SEATTLE - 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 center stage.
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.
Editor's note: To arrange an interview with Patterson, the study's lead author, call Kristen Woodward in Hutchinson Center Media Relations at (206) 667-5095. To obtain a copy of the paper, "Is There a Consumer Backlash Against the Diet and Health Message?"call the American Dietetic Association at (800) 877-1600, Ext. 4802. (This contact information is for media use only and is not intended for public distribution.)
The Fred Hutchinson Cancer Research Center is an independent, nonprofit research institution dedicated to the development and advancement of biomedical technology to eliminate cancer and other potentially fatal diseases. Recognized internationally for its pioneering work in bone-marrow transplantation, the Center's four scientific divisions collaborate to form a unique environment for conducting basic and applied science. The Hutchinson Center is the only National Cancer Institute-designated comprehensive cancer center in the Pacific Northwest and is one of 37 nationwide. For more information, visit the Center's Web site at http://www.fhcrc.org. Advancing Knowledge, Saving Lives
Journal
Journal of the American Dietetic Association