eating healthily – changes needed dr rosemary stanton oam

Eating healthily – changes needed

Dr Rosemary Stanton OAM

© Rosemary Stanton 2013

influences on food choices

- availability- cost- cultural influences- convenience- marketing - ethical considerations...- nutrition & health

© Rosemary Stanton 2013

why dietary guidelines?

1960s – 600-800 foods available now - >30,000 foods in

supermarket diet-related health problems

(obesity, type 2 diabetes, cancers, cardiovascular disease, osteoporosis)

costs to individuals costs to governments

© Rosemary Stanton 2013

Australian ‘history’1979 Dietary Goals1981 Dietary Guidelines1991 1st revision 2003 2nd revision2013 3rd revision

© Rosemary Stanton 2013

dietary guidelineschanges from first guidelines increase in breast feeding refined sugar (led to a campaign

‘sugar – a natural part of life’) meat consumption (led to a

campaign titled ‘feed the man meat’) fat-reduced milk became popular

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dietary guidelineseffective ?

Melbourne study, 10,561 women, aged 50-55one in three followed some guidelinesonly 2 followed all guidelines

Ball K, Mishra GD, Thane CW, Hodge A. How well do Australian women comply with dietary guidelines? Pub Health Nutr 2004; 7: 443-452.

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key question for guidelineswhat should

Australians eat?

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2013 dietary guidelines

changed focus– foods, food groups & dietary

patterns– not food components or individual

nutrients

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dietary guidelines

aim of the revision– ‘aspirational’– realistic, practical & flexible– evolutionary (incremental, not

radical)– based on best available scientific

evidence for food, diet, health relationships

© Rosemary Stanton 2013

dietary guidelines

other aims (wanted by some)– include a guideline on

environmental aspects of food choices

– give social equity more priority- avoid fortified & functional foods

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approach changed– commissioned systematic literature review

– developed set of targeted questions to answer question ‘what should Australians eat?’

– prioritised questions focussing on new or emerging issues since 2003 (did not re-examine established relationships)

– evidence report (1100 pages, >55,000 papers)

– process manual (evidence statements if >5 studies)

– harmonisation assisted by a methodologist

– results informed revision of core food group modelling & dietary guidelines

© Rosemary Stanton 2013

evidence informing the revised draft dietary

guidelinesdietary intakes from

national surveys

authoritative reports &additional literature

draft evidence report to inform the review of the

Australian Dietary Guidelines

NRVs for Australia and New Zealand incl RDIs (2005)

food modelling system to inform the AGTHE (2010)

Draft (2012), Australian

Dietary Guidelines

(2013)draft AGTHE (2011)

Dietary Guidelines for all Australians (2003)

draft literature review pregnancy &

breastfeeding (2011)

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what has changed - format

– all age & gender groups in one concise document

– infant feeding guidelines for health workers as a separate document

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what has changed - formatstandardised structure: context of the food/group in Australian diet supporting evidence including:

- graded evidence statements (Evidence Report) - other evidence (established relationships - previous DGs) - comparison with other authoritative international reports - (brief) plausibility/mechanisms

practical considerations- additional information (infants, children, pregnancy, breastfeeding, Aboriginal & Torres Strait Islanders)

© Rosemary Stanton 2013

what has changed - content

evidence base supports focus on total energy intake/balance & energy-

density rather than specific macronutrients

less emphasis on decreasing total fat, but focus on limiting foods high in sat/trans fat + moderate consumption of foods rich in unsaturated fats

guidance for population-based weight loss (for those without other health problems)

more emphasis on dietary patterns across the life stages, supporting family-focused eating patterns

© Rosemary Stanton 2013

changes in evidence strengthened for health benefits of

- breastfeeding (benefits later in life)

- milk (cardiovascular & some cancers)- fruit (cardiovascular) - non-starchy vegetables (some cancers)- wholegrains (cardiovascular & weight)

strengthened for health risks of- sugar-sweetened beverages & weight gain in children & adults

