Why is so much good dietary advice ignored?
I wrote an article about this in 1999 which seems so long ago. Yet, it's still true. We have more access to good nutrition advice than ever before from dietitians, nutritionists, nurses, UK and devolved government organisations, the British Nutrition Foundation and the British Dietetic Association to name a few. But has the UK population changed their often dire eating habits? Not really.
This isn’t because these groups are lax or promoting the wrong messages – instead they are working hard to deliver evidence-based nutrition advice. So, what's the issue? Why are many of us ignoring their good advice?
0.1% achieving dietary targets
In 2022, I was invited to speak at the Nutrition Society annual conference on the topic of promoting and disseminating consistent and effective nutrition messages. In doing my research, I was struck by the finding that just 0.1% of British adults achieve all nine of the official dietary recommendations: to reduce fat, saturated fat, salt, sugar and red/processed meat, and eat more fibre, oily fish, fruit and vegetables.
Looking at these individually, more people are successful in cutting down on fat, salt and red meat but it's disappointing that fewer than a third of adults eat the recommended 5-a-day fruit/vegetables when probably most people can reel off this piece of advice. So, what's going on?
Dissection of a nutrition message
Behavioural research reveals that the design of nutrition messages has a major impact on how people respond. When crafting a new message, educators first need to decide if the message should be:
General mass media, segmented to a particular group, or personalised;
Fear-based (do this or you will get sick) or gain-framed (do this and you will feel great);
Simple (eat more fibre) or complex (eat less fat, sugar and salt, and eat more fibre).
Research shows that simple, gain-framed messages which target specific groups are more effective than blanket, complex, fear-based messages. Even with a perfect message, the language still needs to be compelling. "Eat your 5-a-day" is much clearer than "it's beneficial to eat at least 400g of fruit and vegetables a day". However, the 5-a-day message still hasn't worked, possibly because people think it doesn't apply to them. One survey found that 65% of British adults think their diet is already healthy.
Case studies on sugar and meat
Two messages that have worked better are to reduce sugar and eat less red and processed meat. Why are these special?
Interestingly, sugar reduction started a few years before the introduction of the soft drinks industry levy, which taxed sugar in soft drinks, and has continued as sugar remains in the news as an issue. Reductions in meat began just after the Horsemeat scandal, when imported meats were found to be adulterated, and has also continued in line with media coverage around planetary health. So, unlike 5-a-day or fibre messages which rarely get aired in public, messages to reduce sugar and red have benefited from:
Clear government targets and policy development;
Extensive media coverage, including social media;
Active high-profile campaigning groups talking about sugar and meat;
Alternative foods, e.g., reduced sugar and meat-free products, being widely available in retail and out-of-home.
Five factors
How do we move forward and make sure that nutrition messages are more effective in future? Here are five factors to consider:
Talk about food rather than nutrients, using positive/gain-framed messages;
Consider whether taking a ‘good, better, best’ approach could encourage small, sustainable steps between our current UK diets and healthier diets;
Engage wider stakeholder alignment in nutrition messaging from government, civil society, industry, media and health professionals;
Segment to enable the message to resonate better with target groups;
Mitigate mixed messages in the food environment such as not putting a 5-a-day message next to a prominent BOGOF for cakes!
If you'd like to read my paper which I co-authored with Alex Ruani and Charlotte Evans, you can find it here: https://pubmed.ncbi.nlm.nih.gov/36603858/ Email me for a full text version if it's behind a paywall carrie@nutrition-communications.com