Nutrition Policy Isn’t Working. Let’s Try Something Different

Nutrition expert Jack Winkler says we can’t succeed just by telling people to eat healthy because too many have other priorities. Subterfuge may be necessary.
(Photo: Ronaldo Schemidt/AFP/Getty Images)
Dec 9, 2016· 5 MIN READ
Jeanette Marantos is a freelance writer and reporter based in Southern California. She has worked as a journalist, an author, and a teacher.

It’s enough to make any nutrition wonk weep. Despite decades—and millions of dollars—spent on educating the public about healthy eating, the number of overweight people continues to rise.

Of the 129 countries surveyed for the 2016 Global Nutrition Report, 57 “face a double burden of malnutrition—that is, undernutrition combined with overweight, obesity and/or nutrition-related” diseases such as diabetes, heart disease, and some cancers, according to the report’s “50 Numbers on the World’s Nutrition Challenge and Actions to Overcome It.”

As incomes rise around the world, studies show more humans are choosing processed foods high in fat, salt, and sugar, says Jack Winkler, professor emeritus of nutrition policy at London Metropolitan University.

“Nutrition policy has failed,” Winkler wrote in the British Medical Journal in 2014. “It’s time to do something different, something that works.”

Winkler believes the changes must happen soon to avert a worldwide health catastrophe. The numbers in the report bolster his sense of urgency: About 38 percent of the world’s people were overweight in 2014. In North America, it is 67 percent, and in Europe, it is 58 percent. Rates of obesity and diabetes have increased dramatically in the last 20 years.

Information programs have been mostly effective in making us feel guilty, Winkler says. Questionnaires show that North Americans and Europeans understand the correlation between good nutrition and healthy lives because they tend to lie about how much and what they eat. “In one study, 40 percent of the women and 27 percent of the men claimed to be eating less than is necessary to stay alive,” Winkler says.

Clearly there’s a disconnect between what people know about healthy eating and what they eat. That’s because people often have other priorities for food besides health, according to Winkler. He spoke to TakePart about nutrition policy.

TakePart: What are the other priorities for eating?

Jack Winkler: Taste is usually the No. 1 priority for the food we eat. Assume you’re a woman with children and a short budget for food. You aren’t going to buy fruits and vegetables because they’re expensive and your kids and husband won’t eat them. You’re pressured to buy what your kids will eat.

Then some people are absolutely repelled by intrusive “nannying”—health experts wagging a finger and telling them what to eat—so governments stop short of antagonizing voters with compulsory actions. My guess is that this will change in the decades ahead as the rise in type 2 diabetes puts pressure on health care budgets.

TakePart: So what are public health officials to do?

Winkler: Strategically there is a big divide between people who are principled and want to eliminate a problem versus people who are more pragmatic and satisfied with small progressive steps, as long as they’re in the right direction. I am 100 percent pragmatic. I don’t want to be a glorious failure. I’d like to think somebody will be a little bit healthier as a result of my working life.

There’s two things I would do as a practical matter. The first is a nutritional reformulation of foods but following an unobtrusive policy. In other words, improve the foods, but don’t shout about it because when you tell people about it, sales tend to decline.

In Britain, 75 to 85 percent of what we eat is manufactured food, depending on whether you consider hamburger a processed food, so everyone who eats these reformulated foods benefits, whether they’re concerned about eating healthy foods or not. It doesn’t depend on people making a conscious choice every time they go shopping.

RELATED: How Do We Feed a Growing World?

TakePart: How do you make companies reformulate their foods?

Winkler: The story I like to tell is about Britain’s salt reduction program, which began in 2005. Salt has been implicated in strokes and various cardiovascular problems, and we had a study that said 70 percent of the salt consumed in Britain is in manufactured foods, so they put together the salt reduction program to encourage manufacturers to reduce the salt in their products.

In 97 percent of the [reformulated] products, there was no indication whatsoever that they had been changed, so people just went on buying them as normal and consumed less salt in the process. As a result, in six years the national salt consumption went down 15 percent. It is the most successful nutrition policy the world has seen since the Second World War.

TakePart: How did the salt reduction program work?

Winkler: It was government organized but a voluntary program. The Food Standards Commission brought the major companies together. The companies did a lot of sensory testing, where you take a few hundred people and give them samples of the product with different levels of salt and say, “Which one do you like?” If you do this several hundred times, you can cut the salt to a level where people don’t recognize the change. Then you let it sit for two years, and when people become accustomed to the change, you do it again.

Doing the program this way had two very important effects. The first was that it eliminated competitive risk to a company. When all the companies are cutting the same amount of salt, people can’t find a different, saltier product. This is a major practical consideration because companies are willing to change as long as they don’t lose business doing it. The second advantage is that the companies monitor the heck out of each other because they don’t want anybody cheating on the deal. That effectively delegates the monitoring to the companies, so the government isn’t saddled with that expense.

TakePart: What happened during World War II?

Winkler: Britain has never been healthier since the Second World War, and the reason was rationing. People who ate too much got less, and people who got too little to eat got an adequate amount. All of Britain’s health problems, from tooth decay to obesity, improved during the war. The same thing happened in Cuba and Poland when they had to put in extreme forms of rationing, and the health of the people improved dramatically. Rationing is good for your health, even if it’s not very popular.

TakePart: You also advocate changes in agricultural subsidies to encourage farmers to grow healthier foods.

Winkler: At the moment, nutrition is not a high priority for agricultural policy. I once went to a meeting with an agricultural minister and said the problem with sugar was very simple: “We should raise the price and impose strict quotas, so our farmers produce less sugar and are paid more.” He looked at me as if I had just landed from Mars, because his job is not nutrition or health. His job is to make sure we have an adequate supply of sugar, and people get well paid for it.

But from a nutrition standpoint, making cheap sugar available in unlimited amounts is the worst policy you can have because the incentives to save on sugar in products are reduced. It’s like putting price instruments into nutrition policy. If you make sugar more expensive and available in limited quantities, manufacturers will seek ways to reduce their use of sugar.

TakePart: Why not impose government restrictions, such as a ban on television advertising of unhealthy foods?

Winkler: In Britain and the United States, the single largest category of television advertising is food and drink. If we begin restricting advertising for food and drink in the name of children’s health, it would be a fundamental blow to the cash flow of television companies. Most governments can’t go down that route because the unintended consequences would be so serious.

Britain has proposed a tax on soft drinks that will come in 2018 [an estimated 25 cents to 34 cents per liter, depending on sugar content]. In principle, I’m in favor of a soft drink tax. I believe in giving consumers material restrictions as well as moral injunctions. I just don’t think this [tax] will be high enough to do much good.

If people would give me all the policy instruments that tobacco has faced—restrictions on advertising and distribution and an extraordinary tax, 348 percent of the full retail price—I could transform our nutritional policies overnight.