Each week we analyse some of the hot headlines in health and nutrition news. This week we look at a new ‘Change4Life’ campaign on children’s snacks and the link between processed meats and breast cancer.
HEADLINE 1: LIMIT CHILDREN’S SNACKS TO 100 CALORIES
Popular in the news this week is the new campaign being launched to encourage healthier snacking in children. This has been reported widely, including the BBC, Sky News, The Telegraph, ITV News, the Sun and The Guardian.
Figures have shown that half the sugar consumed by children in England aged 4–10 comes from unhealthy snacks such as biscuits, cakes and sweets, as well and fizzy and juice drinks.
Public Health England (PHE) have launched a new ‘Change4Life’ campaign promoting children’s snacks which are no more than 100 calories. They also advise cutting number of snacks down to twice per day.
The campaign will run for eight weeks and offers money-off vouchers if parents sign up for lower-sugar snacks. Selected supermarkets including Tesco are supporting the campaign.
The Change4Life ‘Food Scanner’ app has also been updated and improved, showing parents the amount of sugar, salt and saturated fat in their food.
Behind the headlines: the Nutrilicious dietetic view
According to the latest National Diet & Nutrition Survey (NDNS), 4–10 year olds consume on average 53.5g free sugars daily – equivalent to 13 teaspoons. Unhealthy snacks and sweet drinks contribute to at least half this daily intake – equivalent to around 7 teaspoons per day.
We discussed the need for free sugars to be limited for children in a previous blog. Improvements must be made in this area and we sincerely hope this campaign can make a difference.
The scale of the problem
According to the new analysis by PHE, every year each 4–10 year old consumes on average 400 biscuits; more than 120 cakes, buns and pastries; around 100 portions of sweets; nearly 70 of both chocolate bars and ice creams; plus over 150 juice drink pouches and cans of fizzy drink.
As these products are predominantly energy dense with few nutrients on offer, looking at the total calorie contribution per year makes the latest findings even more alarming:
|PHE classified unhealthy snacks/drinks
||Energy contribution to children’s diet per year
|Buns, cakes, pastries
|Sweetened soft drinks including sweetened fruit juices
|Total annual energy intake from unhealthy snacks and drinks
|Daily calorie equivalent
|Weekly calorie equivalent
The campaign to change habits
A simple ‘rule of thumb’ advice is being promoted by the campaign to help make it easier for busy families to reduce the intake: ‘look for 100 calorie snacks, two a day max’.
While 50kcal saving per day may not seem a lot, over a year that’s a saving of over 18,000 kcals.
It should be noted that the advice does not focus on fruit and vegetables. A variety of these should be encouraged, aiming for a minimum of five portions per day.
Examples of snacks that fall at or below 100 calories include:
- One Soreen malt mini lunchbox loaf (30g) – 95 calories
- One small pot of fruit fromage frais (42-85g) – 45-75 calories
- Snack pack of raisins (14g) – 38 calories
- One banana – 81 calories
- One apple – 51 calories
- One Hartley’s no added sugar jelly pot (115g) – 7 calories
- One packet skinny popcorn (17g) – 57 calories
- One packet Tesco’s lentil curls (20g) – 91 calories
(Source: Values obtained from Dietplan 7 and online supermarkets 2018)
The packaged snacks should also ideally show as greens and ambers on the ‘traffic light’ labelling system (indicating they are not too high in sugar, fat, saturated fat or salt). More information on food labelling is supplied by Change4Life.
It is also useful to check on the label that the portion consumed is what the label portion actually relates to. For example, a large pack of crisps may display the calories for 1/8 of the packet but it can be easy for a child to have more than this portion.
What’s missing from the advice
Although it is positive that action is being taken to promote healthier snacking, the campaign only focuses on the role of calories and may not necessarily teach parents about what makes up a healthy snack.
For example, a handful of nuts would contain more than 100 calories, yet nuts are a nutrient dense food and have many benefits to our health. Snacks can contain less than 100 calories but not contain any valuable nutrients, as in the case of many cereal bars. So, it is questionable how well this campaign will educate parents about healthy eating.
