Empirical findings should inform policy – but cannot dictate it

Dr Garrath Williams, Chair of the I Family consumer awareness, ethical acceptability and policy implications work stream, says…

The I.Family project and its forerunner IDEFICS are scientific studies. They aim to improve our knowledge about health and the ways in which health risks – such as obesity or lack of physical fitness – may turn into illness. So they do not seek knowledge merely for its own sake, but also to improve health. Sometimes individuals can use this knowledge. We also hope that governments and other institutions will make policy changes.

There are many reasons why it is difficult to gain certain knowledge in this area – above all, the sheer number of individual and environmental factors that feed into health outcomes. Genetics, psychology, diet, social or economic disadvantage, the availability and costs of different foods – the list could go on. For this reason, even large studies like I.Family and IDEFICS can only contribute to an emerging picture of the factors that influence health.

This complexity is one reason why we should not expect politicians or other powerful actors to “drop everything” when our findings suggest that better levels of health could be achieved if we altered some aspect of our societies. But there are other reasons. In our forthcoming book about childhood obesity, my co-authors and I suggest that even the most convincing findings can only inform policy, not dictate it.

For one thing, health is not the only thing that people or societies or governments care about. It would be crazy for a person to focus only on her health and to ignore all the other things that she might enjoy or achieve in life. The same is true of a society. We need to balance many different priorities – not just health, but also freedom, justice, prosperity, concern for future generations, and much more. For example, if governments were to ban processed foods, people’s health would probably benefit (at least if sufficient whole foods were available!). But such a ban would involve major sacrifices for both consumers and companies. Even certain evidence that health would improve would not be enough to convince us to impose such a ban. It will always be a political decision what costs we should incur and what priority we should give to health.

Second, it is rarely obvious who should take responsibility for making the desired changes. There is broad scientific consensus that most people’s health would benefit from more physical activity. Many health campaigns address us as individuals, urging us to take responsibility for our health and be more active. But experience tells us that such campaigns have relatively slight effects. The geography of our towns, the nature of our jobs, the organisation of our daily lives – all help to explain why physical activity levels remain low. So we need to make social changes – for instance, to make walking and cycling more attractive, and to make car use less common. Yet there is no simple answer as to who has responsibility to make such changes or how they should be done. Again, democratic debate is needed. Such debate needs to be informed by scientific findings – but the fundamental issues are social and political.

All this can be frustrating, since we want scientific findings to make a positive difference. But there are other priorities apart from health, and people and organisations already have many responsibilities. Whether we should act on evidence, and how we should do so – these will always be political rather than scientific questions.

Childhood obesity: ethical and policy issues, by Kristin Voigt, Stuart G. Nicholls, and Garrath Williams, is published by Oxford University Press (April 2014).

The book’s cover image, “Red Velvet Cupcake Boys”, by Christopher Boffoli.

http://ukcatalogue.oup.com/product/9780199964482.do

Are we ready to protect adolescents from deceptive diet gurus and food ads?

Gianluca Tognon, food scientist and collaborator with the I Family cohort in Gothenburg writes…

Paleolithic, raw-food, vegan, no-carb, all protein, all fat, no fat, 5:2 and  hundreds of other diets which are claiming their way to a healthy body, have been  monopolizing the consumer’s attention since  Dr. Atkins sold the first copy of his inaugural book on low-carb diets.

Fad diets are generally delivered by diet gurus, often self-nominated experts in the nutrition field, who concentrate on a very effective strategy: focusing their message on weight and cardiovascular risk. With the increasing obesity epidemic, it is no surprise that the latest book advising how to lose pounds as fast as the speed of light, and prevent myocardial infarction at the same time, will sell like hot cakes. Both weight and heart disease are common problems among adults living in western countries, creating an environment open to the marketing of “super” diet books.

At the same time, a huge number of food ads (frequently targeting children and young people) have inundated our daily life. Although food commercials are specifically designed to induce the desire to consume the advertised product, they are not inherently different to gurus’ messages. Indeed, they also use manipulative tactics to influence consumers’ choices in ways many might even not realize.

Researchers and advocates for children’s health agree that advertising junk food to children is effective. Preschool children report that junk food in branded packaging tastes better than food in plain wrapping, even when it is the same food. Young children in particular not familiar with the concept of marketing tend to believe whatever they see. Not surprisingly then that, unlike adults, they cannot fully understand the purpose (and the associated risks) of advertising, and are therefore easily influenced by it. Consequently, children are particularly vulnerable to deception by common advertising techniques.

According to a US report, the average adolescent is exposed to approximately 6,000 television food ads every year^[1], with most commercials promoting products high in calories, sugar, sodium and/or fat. At the same time, adolescents can also be a target of diet gurus, and less capable then adults (at least the most educated ones) to find the frequent flaws in their theories. Diet gurus promote their business through advertising campaigns on social networks to attract people to their websites, which often include deceiving messages focusing on weight and body image. These messages can encourage observing adolescents to improve their weight and body shape, potentially convincing them to buy gurus’ books, if not their dietary supplements. Moreover, parents who regularly buy some of these products make them more accessible to their sons and daughters. Therefore, I believe adolescents are vulnerable to the risks of both food advertising and diet gurus.

