Powerful counterpunch

by Josh Sosland
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NEW ORLEANS — Negative information about a healthful food product must be overwhelmingly countered by disseminating information about the foods’ benefits. Only such an effort will help prevent disproportionate consumer rejection of the product, said participants in a panel discussion, "Paradigm shifts in health communications: When don’ts should be do’s."

The panel was held June 29 at the Institute of Food Technologists Annual Meeting & Food Expo at the New Orleans Morial Convention Center in New Orleans.

Participants in the panel focused their comments principally on issues associated with fish consumption in the face of an advisory for certain consumers to limit intake because of the presence of mercury in fish. Given the mixed messages about many dietary staples ranging from apple juice, enriched flour, eggs and milk to red meat, the group’s observations about consumer behavior frequently extended beyond fish to food more broadly.

The advisory was issued in 2004 by the Environmental Protection Agency and the Food and Drug Administration and offers three recommendations about eating fish for women who are or may become pregnant, mothers who are nursing and young children:

1) Avoid eating shark, swordfish, king mackerel or tilefish because they contain high levels of mercury;

2) Eat up to 12 oz (two servings) a week of a variety of fish and shellfish;

3) Limit intake of albacore canned tuna to 6 oz per week, because of higher mercury content.

The E.P.A. guidance goes on to tell consumers to "check local advisories" about the safety of fish caught in local areas.

The F.D.A./E.P.A. advisory actually encourages eating fish but appears to have been interpreted by consumers as a "warning" to avoid fish, said Mary A. Harris, professor of food science and human nature at Colorado State University, Fort Collins. The impact has been particularly strong for pregnant women, 30% of whom never eat fish, versus about 10% of non-pregnant women, Ms. Harris said.

In a 2007 survey, about 55% of pregnant women said the F.D.A./E.P.A. advisory resulted in a decision to decrease their intake of fish.

Mercury is severely toxic. Beginning in the womb, excessive exposure to mercury may impair neurological development of the fetus with adverse effects on cognitive thinking, memory, attention, language and fine motor and visual spatial skills.

Given the frightening consequences of mercury poisoning, Ms. Harris and the other speakers suggested that a "stay away" attitude may prevail among pregnant women and others.

The degree to which mixed messages about the healthfulness of foods affects buying behavior was explored in a presentation by Christine M. Bruhn, specialist in the cooperative extension, Department of Food Science and Technology at the University of California, Davis.

She said messages about a food’s healthfulness must be communicated on an ongoing basis, not only to reinforce the point but in recognition that new consumers are constantly entering the marketplace.

"Risk communication is a process, not an event," Ms. Bruhn said.

Ms. Bruhn explored the degree to which health messages are clear, evidence-based and understandable by consumers. She also explored whether messages were framed in a way to motivate consumers to adapt healthy behaviors.

At least at the federal government level, Ms. Bruhn said messages about fish consumption are clear and consistent across agencies/program — The F.D.A., the E.P.A. and MyPyramid, calling for intake of two servings, or a total of 12 oz of fish per week.

Ms. Bruhn mildly chided the federal government for its species to avoid list that includes shark, swordfish, king mackerel and tilefish.

"Do you know what tilefish is?" she asked. "This group might, but I worry that the general population does not."

Turning to other sources of information about fish, though, Ms. Bruhn said messages were far less consistent, specifically looking at recommendations from Purdue University and the Monterey Bay Aquarium. Purdue offers a completely different group of species to avoid (grouper, Chilean sea bass, golden snapper, tuna and orange roughy) than the E.P.A. with different recommendations for canned tuna servings as well.

Conducting six focus groups with a diverse group of 59 women, Ms. Bruhn said most participants were confused about the healthfulness of various food products because so much information was contradictory. Most like to be told simply whether a food was safe to eat or not and did not like conflicting factors as appear to be the case with fish.

"They want straightforward information — either mercury is okay or it’s not," she said. Similarly, she said the media is not a trusted source of information about health because it is believed the media acts in self interest, playing on the public’s fears to sell newspapers.

