Professors of Human Nutrition and food industry leaders and the nutrition policy of the Dutch government

The ministry of Health invited a bunch of nutrition professors and some representatives of the Dutch food industry to talk about its plans for nutrition policy in the years to come.
The discussion was based on four statements that were each introduced by two of the participants. These statements all concerned what the business sector, i.e. the food industry, retail and other point-of-choice settings can contribute to more healthful nutrition habits in the Netherlands. Like any other ‘western’ country, the Dutch eat too much, too much saturated fat and salt, and not enough fibre-rich foods.
The Dutch ministry of health as well as the representatives of the food industry, but also some of the nutrition professors appeared to have great confidence in the potential contribution of the food industry to promote more healthful diets. Product innovation should be key!
I have much less trust in the industry to really contribute to healthy eating. I think that business primarily want to sell the illusion of health, so that consumers can eat (more of) their products without feeling bad. Advertisements for foods, including foods that are high in calories, saturated fat, sugar and/or salt often promise suggestive health effects or healthful attributes that are very similar to what was promised in tobacco advertisements in the 1950s (see pictures).

I do believe that we need food innovation and involvement of the food industry next to other stakeholder is health promotion and health protection aimed at more healthful diets in the Netherlands. But this will only happen if the Dutch (or European) government sets strict and specific rules related to health claims, food labels, marketing and product enrichments. The European Community has tightened its rules on health claims, which is a good start.

...and use a step counter to promote walking...

Last Wednesday I referred to a systematic review in the Britisch Medical Journal showing that well-planned intervention to promote walking can indeed encourage people to walk an extra 30-60 minutes per week. A study published in the Journal of the American Medical Association (JAMA; see http://jama.ama-assn.org/) shows that using step counters to self monitor walking activity encourages people to walk more. The authors, Bravata and colleagues, reviewed 26 original studies and their review indicates that using step counters on average leads to an extra 2000 steps per day (15-20 minutes walking). This extra activity was associated with a few kilo's less body weight and a lower blood pressure. See http://jama.ama-assn.org/cgi/content/short/298/19/2296 for an abstract of the review study.

Walking review

Physical activity is part of a health energy-balanced lifestyle, and may contribute to weight management. Walking is a daily physical activity of moderate intensity that can be done almost anywhere and by anyone. Oglivie and colleagues published a systematic review of intervention to promote walking in the Britsh Medical Journal (BMJ 2007;334:1204, electronic prepub; http://bmj.com/cgi/content/full/334/7605/1204).
Their review indicates that the most successful interventions could increase walking by up to 30-60 minutes a week. This may not seem like much, but if we could induce such changes in the population it would contribute substantially to prevention of unnecessary weight gain. However, the evidence was mostly concerned the short term only, and the evidence is mostly based on isolated studies, and the authors conclude that studies are needed on true effectiveness in real-life situations.

Is being overweight good for you?

On November 2 I participated in a radio debate organised by radio Netherlands, the Dutch world service (http://www.radionetherlands.nl/features/amsterdamforum/071102af). The debate was inspired by a book called 'Diet Nation: exposing the obesity crusade' (http://www.socialaffairsunit.org.uk/pub/001269.php). The first author of the book, Patrick Basham (http://www.cato.org/people/basham.html), participated in the debate, and he claims that the danger of being overweight is wildly over-estimated. According to Basham, the present “hysteria” about fatness is the result of alarmist lobby groups and bad science. He provides evidence indicating that people who are thin have lower life expectancy than people who are overweight.
Basham is right in claiming that being a bit overweight is not that bad for health. But obesity, i.e. being grossly overweight is, and on the road to obesity one passes through different stages of being a bit, than a bit more, and more and more extra bodyweight. Time trend research shows that people generally gain between 0.5 and 1 kg per year, and over the course of a few decades this does lead to health-threatening levels of obesity.
Basham claims that lobby groups, including the dieting industry, exaggerate the dangers of being overweight. Although I am sure that the lobby of the food industry to encourage people to eat more than they need is much stronger than the weight-loss industry, it is true that most dieting/weight loss strategies that are commercially marketed do not work in the long run. Almost all diets do lead to weight loss if people comply to the rules and regulations prescribed, but most diets are hard to maintain and such diets are often not well-varied and maintenance is therefore too difficult and if maintained such diets may lead to unhealthy nutrition. People who do loose weight generally regain the kilos soon enough when they stop dieting and start eating their ‘normal’ diet again. In order to curb the obesity epidemic we should therefore not focus on promoting weight loss among people who are somewhat overweight. We should focus on promotion of health eating and plenty of physical activity to help to prevent further weight gain and to promote physical fitness. It is better to be fit and somewhat overweight than unfit and lean. The HOPE project (Health promotion through Obesity Prevention in Europe) is dedicated to informing obesity prevention efforts: http://www.hopeproject.eu/