Diet gurus and food companies design their messages to evoke an emotional response. In general, the promotion of food brands and diet books is associated with basic human motivations (e.g. happiness, attractiveness, accomplishment), encouraging consumers to purchase the latest dietary product or book. These messages are partially based on science but manipulated in order to be consumer friendly and to stimulate sales. Therefore, they can be very convincing for young people, who are particularly sensitive to image and trends.

Other useful strategies used by food companies and diet gurus are based on animal-rights (e.g. vegetarianism), or environment protection (e.g. organic, GMO-free food), which are themes that can stimulate a reaction from idealist adolescents.

Every year, millions of dollars are poured into the diet and nutrition business, overpowering the sums available to health authorities in the promotion of healthy practices. Little is known about how the brain responds to these messages, which may be of particular importance for individuals at-risk of obesity. Notably, the Internet is quickly replacing television as a media source for the youngest generations, a factor which creates an even greater risk for adolescents, who are known to be eager users of the net and particularly of social networks, where food companies and diet gurus are increasing their presence.

Adolescents are therefore particularly at risk of receiving distorted nutrition messages. If we do not prepare them to think critically –  something people often do not do while watching television, reading a magazine, or surfing the web – then we run the risk of many adolescents accepting many messages offered to them by advertising, thus becoming more likely to adopt unhealthy dietary lifestyles.

The Health Sustainability Nexus – Obesity & Sustainable Development

Prof Dr Lucia Reisch, Chair of I Family Consumer Science WP writes ….

The World Health Summit that took place in Berlin (Germany) last year featured a full day session on the ‘health sustainability nexus’. I was surprised to find out that the discussion of wider issues such as obesity and malnutrition were now so widely accepted in public health debates within the context of sustainable development.   Already a decade ago, the British Commission on Sustainable Developmentdefined food systems as ‘sustainable’ if they (among other things)

• produce safe, healthy products in response to market demands, and ensure that all consumers have access to nutritious food, and to accurate information about food products;
• respect and operate within the biological limits of natural resources and biodiversity needs;
• achieve consistently high standards of environmental performance by reducing energy consumption, by minimising resource inputs, and use renewable energy wherever possible.
• sustain the resources available for growing food and supplying other public benefits over time, except where alternative land uses are essential to meet other needs of society.

The nexus becomes even clearer when we focus in on obesity as today’s major public health issue. Obesity is not only impairing individuals’ lives, but also societies’ sustainability with regard to its social, economic and environmental dimensions.

Social sustainability is jeopardized as social cohesion, equity and fairness erode due to the consequences of obesity. In the developed world, obesity is closely connected with low social economic status (i.e., low income, low education) and migrant background. Overweight and obese individuals are associated with deteriorating health, reduced mobility, poorer employment opportunities, premature mortality and higher living expenses resulting in an overall poorer quality of life. For the individuals involved, obesity may worsen qualify of life in the sense of poor self-image, social ostracism and stigma as well as a decline in life expectancy.

On the societal level, the economic consequences of obesity come in the form of increased healthcare costs and the labour market: National health systems bear the burden of obesity’s many co-morbidities, and obese individuals have lower employment rates, lower productivity with more sick days, and they earn considerably less.

Last but certainly not least, heavily processed, energy-dense, meat-focused modern diets have an undisputed heavy ecological footprint.

It is hence not surprising that putting a stop to the rise in obesity levels has become an explicit goal in political sustainability strategies.   Further information about the World Health Summit 2012 is available here. The 2013 World Health Summit will be held in Berlin 20-22 October 2013.

Lucia Reisch is Professor for Intercultural Consumer Behaviour and Consumer Policy at Copenhagen Business School in Copenhagen, Denmark. She chairs the Work Package “Consumer Science” in I Family.

Regulating food companies: restricting or empowering?

Dr Garrath Williams, Chair of the I Family consumer awareness, ethical acceptability and policy implications work stream says:

“We might think rules stop us doing what we want, but sometimes they give us the power to act.”

 Don’t do this! Don’t do that! – Rules and regulations often look like obstacles. As individuals we may feel that rules take away our freedom. Companies often protest at red-tape and regulation. When it comes to food and diet, companies and consumers often fear that regulations around healthy eating would interfere with what they want to do.

But do rules always take away our freedom? As a philosopher, I think rules are much more interesting than this. Rules can actually give us new abilities and powers. This is as true for organisations as it is for individuals.

