Why did healthy eating get so complicated?

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Why did healthy eating get so complicated?

Why has eating well become such as minefield?

Healthy eating has become a tricky little fellow over the years, but the basic messaging has not changed over the last few decades.  Eat more fruit and vegetables, choose wholegrain foods, choose low fat dairy foods, eat oily fish and opt for lean proteins are a few of the key messages.

Alongside this we are advised to eat less sugar and processed foods while also paying attention to the portion size of foods we choose to eat.  If you stick by these basic concepts, then you are likely to be eating in a way that will benefit your health and reduce the risk of disease.

“Only 30% of adults in the UK eat 5-a-day and only 4% of women and 9% of men achieve the recommended 30g of fibre daily according the NDNS survey”

Despite this simple messaging the majority of the population still don’t manage to eat a healthy balanced diet and are confused about what to eat.  There are also many other factors which influence food choice such as those relating to society, lifestyle, psychology, environment, food access and finances.

How has the food industry and modern culture impacted on food choice?

These basic healthy eating messages have been around long enough for most people to understand what a healthy plate of food looks like while also recognising that a piece of fruit or yoghurt is a better option than a mars bar if you fancy a snack. However, the way food is marketed and how health is interpreted in the media have likely caused some confusion.

The obesogenic environment

The obesogenic environment does not make it easy for people to make healthy food choices.  This concept was fist coined in the 1990’s as a hypothesis to help explain the obesity pandemic.

“The obesogenic environment is defined by the influence that the surroundings, opportunities or conditions have on promoting obesity on individuals or populations”

In 2007 the Government’s Foresight report was published and one of the highlights was the monumentally complex obesity system map. This map illustrates the many factors that contribute to energy balance including psychology, food production, food consumption, physiology, physical activity and physical activity environments (1).

Fast food

Yes, the crux of weight gain is eating less and moving more but you only have to take a look at this diagram to appreciate the many complexities involved in order for people to achieve this ideal (see below).

Foresight report

The complexities of this diagram highlight the fact that we all need to work together to help improve the health of the nation.  While the food industry has become much more transparent in their marketing of foods which is driven by legislation around health claims and food labelling,  supermarkets and other high street outlets are still offering promotions on unhealthy foods more than they are healthy food options.

How have our eating patterns and habits changed?

Modern eating habits have changed and one the most significant is our penchant for snacking.  In part this has been driven by the food industry and an ever-growing number of snacks made available to us.  Many of these snacks are marketed as being healthy or having a health benefit which implies, they should be a part of our daily diet.

“More than two thirds of people snack at least once a day according to Mintel who also predict that snacking will become more pertinent post COVID-19″

However, the reality is that snacking is only beneficial when we need more energy throughout the day to match our requirements.  Outside of this they are simply an opportunity to eat more than we need.

Snacking has also been driven by working hours and lifestyle. Both these factors can influence our ability to eat at set hours across the day and can also result in longer periods of time between meals.  In such instances, healthy snacking may prove useful to maintaining energy levels and overall nutritional intake.

How has the media influenced eating habits and perceptions of nutrition?

The growing interest in nutrition over the last couple of decades has led to an increase in scientific reporting in the media.  Over this time period we have also seen countless books on the topic which include those offering many different ways to lose weight as well as those questioning traditional thinking around nutrition.

In combination these two factors have contributed to skewing basic health messaging and a good example is the way in which dairy and gluten-free eating is now considered by many to be a healthier way to eat when in fact they should still be considered special diets reserved for those with food intolerances or conditions such as coeliac disease.

“Only 5% of the UK population are thought to suffer any degree of lactose maldigestion and 1% are thought to suffer with coeliac disease.  It has been estimated that 1-2% have a diagnosed food allergy”

This is not really a major problem as there is no real harm in omitting these foods as long as you understand how to adjust your diet to make up for any nutritional shortfalls.

The bigger issue is that in light of this foods have started to become labelled as ‘bad’ for us when in fact they are still healthy components of a balanced diet.

Media reporting of new research is often misleading as there is usually a bias towards positive findings.  However, on closer inspection the results are often confounded by various limitations of the research which might include sample size or the type of study and its strength (clinical trials are more reliable that rat studies).

Then there is the fact that the journalist has simply not understood or inaccurately reported the findings (although to be fair many experienced health journalists will take their lead from experts in the field).  I love to read the ‘Behind the Headlines’ section of NHS website (2) which brilliantly discusses some of the more popular scientific findings reported in the press.

What about social media?

Unlike other areas of health, people are surprisingly willing to take dietary advice from unqualified influencers or personal trainers with a hot bod and large social media following.

A survey carried out in 2017 on behalf of the British Dietetic Society showed that 58% of people would trust diet and nutrition advice given to them by their personal trainer or fitness instructor. Amongst young people, 41% said they would trust the advice given out by a healthy eating blogger which highlights the importance for more qualified professionals to have a greater voice on social media platforms (3).

“The UK public do not know who to trust for dietary advice according to research carried out by the British Dietetic Association

Celebrities are also highly influential when it comes to food choice and as such, they are frequently used to support the sale of supplements and diet regimes.

Supplement celeb

These people may know a little about nutrition but where the expert excels is in taking a science-based approach to their practice which means they don’t offer advice based on personal experience or opinions. Why would you take advice from someone not qualified to do so? Would you let your PT take a tooth out?  Probably not.