Body@Work and a new professor of occupational health.

On Thursday November 8, Dr. Allard van der Beek held his inaugural address to accept his chair in occupational health. His address was preceded by a symposium reporting on the Body@Work project (http://www.bodyatwork.nl/), a collaboration between the EMGO institute (http://www.emgo.nl/) and TNO Quality of Life (http://www.tno.nl/content.cfm?context=overtno&content=overtnosub&laag1=32&item_id=59) to support an conduct research on physical activity, work and health.
Professor Allard van der Beek argued in favour of carefully planned and evaluated preventive occupational health care in order to develop better interventions and improve evidence-based practice. He further argued that such research to develop preventive occupational health interventions should be especially focussed on opening the ‘epidemiological black box’, i.e. to gain better understanding on why and how certain behaviours are associated with work disability, and on intervention mapping (http://www.interventionmapping.nl/), i.e. to carefully tailor interventions to specific needs and characteristics of the target population. Such research is dependent on multidisciplinary collaborations.Allard also completed his first marathon recently… http://evenementen.uitslagen.nl/2007/amsterdammarathon/details.php?t=nl&s=5002

Towards an interfaculty research institute for health and care research.

Yesterday the senior staff of EMGO research institute (see http://www.emgo.nl/) met to discuss plans to reform our institute into a so-called interfaculty research institute. Our mission is to encourage, initiate, conduct, and publish excellent research of international standing to improve public and occupational health, primary care, rehabilitation, and long-term care.
The main challenges in these research fields all require interdisciplinary research, involving medical doctors as well as health scientists, psychologists et cetera. This asks for close collaborations between experts from different university faculties.
Our policy day was focussed on exactly that: what are the strengths, weaknesses, opprtunities and threats related to forming a formal interfaculty research institute, involving the VU University Medical Center (www.VUMC.nl), the Institute for Health Sciences (http://www.falw.vu.nl/Onderzoeksinstituten/index.cfm) of the faculty of earth and life sciences and the faculty of psychology and education (http://www.psy.vu.nl/fpp.php/research/). Other collaborations are with the faculty of Social Sciences (http://english.fsw.vu.nl/home/index.cfm) and the faculty of Law http://www.rechten.vu.nl/).
Important examples of ongoing interfaculty collaboration include the Netherlands Study on Depression and Anxiety NESDA (http://www.nesda.nl/site_en.php) as well as the longitudinal Aging Study Amsterdam (http://www.lasa-vu.nl/).

Nutrition and cancer?

This week the new report from the World Cancer Research Fund on the association between nutrition, physical activity and cancer will be published (see http://www.wcrf.org/). This report is the result of one of the most comprehensive series of systematic reviews and meta analyses. The title of the new report is Food, Nutrition, Physical Activity and the Prevention of Cancer.

In a process that has taken five years, an expert panel of 21 renowned scientists from around the world reviewed and assessed the body of research on the relationship between food, nutrition (including obesity) physical activity and cancer risk. The expert panel has drawn conclusions based on this evidence and developed 10 health recommendations for the prevention of cancer.

Based on early ecological studies and case-control studies it was hypothesized that nutritional factors such as fat intake, fiber intake and fruit and vegetable consumption were strong determinants of risk for certain cancers.
In the last decades more and more longitudinal cohort studies have become available, and these studies show that the association between diet and cancer risk appears to be much weaker than was believed from the earlier weaker designed investigations.

However, the WCRF reviews will probably also make clear that obesity is a major risk factor for certain cancers, such as breast cancer.

Registration for the meeting where the new report will be launched is still possible…http://www.wcrf.org/launchconference/registration.lasso