How many-a-day?

As an adult, you'll make around 35,000 subconscious decisions each day. Interestingly, only 226 of those decisions are about what you do, or do not, eat. When I first leant this statistic, I thought the numbers were wrong. I mean, I think about food all the time. It's hard not to. In a world of targeted marketing, our cookies are read, filtered and interpreted quicker than we can eat them. Aside of making your surprise gift less of a 'surprise' for your significant other, you'll be receiving subliminal messages on how to live and what to buy every time your phone is unlocked.

What is particularly interesting about these food decisions is they invariably go against what most of us know to be best for us. We know an apple is better for us than a Mars Bar, yet we choose the more expensive, less nutritious Mars Bar anyway.

In 1996, some fascinating behavioural research was taking place in California under the eminent Brian Wansink. Amongst other things, researchers were observing the habits of both slim and heavy people to try and identify possible reasons as to why some people chose the Mars bar, and others the apple. It wasn't long before some interesting differences were identified; slim people spent significantly less time in environments that encouraged poor nutritional choices. It wasn't a case of increased willpower or higher motivation. Instead, controlling their environment protected them from even having to contemplate a poor nutritional decision in the first place. In his book, Slim by Design, Wansink summaries his 25 years of research in one sentence; 'Becoming slim by design works better than becoming slim by willpower.' In real terms, this means it is easier to put the biscuit tin in the cupboard than to try and resist eating another biscuit. In essence, create an environment, in your home/workplace/school, that mirrors the behaviours you want to exhibit.

The approach Dr Wansink is advocating makes a lot of sense. We see it at play in other areas of daily life all the time. Example; you have a piece of work to submit. You get home from work and sit down on the sofa with your laptop. After 20 minutes, you flick the TV on to check you're not missing anything. 30 minutes later you turn it off, realising you're wasting precious time. Solution: change your environment - move to a room without a TV. It's a case of applying the same model to your eating environments. Have a look at your environment now. Is it conducive to a healthy lifestyle?

I don't read the Metro often. Mostly because it contains articles I am forbidden to write about on my blog (see previous post). However, I thought it would be interesting to have a nosy and see what was the latest food to be taken hostage. The headline that caught my eye was in fact not singling out a particular cancer-causing food but instead, an authoritative recommendation to eat '10 a day' directly from scientists at Imperial College London. Now, unless you've been living under a rock then you will have heard of 5-a-day; the public health initiative to encourage us to eat more fruit and vegetables. Queue the confusion. How many of each? Do potatoes count? What is a portion? Do men and women have the same portion size? So. Many. Questions. Despite the confusion that messages like this elicit, the aim was very simple – to increase consumption of fruit and vegetables. However, before we jump in and start eating 800g (10x80g portions) of nature's home-grown medicine, let's take a little look at the study behind the numbers.

The researchers began by using data obtained from 95 different studies, via food questionnaires. This is a particularly inaccurate way of gathering information on people's eating habits as they rely on people recalling (and being truthful about) what they ate for a 24-h period. The data gathered was then analysed to search for associations between the number of portions of fruit and vegetables a person ate and their risk of developing cardiovascular disease, stroke and cancer. This part is important. The average Brit consumes 4 portions of fruit and veg each day. Only 30% of us consume 5 or more each day. The data does not extend to the point where people reported eating 10 or 15 portions a day so the researchers have extended the line of best fit through outliers in the data, essentially estimating what would happen if someone did eat 10 portions a day. This means they have created a line of best fit on data that has been averaged, with bonus points for estimating missing data! It goes further. Although this study has a strong method (a systematic review of meta-analyses), it's impossible to detract from the fact they have blatantly assumed the association (more fruit and veg is more protective) is causal. To highlight why associations do not prove causation, I've included a graph;

You get the idea...

Why is this important? It's important because, based on data that is notoriously unreliable (food questionnaires and human memory), researchers have created a headline that will grab attention. We started at 5, then 7 and now 10-a day, why not just say, 'the more fruit and vegetables you eat, the less likely you are to die'? As obesity researcher, Dr Zoe Harcombe highlights, '...fruit and veg intake is a marker of health not the maker of a healthy person'. The last thing we need is to encourage people to eat even more food based upon a flimsy association from recall data.

Another key area this study fails to recognise is other habits will also contribute to your risk of developing a nasty disease, or not. If it is this simple, then we might as well go out and feed 10 portions of fruit and vegetables each day to someone who smokes 20 cigarettes a day, drinks 8 pints and barely moves, transforming them in a pillar of health! As Dr Harcombe highlights, fruit and vegetables are a marker of a person's health. You cannot isolate these things and draw wild conclusions. We know that those who eat more fruit and vegetables are more likely to be female, in non-manual jobs and degree-educated. Those who eat less fruit and veg tend to be male, particularly inactive, drink more alcohol and smoke. Lifestyle is an all-encompassing, multi-factorial beast.

Let's turn our attention back to the curious work of Brian Wansink. His research is particularly interesting as he has worked for numerous large food corporations yet his research is aimed at changing the average person's behaviour, empowering them to make healthier choices. He was, in fact, the man to convince confectionery companies their profits would increase if they sold smaller packets all bunched together in a big bag (Fun Size) – you always tell yourself you'll just eat the one, right? An expert in human behaviour, his philosophy is this; control your environment (the layout of the kitchen, plate size, route through the supermarket) and you'll be less inclined to make choices the big food companies want you to make. I feel there is a distinct difference between this approach and that of our national guidelines which expect us to measure, weigh and count everything. Wansink's approach helps us all to make healthier choices without giving it any conscious thought – making it a more sustainable way to nudge us towards a healthier lifestyle.

What can we learn?

I don't believe that the media have an agenda to confuse us. I think they have a job to do, which is to create a headline that sells newspapers/drives online traffic. I don't blame the journalist or the paper for writing these headlines, however irresponsible they may seem. We need to accept we live in a world of big data and instant communication and take responsibility for our own health. To say that certain foods are 'health neutral', in that they neither positive or negatively impact health is not something that will create a headline. It's boring. But for a lot of foods it is true. Numerous studies (including Framingham & Women's Health Initiative) have shown that people who consume fruits and vegetables are less likely to develop certain diseases, however which fruits and vegetables are 'best' is something that is very difficult to pin down. Let's be clear, we all agree that consuming vegetables and fruits is nutritious, that is not being disputed. Going so far to say that if we all start eating 10-a-day then millions of lives will be 'saved' is just crazy.

There are a few things we do know are truly damaging to our health and do indeed increase the risk of disease. Things that scientists unanimously agree on. Smoking, intake of Sucrose and inactivity. There was a time when smoking would have been prescribed by your doctor, perhaps for stress. Scientific research has got us to a point where we now realise this to be 'unwise'. But it was a fight, tobacco companies aren't poor and neither is the sugar industry. I think the key to finding advice you can rely on is to look for the money. If the research behind the headline was sponsored by a company that sounds familiar, it may be that their agenda is a little different to yours. You want to lose weight, they want to make money – a conflict of interests.

My advice; keep eating fruit and vegetables, they are nutritious. Don't stress about trying to force 10 portions down each day. In order of priority, aim for vegetables that grow above grown followed by berries, vegetables that grow below ground and lastly fruit from trees. Avoid fruit that is in a packet (pre-cut) or highly processed (juice).

10-a-day? I say meat and two veg.


Books that contribute to this blog and are well worth a read:

Brian Wansink's 'Slim by Design' -

Zoe Harcombe's 'The Obesity Epidemic' -