Got a dodgy gut?  Bloated? Constipated? Someone unqualified told you to eat lots of fibre?  Let’s see how that pans out if what you actually have is IBS or even worse coeliac disease. Trying to lose weight?  Someone told you to cut out carbs and eat a shed load of fat in your diet?  Did they ask you if you had a family history of heart disease or whether you were aware of your cholesterol levels? You get my drift.

What about the trailblazers?

These are the guys who set out to challenge traditional thinking around nutrition.  Books and articles that attempt to question traditional thinking around nutrition can often cause a lot of confusion. I personally find this literature massively interesting, but I am qualified enough to read with a degree of objectivity and an understanding of the science.

Often these books are biased in favour of their topic and without this training and experience in nutrition and research it’s really easy to believe everything you read without question.  Also, if you read too many of these books, they can start to become a little contradictory making it tricky to see the woods for the trees.

Scales

A good example here is the debate around saturated fat in the diet which was sparked by findings of a landmark study in 2014 which found no significant evidence that saturated fat increased the risk of heart disease (4).

The study caused a lot of controversy amongst leading researchers in the field of nutrition who questioned the data analysis. Subsequently a report in 2019 by the Scientific Advisory Committee on Nutrition (SACN) found no reason to change the current advice around saturated fat intake (5).

In the meantime, messaging around saturated fat and fat in general became confused which potentially left many people thinking it was OK to eat lots of saturated fat in their diet. The problem with this type of reporting in the media is that the findings are open to interpretation by the public which can prove detrimental to their health. The other issue with this type of reporting is that people take the initial findings on board pretty quickly which makes it more difficult to reset the message.

As far as this research was concerned. Wholefoods high in saturated fat include full fat dairy and fatty cuts of meat which can form part of a healthy balanced diet but should still be eaten in moderation given their high energy content which can contribute to weight gain (a risk factor for heart disease).

However, other sources of saturated fat include convenience foods often loaded with salt and sugar which in themselves can increase the risk of heart disease. Also, eating lots of red meat and processed meat (often high in saturated fat) is not a healthy option given their association with the increased risk of colorectal cancer.

What about superfoods?

The term ‘superfoods’ was thought up in the nineties.  A handful of people are said to have coined the term including the alternative medical practitioner Michael Van Straten who wrote a book called superfoods.  The idea behind the term is that certain foods have a higher nutritional value deeming them more beneficial for health and well-being.  However, the term has little significance when talking about overall diet.

“There is no official definition of a superfood and the EU has banned the use of the word on product packaging unless the claim is backed up by convincing research”

This term also highlights the attention placed on individual foods in the media based on their supposed ability to prevent disease.  Research into the effects of individual foods on health are very tricky to carry out.  Our diets are hugely complex and it’s difficult to entangle the effect of one particular food or compound from all the others we consume.

Superfoods

Much of this research is carried out in a lab or on animals which can’t be translated to humans.  Often this type of research also involves a very concentrated amount of a compound or large amount of food in a form which is not viably consumed as a whole food in reality.  A good example is the research surrounding beetroot and blood pressure which has used both supplements and juices which represent a huge amount more than an 80g serving of the whole vegetable (6).

Blueberries

While this research is interesting it has to be taken with a pinch of salt.  While blueberries may have been shown to reduce the risk of cancer it doesn’t mean eating a bowl everyday will prevent you from getting cancer.  Besides the fact that the research is not strong enough to prove cause and effect there are many other dietary and lifestyle factors that contribute to an increased risk of the disease.

Can food really heal? 

The food you eat provides you with macronutrients which are used for energy (carbohydrates and fats) and the growth and repair of tissues in the body (protein).  We also glean micronutrients (vitamins and minerals) from foods which are needed for all bodily processes.

If we don’t get enough of any of these nutrients in our diet, then there may be health consequences such as a lack of iron which can cause anaemia.  In terms of healing then these deficiencies and the symptoms that come with them can be corrected by eating more of the foods which contain one or another nutrient in question.

In some cases, certain foods have been shown to be beneficial for specific health conditions.  A good example is high cholesterol which can benefit from increasing the amount of fibre in the diet as well as other specific foods such as oats (7).

So, what’s the take home message?

The thing to remember here is that nutritional science is relatively new and as such ever evolving so what you read at one point in time could be completely different at another.

People love the idea of a quick fix or miracle cure, but the reality is that there is no such thing when it comes to health. Diet has a hugely significant role to play in the prevention of disease and overall health but it’s the balance, moderation and consistency of our diet overall that has the greatest impact.

Getting back to the basics of healthy eating is your best bet and it also helps you to find a baseline which is a useful starting point for nutritionists and dietitians how may adapt you diet to help with a diet-related condition.

References

  1. https://www.gov.uk/government/publications/reducing-obesity-future-choices
  2. https://www.nhs.uk/news/
  3. https://www.bda.uk.com/resource/survey-finds-that-almost-60-of-people-trust-nutrition-
  4. https://www.acpjournals.org/doi/10.7326/M13-1788
  5. https://www.gov.uk/government/publications/saturated-fats-and-health-sacn-report
  6. https://www.ahajournals.org/journal/hyp
  7. https://www.frontiersin.org/articles/10.3389/fnut.2019.00171/full

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