Good food=Good health: making it add up

Image: Hawkesbury Council

A healthy diet is fundamental to good health, acknowledges the latest Australian Dietary Guidelines prepared by the National Health and Medical Research Council (NHMRC) this week. Based on a stringent review of over 55,000 scientific publications, the guidelines update and strengthen the evidence from the previous 2003 dietary guidelines. Primarily aimed at health professionals, the key recommendations of the guidelines are:

• Eat a variety of nutritious foods from the 5 key food groups (vegetables, fruit, grains, lean meats and nuts, low-fat dairy) to meet your energy needs
• Limit intake of foods containing saturated fat, added salt, added sugars and alcohol
• Encourage and support breastfeeding
• Prepare and store food safely

Notably, the NHMRC acknowledges in the accompanying press release, the growing evidence that the increasing prevalence of overweight and obesity is being driven—at least partly—by the replacement of healthy, nutritious foods with energy dense foods with poor nutritional value.

Of note, the new guidelines strengthen the advice around consumption of added sugars and saturated fats. The advice is to ‘limit’ the intake of added sugars and foods high in saturated fats (such as butter, processed meat, fried foods, coconut and palm oil) replacing these with ‘healthier’ unsaturated fats (such as low-fat dairy, nuts, lean meat and oils such as sunflower). The advice to limit sugar, which includes specific advice to limit intake of soft drinks, reflects the growing evidence linking added sugar consumption to excess weight gain (see this previous Flagpost outlining some of this evidence). While many have welcomed the new guidelines, particularly public health advocates and nutritionists, some, such as the Australian Food and Grocery Council had argued against advice limiting fats and sugars when a draft guideline was released for comment last year.

Whether these new guidelines will be sufficient to change our poor dietary habits remains unclear. The NHMRC notes that adherence to previous national dietary recommendations is poor. A 1995 national nutrition survey (the latest conducted) found inadequate intake of healthy foods, while intake of saturated fat, sugar and salt exceeded recommendations. Since then, rates of overweight and obesity have risen, along with the risk factors for a number of chronic and preventable diseases, such as diabetes. If these trends continue (and a new national nutrition survey currently being undertaken should confirm this) the NHMRC warns that 83 per cent of men and 70 per cent of women will be either overweight or obese, with flow-on effects in mortality, morbidity and health system costs.

Barriers to adherence may include the availability and affordability of food, poor communication and understanding of nutritional advice, low levels of food literacy, high levels of food insecurity (including the inability to access adequate amounts of nutritious, culturally acceptable foods), conflicting messages from advertising around energy-dense but nutrient poor foods, and personal preferences.

However, there is also a growing body of evidence that healthy foods are becoming more expensive and out of reach for those on low incomes. Food with high nutritional value, such as meat, fruit and vegetables can cost more than food with lower nutritional value but higher energy density, such as sweets and salted snacks. The NHMRC notes that between 2000 and 2006 the Consumer Price Index (CPI) for all food in Brisbane increased by 32.5 per cent while the cost of a standard basket of healthy food increased approximately 50 per cent. They point to an Australian study which found that nutritious food costs ate up 40 per cent of a welfare-dependent family’s income, compared to 20 per cent for a family on an average income. All this suggests that achieving and maintaining a healthy diet is not simply a matter of personal choice—socio-economic factors play a major part.

Of key importance to the effectiveness of these guidelines will be translating the evidence and guidelines into meaningful and easily understood advice to consumers. Advice on meal planning is already provided on the eatforhealth.gov.au website, with a range of further consumer information promised soon. But addressing issues around health literacy (particularly food labelling, as this other Flagpost notes), combating conflicting messages from relentless advertising of high density foods, improving affordability of and access to healthy food options and improving food security, particularly among low income and other disadvantaged groups such as Aboriginal and Torres Strait Islanders, remain key challenges.