Category Archives: nutrition

stealth sugar reduction is best!!??

“Stealth reduction for foods is the best way for manufacturers to retain their consumer base as consumers are for the most part unaware the recipe has changed – particularly as better-for-you products are less appealing due to the fact they are considered to have less flavor.”

Katharine Jenner, campaign director for Action on Sugar and CASH, told this site that the health world would recognize the strategy as “unobtrusive reductions for the betterment of health”.

“The salt reduction campaign has, however, been so successful because the salt has been unobtrusively removed, meaning customers don’t have to read the labels and make a choice to eat less salt. Our view has always been these if people don’t like their food with less salt, they can always add it back in – whereas they can’t take it out.”

http://www.foodnavigator.com/Market-Trends/Stealth-reduction-the-best-option-for-sugar-in-confectionery-Euromonitor/

‘Stealth reduction’ the best option for sugar in confectionery: Euromonitor

A spoonful of sugar less could aid public health, but might it also put consumers off? Better not to tell them, says Euromonitor

A spoonful of sugar less could aid public health, but might it also put consumers off? Better not to tell them, says Euromonitor

Confectioners should keep quiet about sugar reduction or risk irritating consumers, according to analysts at Euromonitor International.

In a recent podcast , the research organization said that it expected confectionery to be one of the main targets for calls to reduce sugar as it was widely associated with high levels among consumers.

Low-profile reduction

Lauren Bandy, ingredients analyst at Euromonitor, said: “It seems unlikely that manufacturers will launch low sugar variants again, simply because consumer demand would be low.”

She pointed to reduced sugar products launched by Cadbury’s, Kit Kat and Haribo in the UK several years ago that were pulled due to low sales.

 “Stealth reduction might be a better option for confectionery players,” she said.

Sugar in Confectionery

2.3m metric tons of sugar and bulk sweeteners were consumed in confectionery in 2013. The average consumer in Western Europe spent $120 on confectionery, equating to around 7.5 kilos of sugar, more than half of which was chocolate confectionery. Source: Euromonitor International.

Diana Cowland, health and wellness analyst at Euromonitor, added: “Stealth reduction for foods is the best way for manufacturers to retain their consumer base as consumers are for the most part unaware the recipe has changed – particularly as better-for-you products are less appealing due to the fact they are considered to have less flavor.”

Is ‘stealth reduction’ underhanded?

Sugar came under the spotlight at the start of the year after the group behind Consensus Action on Salt and Health (CASH) setup Action on Sugar, a group urging manufacturers to reduce sugar in products by 30-40% in the next three to five years.

‘Stealth’ is not a term favored by the campaign as it says it has negative connotations.  Katharine Jenner, campaign director for Action on Sugar and CASH, told this site that the health world would recognize the strategy as “unobtrusive reductions for the betterment of health”.

“In our view, it is up to manufacturers to decide how to communicate any improvements to their food, they know their customers better than we do. “

Industry View

The US National Confectionery Association (NCA) argues  that sugar is being unfairly demonized. The industry body recently said that its members would not reformulate products en mass as confections could fit into a healthy lifestyle. It aims to educate consumers how to enjoy confectionery in moderation.

“The salt reduction campaign has, however, been so successful because the salt has been unobtrusively removed, meaning customers don’t have to read the labels and make a choice to eat less salt. Our view has always been these if people don’t like their food with less salt, they can always add it back in – whereas they can’t take it out.”

Euromonitor: Better-for-you switches off most consumers

Euromonitor analyst Diana Cowland said that if the UK’s salt reduction strategies were used as a reference, then products communicating reduced content put off consumers. Reduced salt packaged food in the UK recorded a constant value compound annual growth rate (CAGR) decline of 1.8% from 2008 to 2013 – equivalent to a £7m ($11.7m) loss.

Bandy said: “The problem with removing sugar from confectionery is that it can lose its taste and texture, the factors that make the product indulgent and the ultimate reason why consumers buy confectionery in the first place.”

Katz on breast cancer

Good, solid advice on appropriate screening, prevention and detection of breast cancer.

>> check the credentials of the radiologist reviewing the films!

Can We Unmuddle Mammography?

