1. Eating healthily – changes needed Dr Rosemary Stanton OAM

2. © Rosemary Stanton 2013 influences on food choices - availability - cost - cultural influences - convenience - marketing - ethical considerations... - nutrition & health

3. © Rosemary Stanton 2013 why dietary guidelines? 1960s – 600-800 foods available now - >30,000 foods in supermarket diet-related health problems (obesity, type 2 diabetes, cancers, cardiovascular disease, osteoporosis) costs to individuals costs to governments

4. © Rosemary Stanton 2013 Australian history 1979Dietary Goals 1981Dietary Guidelines 19911 st revision 20032 nd revision 20133 rd revision

5. © Rosemary Stanton 2013 dietary guidelines changes from first guidelines increase in breast feeding refined sugar (led to a campaign sugar – a natural part of life) meat consumption (led to a campaign titled feed the man meat) fat-reduced milk became popular

6. © Rosemary Stanton 2013 dietary guidelines effective ? Melbourne study, 10,561 women, aged 50-55 one in three followed some guidelines only 2 followed all guidelines Ball K, Mishra GD, Thane CW, Hodge A. How well do Australian women comply with dietary guidelines? Pub Health Nutr 2004; 7: 443-452.

7. © Rosemary Stanton 2013 key question for guidelines what should Australians eat?

8. © Rosemary Stanton 2013 2013 dietary guidelines changed focus –foods, food groups & dietary patterns –not food components or individual nutrients

9. © Rosemary Stanton 2013 dietary guidelines aim of the revision –aspirational –realistic, practical & flexible –evolutionary (incremental, not radical) –based on best available scientific evidence for food, diet, health relationships

10. © Rosemary Stanton 2013 dietary guidelines other aims (wanted by some) –include a guideline on environmental aspects of food choices –give social equity more priority - avoid fortified & functional foods

11. © Rosemary Stanton 2013 approach changed – commissioned systematic literature review – developed set of targeted questions to answer question what should Australians eat? – prioritised questions focussing on new or emerging issues since 2003 (did not re-examine established relationships) – evidence report (1100 pages, >55,000 papers) – process manual (evidence statements if >5 studies) – harmonisation assisted by a methodologist – results informed revision of core food group modelling & dietary guidelines

12. © Rosemary Stanton 2013 evidence informing the revised draft dietary guidelines dietary intakes from national surveys authoritative reports & additional literature draft evidence report to inform the review of the Australian Dietary Guidelines NRVs for Australia and New Zealand incl RDIs (2005) food modelling system to inform the AGTHE (2010) Draft (2012), Australian Dietary Guidelines (2013) draft AGTHE (2011) Dietary G uidelines for all Australians (2003) draft literature review pregnancy & breastfeeding (2011)

13. © Rosemary Stanton 2013 what has changed - format – all age & gender groups in one concise document –infant feeding guidelines for health workers as a separate document

14. © Rosemary Stanton 2013 what has changed - format standardised structure: context of the food/group in Australian diet supporting evidence including: -graded evidence statements (Evidence Report) -other evidence (established relationships - previous DGs) -comparison with other authoritative international reports -(brief) plausibility/mechanisms practical considerations -additional information (infants, children, pregnancy, breastfeeding, Aboriginal & Torres Strait Islanders)

15. © Rosemary Stanton 2013 what has changed - content evidence base supports focus on total energy intake/balance & energy- density rather than specific macronutrients less emphasis on decreasing total fat, but focus on limiting foods high in sat/trans fat + moderate consumption of foods rich in unsaturated fats guidance for population-based weight loss (for those without other health problems) more emphasis on dietary patterns across the life stages, supporting family-focused eating patterns

16. © Rosemary Stanton 2013 changes in evidence strengthened for health benefits of - breastfeeding (benefits later in life) - milk (cardiovascular & some cancers) - fruit (cardiovascular) - non-starchy vegetables (some cancers) - wholegrains (cardiovascular & weight) strengthened for health risks of - sugar-sweetened beverages & weight gain in children & adults

