The fight against junk food

Fad diets keep coming like a conveyor belt of cream doughnuts. Filled with the promise of turning telly-tubbies into stick insects, a sprinkling of science makes them irresistible.

The Atkins Diet, so we were told, worked by forcing the body to consume stored fats because there was no available carbohydrate to burn. So, instead of filling up on dull carbs such as bread, cereals and potatoes, we could enjoy a juicy steak with garlic butter.

By last month, carbs were back in fashion. Diets have their own use-by date, whether we can stomach them or not.

But if food is our favourite obsession, it is also our biggest killer. What we eat/what we don't eat, combined with sedentary modern lifestyles, is responsible for more premature deaths than smoking, alcohol, infection and other leading causes of death.

The Ministry of Health estimates that 40 per cent of all deaths are a result of nutrition-related risk factors including high cholesterol, high blood pressure and obesity. High-fat, high-sugar diets and inadequate fruit and vegetable intake are linked to diabetes, stroke, heart disease and cancers. Obesity reduces our enjoyment and quality of life.

As the Health Ministry mulls over a review of the food pyramid, health agencies are demanding a more prescriptive approach. Unfazed by reaction to last year's fat tax proposal, they're pushing a trolley of measures including a ban on food advertising aimed at children, limits on "unhealthy" food ads compared to "healthy" foods, bans on junk food sales in school canteens and limits on sugar and fat content in food and drink.

In urging for regulations to force junk food out in the cold, health agencies are drawing strength from the 30-year campaign against tobacco.

But campaigners are battling a foe even more powerful than the tobacco industry - ranging from food producers who form the backbone of our economy to manufacturers and international fast food giants.

Up against the saturation marketing of fast foods, the latest dietary advice, cooking programmes and cafe reviews run the promotional campaigns of health agencies: 5+ a day, Pick the Tick, the green prescription, the food pyramid and variations such as the food kete and Pacific Heartbeat's Eat for Health.

The sheer weight of contradictory messages is part of the problem; another is that knowledge alone doesn't change behaviour, says Heart Foundation dietitian David Roberts. "That's reflected in dietary surveys where we have less than half the population eating 5+ a day, only one in five of the population eating enough bread and cereals and we still have animal fat intake that's about a third higher than it should be.

"We have this obesity epidemic where it's proposed that life expectancies will actually start to fall this generation."

Obesity has soared to nearly 20 per cent of the adult population since the mid-1980s and is projected to reach 30 per cent by 2011. Another third of us are simply overweight.

Obesity Action Coalition executive director Celia Murphy says the modern food supply and sedentary lifestyles are "not a good fit".

"We've got bodies designed to eat little bits of foods and to be very active and that's just not what we're doing. We've got all this processed food that has nutrients taken out of it that we need and a whole lot of energy in it that we don't need."

The Ministry of Health's response to obesity is the Healthy Eating Healthy Action (Heha) strategy - primarily nutrition education and exercise programmes in schools and the community. Key messages include: eat a variety of nutritious foods; eat less fatty, salty and sugary foods; eat more vegetables and fruits and exercise for at least 30 minutes a day.

But Murphy says more drastic initiatives are needed. "Just telling people what to do doesn't make them do it. You have to help people to make the right kinds of decisions and choices.

"Chippies [crisps] have something like 38 to 40 per cent fat in them but they can make chippies with around 25 per cent fat. If we could get manufacturers to reduce fat or sugar content by 5 or 10 per cent over a whole range of products then consumers automatically would get less of the bad things."

What food manufacturers put into products is one target, food marketing is another. A pilot study in Wellington and Wairarapa last summer found food accounted for over 60 per cent of outdoor advertising near 10 secondary schools. Of that, over 70 per cent promoted "unhealthy" foods, mirroring an earlier study on TV advertising to children.

Food producers argue there's little evidence that their ads persuade people to eat too much bad food. Obesity is caused by eating too much, they say.

But lobby groups say there's growing international evidence that children do act under the influence. A ban on food advertising during children's TV time is supported by Diabetes NZ, Agencies for Nutrition Action and many health professionals.

And it's not just the ads - marketing techniques including loyalty programmes (think: toys with your Happy Meal), bundling (combo anyone?) and upsizing are in the firing line.

Another target is what's sold in the school canteen. Only one school tuck shop in three sells fruit, says Carolyn Watts, past chairwoman of Agencies for Nutrition Action.

"Children know what are healthy foods and what they should be eating," says Watts. "They're quite familiar with the food pyramid concept and 5+ a day but what they're taught and what they're faced with in day-to-day life are two completely different things."

Watts, and others, rail about the funding of school health and nutrition programmes by the likes of McDonald's and Coca Cola, and school fundraising using chocolate bars. "Parental choice is fine but if parents don't actually have control over what happens at school - if the school's full of promotional materials from food companies and the canteen's full of unhealthy foods - that negates the whole argument about personal choice."

In a report last year for Diabetes NZ, public policy specialists Allen & Clarke compared obesity control proposals with the gradual chokehold applied to smoking.

