Olive Oil Can Tap Dance!

by Zoë Harcombe

  2) The Professor Sir Michael Marmot work on health inequalities. I had the privilege of hearing the Cochrane lecture, delivered by Professor Sir Michael Marmot, at the Wales NHS conference on 11 November 2010. The comparative health and longevity and healthy years of life are indefensibly different for people from different income groups and this cannot be allowed to continue. However, I remain to be convinced if handing responsibility for this to local government will make any difference. It hasn’t for education or economic development, so what will be different to make this work?

  Things I disagree with:

  1) In the Foreword, Lansley says: “It is simply not possible to promote healthier lifestyles through Whitehall dictat and nannying about the way people should live.”

  I completely disagree.

  – We introduced a clunk click every trip seatbelt campaign. Robert Gifford, of the Parliamentary Advisory Council for Transport Safety charity, said seatbelts had saved 35,000 lives in the UK during the last 25 years.

  – We introduced a smoking ban and an estimated 40,000 lives have been saved.

  The UK government could and should introduce a sugar tax, as has been introduced in Denmark and Finland. Finland have also taken steps to get Pepsi out of schools by 2012 – still not soon enough in my view, but way ahead of the UK. The government could make an enormous difference to our health (obesity and diabetes especially) by banning food companies from advertising to children (as Sweden has done since 1991); banning sugary drinks and confectionery in school; banning cartoon characters in sugary cereal marketing and attempts by the cereal makers to get children (and adults) to eat more of their processed food; banning similar marketing by the fast food industry who want humans eating more burgers, more fries, more milkshakes, more white flour pizza, more chicken in ‘secret’ ingredients and so on.

  This is the biggest outrage of the white paper – it is possible. Lansley doesn’t want to go this route because he is more concerned about the food and drink industry than the nation’s health. I challenge him to prove me wrong on this and take decisive action against the food and drink companies.

  2) Lansley is doing the exact opposite to taking decisive action against the food and drink industry. He is meeting with them at Unilever house, with Unilever in the chair. His Foreword goes on to say: “All of this will be supported by work with industry and other partners to promote healthy living”.

  As Professor Philip James, Chair of the International Obesity Taskforce, said on BBC Newsnight last week – this is utter madness. Food and drink companies have one purpose – to grow. They need to deliver increasing returns to shareholders and their ‘well being’ depends on them selling more of their food and drink. The biscuit companies need humans to eat more biscuits; the cake companies need humans to eat more cakes; the cereal companies need humans to eat more cereal; the confectionery companies need humans to eat more confectionery; the fizzy drink companies need humans to drink more fizzy drinks – human beings end up being nothing more than consumers in the food and drink companies’ pursuit of growth.

  The food and drink companies love the current dreadful public ‘health’ dietary advice. They love everything being about calories and energy in and out. They will happily keep the focus on exercise – we need to exercise more; we’re fat because we’re sedentary kind of thing. Heaven forbid that the public stops eating processed food because they realise it makes them fat.

  As I detail in my latest book “The Obesity Epidemic: What caused it? How can we stop it?” , many food and drink companies actually have the government “eatbadly plate” (I think it is supposed to be called “Eatwell Plate“) on their web sites. They love the box of cornflakes on there (branded Kellogg’s in earlier versions of the plate); they love the cola on there (yes really); the Battenberg cake, sweets, biscuits, white bread, sugary baked beans, fruit in syrup, fruit juice – and many more – all the processed food that they love to sell us and they want us to consume more and more of.

  Our waistlines grow in sync with the growth in sales of processed food and drink. How on earth can we think that food and drink companies will lead a campaign to reduce waistlines and, inevitably, their sales in parallel. The cure to the obesity epidemic lies in returning to eating food – real food – the food we ate before two thirds of us were overweight. It does not lie in eating the processed food that we have eaten during the time in which obesity has increased nearly 10 fold – the stuff that Lansley’s partners make. It really is utter madness.

  3) I disagree with point 7 in The Executive Summary: enhanced nutrition is heralded as a “formidable public health achievement”. Our nutrition could be the best it has ever been, but it is far from this. I analysed the UK Family Food Survey (2008) with the following conclusions:

  a) Vitamins: If you take the higher of the Recommended Dietary Allowances (RDA’s) for the USA and Europe, UK intake falls short for Vitamins A, C, D, E and Folic Acid. Interestingly the fat soluble vitamins (those delivered in foods with a fat content) are A, D, E and K. K was not recorded, but the deficiencies in A, D and E make it likely that our low-fat obsession is making us deficient in all the fat soluble vitamins. This should be of deep concern to our governments. Instead, when they present the latest annual food survey we are again told to eat less fat – and to become even more deficient in these vital nutrients. The vitamin E deficiency is both interesting and worrying – vitamin E is the body’s natural antioxidant and is known to repair damage in the blood vessels. I wonder if that has anything to do with heart disease?

  b) Minerals: The average UK citizen is lacking in every mineral recorded by the National Food Survery, compared to the higher of the RDA’s for the USA and Europe. The UK is missing even the low European target in all but calcium. (No wonder so many people are now taking osteoporosis tablets with 500mg assumed to be adequate for calcium). Since so many of the minerals are not even recorded, we may be able to assume from the deficiencies in those that are recorded, that the overall picture is bleak.