February 20, 2014

new study of mammography, showing lack of survival benefit, has once again muddied these waters and muddled the relevant messaging. The study, generating considerable controversy, as has much prior research on the topic, looked at breast cancer mortality over a 25 year period in nearly 90,000 Canadian women assigned to mammography or usual medical care without mammography during the initial 5 years of the study period. There was no appreciable difference between groups.

Perhaps you see a major problem already. To study the effects of mammography, or any cancer screening, on mortality over time requires…time. Time goes by at its customary pace no matter the research goals. So, if it takes 25 years to get the desired data, the intervention needed to take place 25 years ago. And so, inescapably, this study is entirely blind to any advances in mammography technique, technology, or interpretation over the last 20 years at least. In medicine, two decades is just about forever.

Perhaps the value of mammography is perennially muddled- if just a bit less so than prostate cancer screening– for the most obvious of reasons. The truth is in the middle, between slam-dunk and fuhggeddaboudit. With the apparent exception of titillating (if not salacious) novels, we don’t tend to like shades of gray. But that’s where mammography falls; it’s pretty close to a toss-up.

There is a long history of research on the topic, and conclusions have been anything but consistent. Some studies suggest clear potential benefit for women who would not otherwise be screened. But, of course, women who would not be screened are apt to differ in a variety of ways from those who would- including, perhaps, their access to, and the quality of, primary medical care. Unbundling such influences is nearly impossible.

But, if, instead, you attempt to study women who would be screened anyway, how do you randomize them to a control group? What woman, inclined to get mammograms, would go without for 20 years for the sake of a clinical trial? Not very many I know.

Enrollment in a trial itself can exert an influence. Regardless of assignment to mammogram or control, there may be more attention to breast health and a greater likelihood of finding breast cancer early among all women participating in a study. This effect obscures any real world, and potentially important differences between intervention and control arms.

We are, as well, dependent on an imperfect technology. Even if finding breast cancer early through imaging is decisively beneficial, studies will produce variable results based on flawed imaging, variable performance of the same technology in different women, and variation in the quality of interpretation of mammograms. That much more so when today’s data are the product of mammography done 20 to 25 years ago. There have been improvements in scans, scanners, and the training of radiologists during that span.

And complicating things further, mammography is a source of radiation, and may be doing some direct harm as well as good.

The false positive error rate of mammography is notoriously high, and unavoidably so if we want to avoid false negatives. False positives occur when we think we’ve found cancer that isn’t there. It can be avoided by raising the bar, but then there is a risk of missing cancers that are there. We tend to favor the former error over the latter, and in the absence of perfect tests, are forced to choose.

We may have failed to translate good evidence into practice. Pre-menopausal mammography would likely be more useful if performed more than once a year. Breast cancer tends to be more aggressive and progress faster in younger women. Post-menopausal mammography might be just as useful done every other year. A one-size-fits-all approach may attenuate benefit and raise the rates of harm to both groups.

And then, perhaps most important: not all the trouble we find through screening deserves the attention it gets. Some tiny breast cancers, like the majority of prostate cancers, are destined to do nothing if just left alone. These are cases where cure is very likely to be worse than disease- but we are not good yet at differentiating. Doing so requires analysis at the level of histopathology (i.e., tissue and cell analysis), and molecular genetics. This can be done, but it’s not routine and our abilities in this space remain limited.

One very important issue routinely ignored when parsing the benefits of any cancer screening modality, mammography included, is that screening does not prevent cancer. The goal of screening is to find cancer early- which is generally much better than finding it late. But it’s not nearly as good as not getting it in the first place. The evidence is strong that optimal lifestyle practices can slash risk for all major chronic diseases, cancer included. Related evidence shows that lifestyle as medicine can modify gene expression in a manner projected to protect against cancer development, and progression. DNA is not destiny; dinner may be! There isinteresting literature on the relevant timing as well. It may be the best way to improve breast cancer in women is to focus on healthy living in childhood. That we could dramatically lower rates of cancer overall by living well across the life span is all but undisputed.

There are many reasons why decisive evidence that mammography confers net survival benefit at the population level, or that it lacks benefit and should be abandoned – is elusive. The result is something of a muddle for epidemiology. Until technology, interpretation, application, and histopathological confirmation all rise to consistently high standards, we can’t unmuddle mammography for populations.

