Bias-free dietary guidance
Canada’s revamped 2019 Food Guide centres on a simple yet arresting image: a plate filled with unprocessed, mostly plant-based foods. Dairy foods no longer have their own category, with the usual five food groups trimmed to just four. Swapping hard-to-follow and prescriptive serving sizes for an emphasis on overall healthier eating habits, the “plate”, a visual snapshot of the new recommendations, is 50 per cent fresh fruit and vegetables. Wholegrain carbs and protein foods occupy a quarter each. Pushed backstage, the meat, fish, egg and yoghurt sit equanimously among the plethora of plant-based protein options, including tofu, nuts and legumes.
Historically, in most countries, meat and dairy products have been mainstays in the food guides used to inform the public on healthy nutrition. So why their sudden reduced status in the Canada guide?
Health Canada spokesman Geoffroy Legault-Thivierge said the updated guide reflects the current evidence around diet and health. “Evidence showed that the regular intake of plant-based foods, including plant-based proteins, is associated with lower risks of chronic diseases, such as heart disease,” he said. The guide also uses language people use to refer to food, such as “protein foods” rather than specific food groups, he said.
More telling, perhaps, is another fact. Health Canada excluded the food industry, including all industry-commissioned research, from the evidence review process in the 2019 update of the Food Guide. “It was important to ensure that the development of dietary guidance was free from conflict of interest,” Legault-Thivierge said.
Following Canada’s lead, in the United States the Physicians Committee for Responsible Medicine urged the newly appointed 2020-2025 Dietary Guidelines Advisory Committee to also ditch dairy. They cite the scale of lactose intolerance, and links between saturated fat in dairy foods and increased risks of heart disease, breast, ovarian and prostate cancer, cognitive decline and early death.
Understandably, the agricultural industry is fighting back. Dairy Farmers of Canada, which represents the Canadian dairy industry, issued a statement in January challenging the science for reducing dairy intake. “There is abundant research that demonstrates that milk products with various fat content can be a part of healthy diet,” they said.
However, consumers are cautioned against the bias inherent in health advice from the food industry. “Be aware of food marketing,” the new Canada Food Guide advocates. “Cook more often”, “Read labels” and “Be mindful of your eating habits”.
“Canadian children see more than 25 million food and beverage advertisements per year on their favourite websites, of which 90 per cent are for products high in sugar, fat and sodium,” Legault-Thivierge said. “The marketing of such foods and beverages has been identified as a major contributor to childhood obesity.”
Historical analysis of internal sugar industry documents, examined in a 2016 journal article for JAMA Internal Medicine, also show that industry-funded studies in the ’60s and ’70s were behind the targeting of fat (and minimisation of sugar’s role) in heart disease.
Fortunately, awareness of the unhealthy influence the food industry exerts over public nutritional advice has been gaining momentum across the world. Among those leading the charge is esteemed British cardiologist and author Dr Aseem Malhotra. In a 2018 Diet Doctor podcast, Malhotra said: “One of the reasons we have a complete healthcare epidemic failure is because there is a root of misinformed doctors and misinformed patients, and that stems from biased funding of research.”
Where does Australia stand on the issue?
Dr Katherine Cullerton, a research fellow at the University of Queensland’s School of Public Health, said awareness is building. Cullerton is the first person to provide empirical evidence on the relationships between food giants and policymakers in Australia. She mapped out the connections between different stakeholders including the nutritional sector, academics, politicians and the food industry. “Through that process, I was able to build up, like a spider’s web, showing the connections between different people,” she said. “What that research showed was the food industry are really, really close to decision-makers. They’ve got the most direct and most number of relationships with these decision-makers, more so than any other group in Australia.”
In this relationship, science – and public health – often takes a back seat to those with the most money. “The food industry is very well resourced with money, time and people,” Cullerton said. “Whereas nutrition scientists and nutrition professionals, who are often trying to advocate for evidence-based policy change, just don’t have these resources. As a consequence, the voices that the decision-makers hear is predominantly from the food industry. They pull a lot of weight with politicians and the policymakers in different countries, including Australia. It feels we’re constantly fighting this goliath of power. When it comes to public health decision-making, the food industry should not be at the table. It’s totally inappropriate.”
Conservative governments encourage big corporations to dominate in the web of associations. “Our current government is very supportive of the market rules, and the commercial solutions to these problems,” she said. “Food is political.”
Another way food companies influence nutritional advice is via funding partnerships with key health organisations. However, Cullerton said Australian health organisations are starting to bow to media backlash and pressure from their members over their links to food giants. The Dietitians Association of Australia announced an end to its partnerships with food manufacturers, including Nestlé, in October 2018.
Cullerton views the revised Canada guidelines as another line in the sand, and praises the process used to develop them. “They have a great focus on sustainability and also how we eat, when we eat. They looked at all the evidence that had come out since the previous guidelines. They omitted all industry-funded research as we’re becoming more and more aware of the bias that is in industry-funded studies.”
Within Australia, public health policy centres around the government’s Food and Health Dialogue and Health Star Rating, Cullerton said. However, both draw on voluntary committees that include the food industry.
As campaigns and policy adviser for Australian non-profit consumer advocacy group Choice, Linda Przhedetsky has been fighting for better sugar labelling and changes to the currently under-review Health Star Rating. Loopholes in the system – which rates the nutritional profile of a packaged food or beverage between 0.5 and 5 – mean processed foods high in sugar, fat and salt can be rated highly if they contain healthier ingredients such as fruit, or can be mixed with something more wholesome, such as milk. “When you see a 140-gram pack of Nutri-Grain Banana and Honey Smash getting a 3.5-star health rating, despite containing 3.5 teaspoons per serving of sugar, you have to wonder how industry keeps getting away with this conflict of interest,” Przhedetsky said.
While the buck ultimately stops with food ministers, the voluntary committee of the Health Star Rating system includes the Food and Grocery Council and the Australian Industry Group, Przhedetsky said. The latter represent the confectionery sector. “Effective health star ratings can and do help people, but one of the problems is that the system is voluntary and it’s disproportionately influenced by the food manufacturers and the needs that they put forward,” she said.
Choice wants regulation and practices that protect policy development from the vested commercial interests of the food and beverage industry. “At the end of the day food manufacturers are there to make money selling popular products,” Przhedetsky said. “We really need health professionals to be making these decisions. The system needs to make nutritional sense, not marketing sense. What we say to companies is: go ahead and sell sugar, but do it honestly and be transparent about what you’re doing. Don’t ‘healthwash’ unhealthy products.”
Scientific studies link some of the biggest health issues facing Australians – obesity, diabetes, heart and cerebrovascular disease – with diets high in sugar, salt and saturated fat. Coronary heart disease kills more Australians than any other cause, according to 2018 Australian Institute of Health and Welfare data. Two out of every three Australians are now overweight.
“The food environment is really stacked against Australians,” Przhedetsky said.
Perhaps Canada’s new guidelines could offer some healthy solutions.
This article was first published in the print edition of The Saturday Paper on May 18, 2019 as "Influence off the table". Subscribe here.