  A recent report confirmed that one in five middle class children are effectively suffering rickets – what was considered to be a disease of the Victorian period. This is a direct result of our negligent low fat dietary advice, telling people to avoid the health benefits of the sun and cereal companies ruling our breakfast choices, when we should be eating eggs. (Doubly ironically, on p11 of the white paper – bullet 1.1 says “once common conditions such as rickets” have been “consigned to the history books”. If only….)

  This is not a formidable public health achievement Mr Lansley – it’s a disgrace.

  4) Bullet 9 of the Executive Summary is, as a number of media commentators have already noted, “high on rhetoric” and “low on substance”. It is described as a “Radical new approach”. It is far from radical, although inviting food and drink companies to set policy may be new and catastrophic. A sugar tax would be new and radical; banning food and drink company marketing to children would be radical; using a tax on processed food to subsidise real food (especially directed towards people less able to afford real food) would be radical. All of these could have an enormous impact on obesity and health. Having a “ladder of interventions” and adopting “the least intrusive approach” is only radical and new in its certainty to be ineffectual.

  A few other points:

  In the main body of the paper:

  1.6 – “People in England are healthier and living longer than ever”.

  I disagree. I rarely see a healthy person. Two thirds are overweight; one quarter obese; one in three will die from a modern illness – heart disease; another one in three will die from another modern illness – cancer. Approximately three million British citizens are suffering diabetes – another modern illness. The average person that I see walking around the UK is fat and sick; tired and depressed – all, I would argue, as a result of the appalling dietary advice that they have been given over the past 30 years. We are keeping people alive longer, as a result of modern medicine an
d pharmacology (not always in a good way), but there are too many people “existing” rather than “living”. As point 1.10 says, and surely this is contradictory, “some 15.4 million people in England have a long standing illness.”

  1.30 – “only 3 in 10 adults eat the recommended 5 portions of fruit and vegetables a day”.

  This is bad science. 5-a-day has no scientific foundation whatsoever. It was a marketing campaign started by the American National Cancer Institute and c. 20 fruit and vegetable companies in California in 1991 – the influence of the food industry in demonstration. Nearly 20 years later, this marketing slogan still has no evidence base (see reference 278) and yet it features in government, Department of Health, documents as if it is scientific. A 5-a-day marketing slogan, which could have had a significant impact on the health of English people, would have been liver, sardines, eggs, sunflower seeds and a green leafy vegetable. The fruit juice that mums are trying to get into their children, thinking they are following sound government advice, is fuelling the obesity epidemic and damaging our children’s livers. (There is more nonsense implying that 5-a-day is sound in point 3.31).

  There are then 5 questions for consultation on which public comment is invited:

  a. Are there additional ways in which we can ensure that GP’s and GP Practices will continue to play a key role in areas for which Public Health England will take responsibility?

  b. What are the best opportunities to develop and enhance the availability, accessibility and utility of public health information and intelligence?

  c. How can Public Health England address current gaps such as using the insights of behavioural science, tackling wider determinants of health, achieving cost effectiveness and tackling inequalities?

  d. What can wider partners nationally and locally contribute to improving the use of evidence in public health?

  e. We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary registration for public health specialists?

  – nothing about should we have food and drink companies writing our obesity and drinking strategy. Just the usual vacuous ‘consultation’ questions that are designed to only invite comments on the least contentious areas in the secure knowledge that consultation won’t change the government’s plans anyway. As for evidence in public health? 5-a-day?!

  I await the obesity paper in the spring.

  Zoë Harcombe

  UK Women are the “World’s Worst Dieters”

  December 23, 2010

  This story was in the Daily Mail December 22 2010. The headline says “World’s Worst Dieters” but the article is only talking about women, so we need to be fair to men here.

  SPA Future Thinking, a market research firm did a “Question of Taste” survey. They surveyed 1,534 women around the world in the following countries: Brazil, China, France, Germany, UK and USA. Some of the key findings were:

  1) Although most adults are on a diet (defined by some kind of restrained eating) for much of the time, 34% of British women had gained, rather than lost, weight over the previous year. This compared to 19% of German women who had gained over the previous year (that’s still a lot of people on the rise in the absence of many people losing).

  2) 86% of British women had not lost weight since the previous year – this was the worst ‘dieting success statistic’. This is interesting because we have known for 50 years that sustained weight loss (on eat less/do more diets) has a 98% failure rate:

  “Having reviewed the literature from the first half of the twentieth century and having done their own study Stunkard and McLaren-Hume (1959) concluded “Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it.” Stunkard and McLaren-Hume’s own statistical study showed that only 12% of obese patients lost 20 pounds, despite having stones to lose, only one person in 100 lost 40 pounds and, two years later, only 2% of patients had maintained a 20 pound weight loss. This is where the often quoted “98% of diets fail” derives from.” (From The Obesity Epidemic: What caused it? How can we stop it?)