But by combining what we know about the test with what you and your doctor know about you, a basis for a good decision should be at hand. Inquire about the technology, making sure it is state of the art. Ask about the training of the radiologist reading the film. Ask as well about plans for immediate next steps if the mammogram is abnormal. Good breast care centers follow up right away with additional testing to differentiate false from true positives. Ask whether screening has been personalized- taking into account your age, breast density, family history, and risk profile.

Evidence-based recommendations about mammography for the population at large where one size must fit all are, for now, ineluctably muddled. By personalizing the decision, as good clinical medicine always should, we can, I believe, unmuddle things for you.

-fin

Lethal but Legal

Thanks Marion. Another book to chase up…

Reading for the weekend: Lethal But Legal

Reading for the weekend: Lethal But Legal

Nick Freudenberg.  Lethal but Legal: Corporations, Consumption, and Protecting Public Health.  Oxford, 2014.

Lethal But Legal

 

I spoke last night on a panel celebrating the release of this book.  I gave it a rave blurb:

Lethal But Legal is a superb, magnificently written, courageous, and thoroughly compelling exposé of how corporations selling cigarettes, guns, cars, drugs, booze, and food and beverages enrich themselves at the expense of public health.  Even more important, Freudenberg tells us how we can organize to counter corporate power and achieve a healthier and more sustainable environment.  This book should be required reading for anyone who cares about promoting health, protecting democratic institutions, and achieving a more equitable and just society.

I will be using this one in classes.  Congratulations to Nick Freudenberg, director of Hunter College’s Food Policy Center, for producing this distinguished work of scholarship.

Partnership for a Healthier America Innovation Challenge

Nicholas Gruen put me on to this effort… so impressed to see these efforts emerge in such a can do endeavour and with the first lady giving the welcoming address.

http://govfresh.com/event/partnership-healthier-america-innovation-challenge/

Partnership for a Healthier America Innovation Challenge

Event Navigation

A gathering of business, government and non-profit visionaries, the Building a Healthier Future Summit focuses on action over talk. The PHA Innovation Challenge offers a unique opportunity to realize the event’s mission of creating bold, tangible and actionable solutions using the most powerful tool available – technology. This year, Partnership for a Healthier America (PHA) is working with The Feast to engage the most talented innovators and makers in technology and design to help solve the childhood obesity epidemic.

PHA is hosting a hackathon in the lead-up to the conference, when participants will prototype and build working solutions focused on the theme of Childhood Obesity. The hackathon will explore two opportunities within the challenge of Childhood Obesity:

  1. To help teachers empower students to make healthy choices about the food they consume, whether at home or at school.
  2. To create an information avenue that shows families the healthy food options and physical activity opportunities available locally.

PHA and The Feast are recruiting a group of the best designers, developers, stakeholders and entrepreneurs to create solutions that will help make the healthy choice the easy choice. Over two dedicated workdays the weekend prior to the Summit, participants will form teams to work on one of the two opportunities. Participants will receive support from subject matter experts and mentors in crafting their solutions while partaking in exciting activities and enjoying healthy meals. The following week, all the participating hackers will receive free admission and full access to PHA’s Building a Healthier Future Summit, with the opportunity to engage with innovators in the health sector. Two winning teams will then take the stage at Summit to present their work to an audience of 1,000 industry leaders, with one team winning an audience choice award.

PHA believes that change happens when anyone is empowered to re-imagine how something might be better and seizes the opportunity to realize that vision.

Details

Start:
End:
March 9, 2014 5:00 pm
Event Category:
Event Tags:
Website:
http://ahealthieramerica.org/summit/innovation/

Organizer

Partnership for a Healthier America
Website:
http://ahealthieramerica.org

Venue

Partnership for a Healthier America
2001 Pennsylvania Ave. NW Suite 900,Washington, DC, 20006 United States

+ Google Map

Website:
http://http://ahealthieramerica.org/

if we approached drowning like obesity, we would go looking for those genes

It is equally true that the sinking of the Titanic did not affect all passengers equally. More generally, falling into water does not affect all human beings equally. Some of us know how to swim, and some do not. Some of us can hold our breath longer than others.

