Choice and healthy eating

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Choice and healthy eating

• Geof Rayner PhD FFPH
• Visiting Research Fellow
• City University
• GR Associates public health consultancy
• Geof_at_GRAssociates.net

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This presentation

• Asks why making healthy choices is so difficult
  when society is richer than ever before. Suggests
  that food problems are not just about food.
• Proposes that consumer marketplace leads to
  paradoxes of food choice
• Says that obesity is the visible indictor of a
  general social problem made into a medical
  problem
• Examines what has been called by Popkin the
  Nutrition Transition one of the best
  explanatory models of what is happening to diet
  and nutrition
• Considers briefly - the strategy developed in
  the white paper
• Examines what could be done in the public sector
  right now .

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Why is making healthy choices so difficult?
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Why are Ben and Jerrys icecream, ciggies, booze,
chocolate, etc so difficult to resist?
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Why are we producing fewer apples? Why are they
expensive?
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Question How do you attract the attention of
someone with a weight problem?
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The Obesity crisis.. For cats
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Inserting brands into the minds of children
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The power of brands
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Linking one brand to another
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Linking one brand to another
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The Hastings Report (FSA)

• there is a lot of food advertising to children
• the advertised diet is less healthy than the
  recommended one
• children enjoy and engage with food promotion
• food promotion is having an effect, particularly
  on childrens preferences, purchase behaviour and
  consumption
• this effect is independent of other factors and
  operates at both a brand and category level.

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Ads the public view
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Ofcoms view

• Ofcoms view is that it does not believe a total
  ban on food advertising to children would be
  proportionate or effective.
• But evidence points the need to do something..

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Can we really choose?

• .. There may be no sharp line between behaviour
  that is a matter of free choice that implies
  personal responsibility for the consequences and
  behaviour or outcomes that are due to inherent
  qualities over which the individual has no
  control.
• Jeff Strnad, Conceptualizing the Fat Tax The
  Role of Food Taxes in Developed Economies,
  Stanford Law School, July 2004

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Food paradoxes

• Enormous subsidy for food production/ no
  assessment of subsidies in terms of health impact
• Massive choice of the unhealthy foods/ Too
  little choice of the healthy foods, particularly
  for some of us
• High consumption on ready prepared foods/ Too
  little (domestic) production and consumption of
  fresh foods
• Massive propaganda for unhealthy foods/ Limited
  promotion of healthier range of foods or healthy
  food cultures

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Paradoxes of our food choices .. A little list

• Unhealthy foods are cheap/Healthy foods not cheap
  enough
• Too many cooks on television/ Not enough cooks in
  the home
• Food industry informs about diet and fitness (FDF
  Manifesto) /less eager to change products or
  marketing
• Lots of talk around healthy diet for children
  (improving school meals)/Less action to create a
  healthy diet for children or protect children
  from food chain
• Public sector major purchaser of, and setting
  for, food/ limited awareness as promoter of
  healthy food/healthy choices
• Citizens are referred to as choosers or
  consumers/ we are not referred to as producers
  of health

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Why are cheap calories so difficult to resist?

• Effectiveness of advertising/marketing
• Pervasiveness of snacking opportunities go to
  any WHS on any mainline station
• Bounded rationality based on incomplete
  information
• Cognitive errors linked to intertemporal choice
• Income energy dense foods are cheap
• Opportunity they are everywhere
• Power consumerism is felt to be an expression
  of our personal power

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•  
• The triumph of advertising in the culture
  industry is that consumers feel compelled to buy
  and use its products even though they see through
  them.
•  
• Theodor Adorno and Max Horkheimer. Dialetic of
  the Enlightenment (1944)

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US and worldwide ad spend
Universal McCann 2004
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Obesity converting social and economic trends
into medical problems
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Weight gain a simple descriptive model
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Obesity rising across OECD countries but
centred so far on Americas and Europe
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Over consumption (USA) and underconsumption (LDCs)

• Average US adult male consumes 154 of RDA for
  protein (97gms vs RDA of 63)
• Average US adult female consumes 127
• Average American derives 67 of protein from
  animal sources compared to 34 worldwide
• WHO estimates more than 230 million (40) of LDC
  children are stunted
• WHO also suggests that obesogenic factors in
  developed countries are taking root globally,
  even in LDCs

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Impact in USA

• Forty-year-old female nonsmokers lost 3.3
  years and 40-year-old male nonsmokers lost 3.1
  years of life expectancy because of overweight.
  Forty-year-old female nonsmokers lost 7.1 years
  and 40-year-old male nonsmokers lost 5.8 years
  because of obesity. When linked with another
  serious disease precursor, cigarette smoking,
  years of lost life doubled. Obese female smokers
  lost 13.3 years and obese male smokers lost 13.7
  years compared with normal-weight nonsmokers.

