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Medicine, Nursing and Health Sciences
Melanie Voevodin, PhD Candidate Paul Komesaroff, DirectorDepartment of Medicine Centre for Ethics in Medicine & SocietyCentral Clinical School Central Clinical School
28 May 2012
Is there life outside the Australian Dietary Guidelines
Declaration of interest
2
1998
28th May 2012Life After the Australian Dietary Guidelines
2003 2005 2012
Dietetics Policy & Gov Health Eco PhDStudy
Austin RMH AlfredReal Jobs RMIT Deakin Nestle
WCMICSARBIAS / YPINH Food LawOther Jobs
28th May 2012 3
The Problem
World’s ‘worst third’ for obesity
Almost in the world’s ‘worst third’ for fruit & veg intake
Australians are not choosing the food science says to:
Australian Dietary Guidelines (ADG)
Life After the Australian Dietary Guidelines
28th May 2012 4
What is it about the ADGs?
What the ADGs want us to do What we actually do
Life After the Australian Dietary Guidelines
28th May 2012 5
Dietitians use the ADGs
The Professional(done study at uni)
The Client(seeks advice from the professional)
ADGsAnd related disease-specific guidelines, websites, support
material
Evidence-based
ResearchLevel 1 Systematic review & meta-analysis [of]
Level 2 DBRCT (>24 months)
Tailor the science to the individual
(ADGs benchmark)
Financial Exchange
Life After the Australian Dietary Guidelines
28th May 2012 6
But the ADGs are a limited view
MJ Franz JJ VanWormer AL Crain JL Boucher T Hilston W Caplan JD Bowman NP Pronk
Journal of the American Dietetic Association 2007 107(10):1755-1767
Life After the Australian Dietary Guidelines
28th May 2012 7
‘They all work….when you stick to them’
SL Thomas J Hyde A Karunaratne R Kausman P Komesaroff
Nutrition Journal 2008 7:34
The challenge is in the sticking….
Life After the Australian Dietary Guidelines
28th May 2012 8
The constant challenge to stick
Consumer
Life After the Australian Dietary Guidelines
28th May 2012 9
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
Life After the Australian Dietary Guidelines
28th May 2012 10
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
Life After the Australian Dietary Guidelines
Not following the ADGs is easier
28th May 2012 11
kJ 300 300
Price $0.20 $0.45 – $0.90
Effort Easy Hard
Enjoyment 10 6
Spoilage risk Negligible Medium
Taste risk Negligible Medium
Life After the Australian Dietary Guidelines
Not following the ADGs is easier
28th May 2012 12
kJ 300 300
Price $0.20 $0.45 – $0.90
Effort Easy Hard
Enjoyment 10 6
Spoilage risk Negligible Medium
Taste risk Negligible Medium
Life After the Australian Dietary Guidelines
Income ($/week)
Con
sum
er e
ffort
28th May 2012 13Life After the Australian Dietary Guidelines
Healthy
Not Healthy
Dietitian
28th May 2012 14Life After the Australian Dietary Guidelines
Healthy
Not Healthy
Dietitian
Oh its so easy, look at this pyramid…eat most is here..
Cost? Healthy eating is cheaper here look at this
I use Avocado instead of mayonnaise its still just as creamy but better for you
Herbs instead of salt – yeah I get herbs from my garden
Recipes: yes here are some you’ll like… lean beef and cranberry salad…here’s another…lentil and leek
soup
Oh money is tight…here’s some ‘recipes on a budget’ no frypan? Maybe use a pot then, here’s some one-pot
recipes
Shiftwork? Here’s a meal plan for shiftworkers
28th May 2012 15Life After the Australian Dietary Guidelines
Healthy
Not Healthy
Dietitian
Oh its so easy, look at this pyramid…eat most is here..
Cost? Healthy eating is cheaper here look at this
I use Avocado instead of mayonnaise its still just as creamy but better for you
Herbs instead of salt – yeah I get herbs from my garden
Recipes: yes here are some you’ll like… lean beef and cranberry salad…here’s another…lentil and leek
soup
Oh money is tight…here’s some ‘recipes on a budget’ no frypan? Maybe use a pot then, here’s some one-pot
recipes
Shiftwork? Here’s a meal plan for shiftworkers
May not have experienced poverty, obesity, limited kitchen and facilities, having little children with you all day and having to shop on public transport with them,
drug and alcohol abuse, daily threats of violence
The difference with food as the problem Necessary to sustain life: every person eats Individual makes final choice Choice about food made two, three or more times a day Influenced by attitudes, beliefs, behaviours Everyone’s an expert (or can be)
28th May 2012 16Life After the Australian Dietary Guidelines
Life after ADGs for dietitians?
28th May 2012 17Life After the Australian Dietary Guidelines
….Yes. And it is good.
DBRCTs (guidelines) may not be gold standard for food
Professional support for options outside ADGs
Policy (legislation) and practice to consider:
Consumer food behaviour [is not rational]
Effort as linked to income (income affects choice)
Because of income, we are not at same starting point