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The Benefits of Balance: Giving Consumers Choice

Issue November/December 1997

We have met the communications challenge and it is us. "Nutrition and health professionals and communicators must work together to provide the actionable information that consumers want and need to help consumers both achieve a balanced diet and understand they have numerous food choices."

This was the challenge the International Food Information Council (IFIC) President Sylvia Rowe issued to more than 70 key health, government and private sector professionals in the fields of nutrition education, food science, communications and journalism. The setting was the August 1997 San Francisco roundtable, "Fats and Fat Replacers: The Benefits of Balance," the third in a series of roundtables conducted around the country in the last three years.

Initially designed to provide up-to-date scientific information about dietary fats and fat replacers, the roundtable series has progressed to explore consumer understanding of messages about fat in the diet and obstacles that those communicating the messages must overcome in order to be effective. Compared to the 1995 and 1996 roundtables where the sessions focused on a comprehensive review of the science, participants in the August roundtable spent much of the day discussing how nutrition messages need to evolve to help consumers make necessary changes to achieve a healthful diet and lifestyle.

Participants overwhelmingly agreed that today's consumers need a break from an overemphasis on fat in the diet. Attention paid to dietary fat in recent years has distracted consumers from other issues also key to diet and health. In particular, consumers at this point need to better understand the importance of the classic energy equation: Balancing the number of calories consumed with the amount of physical activity expended.

Fat in the American Diet
A portion of the roundtable was devoted to scientific presentations on new research surrounding dietary fats and fat replacers. The following is from Penny Kris-Etherton's, Ph.D., update on the science surrounding specific fatty acids and health.
Fatty Acid Class % Calories in Diet Major Food Sources
Saturated 12-13% Meat, poultry, fish; Milk products; Grain products. 
Unstaurated 22%  
Monounsaturated 13% Meat, poultry, fish; Grain products. 
Polyunsaturated
7% Grain products; Meat, poultry, fish; Fats, oils, salad dressings.
Trans
2-4% Fried foods; Most stick margarine; Cakes, baked goods and some snacks.
TOTAL FAT 34-35%Calories  See above.




12-13%  22%  

 13%  7% Trans
 2-4% 34-35%

Fat Rules But Calories Still Count

These opinions derive from some convincing evidence regarding consumers' attitudes toward nutrition and how that translates into practice. According to the Food Marketing Institute (FMI) survey Trends in the United States: Consumer Attitudes and the Supermarket 1997, consumer concern about fat remains high. But although the percent of calories from fat has dropped in recent years, the actual amount of fat in the diet has not. How is that happening? Part of the reason is calorie intake has increased (see Sep/Oct 1997 Food Insight).

While health benefits, such as a reduced risk of heart disease, may be gained from reducing calories from fat to recommended levels, any advantage may be wiped out by the health risks associated with obesity. Obesity is an independent risk factor for heart disease as well as other disorders.

Surveys about consumer attitudes also suggest that the message to reduce fat has been heard more clearly than other messages about diet. For example, the advice to eat more fruits and vegetables, which could reduce fat in the diet as well as provide other important disease-fighting nutrients, does not register as well in the consumer consciousness.
"Nutritionists have always known that focusing on fat alone won't achieve better overall nutrition or even improved fat intake," said Ann Coulston, M.S., R.D., senior research dietitian at Stanford University Hospital. "Their goal is to find ways to encourage, and make it easier to get, more variety in food choices, especially different kinds of fruits and vegetables. This message helps improve fat intake because fruits and vegetables, besides having numerous nutritional benefits, are mostly fat-free and would replace some other high-fat foods."

Still, the FMI survey showed 56 percent of shoppers who changed their diet for health reasons are trying to decrease the amount of fat in their diets, while only 15 percent are trying to eat more fruits and vegetables.

Additionally, messages and beliefs that focused only on the fat content of food may have unintentionally distracted consumers from the bigger picture. Reporting on why and how consumers use fat-reduced products, Penny Kris-Etherton, Ph.D., R.D., professor of nutrition at the Pennsylvania State University said, "The short answer is to improve their health and reduce fat and calorie intake. The key question, though, seems to surround calorie compensation. Certain groups of people will compensate [for calories saved when eating fat-reduced products]."

In a straw vote, almost all of the San Francisco roundtable participants said they would prefer to develop messages about calories rather than fat. Important concepts to help consumers put messages about calorie intake into action included portion size, dietary variety and understanding the nutrition facts panel.

Translating the Science into Actionable Consumer Messages
Science:
As discussed during plenary presentations.
Strategies Suggested by Presenters:
When consumers use many of these strategies, they have more flexibility in food choices.
The American Heart Association recommends less than 30 percent calories from total fat and no less than 15 percent calories from fat. Choose leaner meats, poultry and fish for higher fat items; lower fat dairy for full fat counterparts; and fat modified grain-based products, breads and crackers. 
Saturated fatty acids are found in most food groups. Target food groups that are rich sources of specific saturated fatty acids. Using lower fat dairy foods results in a greater reduction of myristic acid than that achieved by simply decreasing total saturated fatty acids. Use nonfat/reduced fat milk and dairy products.
Omega-3 fatty acids affect blood clotting and reduce triglycerides.
Choose two fish meals per week.

Research supports an option to replace saturated fat calories with carbohydrate OR monounsaturated fatty acids.
Use about 1 tablespoon high monounsaturated fatty acid oil (olive, canola or low saturated fat oil blend) OR mixed nuts to replace saturated fat calories with non-carbohydrate sources.
Caloric intake is inversely related to body weight in population-based studies. Be active most days of the week-strive for at least 30 minutes total of moderate activity daily.

The A Word: Activity

Emphasizing the importance of regular physical activity in messages about eating for health also received a strong nod from the roundtable presenters and participants. "The evidence to say that we eat too much is poor, even though calorie intake in the United States is up," said Thomas A. Pearson, M.D., Ph.D., professor at the University of Rochester School of Medicine. "Our energy expenditure appears to have declined remarkably. The real issue is getting people in the United States moving rather than fasting."

Broadening the focus of nutrition messages to include physical activity may also help consumers take "ownership" of the messages, according to Susan Borra, R.D., senior vice president and director of nutrition at IFIC. "We can help consumers take the pressure off food choices when we get them up and moving more. Rather than looking outside themselves for all solutions, consumers need to realize that they put food into their mouths and use the remote control."

Expanding the Options

Food and eating play a variety of important roles in health, from supplying purely physical needs to providing social outlets and, at times, psychological salve. Roundtable participants emphasized that concerns about the relationship of food to physical health must not obscure the other vital contributions food makes to overall health. In short, consumers need to understand how to keep the joy in eating while planning dietary and physical activity programs that meet their personal needs. "Consumers have more choices and leeway in their diets than they think—particularly when coupled with increased physical activity," pointed out Mary Anne Burkman, M.P.H., R.D., Dairy Council of California. "Our job is to show how they can choose foods for taste and health from a broad, not narrow, range of options."

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