==

Imagine that these pioneers were intrigued by the sea, and therefore boldly wandered in. Having no experience with matters maritime, and knowing nothing about swimming, several of them drowned. Several others nearly drowned, but managed to climb out in the nick of time.

And then imagine, rather than reaching any fundamental conclusions about the interactions of their kind with large bodies of water, these sagacious people scratched their extra-terrestrial heads and said something like (in whatever language they speak): “When we wander into that enormous puddle, some of us die and some of us don’t. Clearly, then, there must be variation in our go-forth-into-enormous-puddle genes. Let us study our genes and look for that variation so we may better understand what happened here today. Then, perhaps, we might find a way to fix the go-not-into-great-puddles-or-you-will-surely-drown genes, as those must be defective. After all, a few of us went into the big puddle and lived. Surely there must be some way for us all to have those wonderful you-will-only-almost-die-if-you-go-into-great-puddle genes. ”

==

Human beings don’t have gills, and there are genes to blame. But the right response looks like swimming lessons, and lifeguards, and fences around pools- not studying genes while pushing kids into the surf. Not a new pill to fix an age-old part of who we are that was never really broken.

 

http://www.linkedin.com/today/post/article/20140219143107-23027997-gills-pills-and-obesity-genes

Gills, Pills, and Obesity Genes

February 19, 2014

Two new studies, just published on-line in JAMA Pediatrics, may have us fired up yet again about the genetic variation to blame for obesity. But then again, is that really the problem?

One of the studies examined variation in food and satiety responses, which we may summarize as appetite, in roughly 400 pairs of 3-month-old twins in the U.K., and tracked growth and development over time. There are always lots of important details in biomedical research, but the perhaps predictable punch line was this: the babies with the heartier appetites gained the more weight.

The second study was directed at the same basic issue, but went a bit deeper. Investigators again examined the association between appetite and weight gain in a group of over 2000 twin children in the U.K., but this team included an assessment of genes associated with variation in satiety responses, essentially how much eating it takes to feel full. Once again, more appetite meant more weight gain. But this time, more genes for more appetite was identified as the real culprit.

Finally, an accompanying editorial noted the importance of this kind of genetic research because the obesigenic environment “does not affect all children equally.”

That is undeniably true. It is equally true that the sinking of the Titanic did not affect all passengers equally. More generally, falling into water does not affect all human beings equally. Some of us know how to swim, and some do not. Some of us can hold our breath longer than others.

And while there is, I am quite confident, genetic variability we could find and associate with variation in how long we can hold our breath, I am not sure how illuminating that would truly be about the risk of drowning.

Human beings are vulnerable to drowning because we don’t have gills, and the reason absolutely resides in our genes. We have Homo sapien genes that include the recipe for lungs, and exclude the recipe for gills. In contrast, blue fin tuna and guppy genes reliably include the recipe for gills and exclude the recipe for lungs. Blue fin tuna and guppies have just the kind of trouble out of water that we are prone to have in it. We don’t have gills because we aren’t fish- and fish don’t have lungs because they aren’t people. And in both cases, the reason we aren’t them and they aren’t us resides in our respective genes.

Given that, if we approached drowning like obesity, we would go looking for those genes. We would, readily, find the divergences between human and guppy genes. And we might, I suppose, declare that a genetic basis for drowning had been identified. And once genes were indicted for drowning, we could head off down the path of drug development or genetic engineering to deal with the problem.

Hold that thought, if not your breath, and let’s probe the corresponding depths.

Imagine a people on some imaginary world that lived on a great landmass, far from any body of water, evolving and adapting accordingly throughout their long history. Then imagine that, after however many eons in their native land-locked state, and for reasons we may ignore or guess at, these people set off on an excursion, and encounter the sea for the first time. They knew water, of course-because they drank it like we do; but they had never before seen any body of water larger than a puddle.

Imagine that these pioneers were intrigued by the sea, and therefore boldly wandered in. Having no experience with matters maritime, and knowing nothing about swimming, several of them drowned. Several others nearly drowned, but managed to climb out in the nick of time.

