Why dietitians should work with the food industry

Food dominates our culture. When we’re not bewailing our obesity epidemic, we’re sitting at home watching TV cookery shows, or clicking our smartphones for instant takeaways, or downloading recipe clips from YouTube, or even checking out the new diets from Rihanna or Gwyneth.

Perhaps this is unsurprising given that it’s impossible to travel 100 yards in our towns and cities without being able to buy food and drink. This isn’t the case in many other European countries where the weary late-night traveller has to go to bed hungry – as I know from my own experience.

Whether we love or loathe the food industry, the fact remains that Brits source the majority of the food we eat either from manufacturers or out-of-home establishments, like restaurants, cafes and takeaways.

According to a BBC Good Food Nation survey[1], the average household spends £19 a week on eating out, while richer Londoners are blowing nearly £60. Grocery shopping equates to 11% of our household income and our annual spend has risen year on year to reach more than £200 billion in 2016[2].

So, if we are to make any progress in changing the nation’s diet from a calorie-fest of sugary drinks, fast foods, sweets, desserts, snacks and alcohol, we need the food industry to get on board, including out-of-home. This will take time and effort by a whole raft of people, including policy makers, food industry staff and health experts.

Simply telling the average consumer to dump their microwaveable lasagne or fish supper for a home cooked plant-based meal won’t wash. Apparently we spend more time looking at food on social media (5 hours weekly) than we do cooking the stuff (4 hours)[3]. Nearly half of adults have a limited cooking repertoire – fewer than 10 different meals – while one in ten say they can’t even boil an egg[4].

Guilt-tripping the public into giving up all the foods they enjoy is another no-hoper. Successive decades of public health messages, from government, charities, media and campaigners have succeeded in boosting knowledge – we can all happily trot out 5-a-day, sugar-free, less salt etc – but actual dietary intakes have barely budged in the right direction.

In contrast, the mere threat of a tax on beverages sent manufacturers of soft drinks back to the drawing board, resulting in a 16% drop in the sugar content of beverages between 2012-16, according to the industry’s trade body[5]. This, and the steady year-on-year reformulation of sugar, salt, fat and calories, is likely to have a bigger impact on future dietary intakes than asking consumers to make a wholesale switch to the way they shop, eat and cook.

So, where do dietitians fit in? Should they work with the food industry, or not? Certainly there are purists on social media who believe that dietitians should remain aloof from the industry that supplies most of us with the majority of our food. According to this view, dietitians should only promote fresh ingredients that can be cooked at home. I don’t agree, for three reasons.

Firstly, we have to acknowledge where the public are now in terms of their cooking skills, dietary preferences, beliefs and purchasing power. Working with patients during our hospital training means that dietitians have the skills to nudge people in the right direction rather than setting unachievable goals.

This matters at an individual as well as at a population level. By working with industry, dietitians can advise on product changes that improve the nutritional content of foods and drinks without alienating consumers (whose top 3 reasons for purchasing are still price, convenience and taste). Dietitians are also key in revising marketing and labelling messages to keep them in line with regulations and evidence.

Secondly, with a minimum of 4 years of training at degree level, dietitians are the most qualified work force in the UK to comment on evidence-based nutrition. Our training includes an understanding of how food is manufactured so we can appreciate the opportunities and limitations of reformulation. This is why the food industry values the input of dietitians, either as in-house staff or as consultants.

Thirdly, dietitians work under a code of professional conduct[6] which ensures that we behave ‘safely, responsibly and legally’, and don’t ‘convey any information that is false, fraudulent, deceptive or untrue’. We also have to take great care when communicating information about brands, ingredients or sectors in order to avoid making personal recommendations to purchase specific products. These limitations ensure that we put the consumer first.

So, the work goes on to persuade the average British consumer that a balanced diet is not only healthier but enjoyable. There is no ‘one size fits all’ diet given our differences in nutrient requirements, age, cultural mores, preferences, finances, food access and cooking skills. Dietitians understand that, and are pragmatists at heart.

Years ago, when working as an NHS dietitian, a patient told me of her loathing of dietitians. Apparently, as a newly diagnosed type 1 diabetic, she was told to follow a strict sugar-free, low fat, high fibre diet – something which was completely alien to her. With family problems to deal with, she simply could not make such a drastic change and left the dietetic clinic never to return. Now, two years later and with a risk of diabetic complications, she had reluctantly agreed with her consultant to give it another go. The most I could achieve was to persuade her to eat three regular meals a day. It wasn’t ideal, but it was a start.

[1] https://www.bbcgoodfood.com/sites/default/files/editor_files/2016/11/report_v16_low.pdf

[2] https://www.gov.uk/government/statistics/food-statistics-pocketbook-2016

[3] http://www.telegraph.co.uk/food-and-drink/news/we-spend-more-time-watching-food-on-tv-than-we-do-cooking-it/

[4] http://www.telegraph.co.uk/food-and-drink/news/we-spend-more-time-watching-food-on-tv-than-we-do-cooking-it/

[5] http://www.britishsoftdrinks.com/Industry-Initiatives/bsda-2016-annual-report-sugar-intake-from-soft-drinks-is-falling-year-on-year-over-16-since-2012/145583

[6] https://www.bda.uk.com/publications/professional/codeofprofessionalpractice2015