intention is to track any changes in consumption that come from the guidelines, but this will be far from easy or conclusive. Indeed, food-based dietary guidelines are just a first baby step – an official perspective of what “good diets look like”, said FCRN’s Tara Garnett.

“No one in their right mind would say that once you have the guidelines in place, problem solved. But they have a role to play in providing a statement of intent – a vision of what ‘good’ looks like – which should then inform subsequent policies and actions,” she explained.

Indeed, to have a real impact on food consumption patterns the guidelines must have clear links to food policies that are actually implemented, such as school and hospital meals, public procurement, advertising regulations and industry standards.

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