Nevertheless, if improvements can be made to the current eating habits in children it will be beneficial.
HEADLINE 2: EATING BACON, SAUSAGES AND OTHER PROCESSED MEATS INCREASES BREAST CANCER RISK IN OLDER WOMEN
Also in the news this week is the suggestion that eating processed meats will increase the chances of getting breast cancer. This was picked up by the Sun, the Daily Mail, the Evening Standard and the Independent.
The study involved 262,195 women aged 40–69, followed over a period of seven years. For this cohort, a 21% increased breast cancer risk was associated with women consuming more than 9g processed meat per day.
However, when the study was combined with another 10 cohort studies and a meta-analysis performed, the risk was significantly lower.
The meta-analysis found processed meat consumption to be associated with 9% increased risk of breast cancer in post-menopausal women only. No association was found in pre and peri-menopausal women, nor was an association found with red meat consumption.
Behind the headlines: the Nutrilicious dietetic view
The study looked at a variety of processed meats, but clearly the UK headlines are pulling at the Brits’ heart strings by focusing on bacon and sausages.
Firstly, what counts as processed meat? Processed meats are defined as meat which has been preserved through salting, curing, fermentation, smoking or other processes. Examples include sausages, bacon, ham, salami, chorizo, corned beef, hot dogs and pepperoni.
9g processed meat equates to:
- 1 and a bit sausages
- 2½ rashes of back bacon or medium slices ham
- 13 thin 5cm diameter slices of salami
- Almost 3 Peperamis
This study adds further supports to one of the key messages for cancer prevention to avoid processed meat and reduce overall intakes of red meat (no more than 500g per week) whilst focusing on a more plant-based diet.
In order to truly help women reduce their risk of breast cancer, messages like this, focusing on one food type, are not helpful. Study findings should be placed in context of overall dietary and lifestyle advice proven to lower risk as well as regular breast screening checks. This study only found correlation in post-menopausal women and only reported on processed and red meat findings.
With 50,000 new cases of breast cancer every year in the UK, 20,000 of which could be prevented through dietary and lifestyle modifications, there are far more pertinent actions women can take. The World Cancer Research Fund (WCRF) highlights the following as major risk factors for breast cancer:
- Gaining weight in adulthood
- Drinking alcohol
- Being physically inactive
- Not breastfeeding when you have a baby
- Being overweight or obese (for post-menopausal breast cancer)
Although this study further supports the evidence that processed meat isn’t great for women’s health (or, indeed men’s health), we need to stop scare-mongering and instead provide helpful advice to women concerned about the UK’s number one cancer. Scientific findings need to be put into context and then interpreted into practical and helpful advice for consumers.
As well as the lifestyle recommendations by WCRF, it is also important to continue encouraging women to regularly check their breasts for lumps and seek medical assistance if they have any concern as well as attend any breast cancer screening invitation from their health service.
For more tips and advice see World Cancer Research Fund UK and Cancer Research UK
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Currently 2.3 million people in the UK are living with heart disease, at an annual cost of £953m to the NHS. We’re involved in an on-going battle to try to reduce it.
For those in the health industry, the link between high cholesterol and heart disease is well known. Meta-analyses, genetic studies and randomised controlled trials totalling more than 2 million participants, 20 million person-years of follow up and 150,000 cardiovascular events demonstrate a close correlation between cardiovascular disease (CVD) and high levels of low-density lipoprotein cholesterol (LDL-C).
What’s less known is the impact plant stanol esters can have on lowering cholesterol.
Changing behaviours of those at risk of heart disease
GPs and practice nurses are key influencers when it comes to persuading people to change their lifestyle to improve their health. So it’s vital to make sure these healthcare professionals (HCPs) have the facts – and materials – they need to support this.
In a survey we undertook this year of HCPs on behalf of Benecol, we found that persuading patients to improve their diet change is a key priority when it comes to reducing cholesterol – along with cutting smoking and increasing physical exercise.
We discovered that while the HCPs are well aware of the importance of cutting saturated fat and sugar, and want to communicate about healthier eating to patients, they are less likely to know the impact plant stanol esters can have on lowering cholesterol.
