Is there life outside dietary guidelines?

Medicine, Nursing and Health Sciences

Melanie Voevodin, PhD Candidate Paul Komesaroff, DirectorDepartment of Medicine Centre for Ethics in Medicine & SocietyCentral Clinical School Central Clinical School

28 May 2012

Is there life outside the Australian Dietary Guidelines

Declaration of interest

2

1998

28th May 2012Life After the Australian Dietary Guidelines

2003 2005 2012

Dietetics Policy & Gov Health Eco PhDStudy

Austin RMH AlfredReal Jobs RMIT Deakin Nestle

WCMICSARBIAS / YPINH Food LawOther Jobs

28th May 2012 3

The Problem

World’s ‘worst third’ for obesity

Almost in the world’s ‘worst third’ for fruit & veg intake

Australians are not choosing the food science says to:

Australian Dietary Guidelines (ADG)

Life After the Australian Dietary Guidelines

28th May 2012 4

What is it about the ADGs?

What the ADGs want us to do What we actually do


28th May 2012 5

Dietitians use the ADGs

The Professional(done study at uni)

The Client(seeks advice from the professional)

ADGsAnd related disease-specific guidelines, websites, support

material

Evidence-based

ResearchLevel 1 Systematic review & meta-analysis [of]

Level 2 DBRCT (>24 months)

Tailor the science to the individual

(ADGs benchmark)

Financial Exchange


28th May 2012 6

But the ADGs are a limited view

MJ Franz JJ VanWormer AL Crain JL Boucher T Hilston W Caplan JD Bowman NP Pronk

Journal of the American Dietetic Association 2007 107(10):1755-1767


28th May 2012 7

‘They all work….when you stick to them’

SL Thomas J Hyde A Karunaratne R Kausman P Komesaroff

Nutrition Journal 2008 7:34

The challenge is in the sticking….


28th May 2012 8

The constant challenge to stick

Consumer


28th May 2012 9

Tomorrow I’ll get apples

..and after dinner we will all go for a walk and work

off the Tim Tams

….and then I’ll never buy Tim Tams again


ConsumerTim Tams2 packs $4


28th May 2012 10

Tomorrow I’ll get apples

..and after dinner we will all go for a walk and work

off the Tim Tams

….and then I’ll never buy Tim Tams again


ConsumerTim Tams2 packs $4


Not following the ADGs is easier

28th May 2012 11

kJ 300 300

Price $0.20 $0.45 – $0.90

Effort Easy Hard

Enjoyment 10 6

Spoilage risk Negligible Medium

Taste risk Negligible Medium


Not following the ADGs is easier

28th May 2012 12

kJ 300 300

Price $0.20 $0.45 – $0.90

Effort Easy Hard

Enjoyment 10 6

Spoilage risk Negligible Medium

Taste risk Negligible Medium


Income ($/week)

Con

sum

er e

ffort

28th May 2012 13Life After the Australian Dietary Guidelines

Healthy

Not Healthy

Dietitian


Healthy

Not Healthy

Dietitian

Oh its so easy, look at this pyramid…eat most is here..

Cost? Healthy eating is cheaper here look at this

I use Avocado instead of mayonnaise its still just as creamy but better for you

Herbs instead of salt – yeah I get herbs from my garden

Recipes: yes here are some you’ll like… lean beef and cranberry salad…here’s another…lentil and leek

soup

Oh money is tight…here’s some ‘recipes on a budget’ no frypan? Maybe use a pot then, here’s some one-pot

recipes

Shiftwork? Here’s a meal plan for shiftworkers


Healthy

Not Healthy

Dietitian

Oh its so easy, look at this pyramid…eat most is here..

Cost? Healthy eating is cheaper here look at this

I use Avocado instead of mayonnaise its still just as creamy but better for you

Herbs instead of salt – yeah I get herbs from my garden

Recipes: yes here are some you’ll like… lean beef and cranberry salad…here’s another…lentil and leek

soup

Oh money is tight…here’s some ‘recipes on a budget’ no frypan? Maybe use a pot then, here’s some one-pot

recipes

Shiftwork? Here’s a meal plan for shiftworkers

May not have experienced poverty, obesity, limited kitchen and facilities, having little children with you all day and having to shop on public transport with them,

drug and alcohol abuse, daily threats of violence

The difference with food as the problem Necessary to sustain life: every person eats Individual makes final choice Choice about food made two, three or more times a day Influenced by attitudes, beliefs, behaviours Everyone’s an expert (or can be)


Life after ADGs for dietitians?


….Yes. And it is good.

DBRCTs (guidelines) may not be gold standard for food

Professional support for options outside ADGs

Policy (legislation) and practice to consider:

Consumer food behaviour [is not rational]

Effort as linked to income (income affects choice)

Because of income, we are not at same starting point

Health & Medicine

Is there life outside dietary guidelines?