Diet-related disease is an increasing problem in the UK and many developed countries, yet there has never been more readily accessible healthy-eating advice. Where is it all going wrong? Giving our perspective, we are publishing a video of SFT Policy Director, Richard Young, speaking to students at Bristol University on a ‘Culinary Medicine’ course. Below, Richard sets out some of the background for this talk and strongly recommends the two most recent editions of Radio 4’s The Food Programme.
The Eatwell Guide, published in various forms by the Food Standards Agency and the NHS, still recommends skimmed milk for children. However, at least two published studies have found that children who drink full cream milk are less overweight than children who drink skimmed milk. Is official advice on choosing a low-fat diet right? The issue is, of course, complex, because we are not all the same. But how could it be that a higher fat intake can lead to thinner children?
One of the often overlooked issues in the diet-health debate is appetite – influenced as it is by the hormones which encourage us to eat more, those which encourage us to eat less, and the foods which help us to keep these in balance. Another little understood issue is that all carbohydrates eventually break down to glucose. When we consume too much refined carbohydrate – which we find it difficult not to do because it stimulates our appetite rather than suppressing it – there isn’t enough fibre to slow down the absorption of glucose and our livers can become overwhelmed by it. Any surplus glucose that can’t be stored is converted into unhealthy fats and these are off-loaded into our blood streams. But the high blood sugar levels also fall away very quickly, affecting our mood and leaving us craving more.
While eating a balanced diet rich in the complex carbohydrates and the fibre found in vegetables is a big part of the solution, could it also be that that children who have a more substantial breakfast including full cream milk will have more balanced blood sugar levels and, therefore, be less inclined to rush off to buy sugary foods as a result?
Earlier this year a report by a committee of MPs called for doctors to play a bigger role in preventing childhood obesity. Data published last year by the NHS found that one in five UK children are obese by the time they leave primary school. More recent evidence shows that one in every 25 children aged 10 or 11 are severely obese.
Obese children generally go on to become obese adults and add to society’s broader problems with obesity and its related diseases, such as type-II diabetes, which are projected to overwhelm the NHS within a decade if things don’t change dramatically.
One of the problems with taking the committee’s recommendation forward is that nutrition has traditionally played a very small role in medical training, with students receiving as little as 16 hours of lectures on dietary issues in their seven year courses, meaning that GPs are poorly prepared to take on this role.
Now medical students themselves are demanding that this is changed. With student support, the organisation Nutritank has been set up as a hub ‘to bring nutrition to medicine’, and some students are now organising additional lectures themselves under the theme of ‘culinary medicine’.
This is one of the issues explored in a very important edition of the Food Programme on Radio 4 last weekend, in ‘The Food and Medicine Debate’.
Equally relevant though, is the issue of whether current government advice on healthy eating is part of the solution or part of the problem. As a population in the UK, we started to put on weight in the 1970s. Amongst the various theories that have been put forward to explain this, is the rise of supermarkets and the extent to which their marketing methods have subliminally encourage us all to buy and consume more food than we need, much of it highly processed.
But it wasn’t until the mid-1980s that the obesity crisis started to develop – and we have to ask, is it just a coincidence that this coincided with advice from the Committee on the Medicinal Aspects of Food (COMA) to reduce our consumption of saturated fat and total fat? It may seem counter-intuitive given how many calories are packed into a gram of fat, but while official advice now tends to promote complex carbohydrates (which are healthy) over refined carbohydrates (which are unhealthy), the initial trend towards low-fat foods actually increased sugar consumption. The reduction in saturated fat consumption (most of which at the time came from animal sources) was also partly replaced by increased consumption of trans fats from hydrogenated vegetable oils.
Things have improved a little, but the issues are still hotly disputed. The 1984 COMA panel was heavily dominated by sugar industry-funded scientists, but even today a significant proportion of leading academics still vilify fat as the main cause of obesity rather than sugar. And arguably, at least partly as a result, the UK as a nation still gets a high proportion of its daily energy from sugar and other refined carbs, including white bread, white rice, pastries, confectionary and the rest. Artificial trans fats have been reduced to much lower levels in recent years, but a high proportion of the vegetable oils used in processed foods are still being chemically altered to create fats we have not evolved to digest and it is too early to judge whether the impact of this is positive or negative.
Equally important, therefore, was the previous edition of The Food Programme, ‘The Big Carb Debate’ which similarly comes with a highly recommended tag from the SFT.
Our thanks to Samya Sarfaraz and her colleagues, who organized the Students for Global Health short course with Nutritank, for allowing us to film Richard’s presentation.
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