Plant stanols and sterols can reduce cholesterol by up to 10% in two to three weeks.
Over 70 clinical studies have demonstrated that plant stanols effectively lower cholesterol.
How do they work?
Consumption of foods with added plant stanols or sterols (1.5 – 2.4g/day) should take place at meal times. Mixing with food and digestive juices results in the displacement of dietary and biliary cholesterol in the fat absorption pathways in the gut.
Cholesterol absorption is reduced by about 50% and studies have shown a dose-dependent reduction in circulating LDL-C of 7 – 10% on average.
Cholesterol begins to lower immediately. With continued use full reduction is achieved within 2 – 3 weeks and is sustained over the longer term. What’s more, if used alongside statin therapy, plant stanols lower LDL-C by an additional 10% – an effect greater than doubling the statin dose, which, at best, only provides a 6% additional LDL-C reduction.
Plant stanols provide an easy diet-based solution to all hypercholesterolaemic patients, including those with mildly elevated serum cholesterol level. They would also be especially recommended for those averse to taking statins, anxious to keep statin doses low, or at higher risk from potential statin-related side effects.
They are recommended by a number of prevention and treatment guidelines as part of a cholesterol-lowering diet, including the European Society of Cardiology, the Atherosclerosis Society, UK JBS3 guidelines and the World Health Organisation.
Our holistic communications approach to help reduce cholesterol
As a result of our research, we created a holistic communications approach in association with HEART UK – the Cholesterol Charity and leading heart health dietary specialists – to support practice nurses and GPs, and their patients.
- We created information sheets for the healthcare professionals with full information about dietary changes patients can make to lower LDL-C levels. Included in this was the latest evidence not only on plant stanols but on all dietary recommendations for lowering LDL-C.
- Alongside this were fact sheets for patients, clearly explaining the problem of high cholesterol and the lifestyle changes that would have a significant impact on their health.
We highlighted the key motivators for patients – the fact that a small change would bring quick results.
Companies are accused of only being interested in their profits – and of course, they are ultimately accountable to stakeholders, so money is always going to come into it.
But what we found with Benecol’s approach is that they are genuinely determined to help combat the huge problem of heart disease that exists. Reaching out to health professionals they wanted to understand issues fully and how best to communicate lifestyle change – not just dietary, which would help promote the message of plant stanols, but also more widely, include all dietary matters as well as smoking and exercise.
The materials tell the whole story, educating the professionals and patients and then leaving it in their hands how to act.
Health professionals responsible for communicating heart health cholesterol lowering advice can order these packs by calling the Benecol Helpline 0800 018 4010 and asking for your health professional Benecol Toolkit ‘Small Change, Big Results’ pack.
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A new World Wildlife Research Fund (WWF) report, Eating for 2 Degrees – New and Updated Livewell Plates, calls on the UK Government and Climate Change Committee to set goals for reducing emissions from the food sector. Following-up from the original 2011 WWF Livewell report, it aims to ‘provide diets that are good for both people and the planet.’
There are new plates developed specifically for adolescents (10–17 years old), adults (18–64), the elderly (65–85) and vegans. They illustrate the absolute minimal dietary changes needed by 2030 to keep below a two-degree rise in global temperature, as per the 2015 Paris Climate Change Agreement. The new Livewell Plates are described as,”representative diets that meet national nutritional requirements while reducing the environmental footprint of the food system that produces them.”
The Plates were based on modelling from Public Health England’s Eatwell Guide and current dietary intakes as baselines. They aim to create a diet with the fewest possible changes to current recommendations while meeting the restrictions imposed. In general, they contain more plant foods, particularly those that are nutrient dense such as vegetables, wholegrain cereals products, nuts, legumes and vegetable oils.
This report builds on thinking on healthy sustainable diets that we are increasingly seeing from consumer and public health organisations and think tanks. And the WWF believe it’s time that the UK Government implements healthy eating advice that also integrates sustainability.
The authors hope to develop additional Plates in future, including one for infants and primary school children, as well as country-specific Plates.
What are the Livewell Principles?
