First, butter is the enemy. Then solid
margarine is on the forbidden list. Next, beta-carotene supplements are
thought to prevent cancer -- until they are found to increase the risk of lung
cancer in smokers. Later, tomatoes are the darlings of the prostate-cancer
prevention community -- until broccoli, cabbage and other crucifers take
As incremental advances in scientific knowledge cause shifts and reversals
in diet and health messages, what are confused, frustrated consumers to do?
Some appear to be responding by tuning out the conflicting advice and
eating less healthful diets, according to a study by researchers at the
Fred Hutchinson Cancer Research Center in Seattle, Wash.
The results of this National Cancer Institute-funded study, led by
Ruth E. Patterson, Ph.D., R.D., an associate member of the Hutchinson Center's
Public Health Sciences Division, appear in the January issue of the Journal of
the American Dietetic Association.
"The more negative and confused people feel about dietary recommendations,
the more likely they are to eat a fat-laden diet that skimps on fruits and
vegetables," Patterson said.
"From an anecdotal perspective, it seems as if all of a sudden big
steakhouses are IT, and they're not just serving steak, they're serving a
1-pound steak and everything is drenched in butter and bleu cheese," Patterson
said. "We wanted to determine whether there truly is a growing rebellion
against diet and nutrition messages, and if so, how it may be affecting
Americans' eating habits."
While public skepticism regarding inconsistent nutrition messages appears
to be growing as fast as America's appetite for steakhouses, martini menus and
cigar bars, this was the first population-based study of its kind to track the
existence and extent of nutrition backlash.
Patterson and collaborators from the Hutchinson Center and the
University of Washington conducted a cancer-risk behavior survey that included
questions regarding attitudes toward dietary recommendations. The random
survey, which involved 1,751 adults in the state of Washington (60 percent
women; 90 percent white; mean age 44), asked also about consumption of fat,
fruits and vegetables.
The results found evidence both for and against nutrition backlash,
defined as negative feelings about dietary recommendations, such as anger,
skepticism, helplessness, worry and cynicism.
About 70 percent of respondents felt that Americans are obsessed with the
fat in their diet and that the government should not tell people what to eat.
In addition, more than a quarter agreed that eating low-fat foods takes the
pleasure out of eating and more than 40 percent stated that they were tired of
hearing about what foods they should or should not eat. They felt that dietary
recommendations "should be taken with a grain of salt."
Those who scored highest on the backlash scale were young men
(age 18 to 35), the elderly (age 60 and over) and people of lower
socioeconomic status, as measured by education or income.
Consumers who reported the greatest degree of backlash had diets that were
approximately 4 percentage points higher in percent energy from fat compared
to those at the opposite end of the spectrum -- "a substantive difference,"
Patterson said. "For example, if we assume that on average, Americans eat
diets with 34 percent of energy from fat, we could hypothesize that
individuals with high backlash chose diets with 36 to 38 percent energy from
fat." Nutrition experts recommend that consumers get 30 percent or less of
their daily calories from fat.
The findings of the cancer-risk behavior survey were not all bad news,
however. For example, more than 90 percent of the respondents felt that
nutrition research would help them live longer and three-quarters agreed that
there should be warning labels on high-fat foods.
"The majority of the public still care about their diet and health, but
there are definitely some subgroups that have just plain had it," said
Patterson, also a research associate professor of epidemiology in the
UW School of Public Health and Community Medicine.
The high degree of public interest in nutrition information can be a
double-edged sword, Patterson feels. "Interest in new scientific findings
presents the opportunity to improve the nation's health by providing
information that helps consumers adopt healthy diets," she said. "However,
perceptions that the diet-health message is constantly changing or that
dietary recommendations are conflicting could undermine the credibility of
future nutrition-education efforts."
To counter the barrage of inconsistent diet and health messages, Patterson
and colleagues call for collaboration among health organizations, government
agencies, the food industry and the media. "Such a partnership could work to
ensure the development and dissemination of consistent, positive messages that
promote wise food choices," she said.
In the meantime, Patterson suggests that Americans adopt a more European
attitude about food, citing the first recommendation of the French Dietary
Guidelines: "Enjoy your food."
"Research indicates that taste is one of the most important factors in
determining the foods we eat. Therefore, nutrition-education efforts must
acknowledge the importance of enjoying food," Patterson said. "To acknowledge
that eating is one of life's great joys and that pleasure isn't inconsistent
with a good, healthy diet would be a great message for the public.
"We need to celebrate the fact that we have a wonderful, diverse food
supply in this country and that there are all kinds of ways to have a good,
healthy diet while still eating many enjoyable foods."
Study collaborators from the Hutchinson Center's Public Health Sciences
Division were Alan R. Kristal, Dr.P.H., division member and UW professor of
epidemiology; staff scientist Marian L. Neuhouser, Ph.D., R.D.; and
post-doctoral fellow Jessie A. Satia, Ph.D., M.P.H. Also collaborating was
Adam Drewnowski, Ph.D., director of the Nutritional Sciences Program in the
UW School of Public Health and Community Medicine, who also holds a joint
membership in the Hutchinson Center's Public Health Sciences Division.