  This statistic is astonishingly supportive of Stunkard and McLaren-Hume’s finding. They found that only 12% of patients lost 20 pounds. This survey is saying only 14% lost anything at all.

  3) Half of the British women surveyed said that they exercised for less than 3 hours a week. Here’s the really interesting exercise bit, however – French and American women exercised the least – with almost a quarter doing less than half an hour per week. Using the most recent World Health Organisation estimated prevalence for female obesity per country, we find the following (the WHO takes women as aged 15+):

  – Brazil 24.5%;

  – China 3.6%;

  – France 7.6%;

  – Germany 22.1%

  – UK 26.3% and

  – USA 48.3%

  So – the most obese and closest to the least obese exercise the least. The Daily Mail article quotes “diet experts” (not named) as saying “people are simply doing too little exercise.” On this evidence it doesn’t do the French any harm. Could it be that French women eat meat, fish, dairy and vegetables and very little refined carbohydrate and American people are told to base their meals on carbs?

  4) British women were only second in reliance upon convenience food – USA ‘won’ this category with 20% reliant on convenience food. The British figure was 13%. The other countries were in single figures – France and Germany at 6%.

  If you want to be a successful dieting statistic this time next year, here are my top 3 tips:

  1) Eat food – real food only and no processed food;

  2) Eat three meals a day – stop snacking every couple of hours;

  3) Manage your carbohydrate intake. Most people should be able to lose weight successfully with just tips 1&2. If you have weight to lose and are not losing by including ‘good’ carbs in your diet – these are the ones that need to go. Very carb sensitive people are becoming increasingly commonplace (hence the 171 million diabetics in the world –WHO data again) and they often need to cut back to naturally reared meat, fish, eggs, vegetables and salads to lose weight – no potatoes or grains or fruit or even dairy products in extreme cases.

  Red meat & cancer & very bad journalism

  February 25, 2011

  I am struggling to think of a diet & health story, which has been reported worse than the one dominating the press this week – and there tends to be at least one in the press every day. The newspapers seem to think that “artery-clogging” is an adjective to precede either, or both, of the words “cholesterol” and “fat” – whereas “life-vital” would be more appropriate words.

  The story on red meat and cancer has to take the biscuit, however…

  The story started to break on 20 February 2011 – we were forewarned that a report from the Scientific Advisory Committee on Nutrition (SACN) was about to be released. “Red meat does increase cancer risk, new report will confirm” screamed the Daily Mail headline. The article opened with the following three sentences:

  “Britons should cut their consumption of red and processed meat to reduce the risk of bowel cancer, scientific experts are expected to recommend in a report.”

  “The Scientific Advisory Committee on Nutrition (SACN) was asked by the Department of Health to review dietary advice on meat consumption as a source of iron.”

  “In a draft report published in June 2009 the committee of independent experts said lower consumption of red and processed meat would probably reduce the risk of colorectal cancer.”

  So, SACN was asked to look at meat consumption as a source of iron and are going to conclude instead that lower consumption of red and processed meat would probably reduce the risk of colorectal cancer (bowel cancer)? (All the emphases are mine).

  Notice how red meat has become red and processed meat – could these two s
ubstances possibly be more different? Real meat (by weight) is the most nutritious food on the planet – offal is best, red meat next best and white meat the next best for essential fats, essential proteins (amino acids), vitamins and minerals. Processed meat should not be ingested by a human being – full stop. Putting these two together is like putting drinking water and coca-cola together or sardines and sugared, breaded fish sticks. This is irresponsible and ignorant in the extreme.

  Then notice the word probably - despite the fact that SACN were asked to look at meat and iron – we expect them to recommend that lower consumption will probably … No one reads that caveat – the damage is done in the sensational headline screaming out from every newspaper and on line news tweet on the 20 February.

  So, 25 February 2011 arrives and the SACN report is published. All 374 pages of a report called Iron and Health - all about – Iron and Health!

  The headline writers obviously don’t read the report – we know the headline already – “red meat causes cancer”.

  BBC Breakfast kicks off the day of meat demonisation. Dr Alison Tedstone is the spokesperson from the Department of Health and she doesn’t slip up during the interview in her careful use of the words “red and processed meat.” She specifically says: “Our experts have said that there’s a probable link between red and processed meat and bowel cancer.” Note that probable and red and processed again. Plus note the word link - there is no causation being claimed – so, there might be a link between one terrific food and one evil food and bowel cancer? Um – I wonder which one might be the problem. The fab Susanna Reid starts to ask the right question “Why would red meat?…” and then corrects this to “why would red and processed meat be a particular problem?” Tedstone says that there are a number of “plausible” mechanisms by which “red and processed meat” “might be a problem”, “we don’t exactly know why…” But, despite not knowing why, we are then told to limit our red and processed meat consumption to around 70g per day – approximately 2 slices of meat a day. Boy, those cavemen should have been dropping like flies.