New review concludes omega-3 fats have no benefits for heart health… or does it?

New review concludes omega-3 fats have no benefits for heart health… or does it?

An extensive detailed analysis of the current scientific evidence into omega-3 seems to have thrown a spanner in the works for heart health dietary advice.

Conducted by Cochrane, the review concludes that there is no correlation between cardiovascular health and intakes of the long chain omega-3 fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) over a one- to six-year period.

Long chain omega-3 fats have long been associated with reductions in blood triglycerides, blood pressure and thrombosis; producing anti-inflammatory and anti-arrhythmia effects as well as improving endothelial function and insulin sensitivity.

This most recent publication will raise many eyebrows within the heart health professional arena and likely to be taken up by media editors who seem to enjoy questioning the trustworthiness of public health guidelines. These recommend a diet including omega-3, especially found in oil-rich fish such as salmon, tuna and mackerel.

So, do we need to change dietary guidelines on the importance of omega-3 and oil-rich fish?

Before we jump the gun, it’s important to put things into context:

1. The shortcomings of the review

a. The studies investigated in this review predominantly used omega-3 supplements. Thus the outcomes cannot be related to oil-rich fish consumption which is the main dietary source of EPA and DHA.

b. The studies were also of one to six years’ duration, which is a relatively short period to assess disease and mortality risk. And conclusions cannot be reached for a lifetime consumption of foods rich in EPA or DHA.

c. Many of the studies may not have used adequate number pf subjects in the studies to elicit a result. This is especially the case for studies conducted in healthy individuals (and therefore low risk of heart disease), which would require very high numbers to demonstrate a difference in the omega-3 and non-omega-3 study groups.

d. Any studies conducted over the last two decades of people at risk of cardiovascular disease (CVD) will be in individuals already medicated with statins and other cardio-protective drugs, which may mask the effect, if any, of additional omega-3.

2. Omega-3 benefits go beyond heart health

Long chain omega-3 fats are critical for eye and brain development of the foetus and young children. Therefore, food sources should be included in a healthy balanced diet of children and adults planning for a family.

3. Oil-rich fish is not just omega-3. It offers so many health benefits.

a. Unlike omega-3 supplements, oil-rich fish is a rich source of not only the long chain omega-3 fats but also of selenium, zinc, vitamin D and iodine; woefully lacking in the UK diet.

b. Oil-rich fish has a healthier fat profile when compared to red meat and other animal proteins. Replacing saturated fat with unsaturated fat in the diet has been proven to have a positive effect on blood lipids and cardiovascular health (as confirmed by Cochrane’s 2015 review and the SACN’s & the WHO’s draft 2018 reports). See our saturated fat blog

Indeed, the authors themselves remind us of the other nutritional benefits of oil-rich fish and that this review does not negate public health advice that consuming oil-rich fish is beneficial to health.

The Nutrilicious view

Taking vitamin and mineral supplements as a substitute for eating a healthy balanced diet has never been encouraged by health professionals. However, dietitians recognise that when demands for specific nutrients are high, or when an individual’s nutritional intake is at proven risk of being compromised, supplements can play an important role. For example, pregnancy and folic acid; under-5 year olds and vitamins C and D; or sufferers of osteoporosis and calcium and vitamin D.

Therefore, these findings do not come as any surprise: omega-3 supplements are not a solution to better heart health. There are numerous dietary and lifestyle factors that impact on heart health. It should always be about food rather than the benefits of single nutrients.

As Linda Main, Dietitian and dietary advisor for cholesterol charity HEART UK, explains: “We continue to advise the lifelong consumption of a heart healthy diet centred around eating whole foods rather than the emphasis being on nutrients.

“Eating patterns such as the Mediterranean, DASH or the UCLP© diets result in the consumption of a nutritionally appropriate diet. This is characterised by eating plenty of vegetables, fruits, wholegrains, vegetable proteins such as nuts and soya, seeds, vegetable oils and spreads. In those who consume animal proteins, the inclusion of low fat dairy, lean and largely unprocessed meat and white and oily fish and seafood are recommended.

“Omega-3 supplements are not currently advised by HEART UK and would not be our first choice, except when prescribed by a recognised qualified health professional or when needed to safeguard the intake of the essentially fatty acid – alpha-linolenic acid.”

