Research and messaging central to heart health

by Allison Gibesom
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Determining whether additional potassium in the diet may negate excessive sodium’s negative effects on the heart is just one area of heart-health research that merits greater exploration, said Rachel Johnson, pro-fessor of nutrition and medicine for the University of Vermont and spokesperson for the American Heart Association.

Ms. Johnson said many consumers may not realize potassium is beneficial in lowering blood pressure and is one of the reasons fruits and vegetables are encouraged in diets for high blood pressure. There also has been an emphasis on portraying fat as detrimental to heart health. But Ms. Johnson said that focus has shifted to distinguishing heart-healthy fats (monounsaturated and polyunsaturated fats) from unhealthy fats (saturated and trans fats) and understanding the role heart-healthy fats may play in the diet.
“I hope consumers have gotten the message that not all fats are bad,” she said.

Survey suggests more work ahead

Yet the 2012 Food and Health Survey from the International Food Information Council (IFIC) indicates there is still some work to do in this area. IFIC said 49% of consumers are trying to limit or avoid trans fats with 47% doing the same for saturated fats. Meanwhile, 32% of consumers are trying to limit and avoid mono and polyunsaturated fats with 45% of consumers not paying attention to healthy fats at all. Only 3% of consumers were mistakenly trying to avoid omega-3 fats, 59% aren’t paying attention to omega-3s, and just 25% are trying to consume them. Twenty-two per cent of consumers incorrectly agreed either somewhat or strongly that all types of fats have the same impact on health, according to the IFIC study.

Avoiding fat completely and shifting to a high-sugar diet is not beneficial, Ms. Johnson said, noting it would be better for someone to use a salad dressing with heart-healthy fats than a non-fat salad dressing with high levels of sugar. She said products promoted as non-fat but that are also high in sugar confuse consumers and may give the false impression of being heart-healthy. In fact, added sugars have been proven detrimental to heart health, she said.

Ms. Johnson said it is important for consumers to get at least two servings a week of seafood for sufficient consumption of omega-3 fatty acids. In addition, despite all the current industry efforts in sodium reduction, she said there is still an “increasing drumbeat” to continue cutting sodium. Currently, 77% of the sodium Americans consume comes from processed foods and foods eaten away from home, she said.

Ms. Johnson and Nancy Childs, professor of food marketing at Saint Joseph’s University in Philadelphia, agreed blood pressure is an increasingly important aspect of heart health. Yet consumers with high blood pressure place a slightly higher importance on medication to control blood pressure than diet-related changes, according to the IFIC survey.

The survey found 79% of those with high blood pressure have taken medication to control blood pressure, with 68% attempting to lose weight, 65% reducing sodium and 51% increasing physical activity. For those with normal blood pressure, only half are working to keep it down with only 29% reducing sodium, 27% trying to lose weight and 27% increasing physical activity.

Though food companies may work to produce lower-sodium, lower-sugar products, it’s often another challenge to get those products into the hands of consumers.

“We look at the companies, and we put all this responsibility on them,” Ms. Childs said. “It’s hard for them to get their products on the shelves at the retailers. With category management and all the ways in which retailers are managed in such a sophisticated way in determining what goes on the shelf to maximize profit, it demands a lot of compromise from the retailer in terms of introducing healthier products.”

While the role of different nutrients is being studied and more information becoming available, maintaining weight for heart health is a piece of advice that has never changed.

Some messages stay the same
“Overall, the healthiest thing you can do as a person is to manage your weight,” Ms. Childs said. “That goes further toward heart health than almost anything you can do through diet in terms of an individual heart-healthy food. That’s one of the challenges for someone in the food areas — how do you get someone into a better balanced position? Even though consumers want permission to eat more healthy foods, they aren’t recognizing you should be doing this within the context of a healthy amount of calories.”

Ms. Johnson also echoed this truth about the significance of a healthy weight. She said it’s not truly beneficial to emphasize physical activity unless you also are emphasizing portion control and eating less.

“A lot of heart health depends on being at a healthy weight — we need to eat less,” Ms. Johnson said. “The portion sizes are so important. In the food environment we live in, you have to be so vigilant about portion sizes.”

But when it comes to getting consumers to take action to eat healthier, stating the dangers of what may happen if one doesn’t change isn’t effective, Ms. Childs said.

“It’s one thing to have the healthiest food on earth,” Ms. Childs said. “It’s another thing to get someone to buy it. Consumers don’t like to be told what to do, and they don’t like negative messages that talk about what they shouldn’t do and what they should eat less of. They are much more responsive to messages saying you are doing the right thing and do more of this. We have to reverse the communication from what one could call low-level fear messaging into affirmation of positive food choices. And that gets tricky because then you are basically saying ‘eat more of this’ and we’re a population that’s already eating too much more of everything. It’s a little tough in that regard.”

Communication is key
General Mills, Inc.’s messaging with Cheerios in which they show a bowl shaped like a heart is a subtle, non-verbal and positive way of communicating heart health, Ms. Childs said. She said the Cheerios advertising theme over time has been related to nurturing and how to be good to one’s self for all the good things in life, but the health claim on the box is for heart-health. She said the goal is to help consumers make a preferred substitution and not a prescribed substitution.

“The headlines nowadays are not about the science and not about the bad things that can happen if you don’t do this,” Ms. Childs said. “That doesn’t motivate change.”

The American Heart Association recently announced the Heart-Check Meal Certification program as another method of positive messaging. Subway is the first restaurant to participate in the program that expands on the Heart-Check Food Certification Program for retail products, which was launched in 1995. Among other requirements, the new restaurant meal program requires the meals to be 700 or fewer calories as well as 3 or less grams of total fat per 100 grams and 30% or fewer calories from total fat in the meal and 26 or fewer grams of total fat for the entire meal.

Ms. Johnson said other potential areas of heart-health research in the future include finding out how exactly added sugars impact blood pressure and how lipids impact heart health. She also said there will be an increased focus on nutrigenomics, or the science of how people may respond differently to dietary interventions, based on their genetic profile. She said some people are more responsive than others to certain dietary changes, and there is a lot to be learned about this concept.

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