© Rosemary Stanton 2013

recommendations1. to achieve & maintain a healthy

weight, be physically active & choose amounts of nutritious foods & drinks to meet energy needs

© Rosemary Stanton 2013

recommendations2. enjoy a wide variety of nutritious foods

from these five groups every day plenty of vegetables, different types & colours, &

legumes/beans fruit grain (cereal) foods, mostly wholegrain &/or high cereal

fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa, barley

lean meat & poultry, fish, eggs, tofu, nuts, seeds & legumes/beans

milk, yoghurt, cheese or alternatives, mostly reduced fat (not for under 2s)

and drink water

© Rosemary Stanton 2013

recommendations3. limit intake of foods containing

saturated fat, added salt, added sugars & alcohol

© Rosemary Stanton 2013

recommendationsa. limit intake of foods containing saturated

fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips & crisps & other savoury snacks

- replace high fat foods that contain predominantly saturated fats such as butter, cream, cooking margarine, coconut & palm oil with foods that contain predominantly polyunsaturated & monounsaturated fats such as oils, spreads, nut butters/pastes & avocado.

- low fat diets are not suitable for children under the age of 2 years.

© Rosemary Stanton 2013

recommendationsb. limit intake of foods containing added

salt- read food labels to choose lower sodium

options among similar foods- do not add salt to foods in cooking or at the

table

© Rosemary Stanton 2013

recommendationsc. limit intake of foods & drinks containing

added sugars such as:- confectionary - sugar-sweetened soft drinks & cordials - fruit drinks - vitamin waters - energy & sports drinks

© Rosemary Stanton 2013

recommendationsd. if you choose to drink alcohol, limit

intake. for women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option

© Rosemary Stanton 2013

recommendations

4. encourage, support & promote breastfeeding

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recommendations

5. care for your food; prepare & store it carefully

© Rosemary Stanton 2013

what has changed

food modelling system & AGTHE– ages 6 mths to 70 + (previously 2 years and over)

- reflects the food supply & consumption patterns

- reduced serve size for bread (40g) cf 1994 (60g)

- wholegrain: refined grains = 2:1

- plant-based options given greater prominence

- greater flexibility

- limited scope for smallest, least active people to choose any ‘extras’

© Rosemary Stanton 2013

what needs to change vegetables , but chips fruit , but limit juice nuts/seeds wholegrains , refined grains fish red meat for men reduced-fat milk

© Rosemary Stanton 2013

what needs to change sugary drinks junk foods alcohol discretionary foods from 35-40%

energy to 10% energy (or zero)

Rangan AM, Randall D, Hector DJ, Gill TP, Webb KL. Consumption of ‘extra’ foods by Australian children: types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2008; 62(3):356-64

Rangan AM, Schindeler S, Hector DJ, , Gill TP, Webb KL. Consumption of ‘extra’ foods by Australian adults: types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2009; 63:865-71

© Rosemary Stanton 2013

graph represents proportions for each group

accompanying tables explain serves (& serve sizes) for each age group

educator’s guide includes rationale

consumer materials with messages and practical tips

© Rosemary Stanton 2013

common questions why isn’t there a guideline on

sustainable food choices ? fats – why not a separate fat group

? GI – why is it not included ? ‘extras’ – why don’t they get a

place on the plate ?

© Rosemary Stanton 2013

what needs to change no industry influence at policy

level (their aim is to sell products; ours is to set guidelines, do the teaching)

accept that we need ‘less’ accept that discretionary foods

don’t fit every diet accept that we must incorporate

sustainable food futures

© Rosemary Stanton 2013

challengesenvironmental /sustainability rapidly emerging evidence base type of evidence differs from

food/health relationships differences between & within

countries politically sensitive issue

© Rosemary Stanton 2013

key messages discretionary foods – no need & not

much room for them dietary patterns promoted by the DGs

are good for health, more sustainable, practical, realistic & socially equitable

dietary guidelines are the reference for nutrition policies

details at www.eatforhealth.gov.au

© Rosemary Stanton 2013

what we eat

social equityhealth

protection of land & water