What’s the best way to improve the health of Britain? For participants at a recent Guardian roundtable, the answer was simple: improve the nutritional health of pregnant women and young children, and the benefits will roll down through the generations.
How to make that improvement was more complicated, although participants at the Danone Nutricia Early Life Nutrition-sponsored roundtable were optimistic that it is possible.
There was broad agreement that opportunities to put out positive messages to parents and parents-to-be were being lost, and one change that would make a huge difference was to encourage better collaboration between government and the food industry. But this partnership was either not happening, or, when it did happen, was being undermined by media negativity.
“Government and industry need to work much more closely together – however, the problem is that we’ve not developed trust in the industry,” said Paul Gately, professor of exercise and obesity at Leeds Beckett University.
“At the moment it’s easy for the media to drive a wedge. We need dialogue and debate so industry and government can work collaboratively.” It was, he said, “one of the shames of the past decade that we’ve not addressed the issue”. Where companies run healthy eating initiatives they are overwhelmingly positive, said Gately.
Helen Crichton of Danone Nutricia Early Life Nutrition said her organisation was one of 780 partners signed up to the Department of Health’s Public Health Responsibility Deal, a commitment to improve nutrition and health. However, in doing so companies such as Crichton’s set themselves up to be criticised, even when they’re prepared to take a positive and active stance.
So how could better collaboration make a difference? Various speakers criticised the fact that healthy eating messages were often negative: eat less red meat, or less sugar, or cut down on calories. But positive messages were more likely to be effective. “The industry talks about benefits not problems, and that’s where collaboration could really start to have some impact,” said Gately
Participants returned, time and again, to the fact that nutrition – so much a feature of life in Britain during the second world war – had since been dramatically downgraded. Food and its production was not given sufficient emphasis in school or at home.
Richard Marsh, chief executive of the Institute for Food, Brain and Behaviour, noted that as a nation we tend to see health as “pharma-centred” rather than nutrition-centred, despite the fact that better nutrition could have a far greater impact on health than popping pills.
The sheer enjoyment of food and eating together was also being lost; eating on the hoof and grazing was undoubtedly having an effect on children’s eating habits, taste preferences and behaviours, said Crichton.
Ella’s Kitchen founder Paul Lindley said: “Food is what brings people together, but they’re not eating together very often and very young children aren’t learning the art of conversation or the joy of eating with others.”
Improving the diet of pregnant women was one of the most effective ways to change the health of the population, participants agreed. Good nutrition is crucial to early brain formation. However, according to a study by Alberta Pregnancy Outcomes and Nutrition, only 27% of women during pregnancy and 25% of women at three months post-birth meet the current EU recommendation for DHA (docosahexaenoic acid, an omega-3 fatty acid). This is essential for neurological development – embryos in utero and newborns cannot make their own and so are dependent on obtaining the nutrient via their mother through the placenta or breast milk.
Supporting women to eat well during pregnancy and breastfeeding was especially important because early-life nutrition is so complex that it is not well understood, even by professionals. “Infant nutrition is a highly complicated issue,” said Gately. “In my field, obesity, we tend not to get involved before the age of five because it’s our view that we don’t know enough about it to start tinkering around with issues when we don’t know what the outcome will be.”
Despite the problems, some participants mentioned examples of good practice. Lucy Cooke, honorary senior research associate at University College London, said she knew of nurseries where young children helped grow vegetables and were then able to taste them at snack time. Crichton said there is a new qualification for nursery chefs, available in some London colleges, to equip them to menu plan and cook for small children.
One major area of concern at the roundtable was that public health messages tend not to be universally effective, with disadvantaged and vulnerable groups being consistently hard to reach. What that meant in practice, said Gately, was that messages on, for example, child obesity were very successful in general terms, but when you look at the figures more closely it’s clear that disadvantaged groups aren’t taking them on board. Too often, participants agreed, messages about healthy eating and nutrition were only taken on board by the people least in need of them – the “worried well”.
“I’m really worried about that group of people who are hard to reach,” said Cooke. “Messages are lapped up by the middle classes, but it’s how you reach the proportion of the population who are vulnerable that’s important. I don’t see any sign of anyone taking it seriously. There may be stirrings, but there’s an awful lot to do.”
Even where nutrition was taken seriously, and public health messages were issued, they were too often inconsistent, or even contradictory. One solution would be to create a system, similar to that used in Canada, whereby any new public health message had to be filtered through a central point. If the next government could do just one thing to improve the nation’s nutrition, said paediatric dietician Judy More, this should be it.
Also key, More said, was informing newly pregnant women of the importance of nutrition and providing them with the correct information. On both counts, midwives and GPs were failing. Nutrition wasn’t being mentioned at early antenatal appointments – often, she said, because women were overweight and midwives didn’t want their relationship with them to get off to a bad start by talking about what would obviously be a difficult topic. She also lamented the fact that there was very little in the way of training on nutrition for either GPs, or later on in a child’s life, many messages were shrouded in confusion and there was a lack of willingness to take a lead on proper advice.
“There’s a lot of confusion over breastfeeding,” said Cooke. “The Department of Health says breastfeed to six months, but baby foods say 4-6 months on the jar.” More agreed. The fact was, she said, that from a health visitor’s point of view it was easier to give out the straightforward message that babies should be weaned from six months, but actually the “right” time was when a mother felt the baby was ready, and there was no harm in weaning from four months.
“There’s an inconsistency and no one really wants to take responsibility for giving advice,” said Lindley. “When is the right time to wean? What foods should you give?” These questions really matter, he pointed out, for the child’s long-term as well as short-term health. “The earlier children have vegetables, the more likely they are to like vegetables when they’re older,” he said. Confusion over whether to wean at four or six months was causing all sorts of problems, and advice at this crucial moment should be made much clearer.
At the table
Jane Dudman (chair) Editor, public leaders network,
the Guardian
Lucy Cooke Honorary senior research associate, University College London
Paul Lindley Founder, Ella’s Kitchen
Richard Marsh Chief executive, Institute for Food, Brain and Behaviour
Judy More Paediatric dietician, child nutrition
Paul Gately Professor of exercise and obesity, Leeds Metropolitan University
Helen Crichton Head of public affairs, Danone Nutricia Early Life Nutrition
This content has been sponsored by Danone Nutricia Early Life Nutrition (whose brand it displays). All content is editorially independent. Contact Matt Nathan (matt.nathan@theguardian.com). For information on debates visit: theguardian.com/sponsored-content