As oil-rich fish is an excellent low saturated fat protein source, and the main dietary source of long-chain omega-3 fats as well as other crucial nutrients, it should continue to be part of dietary guidelines.

Additionally, for those wishing to follow a more plant-based diet, it’s reassuring that the report finds consumption of the shorter chain omega-3 fats found in plant foods (like rapeseed and soya oil) has cardio-protective qualities. This supports findings from population studies that vegetarians and vegans have a lower incidence of cardiovascular events and mortality compared to non-vegetarians.

Current UK heart health dietary advice remains unchanged:

  • Lower the amount of food eaten which is high in saturated fat and replace it with foods high in unsaturated fats (which Cochrane’s 2015 review supports, SACN 2017 Saturated fat draft guidance).
  • Increase our intake of fibre (especially from beans, pulses, oats and barley), nuts.
  • Consume at least five servings of fruit and vegetables daily.
  • Reduce intakes of red meat and avoid/limit processed meat.
  • Consume two portions of fish weekly – one of which should be oil rich.
  • Increase intakes of leaner and plant-sources of protein.
  • Use sterol or stanol fortified products (if blood cholesterol is raised after other dietary changes have been made).

It’s interesting to note that, unlike the US, the UK does not (and has never) recommended taking dietary supplements of omega-3 fish oil.

For up to date expert advice on heart health visit: heartuk.org.uk

Further references

Saturated fat and heart health reports

Supplements for specific groups
NHS UK: Vitamins for children; Vitamins, supplements and nutrition in pregnancy

 Vegetarian and vegan diets and health outcomes

  • Rizzo N, Jaceldo-Siegl K, Sabate J et al. Nutrient profiles of vegetarian and non-vegetarian dietary patterns. J Acad Nutr Diet.. 2013;113(12):1610-9.
  • Sobiecki J, Appleby P, Bradbury K et al. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res.. 2016;36(5):464-77.
  • Springmann M, Godfray H, Rayner M et al. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci U S A.. 2016;113(15):4146-51.
  • Clarys P, Deliens T, Huybrechts I et al. Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients.. 2014;6(3):1318-32.

Cochrane is an established body of researchers, health professionals and patients across the globe renowned for their high quality scientific reviews of nutrition and health evidence.

 

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Sugar Reduction Programme – PHE one year progress report

Sugar Reduction Programme – PHE one year progress report

This week, Public Health England (PHE) published their first assessment on the government’s sugar reduction programme, introduced to help reduce rates of childhood obesity.

The food industry – including retailers, manufacturers, restaurants, cafes and pub chains – was given the target to cut 20% of sugar from a range of products by 2020, with a 5% reduction in the first year. The first year of the programme was from August 2016 to August 2017.

What does the assessment show?

  • Retailers and manufacturers have achieved only a 2% reduction in sugar.
  • Sugar has been reduced by 11% by retailers and manufacturers in drinks that are included in the Soft Drinks Industry Levy and average calories per portion has been reduced by 6%.
  • New guidelines have been published for the drinks industry to reduce sugar in juice and milk-based drinks.

Importantly, PHE highlight that there are forthcoming sugar reduction plans from the food industry and that some changes of products were not captured in the data (as the changes took effect after the one-year mark measured). This all points towards hopefully seeing greater reductions in future assessments.

Measuring the progress
Ten food categories were measured that contribute the most sugar to children’s diets, although breakfast pastries and cakes were not included due to insufficient data. Some of the key findings from the assessment include:

  • Reductions in sugar levels were seen across five of the categories.
  • Yogurts and fromage frais, breakfast cereals, and sweet spreads and sauces have all met or exceeded the initial 5% sugar reduction ambition.
  • Biscuits and chocolate confectionary have seen no change at all in sugar levels.
  • The puddings category has actually seen a slight (1%) increase in sugar content overall.
  • It has been noted that for the eating out of home sector, portion sizes in products likely to be consumed in one go are substantially larger (on average more than double) those of retailers and manufacturers.
  • Calories in products likely to be consumed in one go have reduced in four categories. Of these, ice cream, lollies and sorbets, and yogurts and fromage frais have reduced average calories by more than 5%. Often this is due to smaller portion size.

