Abstract
Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden. Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into: (i) population level socio-educational approaches to enhance diet knowledge; (ii) pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods); (iii) regulations to modify the food environment, and (iv) the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of “junk foods” is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians) per 10,000 persons or 75 nurses per 10,000 persons. It is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs.
Highlights
In Australia, where extras constitute 30.6% of the diet, in terms of energy excluding alcohol (Australian Bureau of Statistics, 2013), a 50% fall in consumption would bring extras down to
Given the high rates of nutrition related chronic disease and risk which including high blood pressure, high cholesterol, obesity which affect over 50% of adults, it is inconceivable that the current level of dietetic services is adequate
It is time to get serious about developing and implementing national nutrition strategies that are capable of effecting change
Summary
It is uncontentious that diet quality has a major impact on health. This is not relational, which it certainly is—populations with better diet quality are shown consistently to have better health outcomes (Keys et al, 1986; Sofi et al, 2008; Lai et al, 2014), but it is undeniably causal. Considering the complexities of the role of diet quality, the preoccupation with caloric restriction and weight loss is not justified by the evidence It is not uncommon for dietary intervention trials to improve diet quality with improvements in health outcomes, independent of weight change (Itsiopoulos et al, 2011). The health benefits of the Mediterranean diet are widely confirmed by systematic reviews of intervention studies and cohort studies (Serra-Majem et al, 2006; Sofi et al, 2010) This diet is high in vegetables, legumes, fruits and nuts, fish, unrefined cereals, olive oil, low-to-moderate intake of dairy products and low in meat and “extras.”. Diet related diseases continue to rise as reported in the Global Burden of Disease (Lim et al, 2012)
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