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Healthy eating - diet and nutrition

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Introduction

Consuming a healthy diet throughout the life course helps prevent malnutrition in all its forms as well as a range of non-communicable diseases and conditions. But the increased production of processed food, rapid urbanisation and changing lifestyles has led to a shift in dietary patterns. People are now consuming more foods high in energy, fats, free sugars or salt/sodium, and many do not eat enough fruit, vegetables and dietary fibre such as whole grains1. The importance of diet as a major contributor to chronic disease and premature death in England is recognised in the White Paper 'Healthy Lives, Healthy People'. Poor diet is a public health issue as it increases the risk of some cancers and cardiovascular disease (CVD), both of which are major causes of premature death. These diseases, and type II diabetes (which increases CVD risk) are associated with obesity, which has a very high prevalence in England. The costs of diet related chronic diseases to the NHS and more broadly to society are considerable. Poor diet is estimated to account for about one third of all deaths from cancer and CVD.

Current nutrition advice from the NHS advocates balance is the key to a healthy diet. It states eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink will achieve and maintain a healthy body weight. It promotes a diet based on starchy foods such as potatoes, bread, rice and pasta; plenty of fruit and vegetables; some protein-rich foods such as meat, fish and lentils; some milk and dairy foods; and not too much fat, salt or sugar. Figure 1 shows the 'Eatwell Guide' which highlights the different types of food that make up our diet, and shows the proportions we should eat them in to have a healthy, balanced diet.

Figure 1: The 'Eatwell Guide'

Eatwell-guide-2016-FINAL-MAR-16
Source: NHS choices, the eatwell guide

In the UK, the poorer people are, the worse their diet, and the more diet-related diseases they suffer from. This is food poverty2. Poor diet is a risk factor for the UK's major killers of cancer, coronary heart disease (CHD) and diabetes. Yet it is only in the past few years that the immense contribution it makes to poor health has been quantified: poor diet is related to 30% of life years lost in early death and disability. Inequalities in people's diets can result in inequalities in people's health. Those on low incomes suffer from poor diets, as evidenced by lower fruit and vegetable intakes, and a higher prevalence of dental caries among children. They are also disproportionately affected by the major killer diseases. It is estimated that as many as 10 million people in the UK live in poverty, including nearly three million children3.

Facts and figures

The Public Health Outcomes Framework provides estimates on healthy eating behaviour. Across Blackpool it is estimated that:

    • 75% of adults and 36% of children (age 10-11) are overweight or obese in Blackpool4 (link to obesity pages)
    • 7.4% of the population have been diagnosed with diabetes, significantly higher than the national average5
    • Blackpool has one of the highest rates of fast food outlets of all local authorities in the country 6
    • Less than half (44.6%) of all adults are eating the recommended 5 portions of fruit and vegetables per day.
    • The average number of portions of fruit and vegetables eaten per day in Blackpool is significantly fewer than the national average (Figure 2)
    • Blackpool is in the lowest quintile nationally for eating the recommended '5-a-day' (Figure 3)

Figure 2: The average number of portions of fruit/vegetables consumed per day and the proportion of people eating the recommended '5-a-day', 2014. Blackpool compared to England and North West

Figure-2-fruit-and-veg-consumption
Source: Public Health Outcomes Framework

Figure 3: Proportion of the population meeting the recommended '5-a-day' consumption of fruit and vegetables, 2014. Blackpool compared to upper tier local authorities

Figure-3-fruit-and-veg-consumption-Blackpool-comparison
Source: Public Health Outcomes Framework

There are many factors which impact on healthy eating and the ability to have a nutritious diet. Key research shows that households/individuals who are in poverty or socially disadvantaged have worse dietary-related outcomes. Food poverty is more likely amongst those who have a low income, are unemployed, have a disability, or are a member of a black or minority ethnic community2. The Health Behaviours in Blackpool survey returned a much lower proportion of the population eating the recommended '5-a-day' than was expected in comparison with other data sources7 but the collated evidence supports the findings that healthy eating is less likely in those who are struggling financially, younger people, those with a disability and the obese.

    • 43% of survey responders reported eating less than 3 portions of different fruit and vegetables the previous day.
    • Of these, 12% didn't eat any fruit or vegetables the previous day.
    • The number of portions of fruit and vegetables consumed increases with age and financial security.
    • Males and those out of work consume fewer portions of fruit and vegetables then the general population.

Income is not the only factor which can influence healthy eating; cooking and storage facilities or the cost of gas/electricity can be problematic for some, as can a lack of knowledge around food preparation. In these situations convenience foods are more likely to be eaten - this includes processed foods and takeaway/fast food.