The British Retail Consortium (BRC) provided an interesting infographic showing how the food industry has been cutting sugar.

In response to the PHE assessment, Andrew Opie, Director of Food Policy at the BRC, stated: “Retailers are fully committed to helping improve the health of their customers and have led the way in reducing sugar in their products. Thousands of tonnes of sugar have been removed from retailers’ own product ranges to date and continuing work will result in even greater reductions over the next few years.

“Retailers have shown that reducing sugar levels across a wide range of products is possible but all food businesses must follow suit if we are to see significant reductions in the level of sugar in the nation’s diet.”

The British Dietetic Association‘s Head of External Affairs, Jo Instone, said: “We recognise that there are limitations in the data and that these are the early stages of the reformulation programme. However, it is disappointing to have such significant gaps and for a number of manufacturers to have refused to allow information on their progress to be published.”

“Clearly, it will be important for the BDA, the Obesity Health Alliance and others to continue working with Public Health England and the government to drive this programme forward. We would hope that the 2019 report can fill in a number of gaps and that we will see more substantial progress made across the board.”

Milk based drinks and juice
Following our concern about sugar levels in fruit juice, we’re pleased to see new plans by PHE encouraging the drinks industry to achieve the following by mid-2021:

  • Reduce sugar in juice-based drinks by 5% (excluding single juice – that is, products with juice from a single fruit with nothing added to it).
  • Cap all juice-based drinks (including blended juices, smoothies and single juices) likely to be consumed in one go to 150 calories.
  • Reduce sugar in milk (and milk substitutes) based drinks by 20% and cap products likely to be consumed in one go to 300 calories.

What’s next?
Some progress has been made, but it seems we’re still well off hitting targets for sugar reduction. It’s clear that more work is needed – by manufacturers and retailers, but also cafes and restaurants, where calorie intake tends to be significantly higher.

The next progress report from PHE is due in Spring 2019 and should give a clearer picture on the programme’s progress.

Of course, this is only one of the many strategies needed to help combat the obesity crisis. Along with the BDA and many others, we’re looking forward to hearing government measures for issues including broadcast advertising, in-store promotions and other interventions to help tackle the problem.

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Will the new sugar tax work?

Will the new sugar tax work?

This month, the much anticipated sugar tax came into force in the UK. So what it is, why was it introduced and – most importantly – will it have any impact?

The tax
Soft drinks companies are now required to pay a levy on drinks with certain levels of added sugar:

  • 18p per litre of drink if the product contains more than 5g of sugar per 100ml
  • 24p per litre if it contains 8g of sugar per 100ml.

The tax does not apply to milk-based drinks, due to their calcium content. It also excludes fruit juice or vegetable juice that don’t have added sugar.

Foods such as cakes, biscuits and other sugar containing foods aren’t covered, but there is a separate initiative to reduce their sugar content by 20% by 2020.

Why was it introduced?
The tax has been introduced in an effort to tackle childhood obesity. The latest National Diet and Nutrition Survey (NDNS) showed that sugar-sweetened drinks are the single highest source of free sugars for children and teenagers. This is why soft drinks have been targeted.

Action already taken by the industry
An estimated 50 per cent of manufacturers have already reduced the sugar content of their drinks to avoid the new tax, including leading brands:

  • Fanta – reduced sugar from 6.9g (a little under 2 tsp) to 4.6g (just over 1 tsp) per 100ml.
  • Ribena – from 10g (2.5 tsp) to less than 4.5g (just over 1 tsp) per 100ml.
  • Lucozade – from 13g (just over 3 tsp) to less than 4.5g (just over 1 tsp) per 100ml.
  • Irn Bru – from 10.3g (2.5 tsp) to 4.7g (just over 1 tsp) per 100ml.

Others remain the same, for example Coca-Cola (10.6g per 100ml, just over 2.5 tsp) and Pepsi (11g per 100ml, just under 3 tsp). These manufacturers have to decide whether to bear the cost of the tax increase themselves, or pass it on to consumers.

In one leading supermarket, the cost of a 2L bottle of Pepsi went up by 45p when the tax was introduced. By contrast, Coca Cola kept the price the same but reduced the portion size: a 1.75L bottle has shrunk to 1.5L bottle.

