is there life outside the australian dietary guidelines?
TRANSCRIPT
Medicine, Nursing and Health Sciences
Melanie Voevodin, PhD Candidate Paul Komesaroff, [email protected] [email protected]
Monash Centre for the Study of Ethics in Medicine & Society (CEMS)The Alfred Centre, Department of Medicine, Central Clinical SchoolMelbourne, Australia
02 August 2012
Is there life outside the Australian Dietary Guidelines?
Declaration of Interest
1998 2003 2005 2012
Dietetics Policy & Gov Health Eco PhDStudy
Austin RMH AlfredReal Jobs RMIT Deakin Nestle
WCMICSARBIAS / YPINH Food LawOther Jobs
Attitudes Beliefs & Philosophy…on the topic of evidence Fewer DBRCTs et al More case study, observational, market research Behaviour measures linked to intervention and outcome
Health economics puts the story in a language decision-makers respond to
Policy analysis brings it all together to tell the story of what is happening, why, and with what consequences
4
Attitudes Beliefs & Philosophy…on the topic of empathy Difficult to have true empathy for something you haven’t
lived even with the best intentions
5
Melanie Voevodin & Paul KomesaroffPhD Student 2010-2013 Supervisor
[email protected]@monash.edu
MMeasuring DDietetic PPractice for OObesity (MDP-O Study)
Can DietitiansDietitiansturn
thearound ObesityObesityepidemic??
GP Dietitian Patient
Is there life outside the Australian Dietary Guidelines (ADGs)?
YES
7
8
The ADGsAvailable scientific evidence of what to eat to achieve good
health.
Accepted benchmark for policy.
9
The Problem
Australia is ranked in the world’s ‘worst third’ for obesity
Almost in the world’s ‘worst third’ for fruit & veg intake
Australians are not choosing the food science instructs them to
ADGs
10
The Problem
Scientific Evidence(prescribed behaviour)
Real Life(actual behaviour)
Good Health Poor Health
11
It is a problem because… An unwell population is less productive Pain and suffering (QOL) Resource use
One in two Australian adults are BMI>25kg/m2
Treatment is prevention
12
Obesity clusters in households
72% of households are a ‘family’
2.5 million Australians making food choices everydayon behalf of others
Cost is an issue
$8pp/d = 40% of total weekly income for welfare dependent family
Methodology
Policy Analysis
Finding solutions to complex problems
13
X
What is happening, why and with what consequences
Methodology Snapshot
14
+
The difference with ‘food’ as the problem Every person eats Individual is ‘gatekeeper’ Making choices daily, every day Choice based on individual attitudes, beliefs, behaviours Everyone’s an expert (or can be)
15
16
Cost relative to income is an issue
Kettings CM Voevodin M Sinclair AJ. A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependent families. Australian and New Zealand Journal of Public Health 2009 33(6): 566-572
The cost of healthy food habits uses about 40% of the disposable income of welfare-dependent families. Families earning an average income would spend 20% for the same food.
Healthy food habits are a fiscal challenge to welfare-dependent families.
17
Cost of Healthy Eating in Australia
54%40% F&V
18%
10%
Eat MostBread and Cereal $30Vegetables $56Fruit $43
Eat ModeratelyLean meat, eggs, fish, chicken,milk, yoghurt, cheese $44
Eat in small amountsOil, margarine, reduced fat spreads,butter, sugar $22
Cost is to feed family of four for one weekTotal $240; $60pp/week; $8pp/day
‘see…cost is not the issue’
54%40% F&V
18%
10%
Time and effort is cost ($)
54%40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7
54%40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7
Time and effort is cost ($)
54%40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7
Time and effort is cost ($)
What are the ADGs asking us to do? No alcohol or non-alcoholic drinks
Eat three meals a day, most at home
Ignore the price drops and other strategies used to promote and market unhealthy food
Allow time to shop, transport, store, prepare, cook, serve, eat home-prepared meals, and clean-up
Have resources (money) for kitchen, storage, transport, cooking, dining, and cleaning-up infrastructure
23
The Problem
Scientific Evidence(prescribed behaviour)
Real Life(actual behaviour)
Good Health Poor Health
24
Relative effort (effort relative to income)
What the ADGs want us to do What we actually do
25
Relative effort (effort relative to income)
What the ADGs think we all have What we actually have
26
The constant challenge to stick
Consumer
27
Tomorrow I’ll get apples
..and after dinner we will all go for a walk and work
off the Tim Tams
….and then I’ll never buy Tim Tams again
The constant challenge to stick
ConsumerTim Tams2 packs $4
Each moment of choice….
28
kJ 300 300
Price $0.20 $0.45 – $0.90
Effort Easy Hard
Enjoyment 10 6
Spoilage risk Negligible Medium
Taste risk Negligible Medium
Income ($/week)
Con
sum
er e
ffort
29
The information we need to support
healthful behaviour at
point of purchase
is the same information food
companies use to entice consumption.
Primary CarerTim Tams2 packs $4
Key Points Australians do not meet the ADGs
There is a gap between prescribed behaviour and actual behaviour
Cost is important, but may not be the most influential
Investigating actual behaviour is an important next step for policy
Key Points Factors influencing behaviour:1. Food preferences2. Marketing strategies3. Time commitment4. Resources required5. Cost of healthy food
32
What does this all mean for policy & practice?
Issue Consider..
Obesity is bad Business as usual is not an option
ADGs hard DBRCTs might not be best approach
Food choices Understanding behaviour (real life v prescribed)
Treatment Priority given to primary carer for servicesAnd women of childbearing age
Key Points
Effective health policy requires an understanding of how each of the behavioural factors influence food
selection, and how these change with economic status.
34
A starting point for total cost
Preference
Willingness to spend on healthy food compared with unhealthy; Taste, familiarity, texture, risk, satisfaction and effect on willingness to spend
Marketing Frequency and type; effect of price elasticity on demand; relative to unhealthy foods
Time To cook, shop, prepare, clean up, transport; effort (relative to income); opportunity cost
Resources To cook, shop, prepare, clean up, transport; effort (relative to income); opportunity cost
Cost Actual cost; inflation; relative to income; relative to unhealthy food; relative to actual spend