Navigating the nutriscape

Information advising us to follow restrictive diets – ranging from raw, low-fat, low-carb, low-GI, vegan, high protein, paleo, or even to eat for our ‘blood type’ – surrounds, and possibly overwhelms, us on a daily basis.

It’s advice that’s intended to make our bodies healthier, usually by making us smaller, given that Australians have joined Americans and others in the affluent developed world as among the most overweight per capita. But claims that specific nutrients or foods are responsible for weight gain or weight loss, or for chronic diseases such as diabetes and heart disease, may be creating nutrition confusion among the public, while also making us more susceptible to food industry marketing.

According to Gyorgy Scrinis from the University of Melbourne’s School of Land and Environment, an expert on the sociology and politics of nutrition and food production, the focus on nutrients within nutrition science and dietary advice, which he calls nutritionism, may have been counter-productive.

“Studying single nutrients in isolation, and out of any food or dietary context, has led to some fairly exaggerated and simplified claims about the role of these nutrients in the body. The claim that there are good and bad fats, regardless of the types of foods in which they’re contained, is an example of such a reductive interpretation of nutrients.

“This reductive focus on nutrients has also taken our eye off the ball of the quality of the foods we’re eating, by just focusing the attention of both experts and the lay public on this or that nutrient. At the same time, manufacturers come along and say, well, we can work with this, and they have been very successful at engineering the nutrient profile of foods to reflect the latest nutritional trends.”

He says food manufacturers have become expert at co-opting nutrition advice to help market products that in fact aren’t particularly healthy, such as breakfast cereals with added vitamins but containing 30 per cent sugar.  And food regulators have left the door wide open for them to do so by permitting a range of nutrient and health claims on food labels.

Dr Scrinis says the low-fat campaign that dominated the “nutriscape” in the 1980s and 1990s illustrates these points.

“There was never any really good science to support the claims made about the multiple health benefits of low-fat foods and diets. But it also led to this very simplified idea that the definition of a good or bad food was its fat content, rather than, for example, how highly processed a food might be.

“Not everyone was taken in but it allowed
 the food industry to appropriate the low-
fat discourse and re-formulate their products
  accordingly.  They then marketed these products as low-fat and ‘better for you’, even if the fat was just replaced with sugar or refined and modified starches.”

Dr Scrinis says food companies are now also starting to work with the calorie (or kilojoule), and cites a new global anti-obesity campaign by Coca-Cola in which they claim to be “part of the solution”.  By using artificial sweeteners, they can manufacture low-calorie beverages, despite the fact the quality of the ingredients in these products remains low, and their nutritional value negligible.

“The calorie, or kilojoule, is a crude way of measuring the amount of food someone’s eating, but whether telling people to eat fewer calories or introducing calorie labelling are going to be effective public health interventions is open to question,” Dr Scrinis says.

Dr Scrinis argues that the focus on good or bad nutrients by nutrition experts and food marketers has also accentuated the nutritional anxieties of the public. “The fear of bad nutrients that dominated the second half of the 20th century has now been joined by anxieties that we’re not getting enough of some of the good and supposedly health-enhancing nutrients and food components, such as omega-3 fats, antioxidants or plant sterols.

“The concern that contemporary foods and diets are deficient in these ‘functional’ nutrients encourages people to seek out nutritional supplements and nutrient-fortified processed foods.”

Dr Scrinis notes that there are other methods we can draw upon to evaluate the nutritional value of our food. In his recent book Nutritionism: The Science and Politics of Dietary Advice (Columbia University Press), he sets out what he calls the Food Quality Paradigm.

This alternative paradigm “includes appreciating the nutritional-scientific analysis of food, but also looks at other evaluative components, particularly at production and processing quality.  It also acknowledges the information we gain from our senses about food quality and from the experience of growing, preparing and consuming food, as well as from cultural and traditional knowledge of food.

“Our language for talking about the quality of processed foods is very under-developed because of the almost exclusive focus on nutrients as the key to understanding and describing food quality.”

Dr Scrinis sets out a three-level matrix for understanding the impact of processing on both food ingredients and food products.

At the apex of the three-tiered system are whole foods and ingredients, which are minimally processed or beneficially processed, and may be either fresh, or preserved or enhanced through fermentation, sprouting and cooking. Next are foods and ingredients that are refined-extracted and concentrated, and have been processed in ways that often remove some beneficial food components from whole foods, such as sugar, oils and white flour.

At the bottom of the matrix are processed-reconstituted foods and ingredients that are “broken down into their constituent components, and transformed, reconstituted, or significantly degraded during processing, preparation, and cooking”.  Foods such as margarine, highly refined and sugary breakfast cereals, and deep-fried chicken nuggets, fit into the latter category.

Dr Scrinis suggests that making such distinctions and developing our language and understanding of food processing quality – our “food quality literacy” – is now as important as enhancing our nutritional literacy. 