And then imagine, rather than reaching any fundamental conclusions about the interactions of their kind with large bodies of water, these sagacious people scratched their extra-terrestrial heads and said something like (in whatever language they speak): “When we wander into that enormous puddle, some of us die and some of us don’t. Clearly, then, there must be variation in our go-forth-into-enormous-puddle genes. Let us study our genes and look for that variation so we may better understand what happened here today. Then, perhaps, we might find a way to fix the go-not-into-great-puddles-or-you-will-surely-drown genes, as those must be defective. After all, a few of us went into the big puddle and lived. Surely there must be some way for us all to have those wonderful you-will-only-almost-die-if-you-go-into-great-puddle genes. ”

Gazing at these counterparts across the cosmos, they look rather like nincompoops, don’t they?

I am not refuting the value in these new studies. The editorialist very appropriately notes that early identification of genetic vulnerability to weight gain might allow for very early implementation of prevention strategies, so that obesity does not develop in the first place.

I like that- but do we really need maps of our kids’ genomes to take such action? We havepandemic childhood obesity right now-meaning legions of kids around the world are vulnerable to weight gain, whatever their genes. And yet, we routinely feed them junk. We routinely jettison physical activity from their daily routines. We peddle to them foods willfully designed to be irresistible if not addictive, and to maximize the number of calories it takes to feel full. Can we really justify the lunacy of a culture that studies genes looking for variation in satiety responses, while engineering foods to undermine satiety responses?

Yes, our genetic vulnerability to obesity is variable- much, I bet, like our genetic vulnerability to drowning. But I don’t think that invites a genetic study of the drowning victims of the Titanic. I think the bigger issue was the obvious one: the ship went down.

We are all in the same boat, and it’s sinking, too- as evidence by a global rise in bariatric surgery for ever younger children. The genes underlying vulnerability to obesity in all their variation were there a generation or two or twenty ago, too- when childhood obesity was rare. Those same genes are there now that it is rampant. Knowledge of them may be put to good use, but not if it distracts us from the sinking ship. What has changed is not within our children, but all around them. And we don’t need to wait for a genetic map of each child to fix it.

Human beings don’t have gills, and there are genes to blame. But the right response looks like swimming lessons, and lifeguards, and fences around pools- not studying genes while pushing kids into the surf. Not a new pill to fix an age-old part of who we are that was never really broken.

-fin

Brazil’s bloody brilliant dietary guidelines…

succinct. direct. honest. transparent. will never happen here…

Brazil’s new dietary guidelines: food-based!

Brazil’s new dietary guidelines: food-based!

Brazil has issued new dietary guidelines open for public comment.  For the Brazilian Dietary Guidelines document (in Portuguese), click here..

Brazilian health officials designed the guidelines to help protect against undernutrition, which is already declining sharply in Brazil, but also to prevent the health consequences of overweight and obesity, which are sharply increasing in that country.

The guidelines are remarkable in that they are based on foods that Brazilians of all social classes eat every day, and consider the social, cultural, economic and environmental implications of food choices.

The guide’s three “golden rules:”

  • Make foods and freshly prepared dishes and meals the basis of your diet.
  • Be sure oils, fats, sugar and salt are used in moderation in culinary preparations.
  • Limit the intake of ready-to-consume products and avoid those that are ultra-processed.

The ten Brazilian guidelines:

  1. Prepare meals from staple and fresh foods.
  2. Use oils, fats, sugar and salt in moderation.
  3. Limit consumption of ready-to-consume food and drink products
  4. Eat regular meals, paying attention, and in appropriate environments.
  5. Eat in company whenever possible.
  6. Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption.
  7. Develop, practice, share and enjoy your skills in food preparation and cooking.
  8. Plan your time to give meals and eating proper time and space.
  9. When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
  10. Be critical of the commercial advertisement of food products.

Now if only our Dietary Guidelines Advisory Committee would take note and do the same?

Would you like us to have sensible, unambiguous food-based guidelines like these?  You can file comments on the 2015 Dietary Guidelines here.

Thanks to Professor Carlos A. Monteiro of the Department of Nutrition, School of Public Health at the University of Sao Paulo for sending the guidelines and for their translation, and for his contribution to them.