17. © Rosemary Stanton 2013 recommendations 1.to achieve & maintain a healthy weight, be physically active & choose amounts of nutritious foods & drinks to meet energy needs

18. © Rosemary Stanton 2013 recommendations 2. enjoy a wide variety of nutritious foods from these five groups every day plenty of vegetables, different types & colours, & legumes/beans fruit grain (cereal) foods, mostly wholegrain &/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa, barley lean meat & poultry, fish, eggs, tofu, nuts, seeds & legumes/beans milk, yoghurt, cheese or alternatives, mostly reduced fat (not for under 2s) and drink water

19. © Rosemary Stanton 2013 recommendations 3. limit intake of foods containing saturated fat, added salt, added sugars & alcohol

20. © Rosemary Stanton 2013 recommendations a. limit intake of foods containing saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips & crisps & other savoury snacks -replace high fat foods that contain predominantly saturated fats such as butter, cream, cooking margarine, coconut & palm oil with foods that contain predominantly polyunsaturated & monounsaturated fats such as oils, spreads, nut butters/pastes & avocado. -low fat diets are not suitable for children under the age of 2 years.

21. © Rosemary Stanton 2013 recommendations b. limit intake of foods containing added salt -read food labels to choose lower sodium options among similar foods -do not add salt to foods in cooking or at the table

22. © Rosemary Stanton 2013 recommendations c. limit intake of foods & drinks containing added sugars such as: -confectionary -sugar-sweetened soft drinks & cordials -fruit drinks -vitamin waters -energy & sports drinks

23. © Rosemary Stanton 2013 recommendations d. if you choose to drink alcohol, limit intake. for women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option

24. © Rosemary Stanton 2013 recommendations 4. encourage, support & promote breastfeeding

25. © Rosemary Stanton 2013 recommendations 5. care for your food; prepare & store it carefully

26. © Rosemary Stanton 2013 what has changed food modelling system & AGTHE –ages 6 mths to 70 + (previously 2 years and over) -reflects the food supply & consumption patterns -reduced serve size for bread (40g) cf 1994 (60g) -wholegrain: refined grains = 2:1 -plant-based options given greater prominence -greater flexibility -limited scope for smallest, least active people to choose any extras

27. © Rosemary Stanton 2013 what needs to change vegetables, but chips fruit, but limit juice nuts/seeds wholegrains, refined grains fish red meat for men reduced-fat milk

28. © Rosemary Stanton 2013 what needs to change sugary drinks junk foods alcohol discretionary foods from 35-40% energy to 10% energy (or zero) Rangan AM, Randall D, Hector DJ, Gill TP, Webb KL. Consumption of extra foods by Australian children: types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2008; 62(3):356-64 Rangan AM, Schindeler S, Hector DJ,, Gill TP, Webb KL. Consumption of extra foods by Australian adults: types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2009; 63:865-71

29. © Rosemary Stanton 2013 graph represents proportions for each group accompanying tables explain serves (& serve sizes) for each age group educators guide includes rationale consumer materials with messages and practical tips

30. © Rosemary Stanton 2013 common questions why isnt there a guideline on sustainable food choices ? fats – why not a separate fat group ? GI – why is it not included ? extras – why dont they get a place on the plate ?

31. © Rosemary Stanton 2013 what needs to change no industry influence at policy level (their aim is to sell products; ours is to set guidelines, do the teaching) accept that we need less accept that discretionary foods dont fit every diet accept that we must incorporate sustainable food futures

32. © Rosemary Stanton 2013 challenges environmental /sustainability rapidly emerging evidence base type of evidence differs from food/health relationships differences between & within countries politically sensitive issue

33. © Rosemary Stanton 2013 key messages discretionary foods – no need & not much room for them dietary patterns promoted by the DGs are good for health, more sustainable, practical, realistic & socially equitable dietary guidelines are the reference for nutrition policies details at www.eatforhealth.gov.au

34. © Rosemary Stanton 2013 what we eat social equity health protection of land & water