1. The NEEDNT Foods List: Non-Essential Energy Dense Nutritionally Deficient Foods Jane Elmslie, Ria Schroder Doug Sellman, Frances Carter

2. What is the NEEDNT Foods List? A list of 50 non-essential, energy dense, nutritionally deficient foods Key money makers for the food industry Foods high in fats and added sugars, which together with salt, are the food components most commonly associated with food addiction

3. Why was it developed? Need identified from : –Clinician and consumer focus groups –WW vs OA study –Desire to test abstinence/moderation paradigm without compromising nutritional health –Lack of movement on traffic light labelling

4. Clinician and Consumer Perspectives of Obesity Lifestyle change crucial Confusing/misinformation unhelpful Treatment must address the emotional component of overeating Addictive component should be acknowledged. A role for abstinence?

5. Weight Watchers vs Overeaters Anonymous Methodology 27 obese participants Attended 6 WW meetings and 6 OA meetings Randomized order Asked what they thought of them? Asked what they thought about the concept of “problem food”?

6. Weight Watchers vs Overeaters Anonymous (n=27) Majority not satisfied with either WW – “too structured”, “too complex”, “become obsessed by counting points”, “not sustainable”, “too commercial – too much hard sell of products” OA – “I’m not as bad as them”, “not comfortable with the Higher Power”, “not practical enough” “too touchy feely” suggesting that differences between OA & WW go beyond abstinence vs moderation All able to identify 3-4 problem foods Problem foods only part of the problem

7. What to do now? Simplify Clarify which foods contain empty calories Encourage healthy eating

8. Medscape News July 19 th 2011 “Each day, the average American adult consumes roughly 22 teaspoons, 90 g, or 355 calories, of added sugars, well above health guidelines. Caloric sweeteners in beverages are a key source of excess calories.” “New U.S. dietary guidelines recommend drinking water instead sugary drinks. Food and beverage companies say they are being unfairly singled out.” “At various times, states and localities have considered taxing sugary beverages to cover obesity-related health costs.” In 2009 and 2010, as such proposals became more frequent, the ABA, Coke and Pepsi collectively spent $60 million on lobbying, up from $8 million in 2007 and 2008, according to data collected by the Center for Responsive Politics' OpenSecrets.org.”

10. Barriers to change in clinical practice “But aren’t sugar and fat the same thing?” “The citrus slice saga” “I’m having muesli bars now” 10

11. Developing the list Compiled using: –National Heart Foundation and Diabetes New Zealand “Foods to Avoid”, “Stop Eating” and “Optional Foods” lists –CDHB “Supermarket Shopping Guide” – USDA population guidance on discretionary calories. Foods and beverages were included if they: –contained alcohol, –saturated fat, –added sugar, –were prepared using a high fat cooking method – contained a large amount of energy relative to their essential nutrient value.

15. NEEDNT FOODREPLACE WITH: Alcoholic drinksWater/diet soft drinks Biscuits* Butter, lard, dripping or similar fat (used as a spread or in baking/cooking etc.) Lite margarine or similar spread or omit Cakes* Chocolate* Coconut cream Lite coconut milk/coconut flavoured lite evaporated milk Condensed milk * CordialSugar free cordial Corn chips* Cream (including crème fraiche) Natural yoghurt (or flavoured yoghurt depending on use) Crisps (including vegetable crisps)* Desserts/puddings* Doughnuts* Drinking Chocolate, Milo etc.Cocoa plus artificial sweetener Energy drinksWater Flavoured milk/milkshakesTrim, Calcitrim or Lite Blue Milk Fruit tinned in syrup (even lite syrup!)Fruit tinned in juice/artificially sweetened NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

16. NEEDNT FOODREPLACE WITH: Fried foodBoiled, grilled or baked food Frozen yoghurtOrdinary yoghurt Fruit juice (except tomato juice and unsweetened blackcurrant juice) Fresh fruit (apple, orange, pear etc. + a drink!) GlucoseArtificial sweetener High fat crackers (≥ 10g fat per 100g)Lower fat crackers (≤ 10g fat per 110g) Honey* Hot chips* Ice cream* Jam* Marmalade* MayonnaiseLite dressings/lite mayonnaise Muesli bars* Muffins* Nuts roasted in fat or oil Dry roasted or raw nuts (≤ 1 handful per day) Pastries* Pies* Popcorn with butter or oilAir popped popcorn NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

17. NEEDNT FOODREPLACE WITH: QuichesCrust-less quiches Reduced creamNatural yoghurt Regular luncheon sausageLow fat luncheon sausage Regular powdered drinks (e.g. Raro)Water/Diet/Sugar free powdered drinks Regular salamiLow fat salami Regular sausagesLow fat sausages Regular soft drinksWater/Diet soft drinks RollupsFresh fruit Sour creamNatural yoghurt Sugar (added to anything including drinks, baking, cooking etc.) Artificial sweetener Sweets/lollies* Syrups such as golden syrup, treacle, maple syrup Artificial sweetener Toasted muesli and any other breakfast cereal with ≥ 15g sugar per 100g cereal Breakfast cereal with 6g fibre per 100g cereal and <5g fat per 100g cereal (or <10 g fat per 100g cereal if cereal contains nuts and seeds) Whole MilkTrim, Calcitrim or Lite Blue Milk Yoghurt type products with ≥ 10g sugar per 100g yoghurt Yoghurt (not more than one a day) NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

18. Feedback to Date Current research participants –Appreciate the clarity –Have been surprised at some inclusions –Useful as an individual guide to work out own most problematic areas –Useful to choose 5-10 most problematic NEEDNT foods to stop eating completely or focus on reducing significantly –Gives additional focus beyond portion size Current patients –Appreciate the clarity –Have expressed the view that they are “addicted” to some foods on the list –Have used the list to prioritise non essential energy dense food consumption. –Have achieved their weight loss goals

19. Feedback to Date Colleagues working in obesity treatment –Think the list is a valuable tool –Would like to use it with their clients –Agree with the items included on the list Medical Students –Helps reduce confusion –Makes sense –Easy to use and talk about Members of Overeaters Anonymous –What they would refer to as ‘top shelf’ food –OA members in recovery would never eat any of these foods

20. Where to from here Obesity Treatment –Simple tool to help health professionals initiate conversations about food consumption patterns which may promote and maintain obesity Research –Abstinence vs. Moderation – appropriate list of foods to test this paradigm –Kia Akina – a new concept for participants to contemplate/try in their weight loss journey –NEEDNT Food List Moderation Guidelines –NEEDNT Food List FFQ

21. Acknowledgements Ria Schroder Doug Sellman Frances Carter Jim Mann