Ice cream purchasing demographics…

Australians in the ‘Career and Kids’ category are over twice as likely as average to buy ice cream tubs or cartons weekly

These people are typically well educated, younger families working full-time and paying off their suburban homes, But they’re also worried about their finances and mortgages, paying for their kids’ private schooling and keeping up with the Joneses.”

http://www.foodnavigator-asia.com/Markets/Australians-love-of-ice-cream-is-cooling/

Australians’ love of ice cream is cooling

Post a comment11-Feb-2014

Despite having a broader choice of flavours and healthier, reduced fat product options available, Australians are now less tempted by tubs of ice cream.

In 2009, 76% of grocery buyers put ice cream in the trolley at least once in the previous 12 months. But after four consecutive years of decline, that figure is now 72%.

Just 3% of grocery buyers buy ice cream tubs at least once a week—a rate that has been consistent over the last five years. The proportion buying ice cream only every 4-6 months is also steady, at 10%.

As a result, the overall decline stems from fewer people buying ice cream fortnightly (down 2% points), monthly (down 2%) or every 2-3 months (down 1% point).

The rate of purchasing increased only for the least habitual buyers: the proportion of grocery shoppers who buy a tub less often than every six months has risen gradually from 8% since 2009, and is now 9%.

Geoffrey Smith, general manager for consumer products at Roy Morgan Research, said the decline has not been uniform across the population: “Australians in the ‘Career and Kids’ category are over twice as likely as average to buy ice cream tubs or cartons weekly.

These people are typically well educated, younger families working full-time and paying off their suburban homes, But they’re also worried about their finances and mortgages, paying for their kids’ private schooling and keeping up with the Joneses.”

lifestyle program impacts…

lifestyle program reduces weight and cuts diabetes risk…

http://www.medicalobserver.com.au/news/dramatic-impact-from-450-lifestyle-program

Dramatic impact from $450 lifestyle program

18th Feb 2014

Catherine Hanrahan   all articles by this author

MASS action program on diabetes appears to inspire weight loss among participants.

A landmark US diabetes prevention trial has shown that individuals who lost around 7% of their body weight reduced their diabetes risk by 58%.

Achieving these goals in the real world is another matter, yet a Victorian study has shown that a large-scale systematic diabetes prevention program can significantly reduce diabetes risk.

The Life! Taking Action on Diabetes program used 300 trained facilitators to give advice to around 8500 people at risk of diabetes in six group sessions over eight months.

Participants lost an average 2.4kg and reduced their waist circumference by 3.8cm, representing about 2.7% of their starting body weight, which extrapolates to a 21—39% reduced risk of diabetes.

Lead investigator Professor James Dunbar, director of the Greater Green Triangle University Department of Rural Health at Flinders and Deakin universities, says it’s a significant improvement. “One of the great myths is you have to lose a lot of weight,” he says. “Actually the first 3kg is what makes the big difference.”

Professor Dunbar says Life! lacked Medicare funding for cholesterol measurements at three months, but the pilot trial, which did include cholesterol measurements, showed that the protocol also reduced cardiovascular risk by 16%.

He says the key to the success of the program, which cost approximately $450 per participant, was using behavioural change theories pioneered in a Finnish diabetes prevention study.

The Health Action Process Approach model encourages participants to use problem-solving and goal-setting to change their diet and activity.

“The facilitators are trained to get participants to make changes for themselves about what they are going to do rather than pumping facts and figures at them,” Professor Dunbar says.

He says Life! was designed for GPs — who don’t have time to coach their patients to lose weight — to refer to the program.

While Life! does not have long-term data, participants in the pilot have been followed for 30 months and diabetes risk reduction is being maintained.

Professor Dunbar says the Finnish program, from which Life! was derived, showed that diabetes risk was reduced by 37% even after 13 years.

“So even though people start to put on weight again and slip in their habits, the reduction in risk of progression of diabetes is dramatically reduced,” he says.

Professor Dunbar says Diabetes Australia aims to roll out the Life! program Australia-wide.

Diabetes Care 2013; online 6 Dec

UoW on Big Food battle

Haven’t heard of Samantha Thomas before… could be worth speaking to regarding the riot project.

http://thehoopla.com.au/big-food-fight/

BIG FOOD FIGHT

By Samantha Thomas

February 18, 2014

It is said that a powerful industry can sell anything to anyone.