Will it work?
A survey by Mintel of 2,000 people found that just under half (47%) of Brits say that a tax making unhealthy food or drink more expensive would encourage them to cut down on these items. So the measure will hopefully have some effect.

It’s extremely positive that some food manufacturers have already taken action to reduce the sugar content of their recipes. However, the feedback hasn’t always been positive about the new taste of much-loved products (reduced sugar Lucozade and Irn Bru, for example). And a significant proportion of people will simply pay more for the same recipe high-sugar drink they’ve always enjoyed.

We’re also concerned that drinks that fell outside of taxable products, such as fruit juice, often still have high levels of free sugars. The National Health Service discusses maximum intakes of free sugars for all ages.

What happens now?
Drinks manufacturers have made an initial decision on whether to reduce sugar levels to avoid the new taxation or to leave sugar levels unaltered. They’ll be closely monitoring orders from retailers to assess the effectiveness of their initial decision. If it proves that sales of reduced-sugar drinks increases, other manufacturers may be keen to follow suit.

Drinks retailers will need to carefully monitor demand for those reduced-sugar drinks vs unaltered recipes that are subject to the tax, to satisfy any changes in demand.

The Mintel research found that three quarters of consumers say that easier-to-understand nutritional information on product packaging would encourage them to cut down on unhealthy food/drink. We’d love to see improved labelling too, to see what the impact could be.

Takeaway message
It’s going to take months and years to assess the impact the tax has on the nation’s health. And, of course, obesity is caused by many factors. Clearly multiple strategies including education will be needed to combat the problem. We’ll be monitoring closely to see whether the action has any impact on those most affected by obesity – those in the lower socio-economic bracket and children.

Do you agree it’s a step in the right direction? Should the Government be focussing on something else to better address the problem?

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Can nuts and seeds reduce the risk of premature death?

Can nuts and seeds reduce the risk of premature death?

This week, the Daily Mail and the Express reported on the benefits of nuts and seeds, stating that snacking on them could halve the risk of premature death.

This comes following a study published in the American Journal of Clinical Nutrition into omega-6 fatty acid linoleic acid, for which nuts and seeds are a good source.

Study background and findings
The study was carried out following debate about the health effects of linoleic acid.

On the one hand, there was the view that it can reduce cholesterol levels and can increase the production of anti-inflammatory compounds, therefore helping reduce disease.

On the other hand, there was speculation that it may actually cause inflammation when it gets converted in the body into arachindonic acid, thereby increasing the risk of several chronic diseases.

The research aimed to clarify matters…

  • 2,480 men aged between 42 and 62 years were followed for 22 years.
  • Blood levels of the linoleic acid were taken during the study. These levels are determined by your diet.
  • By the end of the study, 1,143 deaths due to disease had occurred.
    • When grouped according to blood linoleic acid levels, the risk of premature death was 43% lower in the group with the highest linoleic acid levels, compared to the group with the lowest level. There was also a lower risk of death due to cardiovascular diseases, as well as for death due to reasons other than cardiovascular diseases or cancer.
    • No specific association between omega-6 levels and death due to cancer was found.
    • The researchers support the current dietary recommendations to increase linoleic acid intake for cardiovascular disease prevention.

 

Behind the headlines: the Nutrilicious dietetic view

Was it a valuable study?

The study had a few weaknesses:

  • Only a single baseline fatty acid measurement was taken for all men. Dietary habits can change during such a long follow up period and this could alter the results.
  • Higher levels of blood linoleic acid were associated with a more healthy lifestyle and diet. This could influence the results, meaning we cannot be absolutely sure it is just the levels of linoleic acid causing the effects.
  • Only white middle-aged and older men were included in the study. We don’t know whether the findings would be the same for women and other races/ethnicities.

However, it also has considerable strengths:

  • Large sample size
  • No participants dropped out
  • The researchers used an objective biomarker – blood levels of linoleic acid – rather than using dietary recall or assessment measures, which are not very reliable.

Translating the findings into practical guidance

To help prevent cardiovascular disease, current guidelines are that we should be limiting our intakes of saturated fats to 20g per day for women and 30g per day for men.

They should be replaced with unsaturated fats including monounsaturated and polyunsaturated fats, which provide essential fatty acids and fat-soluble vitamins.