The report noted that initial public health moves against smoking did not follow public opinion, industry wishes or beyond-doubt medical evidence. But as the scope of health problems associated with tobacco became apparent, steps were taken "which led and formulated public opinion and industry action". Proposed obesity controls fell into the same category, it said. Experts on tobacco control have since addressed conferences here on food advertising.

But the food industry, too, has learned lessons from the smoking experience - about avoiding regulation with pre-emptive strikes.

When lobby groups Fight the Obesity Epidemic and Diabetes NZ called last year for a tax on high fat and high sugar foods, Health Minister Annette King dismissed the idea. A fat tax would be too hard to implement; she preferred education and working with the food industry to improve diets. But King warned regulations could follow unless the industry improved its act.

About the same time, food manufacturers formed the Food Industry Accord and launched a healthy eating campaign, with reconstituted McDonald's character Willie Munchright as flagbearer.

The accord has further ingratiated itself with the Ministry of Health, committing to the ministry's Healthy Eating Healthy Action (Heha) strategy and supporting the Counties Manukau District Health Board's diabetes programme. Closely allied to the Association of NZ Advertisers, the accord is rewriting codes of children's and food advertising.

When agencies release studies on the effects of junk food advertising, the accord wheels out countering research. In July, after Agencies for Nutrition Action had publicised a report on the links between sugary drinks and childhood obesity, Coca Cola put out its own leaflet endorsed by the Nutrition Foundation. The effect was to muddy the waters with statements like "those who have a healthy body weight can and do enjoy sugar-containing fizzy drinks and juices".

The accord is helping to fund a new appointee to the Counties Manukau board to advise at-risk groups on nutrition and exercise.

Spokesman Jeremy Irwin bridles at comparisons between the drawn-out public health campaign against smoking - and the counter-tactics of tobacco companies - and the focus on junk food. Irwin, executive director of the Association of NZ Advertisers, instead frames the debate as one of individual freedom versus nanny state.

"At the heart of this debate is the extent to which the state should intervene in people's lives by determining what they can and can't eat," he told a public health conference in May.

"We take the view that draconian intervention which diminishes the rights and responsibilities of the individual to make choices ... is undesirable. It undermines that very self-reliance of which New Zealanders are very proud."

Irwin says manufacturers are voluntarily making products healthier - citing the introduction of salads by McDonald's and other fast food outlets and the introduction of lower fat and lower sugar alternatives by biscuit and crisp manufacturers. These changes are a response to consumer demand as much as an attempt to head off regulation, he says.

"As far as we're aware, New Zealand's the only country in this obesity debate where industry is working with Government on finding solutions."

But Murphy says it's going to take more than industry action to get the population eating well and physically fit again.

"I don't think industry's going to do it of its own accord," says Murphy. "Industry's responsibility is to its shareholders. The way [manufacturers] make money is by selling more product - that's completely inconsistent with an 'eat less' campaign."

Irwin rails against "a few organisations who are only negative in their approach and quick to bag whatever the food industry does. Instead of trying to find solutions they are ... putting out some pretty scary stuff." Junk food and tobacco are "chalk and cheese in terms of their possibility of causing a problem," he says.

"At least you know if you're smoking a cigarette there's a possibility of it causing lung cancer. You'd have to eat a vast amount of [suspect] foods to have any effect like that."

Clearly, from the statistics, people are. As overseas regulators clamp down on "unhealthy" food, pressure is growing for New Zealand to do more. Sweden and Norway have longstanding bans on junk food advertising on children's TV. British authorities are considering a "traffic light" labelling system for unhealthy foods. Other proposals include restrictions on advertising to children based on a nutrition profiling model which "scores" foods for overall nutrition value.

France's food standards agency has recommended lowering the level of trans-fats in bakery items while the French Government is considering TV advertising restrictions.

For now, the New Zealand Government prefers to give industry a chance. Deputy director-general of public health Don Matheson says tobacco controls were the standout public health success in the past 20 years but were not just about regulation. He says there's a lack of evidence that any single strategy works so the ministry favours a broad-brush approach.

Ministry spending on nutrition programmes has nearly doubled this year to $18.5 million. Matheson concedes it's less than the $30 million spent on anti-smoking initiatives but "it's as big a jump as you could expect in a year". District health boards are also investing in nutrition programmes. He says the food industry's commitment to fighting obesity is "unique internationally".

"Industry won't achieve it on its own but it may achieve it if we create a climate where consumer demand is changing because of greater awareness."

Progress will be measured against health statistics. "What we are seeing is a profound deterioration in obesity over the last couple of decades.

"If the evidence shows the accord is instrumental in contributing to reduced fat, sugar and salt consumption and increased fruit and vegetable [intake] and physical activities, it will be a world first. If it is not successful, then other public health approaches remain on the table."

But agencies say the real problem is the power of the food industry and a lack of political will.

"Nutrition just isn't taken seriously," says Murphy. "I don't think the Government has really committed to putting enough money into it."

She cites a World Health Organisation estimate that for every dollar spent on health promotion, $500 is spent on food advertising.

"The food industry is probably the most powerful industry in the world. A few NGOs wittering on isn't going to do it. It's going to take leadership."