One great example of the power of rules is language. Every language works on the basis of rules – rules about how different sounds should be used, and how different words should be put together. In a very trivial sense, those rules restrict our freedom – we can’t just go around making any old sounds with our voices. In a much more important sense, rules give us a whole new set of freedoms and powers. Without those rules, we could never tell other people how we see the world, let them know what we remember, or explain what we intend to do.

Moral and legal rules are a bit different. It’s true that they sometimes get in the way of what we want to do. But they also give us a lot of freedom and power. If we can count on other people telling the truth, keeping promises, or taking account of our rights, we are freed from all sorts of worries and dangers. We can get on with our lives, and we can do all sorts of things together – whether it’s pursuing relationships or running a company.

In debates about healthy diets, many proposals for regulation are raised – around food labeling, food composition, or food and drink marketing. Opponents often present these rules as limitations on freedom – both for companies and consumers.

Advocates of regulation often reply that regulations create new freedoms. Food labeling rules improve consumers’ knowledge about products, or a ban on trans-fats frees us from worry about an artificial and unhealthy ingredient. Still – critics point out – these rules may lead to additional costs to consumers. Or perhaps consumers’ gains come at the price of commercial freedoms.

But there’s another way that rules can create freedom. Well-designed regulation can enable companies, not just consumers. Most people who work for food and drink companies would prefer not to undermine consumers’ health and well-being – especially the health of children who can’t make informed choices. Still, companies continue to push energy-dense, highly processed foods and drinks.

The blunt fact is that companies don’t have a choice. They can only survive if they maximize sales, and highly processed foods based on cheap ingredients give greater scope for profit. Even worse, companies can’t even admit to the problem. No Director or spokesperson would ever say that their company has no choice but to undermine children’s health.

So companies can’t really support children’s health, and they can’t even admit their inability to do so. And this is another case where rules can create freedom. Regulations on food composition or food marketing mean companies don’t need to worry about competitors making greater profits by behaving less responsibly. So they can give companies the freedom to do what they say they want to do – to support parents and not to undermine children’s health.

Of course, the rules need to be well-designed. That’s hard – especially because companies can’t admit that they need these rules, and often fight plans to regulate. But that doesn’t alter the fact that regulations are not always obstacles. Instead, rules can give people – and companies – the power to do what they want.

Garrath Williams is Senior Lecturer in Philosophy, Lancaster University

Adolescence – an age of health opportunity?

Prof Dr Lucia Reisch,  Chair of I Family Consumer Science WP asks…

Lucia Reisch says:
“Adolescence can be an ‘age of opportunity’ for establishing healthier lifestyles.”

“The recently published Health Behaviour in School-aged Children (HBSC) study, a WHO collaborative cross-national study (http://tinyurl.com/ccgushe) offers some worrying insights into the lifestyle habits of young people which provide even more justification for the investment being made in the I Family study.

Every four years, this WHO survey, involving over 200,000 boys and girls aged 11, 13 and 15 years from some 40 countries and regions across Europe and North America, examines a wide range of topics significant to this age group from liking school to body weight, energy expenditure to bullying in school.

This year, the Report Summary states: ‘While young people enjoy better health and development opportunities than ever before, many are involved in behaviors that compromise their health (such as smoking, drinking and having an unhealthy diet) and report poor self-related health.’ (Currie et al. 2012, p. 1)

What is particularly disturbing is the fact that these unhealthy behaviours drastically increase with both age and low social-economic status.

In other words, even if parents (and hopefully also kindergartens and schools) have managed to help children develop healthy eating and activity patterns into their ‘tweens’ (10-12 years of age), there is a distinct probability that, as teenagers, these healthy routines are lost and are substituted by unhealthier ones such as skipping breakfast, eating less fruit and vegetables, having more soft drinks, not getting enough sleep, smoking and drinking.

While this might not be of surprise to parents of teens, it is still disheartening to see how often this pattern is repeated. Yet, the report also shows that health patterns vary significantly across countries, and also between the genders, suggesting that the social, economic and environmental contexts that the tweens and teens experience influence their choices significantly.

Based on better knowledge, more qualitative and quantitative empirical evidence which will be provided by the I Family study, public policy might be able to contribute to creating and reinforcing the social environments – in particular the family, but also peers and schools – within which young people can be supported to retain healthy habits and establish self-protective strategies.

And there are some good examples cited in the Report such as Sweden (one of the countries involved in I Family) having the lowest consumption of soft drinks by 11 year olds of any country in the world. This has been attributed to strict adherence to the Nordic Dietary Guidelines in school diets and enforced regulation governing marketing and advertising activities directed at children.

In my view, this example demonstrates that adolescence can be – and should be made to be – ‘an age of opportunity’ for maintaining and establishing healthier lifestyles that last for life.

Lucia Reisch is Professor for Intercultural Consumer Behaviour and Consumer Policy at Copenhagen Business School in Copenhagen, Denmark. She chairs the Work Package “Consumer Science” in I Family.