And indeed, industry has profited greatly from its role in some of the most serious public health problems in modern times – smoking, obesity, alcohol and gambling to name but a few.

Public health advocates have argued that industry should have a very limited role (if at all) in health policy decisions about their products. Decisions to reform products may improve the health of communities, but may also impact on the profits of the companies that sell them.

In 2013, the Director General of the World Health Organisation Margaret Cho outlined that our efforts to prevent non-communicable diseases such as obesity certainly go against the business interests of powerful corporations:

 “… it is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics.

Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt.

Tactics also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public. They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.”

fiona-nashImage via The Australian

In Australia, we have seen the might of these powerful industries at first hand. Tobacco successfully lobbied governments for decades. And when gambling reform was touted by Andrew Wilkie, Australia’s major political parties literally ‘hit the jackpot’.

The tactics of junk food industries are no exception.

Until recently there has been very limited government level agreement about how to make Big Food accountable for the way in which they present information about their products to the community.

We know that marketing is an essential component in the way in which the junk food industry sells food that is energy dense and nutrition poor.  We also know that people struggle to read nutrition labels that are often complex and buried on the back or side panels of brightly coloured packets that highlight the ‘good’ aspects of their products and minimise the ‘bad’.

I also doubt if there are many mums or dads who inspect and understand the nutritional labelling on every single product as they drag the kids round the supermarket.

I don’t know about you but I’m just racing around the aisles as quickly as I can to avoid getting into long debates with my kids about why they can’t have the chips or lollies that have been so conveniently placed at child height on the shelves.

Hang on kids… can you just stand there quietly while mummy tries to decipher the Daily Intake Guide? I don’t think so.

Yet most people do understand that the nutritional content of food is important. They want clearer, easy to read information that allows them to make better choices for themselves and their families.

health-star-ratingThis is why the Health Star system is so important. Taken down by Assistant Health Minister Fiona Nash after only a few hours of operation, the website enabled consumers to make choices based on information about the total nutritional content of foods. It has become the source of an ongoing conflict-of-interest controversy, following the resignation of Nash’s chief-of-staff Alistair Furnival, who has links to the junk food industry.

The Health Star website showed a clear ‘five star’ rating system – based on the calculation of sugar, salt and saturated fat.

The higher the star rating, the healthier the product.

So when I’m faced with a choice of two similar cereals I can easily see which one is ‘healthier’ to put in front of my kids in the morning.

Perhaps more importantly it sends a message to industry to improve the content of their products.

Purchasing more 5 star products, and fewer 1 star products, sends a very clear message to industries that we want them to improve the content of their foods.

Effective?

The reported amount of opposition to the scheme by some sectors of the food industry is perhaps an indication that it would have been.

Efforts to improve the health of our communities will not be about how many people tune into the Biggest Loser.

It will be about how we comprehensively tackle the tactics of junk food industry.

And in the case of Health Star it is clearly about how we hold our Federal Government to account too.

Samantha-Thomas

Samantha Thomas is an associate professor at the School of  Health And Society , University of Wollongong.  She specialises in risk behaviours, social marketing campaign and understanding the impact of advertising on health and social behaviours. You can find her on Twitter @doc_samantha.

Could this be Jane Hall be arguing against prevention..?

Haven’t seen this before – a rational argument against prevention based on its difficult to quantify, long-term, positive impacts impacts on life extension. OMG. And while she’s at it, also suggesting that personal responsibility is the issue. Top work. Go Jane.

But systems research from the 1970s shows while that may well be the case, prevention often increases costs because it must be directed toward large groups, if not the whole population, while treatment is targeted at relatively few.

What’s more, not all preventive strategies are cheap, and their success will be reflected in a growing elderly population.

 

http://theconversation.com/commission-of-audit-should-know-costs-but-appreciate-value-21534

Commission of Audit should know costs but appreciate value
Four of the five members of the Commission of Audit during a Senate hearing at Parliament House in January. AAP Image/Lukas Coch

The Senate Select Committee into the Commission of Audit is holding its third Hearing in Canberra today. Witnesses include the Consumers Health Forum and Australian Health and Hospitals Association, so health is clearly the order of the day.

