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Getting the message across With the media, internet, and health professionals often saying different things about nutrition, no wonder the public are confused. In the fourth article in our series on nutrition, Claire Mac Evilly guides you through the maze The science of nutrition is a diverse one as it is the study not only of nutrients, but their interactions with physiology, biochemistry, genetics, and psychology. It is ever evolving as a science and this means that over the past 50 years we have seen the diet health message change from simple directives to more complex goals or targets. Surveys continue to report that consumers are confused about diet and health related messages. So how do we as health professionals get past this hurdle and provide accurate but simple advice and motivate people to make long term change? This article will look at some of the ways in which nutrition messages make their way to the public domain. Who's who in the communication arena? As health professionals we are not alone in trying to communicate the benefits of proper nutrition messages. We do, however, all have the same single objective: to influence eating behaviour. However, each group approaches the goal from a different perspective. For example, the food industry must sell its products. When emphasising nutritional attributes can further that goal, food producers are eager to do so. Certainly there was an explosion of foods with added health benefits during the late 1990s, but the claims associated with some of these foods, such as "special" margarine, were unsubstantiated and the message from health professionals was that it was important to recognise that foods like these addressed only one risk factor. In addition, foods with an added health benefit should not be considered an alternative to a healthy balanced diet or a healthy lifestyle. 
The government also has a vested interest in the dissemination of health messages. Since the Food Standards Agency was set up in April 2000 nutrition has sat on many agendas. It remains core to the workings of the agency alongside food safety but is also integral to the work of the Department of Health, and recent discussions have confirmed that the delivery of public health messages on nutrition will now be orchestrated by the Health Development Agency on behalf of these two government departments. The third group of players are the major health related voluntary organisations, whose messages often parallel those of health related government agencies though are often single issue messages and sometimes more extreme. Yet the government recommendations and those of the voluntary agency may differ. For example, the National Osteoporosis Society suggests that women aged 20 to 30 should have 1000mg of calcium a day. This is well above the recommendations of COMA (Committee on the Medical Aspects of Food and Nutrition Policy) of 700mg a day. The consumer is therefore led to believe that health experts and spokespeople from different health charities are of different minds. Finally, there are special interest groups whose stance ranges from the most liberal to the most conservative, depending on their agenda. Unfortunately, sometimes overly dramatic statements from groups at both extremes tend to drown out less vivid but more reasoned messages on diet and health. A recent example of this concerned a campaign mounted by an extreme group of animal rights activists. The aim was to dissuade children from drinking milk by using scare tactics such as saying that milk gives you spots, makes you fat, and causes wind and phlegm to be produced by the body. Nutritionists across Britain, including the British Nutrition Foundation, roundly condemned this action and emphasised that the claims were completely untrue, being based on pseudo or no science.1 The Food Standards Agency's press statement said the antimilk campaign was "an irresponsible publicity stunt." Using the media Public interest in nutrition has grown rapidly over the past several decades and the media is by far the most popular vehicle through which consumers get their nutrition information,2 although the most trusted source remains the general practitioner.3 Several trends reflect positive changes in dietary patterns, thanks partly to the influence of the media. Changes in consumption of milk, broccoli, and fat are three examples where information provided by the media have had a positive influence on health behaviours.4 Broccoli consumption has increased since the 1970s due to increased production and availability but the considerable media attention to research suggesting that a compound in such cruciferous vegetables might have cancer preventive functions may have also influenced the rise. A few studies of popular press coverage of health and nutrition related topics have evaluated the overall quality of reporting.5 Assessment of the quality of media coverage is necessarily complex. In the first place, there are many different types of reporting, including news articles on single studies, feature pieces in magazines, and coverage of broad versus focused topics. In addition, quality of reporting deals with factors such as accuracy, breadth, and depth of reporting. A recent study which compared nutrition related reporting in five newspapers during a six month period found that only a limited number of scientific journals are routinely covered in newspapers.6 Therefore people who acquire nutrition knowledge mainly from a newspaper are exposed to a limited sample of nutrition related research, and sample characteristics, study methodology, and study limitations are not routinely reported. These components of research are critical for accurate and meaningful nutrition related research. Television requires less attention and does not allow viewers to turn back to something that they have seen to clarify or review information. Perhaps it is because of these limitations that average viewers remember only 30% of what they see on television.7 Television stations use several "experts" to deliver food and nutrition messages and ultimately it is the media gatekeeper who has the power to decide what is newsworthy, how to cover it, and who to ask for the information. This often leads to inaccurate reporting as trained nutrition professionals are often overlooked. In some instances there is premature communication between scientists, institutions, journals, and the media. The number of journals regularly issuing press releases seems to have increased, with the obvious goal of focusing attention on stories to gain publicity and subscriptions. As a result of this, scientists and doctors are now dealing with journalists. Some have regarded this collaboration with the media as interesting while others have remained outside and a minority have found that they can use the media for their own interest to gain fame, financial advantage, and other objectives not always in keeping with good scientific practice.8 Nutrition on the internet The world wide web is promoting a revolution in communication no less important than the development of the telephone. Searching for nutrition topics can be daunting. Enter the term "nutrition" and search engines return 260 000 to 2 400 000 hits. Nutrition research on the net is often used inaccurately to support claims made by the less scrupulous, to market their food, or supplement products, but more recently there has been an increase in dieting related sites on the web. A recent Health Which? report highlighted the pitfalls of these sites, many of which charge a fee for a "personalised" diet plan.9 Much of the information is incorrect, out of date, or misleading, but this will not always be evident for users. People often exclude certain foods from their diet, such as milk, bread, and potatoes, because of something they read or hear, when in fact they could be doing more harm than good. Read the small print Another tool used in the dissemination of the nutrition message is the food label. In addition to the ingredients list, the nutrition labelling panel gives important information about the nutrient content. In March 2001 the results of a survey commissioned by the then Ministry of Agriculture, Fisheries, and Food into the consumers' view of labelling was released. They showed that, of the 3153 consumers asked, 68% seek information from labels when making food purchase choices as well as assessing, for themselves, the quality of different food products. Of this 68%, 39% said they look at fat content, 29% examined the ingredients of the food, and just under a quarter looked at the sell by date or use by date.10 This survey highlights that people do read labels; however these remain confusing and are not helping people to choose healthier options. The difficulty in changing the look of the current label is that the standard format for nutrition labelling is controlled by a European directive. The Food Standards Agency is currently reviewing the United Kingdom labelling format and the hope is that the humble label will get a new look, which will encourage the shoppers among us to read them and make informed choices about our diets. Effective messages Ultimately, nutrition communication is all about changing behaviour and this is complex. The more health professionals, academics, government officials, food industry personnel, and journalists work together to produce a set of clear consistent, evidence based focused, and positive messages based on the body of well funded scientific knowledge, the sooner recommendations for a healthy diet will be accepted and followed. The role of health professionals is to take the mass message, consider the factors that will influence whether or not an individual will respond, and tweak it to make it relevant to the unique individual. Success will, however, depend on the ability of consumers to trust the information source, recognise sound science, and distinguish it from science fiction. Further information www.nutrition.org.uk
Claire Mac Evilly nutrition scientist, British Nutrition Foundation c.macevilly@nutrition.org.uk The British Nutrition Foundation is an independent charity, which raises funds from the food industry, the government, the EU Commission, and other sources.
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