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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
© Rosemary Stanton 2013
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.
© Rosemary Stanton 2013
key question for guidelineswhat should
Australians eat?
© Rosemary Stanton 2013
2013 dietary guidelines
changed focus– foods, food groups & dietary
patterns– not food components or individual
nutrients
© Rosemary Stanton 2013
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
© Rosemary Stanton 2013
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)
© Rosemary Stanton 2013
what has changed - format
– all age & gender groups in one concise document
– infant feeding guidelines for health workers as a separate document
© Rosemary Stanton 2013
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
© Rosemary Stanton 2013
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