Instituted by the Abbott government soon after it came to power, the Commission is charged with finding savings by eliminating waste and duplication of functions, and the consolidation of Commonwealth agencies. And the Australian National Preventive Health Agency(ANPHA) is widely held to be an easy target for it.

The agency was established as part of the raft of reforms under the 2011 National Health Reform Agreement, to lead in preventive health through surveillance and monitoring, policy advice, national social media campaigns, and by sponsoring research.

Eliminating the ANPHA would, of course, look like a positive contribution to the savings and agency reductions needed to justify the Commission of Audit. But the 40 or so ANPHA staff will not contribute significantly to the Commission’s targeted reduction of 12,000 public servants.

But let’s assume the Commission is less concerned with justifying its own existence and more focussed on the wise investment of government resources (that’s our taxes). In that case, there are a number of issues it should bear in mind.

Neither easy nor quick

The goal for the ANPHA is to reduce the prevalence of preventable disease. According to the Australian Institute for Health and Welfare (AIHW), 32% of the current national burden of disease is due to preventable risk factors. And that’s set to grow with rising national levels of obesity and falling fitness.

One could say preventable disease is a big target, so it shouldn’t be that hard to make an impact. Unfortunately, what’s preventable in theory is not so preventable in practice.

Take one of the top risk factors of preventable disease according to the AIHW – intimate partner violence. It’s one thing to say there’s a significant national burden of injury and disease due to violence in relationships; it’s quite another to actually stop the dominant partner acting violently.

Much the same applies to obesity, lack of physical activity and poor diets. To paraphrase Shakespeare’s Brutus from Julius Caesar (I,ii, 140-141):

the fault lies not in our health system. But in ourselves…

In many areas, Australia has done well in reducing the prevalence of preventable disease and, to some extent, that’s now reflected in our improving life expectancy and expected life years without disease or disability.

Clearly, action on prevention didn’t start in 2011 with the establishment of ANPHA; the 2008 COAG National Partnership Agreement on Preventive Health committed A$872m over six years, which is a pretty serious investment.

The problem is the payoff period for such action is long – it takes a lifetime of good habits to enjoy their health consequences. Investment and performance in one period will influence performance in later periods.

The issue for the Commission, then, is what value has been added by the existence of a national agency, and how can that be judged when it’s barely three years old.

Better than cure?

Recent inquiries and reviews, such as the National Health and Hospitals Reform Commission and the Preventative Health Taskforce have made the case for stronger investment in prevention, as they have in other developed countries, including the United Kingdom and the United States. And in much policy development, there’s an implicit view that “prevention is better and cheaper than cure”.

But systems research from the 1970s shows while that may well be the case, prevention often increases costs because it must be directed toward large groups, if not the whole population, while treatment is targeted at relatively few.

What’s more, not all preventive strategies are cheap, and their success will be reflected in a growing elderly population.

The policy issue then isn’t whether there should be more investment in reducing preventable disease, but which programs are “good buys” when considering both effectiveness and cost. And effectiveness must reflect the very human goals of adding years to life and life to years.

Both the National Health and Hospitals Reform Commission and the Preventative Health Taskforce recommended that preventive strategies be subject to economic evaluation in much the same way that new medical procedures and pharmaceuticals are.

But the evaluation of broad-scale prevention is more challenging than therapeutic interventions. There are significant issues around which benefits to select for evaluation and what value to assign them, and modelling risk factors with multiple effects (on several diseases), as well as modelling the multiple risk factors for many chronic diseases.

So it’s not clear that the guidelines that have served so well for appraising immediate treatment effects will work as well for long-term preventative programs.

Things to keep in mind

The Commission’s terms of reference stress that its role is to find efficiencies and savings that will reduce duplication and improve the budget position. For this, it’s important to remember that Commonwealth doesn’t equal national; this country has six state and two territory governments, as well as the Commonwealth government.

Successful public health campaigns require political agreement, sufficient funding and national campaigns backed by local initiatives and action. The Commission must distinguish complementary efforts from duplication.

The Commission’s terms of reference also mention the need to improve value for money – it would do well to remember that while knowing the cost of agencies and programs is simple, appreciating their value is considerably more complex.