Linoleic acid is the most common type of polyunsaturated omega-6 fatty acid, so we’d recommend unsalted nuts as a daily snack. Indeed, HEART UK state: “Nuts are packed full of heart-healthy nutrients such as protein, soluble fibres, plant sterols, vitamin E, magnesium, potassium, zinc and copper. Because they are also naturally rich in unsaturated fats and low in saturated fat they can help lower cholesterol as part of a diet low in saturated fats.”

A portion of nuts would be considered around 30-35g, which is about one handful (about 175-200 calories).

Nuts are quite high in calories, so those watching their weight may need to consider how and where this fits into a calorie controlled eating plan.

Remember the full picture

While the headlines focus on nuts and seeds, vegetable oils and plant-based spreads are also good sources of linoleic acid.

The shift from saturated to unsaturated fats should form part of an overall healthy diet, such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet.

More detailed advice into dietary fats can be found from:

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Health warnings for salt in Chinese takeaways: Nutrilicious News Digest

Health warnings for salt in Chinese takeaways: Nutrilicious News Digest

Coinciding with Salt Awareness Week, this week the BBC, the Daily Mail, the Independent and many more reported on how high salt content in Chinese takeaway meals from restaurants and supermarkets.

The news follows analysis published by Action on Salt, who are calling for health warnings to be mandatory.

Keep this in mind as you read on: The maximum daily allowance for adults is 6g per day (about one teaspoon).

Here are some of the key points from the study…

Chinese takeaway meals

Six independent restaurants in London’s Chinatown were analysed

  • 97% of dishes contained 2g (1/3 of a teaspoon) or more of salt per dish.
  • 58% contained more than 3g (1/2 teaspoon) of salt per dish.
  • Combining side dishes on top would provide over 6g (over 1 teaspoon – the maximum daily allowance for adults) salt per day.
  • The saltiest takeaway main meal with a rice/noodle side dish contained 11.50g of salt (about 2 teaspoons) (Beef in Black Bean Sauce and Vegetable Noodles).
  • Variation was seen between the same dishes but from different restaurants. For example, sweet and sour dishes ranged from 1g to 3.4g of salt per portion.
  • On average, beef in black bean sauce dishes were the highest in salt (1.27g per 100g) and sweet and sour dishes were the least salty (0.54g per 100g).

Supermarket ready meals

141 ready meals were surveyed

  • Nearly half (43%) were high in salt (containing over 1.5g per 100g or over 1.8g salt per portion). These meals would be coded as ‘red’ under salt on the food traffic light labelling system.
  • The highest in salt was Slimming World’s Chinese Style Banquet Rice with 4.40g salt (about 2/3 teaspoon salt) per 550g pack.
  • As well as main dishes found to be high in salt, side dishes such as rice dishes, spring rolls and prawn crackers could easily tot up the salt levels. One example of Egg Fried Rice (Iceland’s Takeaway Egg Fried Rice) contained 4.1g (2/3 teaspoon) salt per 350g pack. That’s more salt than is in 11 ready salted bags of crisps!
  • Variation was apparent, with Tesco’s Egg Fried Rice containing only 0.1g salt per 250g.

For more detailed findings, see the original analysis PDF

 

Behind the headlines: the Nutrilicious dietetic view

Points to consider
As ever, we need to note any limitations of the report. While the analysis included a large number of supermarket ready meals, the restaurant analysis was only conducted on six restaurants in London Chinatown, so we cannot be confident findings will be the same elsewhere. Plus, it’s clear that salt levels will vary between restaurants and between meals.

That said, UK adults eat around 22 million takeaways each week, with Chinese being the most popular. Judging by these findings, it seems there is an urgent need to drastically cut salt levels in these meals.

Why is too much salt bad for us?
Too much salt can contribute to raised blood pressure, which increases the risk of stroke and heart disease.

In the UK, we are currently eating more salt than is recommended, averaging 8.1g per day (1.3 teaspoons of salt, about a third more than the maximum recommendation). This is largely due to the high amounts of salt hidden in the food we buy, for which this analysis of Chinese meals provides further support.

The good news is this average intake has actually reduced by 15% over the last decade, primarily due to product reformulation. Now we need to go further.

Is the government taking enough action reduce salt?