    • 20% reported eating fast food or takeaway meals at least once a week.
    • Almost 10% said they never prepared a meal from basic ingredients.
    • A further 14% said they prepared a meal from basic ingredients less than once a week.
    • Younger people (age <45) eat takeaway food more often than older people and those working full time eat takeaway food significantly more frequently.
    • Those not in work are significantly less likely to prepare a meal from scratch.

Soft and fizzy drinks can be high in sugar (which can damage children's teeth) and have few nutrients. Children and adults who have a lot of sugary soft and fizzy drinks are more likely to put on weight and to be overweight or obese.

    • 14% of people reported consuming fizzy drinks 6 or more times a week.
    • People who are obese are significantly more likely to consume fizzy drinks more often.
    • The number of fizzy drinks consumed decreases with age and financial security.

Breastfeeding

Breastfeeding is the healthiest way to feed babies and exclusive breastfeeding (giving your baby breast milk only) is recommended for around the first six months8. After that, giving breast milk alongside other food will help them continue to grow and develop healthily. The latest breastfeeding initiation rate (2014/15) in Blackpool was significantly lower than the national average with more than a third (38%) of mothers recorded as not breastfeeding at the time of delivery. This indicates that approximately 740 new-borns in Blackpool never received any breast milk. The proportion breastfeeding for the recommended six months is therefore likely to be significantly lower still. These figures highlight that across the town there remains a culture of bottle-feeding as the 'norm' and action is needed to address this.

Risk factors

The benefits of maintaining a healthy weight and nutrition are numerous, not only to the quality of life, but also the quantity of life. An unhealthy body weight is a burden and can lead to an individual being overweight or obese. If you are overweight or obese, you have a higher risk of developing serious health problems , as well as having an impact on the wider society and the economy. (need to link to the obesity pages).

Key research shows that households/individuals who are in poverty or socially disadvantaged have worse dietary-related outcomes. Those who are most likely to experience food poverty are2:

    • people living on low incomes or who are unemployed
    • households with dependent children
    • older people
    • people with disabilities
    • members of black and minority ethnic communities

National and local guidance

Change 4 Life is an NHS initiative which provides information and advice on eating, drinking and leading a more active life.

The Faculty of Public Health have produced a position statement on food marketing to children.

School Food Standards (2015). A new set of standards for food provided in schools is now mandatory in all maintained schools and new academies and free schools, from January 2015. The standards aim to help children develop healthy eating habits and ensure they get the energy and nutrition they need across the whole school day.

PHE have produced an evidence review of measures to reduce sugar consumption

NICE Quality standard 94: Obesity prevention and lifestyles weight managements in children and young people; July 2015 - This guidance covers a fanve of approaches at a population level to prevent children and young people aged under 18 from becoming overweight or obese. It includes interventions for lifestyle weight management.

NICE Guidance 7: Maintaining a healthy weight and preventing excess weight gain amongst adults and children; March 2015

World Cancer Research Fund International Nourishing Framework: Updated July 2015 - an interactive tool to support policy making decisions. The tool helps identify where action is needed to promote healthy diets, reduce obesity and other non-communicable diseases, including cancer. It allows policy makers to tailor options suitable for different populations and assess if the approach is sufficiently comprehensive. The key domains are environment, food and behaviour change.

Recommendations

The promotion of evidence-based healthy eating messages is fundamental. Alongside this, it is necessary to ensure that guidelines concerning a nutritionally adequate diet are implemented to help prevent diet-related deficiencies and malnutrition in vulnerable infants, children and adults.

Priorities around food and nutrition include:

    • Continuing to address and reduce levels of overweight and obesity in children and adults.
    • Increasing knowledge, skills and abilities about healthy eating.
    • Establishing healthy eating habits in children and families.
    • Encouraging a healthy food environment.
    • Reducing sugar consumption

This means focussing on the populations who have been identified including those who are struggling financially and the obese.

 


[1] WHO, Healthy diet fact sheet No 394, September 2015

[2] National Heart Forum, Nutrition and food poverty: a toolkit for those involved in developing or implementing a local nutrition and food poverty strategy, London, 2004

[3] Faculty of Public Health, Food Poverty and Health, 2005

[4] Public Health Outcomes Framework, November 2015

[5] HSCIC, Quality Outcomes Framework, 2014/15

[6] PHE, Fast food outlets, 2013

[7] 19% compared to the Public Health Outcomes Framework estimate of 45%

[8] NHS Choices, Why breastfeed, November 2015