People are advised to follow the following Livewell Principles:
- Eat more plants – enjoy vegetables and whole grains
- Eat a variety of foods – have a colourful plate
- Waste less food – one third of food produced for human consumption is lost or wasted
- Moderate your meat consumption, both red and white – enjoy other sources of protein such as peas, beans and nuts
- Buy food that meets a credible certified standard – consider MSC, free-range and fair trade
- Eat fewer foods high in fat, salt and sugar – keep foods such as cakes, sweets and chocolate as well as cured meat, fries and crisps to an occasional treat. Choose water, avoid sugary drinks and remember that juices only account for one of your 5-a-day however much you drink.
Changes we think should be implemented in light of the report
- Food businesses including manufacturers and caterers should be looking at ways of including more plant foods in general into their products and menus, and using credible certified standards where these are available.
- Food service in particular can look at ways of promoting their expanding range of plant-based options. A new scheme from Veganuary, The Humane League UK and Vegan Chef Day gives a good example of raising awareness.
- Retailers should be looking at ways of shifting their promotional budgets away from high fat, salt, sugar foods and towards the core foods in the Eatwell Guide and Livewell Plates.
- We are already seeing a shift in reported consumption of animal products by consumers. A recent report from Mintel suggesting 28% of Brits have reduced or limited their meat consumption in the last six months. Consumers can further support their efforts towards more sustainable diets by thinking more holistically – eating more plants, wasting less, and so on.
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The European Commission Group on Nutrition and Physical Activity is a high-level group covering all matters related to nutrition and physical activity for tackling obesity in children. They’re creating frameworks to address the health problems endemic in every country in the Western world. As health professionals, we’re delighted.
Government representatives from all EU countries, plus Norway and Switzerland, attend the group. The UK government is represented by the Department of Health.
The driver for the obesity problem to be taken seriously at last? The ever-growing drain on economies caused by obesity-related health problems: from the cost of healthcare provision to increasing numbers of sick days taken by workers.
Meeting at least three times a year, they share experiences and strategies for tackling obesity. To date, they have published an EU Action Plan on Childhood Obesity for 2014-2020, aiming to reduce exposure of foods with high saturated fat, sugars and salt (HFSS), as well as increasing exercise.
They’ve also set frameworks that can be taken up by any country on reformulation of commercial products, focusing on reductions in HFSS. Food categories currently under review are:
- Sugar-sweetened beverages
- Sweetened dairy and dairy imitates
- Breakfast cereals
- Bread and bread products
- Bakery products (for example cakes and cookies)
- Ready meals (including ready to prepare products like dry soups, dried mashed potatoes, rice mixture)
- Savoury snacks
- Sauces (including ketchup)
- Sugars sweetened desserts, ice cream and topping
- Canned fruits and vegetables
- School food offer
- Catering meals
Interestingly, baby foods are not yet covered, although it would not be a surprise if this is the next step once Public Health England’s (PHE) sugar reduction strategy for this category gets under way end of this year.
The EU-specific Commercial Food Reformulation Framework for Added Sugars is set – and is really a reflection of the PHE’s sugar reduction strategy:
- They have proposed benchmarks for each of the above food categories.
- They have recommended that countries set an added sugars reduction benchmark of a minimum of 10% by 2020 (vs. 2015 baseline levels).
- They have used the same definition for ‘added sugars’ as PHE, including fruit juice, fruit juice concentrate and fruit purees.
The frameworks are guidelines with minimum requirements, rather than exact rules every country is bound to. This makes sense – countries can choose to apply them as appropriate, taking into consideration different consumer attitudes to food and nutrients.
So, for example, in the UK, the first nine food categories to come under the sugar reduction targets also used 2015 data as baseline, but we went to 5% reductions by year one and 20% reductions by year 2020.
The Group next meets at the end of the month, with an evolved nutrition labelling initiative one of the points on the agenda. Major multi-national companies are on board, including The Coca-Cola Company, Mars, Mondelez, Nestle, PepsiCo and Unilever.
Let’s hope that what comes out of it actually makes an impact, that it’s not just words no one follows up on. We’re certainly moving in the right direction.
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