  • Public Health England have been encouraging the food industry to cut salt levels in food. However, so far there has been little action, with no progress report on whether the last set of salt targets (due to have been met by the end of 2017) have been reached, nor any plans to set new targets.
  • As part of this 19th Salt Awareness Week, Action on Salt are calling on Public Health England for immediate action – they want to focus on setting new salt targets, making front of pack labelling mandatory and would like to see warning labels on menus for dishes high in salt. More action is needed from the food industry and the out of home sector to reduce the amount of salt added, and to provide us with healthier choices lower in salt.
  • This week, Action on Salt are hosting a Parliamentary Reception at the House of Commons to discuss the future of salt reduction in the UK, with attendees from the Department of Health, Non-Governmental Organisations (NGOs) and the food industry.

Sonia Pombo, Campaign Manager for Action on Salt stated: “Our data shows that food can be easily reformulated with lower levels of salt, so why haven’t all companies acted responsibly? The lack of front-of-pack colour coded labelling on branded products makes it incredibly difficult for consumers to make healthier choices and that is simply unacceptable.”

What can we do to keep our salt intakes low?

Food industry, including all food service providers

All responsible food providers should by now be carrying out at least a six-monthly nutrition and health check on their products and/or recipes, which includes the traffic light coding in order to highlight which ones need to be placed into a programme for reformulation.

At Nutrilicious, we have enjoyed helping numerous food service providers and manufacturers with this ongoing check along with nutrition and advice for ongoing product reformulation and development. If your company or organisation products or recipes need a nutrition and health check we would be delighted to help.

Taking personal responsibility

We should all be keeping salt to a minimum in our diets. For tips and advice on how to do this see:

Clearly, reducing intake of pre-packaged foods and takeaways is important for reducing salt intake, as shown in this analysis.

In the case for ready-made foods, being aware of what the labels mean can help with making wiser choices. For salt, a product is considered high in salt if it contains more than 1.8g salt per portion or if it is over 1.5g salt per 100g of the product.

Takeaway messages
This analysis highlights that salt levels can be extremely high in Chinese takeaway meals and supermarket ready meals. The relevance of reducing salt intake is paramount; each 1g reduction in daily salt intake prevents 7,000 deaths, 4,000 of which are premature, from strokes and heart disease.

We are pleased to see Action on Salt calling on Public Health England to take more action in this issue. Key messages for healthy eating apply to us all: eat a balanced diet, with plenty of fruit and vegetables, wholegrains and less processed foods and takeaways. This can help lower not only salt, but also sugar, fats and saturated fats; all of which in too high amounts can have negative health effects.

Following this advice – alongside other healthy lifestyle decisions such as keeping physically active – can help keep us in good health and reduce the chances of developing negative health effects such as obesity, heart disease and cancer.

 

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New Public Health England report calls for calorie reduction: Nutrilicious News Digest

New Public Health England report calls for calorie reduction: Nutrilicious News Digest

This week, Public Health England published a new report into calorie consumption, calling on food makers to cut calories in the products to help in the combat against obesity. The findings were discussed by the BBC, the Daily Mail and the Guardian, among many others.

Key points of the report include:

  • New evidence highlighting overweight or obese boys and girls consume up to 500 and 290 calories too many each day respectively
  • A challenge to the food industry to reduce calories in products consumed by families by 20% by 2024
    • This will include 13 types of savoury, processed foods such as pizzas, ready meals, ready-made sandwiches, meat products and savoury snacks.
    • Food companies can achieve this by either 1) reducing portion sizes, 2) reformulation of products or 3) signposting to lower calorie options already available.

According to PHE, “If the 20% target is met within 5 years, more than 35,000 premature deaths could be prevented and around £9 billion in NHS healthcare and social care costs could be saved over a 25 year period.”

Alongside the report comes the launch of the One You campaign, encouraging adults to consume 400 calories at breakfast, and 600 each for lunch and dinner, plus a couple of healthy snacks in between. This comes as adults consume 200 to 300 calories in excess each day.

  • Major high street brands are partnering with PHE on the campaign (including Greggs, Starbucks, McDonalds and Subway), helping show consumers which meals can meet the 400-600-600kcal mark. Total daily calorie intake recommendations remain at 2,000kcal for women and 2,500kcal for men.
  • The Only You Easy Meals app gives ideas for what could fit into this (also see our examples listed further below).