Peeters, A., et al., Obesity in Adulthood and Its
Consequences for Life Expectancy A Life-Table
Analysis. Ann Intern Med, 2003. 138(1) p. 24-32.
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But .. obesity is not an inevitable result of
economic growth
Worlds five largest economies
11999 data 2 2001 data 3 2000 data
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But.. We appear to be following America
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The Nutrition Transition
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A snapshot of the nutrition transition.. fast
foods vs pre-agrarian diet
Trenton G. Smith, Ph.D. University of Bonn, June
2003
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Explanation for national/subnational differences
found in differential impact of obesogenic
drivers

• Economic transitions
• Dietary transitions
• Lifestyle and cultural transitions.
• Overlapping to form the Nutrition Transition
  (Popkin)
• Plus - genetic, social class, employment, ethnic,
  and age-related vulnerabilities

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Nutrition Transition

• Shift from domestic food production and
  preparation to industrialised food production,
  preparation and distribution
• Food overproduction and falling commodity prices
• High levels of food sector subsidy (US and EU)
• Emergence of strong international brands among
  obesogenic foods/drinks biggest world brand
  is a carbonated sugary drink

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Nutrition Transition

• Emergence of international brands biggest world
  brand is a carbonated sugary drink
• Time poor domestic economy linked to
  outsourcing of domestic food preparation
• Physically active occupations replaced by
  sedentary occupations
• Sport recomposed as entertainment via
  commercialisation and linked to food marketing

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Nutrition Transition

• Marketing focused on energy dense foods which
  have limited satiation but are high in calories
  (eg Snickers bar has more calories than a meal of
  steak and vegetables)
• Time poor domestic economy linked to
  outsourcing of domestic food preparation
• Physically active occupations replaced by
  sedentary occupations
• Sport recomposed as entertainment via
  commercialisation and linked to food marketing

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European food subsidies

• Over production of some foods
• Production of less healthy or dangerous products
• Underproduction of healthier range of products

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A key element of the Transition the cheapening
of fat and sugar

• In 2000, the CAP spent 32.6 billion in
  production subsidies, equal to just under half
  the entire EU budget
• CAP results in over production of less healthy
  food constituents examples being sugar and fat
• Underproduction - and underconsumption - of
  healthier range of products which receive no
  subsidy (e.g. apples). 60 of Euro FV imported
• In 2000 food share of EU household budget 15
  compared with 30 in 1960

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One consequence of CAP EU sugar exports
Source Oxfam 2004
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US example sugar
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US example soft drinks
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US example food costs home and away
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The McBreakfast
Coca Cola Carbonated water, sugar/glucose-fructos
e, caramel colour, phosphoric acid, natural
flavours (vegetable source), caffeine. 310
calories. McGriddle - 33 gms of fat, 260
milligrams of cholesterol, and 550 calories, 1250
gms salt (bacon, egg, sausage, processed cheese,
between two pancakes soaked in sugar syrup) Hash
Browns (2 oz) 10 gms total fat, 5 gms sat fat
350 mg salt, 134 calories (potatoes, a blend of
partially hydrogenated beef tallow and cottonseed
oil, corn starch, salt, corn flour, dextrose,
sodium acid pyrophosphate (added to preserve
natural colour), spices and cooked in an A/V
shortening blend. (Source McDonalds Corporation)
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The public view concern and confusion
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Will the white paper fix the problem?
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Prime objective

• Halting the growth in childhood obesity is our
  prime objective. We have set a national target to
  halt, by 2010, the year on year increase in
  obesity among children under 11 in the context of
  a broader strategy to tackle obesity in the
  population as a whole. This objective will be
  shared jointly by the government departments with
  responsibility for health, education and sport.
•  

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INTRODUCTION

• Health is inextricably linked to the way people
  live their lives and the opportunities available
  to choose health in the communities where they
  live. This White Paper is about making a
  difference to the choices people make.

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CONCLUSION

• Meeting the new health challenges of the 21st
  century will need a step change in action.
  These arrangements reflect the need for
  Government, communities and
• individuals to taken seriously their respective
• responsibilities for health

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On advertising to kids

• In line with the research conclusions and the
  responses to the consultation, the Government
  considers there is a strong case for action to
  restrict further the advertising and promotion to
  children of those foods and drinks that are high
  in fat, salt and sugar

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What should be done now, right now?
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Getting the social marketing right
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A quick win Change the face of the public sector

• Audit provision, culture, belief to employees
  and users of services
• Change the environment of choice not just the
  ideas in peoples heads. Smoking campaigning
  shows the way.
• Use the White Paper to draw the environment of
  food to peoples attention
• People understand the need to protect children.
  Highlight these examples first
• If you feel intimidated by power system get
  NGOs and public to raise the questions.

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Health promoting NHS?
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Health promoting NHS?
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Health promoting (Council) Leisure centre?
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Health promoting NHS?
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Health promoting social services/housing
department?
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The health promoting school?
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The health promoting celebrity?
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The health promoting Department of Health?
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Thanks!

• Geof Rayner PhD FFPH
• City University GRAssociates Geof_at_GRAssociates.n
  et