Nutrition and Wellbeing is a major focus of the forthcoming Festival of Ideas as well.

During the Festival, a young group of health activists has set themselves an agenda to let people know that non-communicable diseases (NCDs) such as diabetes, heart disease, cancers, lung diseases and mental illness kill more people than any other cause. 

“NCDs kill more than HIV, TB, malaria and malnutrition combined. And we’re passionate about making sure people are aware these are not diseases of laziness, but of inequity and born very often from poverty and a lack of opportunity,” Says Dr Alessandro Demaio, NCDFREE co-founder, Australian medical doctor and Postdoctoral Fellow in Global Health at Harvard Medical School and the Copenhagen School of Global Health.

“We also, importantly, want to show that much can be done – that 80 per cent of heart disease and diabetes can be prevented today. We just have to choose to make this a priority.

“Our organisation – NCDFREE – aims to redefine the global narrative for a group of misunderstood diseases – Non-Communicable Diseases. NCD are the leading cause of death, and very often are thought to be affecting only rich, old, fat, lazy men. 

“Actually, the true face of the epidemic is likely to be female, living in Asia, under 70, living in poverty and with poor access to healthcare. This disconnect between perception and reality permeates all levels of society and government – and is a barrier to investment, prevention and meaningful healthcare responses. Through the voices of young, inspiring change-makers from all over the world, working in their communities to reduce NCDs – often with very few resources – we hope to change this perception, create discussion and inspire support for addressing NCDs globally.”

NCDFREE is a completely crowd-funded organisation, which put a call out around the world, for donations to make their idea happen.

“We wanted to see if people believed in it as much as we did.”

It seems they did, because in 30 days more than $60,000 was raised. 

“Everyone is working pro bono, including our partner and co-founders at Local People design agency,” Dr Demaio says. “One of the great things about this funding drive was bringing onboard some sensational institutions that are helping us make this happen. The University of Melbourne is our launch partner here in Melbourne, which, through Professor Rob Moodie and others in the School of Global and Population Health, has given us great support.”

At the Festival of Ideas’ Saturday evening launch event, NCDFREE will be holding an interactive, and – they hope – inspiring evening symposium during which six young NCD change-makers from around the world will take to the stage at the Melbourne Convention Centre to tell their personal stories, explain why they are passionate about addressing NCDs, and make their call for action.

“The Saturday night event will also see the launching of three short films we have made this year, one in each of Mongolia and Ghana focusing on young NCD change-makers, and one that was commissioned by the UN for their Ministerial meeting in Vienna in July,” Dr Demaio says.

Like the organisation itself, the films were also crowd-sourced, from young people’s phones around the world.

And just like Dr Scrinis, Dr Demaio says as far as NCDs around the world are concerned, it’s not about one or two people making poor choices, but about improving the environment that shapes decision-making.

“We need system change. We need to rethink the way we design cities and make them conducive to health, and our healthcare system to focus on prevention and primary care. We need to reconnect with food and teach food skills to young kids. We need to take back our urban environment and stop letting it become an advertising space for food and drink companies selling us unhealthy choices. We plan to explore all of these issues and more during the Festival.”

One of the recurring themes of those exploring our relationship with food and the intersection with health is that despite the fact NCDs are connected to the resources we put into our bodies – food, drinks, tobacco and alcohol – 80 per cent of the world’s burden of NCDs now occurs in low and middle-income countries. 

“These are diseases which result from, but also result in poverty – this is why we call NCDs a poverty-cycle catalyst, Dr Demaio says. 

“Unhealthy food and beverage companies are moving more and more into these countries, but so are tobacco companies. This is in the context of a less restrictive legal and regulatory framework than we see in the developed world, but in nations with less to invest in healthcare, prevention and treatment. It is a big challenge – and some of the solution must start here in Australia. Trade and the measures we take here affect our neighbours. We also see the highest rates of diabetes and heart disease here at home, occurring in the poorest suburbs.

“To effect change here in Australia, taxation plays an important role in nudging people to make healthier choices, but it should also help fund or subsidise those healthy choices.

“Taxation on tobacco and the work by VicHealth has been a beacon in this field. In my view, unhealthy foods are too cheap and healthy foods are too expensive – particularly in rural and remote parts of Australia.”

Dr Demaio says she supports any measures which “make for a more level playing field between fresh, healthy foods and unhealthy ones.”

“It is also crucial to remember that the way we design our cities, what we teach our children in schools, the support we give parents to make healthier family choices and the accessibility of healthcare, particularly preventative care, are also crucial and part of the puzzle.”

Listen to Stephanie Alexander, Geoffrey Annison, Simran Sethi and others discuss Food and Nutrition on Thursday 3 October at the University of Melbourne’s Festival of Ideas.

www.land-environment.unimelb.edu.au

www.Ideas.unimelb.edu.au