This new plan from the Government comes on top of the sugar levy which comes into force next month and the sugar reduction programme. Read more about both here


Behind the headlines: the Nutrilicious dietetic view

The battle against being overweight or obese is an important one:

  • In the UK, two thirds of adults and one third of children are classed as ‘overweight’ (Body Mass Index over 25kg/m2) or ‘obese’ (Body Mass Index over 30kg/m2).
  • Overweight and obesity can have a serious impact on health and increase the risk of:
    • Type 2 diabetes
    • Musculoskeletal disorders (like osteroarthritis)
    • Cardiovascular disease
    • Some types of cancer (such as breast cancer, endometrial and bowel cancer)
    • Psychological problems

Source: World Health Organisation

While we hope the new plan by the government will help with the obesity battle, there are some points to consider when going through the plans:

  1. Cutting foods by 20% in calories – This is a voluntary target and so unfortunately there is no guarantee food companies will actually respond to these targets. However, PHE have stated that if there is little response, they will ‘name and shame’ the brands that are not co-operating and they would then consider asking the Government to legislate.
  2. The 400-600-600 tip

This could be a useful way to help people stay more on track at mealtimes; it is simple approach and easy to remember. Here are a here are a few examples from the Only You App

400kcal breakfast

600kcal lunch 600kcal dinner
Banana porridge made with milk and oats with raspberry mash Beans on wholegrain toast with mushrooms, tomatoes and peppers Chicken and vegetable parcels with noodles or potatoes
Traffic light omelettes with mixed peppers Salmon and cucumber wholewheat wraps with watercress

 

Lentil and vegetable cobbler
Toasted oats with yogurt, apple and grapes Wholegrain pitta pizza with with mushrooms, tomatoes and light mozzarella New potato and tuna salad

 

 

 

 

 

 

 

 

 

 

 

However, while it’s suggested just as a guide, men require more calories than women… is it appropriate to apply such advice to both? Using the 400-600-600 calorie rules, this would leave men with 900 calories left within their recommended daily allowance for snacks. Would you say this was the best approach?The “guide” element in our view will need to be emphasised much more in the communications.

  1. Nutrient intake
    It’s good to be calorie aware and know rough guides, but sometimes the higher calorie option could be healthier than the lower calorie option. What calorie counting does not do is consider nutrient intake of a meal nor the balance of different foods in a meal, which is a major drawback of the approach.

To give a breakfast example, a white bacon roll (about 290 calories) offers little beneficial nutrition but could come in at lower calories than a bowl of porridge topped with a piece of sliced fruit and a handful of nuts (about 400 calories). The latter offers a healthier source of protein and fats from the nuts compared to processed meat, plus a portion of fruit. The porridge would help contribute to our fibre much more than the roll – and in the UK, the current average fibre intake needs to increased by 60% to be meeting the UK recommendations.

So while we may reduce calorie consumption, we may then lose something else that is good for our health (e.g. fibre). The approach in fact has the potential to be counterproductive if we choose a meal that is lower in quality, causing excess snacking if, for example, you didn’t have enough fibre in the meal to fill you up.

It’s great that the supporting app and website help teach more about healthy choices; hopefully those who decide to follow 400-600-600 will take the advice on board. It will be important for PHE to monitor the uptake and how healthy the choices will be and for us as public health advisers to be aware of these results.

  1. There is the suggestion and worry that such rules with calories could create unhealthy relationships with food for some.
  2. Finally there is no magic bullet to the obesity crisis. It  continues to require large scale urgent multi-pronged approaches to be overcome and we must not loose sight of this which know from unanimous research including the game changing McKinsey Global Institute Report on overcoming obesity, that has yet to be truly taken on board by any overweight nation.

Takeaway message

This is an important new report and initiative from Public Health England which overall we welcome and hope alongside other initiatives already started as well as those yet to come will help to make a difference to the current obesity crisis. We look forward to supporting the initiative in the context of what is also eaten in our communications alongside other strategies dependent on the audiences that we are influencing. In the meantime we also hope that this initiative will be communicated and closely measured by PHE in the context of the above concerns as WHAT we eat is of great value to our overall health and weight, not just how much we eat.

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