Ms. Bruhn’s studies also found that consumers tend to believe information that confirms their current practices and also tend to compare new health information with the experiences of their family.

"They will say, ‘My grandmother ate this food all her life and lived to her 90s,’" Ms. Bruhn said.

The impact on consumption

Turning to whether health information affects consumption, Ms. Bruhn said an impact is mostly likely to be seen when women are pregnant because of a highly protective tendency during this period. Ultimately, though, health concerns were not the principal determinant of whether consumers eat a product, she said. Cost, convenience and current habits were the strongest predictors of consumption, she said.

The focus groups participants’ reaction to the fish advisory, which was aimed at helping consumers, was overwhelmingly negative, Ms. Bruhn said.

"They were angry, irritated or annoyed, believing they were misled by the media or the government and felt anxious or guilty over whether they could eat fish or feed it to their family," Ms. Bruhn said.

While consumers may conclude it is simply best to avoid foods that have health risks associated with them, avoidance carries its own serious risks, Ms. Harris said.

She cited an observation to this effect by Conrad Lautenbacher, administrator of the National Oceanic and Atmospheric Administration.

"…We have concluded that the issue (mercury) has been overstated … public health concerns regarding mercury in fish are not as profound as commonly perceived and can result in unintended consequences by scaring people away from a healthy and nutritious foodstuff," Mr. Lautenbacher said.

Making the point that completely avoiding fish may be worse for a pregnant woman’s baby than eating fish regularly and in moderation, Ms. Harris spent considerable time discussing the so-called ALSPAC study (Avon Longitudinal Study of Parents and Children). In the study, nearly 12,000 pregnant mothers were queried about fish consumption 32 weeks into their pregnancy. Their children subsequently were tested for a variety of development measures at 6, 18, 30, 42 and 81 weeks of ago. The mothers were divided into those who consumed no fish, those who consumed up to 340 grams (12 oz) per week and those who consumed more than 340 grams.

"Those with intakes less than 340 grams per week did poorer on all measures of cognitive development," Ms. Harris said.

The study demonstrated improved visual, cognitive and motor skills among infants whose mothers consumed fish during pregnancy, versus infants whose mothers consumed the least amount of fish. Ms. Harris said that follow-up studies conducted when the children reached three years of age continued to demonstrate the benefits from the fish consumed during the mother’s pregnancy.

"Limiting fish consumption cuts omega-3 intake," Ms. Harris said. "Reducing fish intake excessively to avoid mercury ignores the mitigating benefits of selenium, which reduces the detrimental effects of mercury."

Adverse health effects

A study published in 2007 indicated that selenium, an essential mineral abundant in ocean fish, appears to protect against trace amounts of mercury naturally occurring in ocean fish, she explained.

Also explored by researchers has been the effects on birth weight and premature birth risk of limiting fish intake. An initial study conducted in Denmark demonstrated a significantly higher rate of premature birth and lower birth weight among mothers who consumed the least amount of fish.

A follow-up study in the United States using fish oil supplements tested this theory on "high-risk" pregnant women, subjects who experienced premature birth in an earlier pregnancy. Ms. Harris said 33% of the control group (no fish oil supplements) subsequently had a premature birth, while the rate was only 21% among the women who consumed the supplements.

When a study aimed at repeating the supplement study failed to yield corroborating results, a third study was conducted showing that higher doses were effective but that consumption of whole fish (rather than fish oil alone) was even more effective at reducing the risk of low birth weight and premature birth.

Broadly speaking, Ms. Bruhn said it is difficult for consumers to judge contradictory information about the healthfulness of food and that when benefits and risks are presented with regard to a particular food, many consumers only see the potential risks. As a result, benefits need to be presented in greater detail.

Reinforcing Ms. Bruhn’s observations about skepticism with regard to media information was Danielle Schor, senior vice-president of food safety at the International Food Information Council, Washington.

The media is a leading source of health and nutrition information for 71% of consumers, nearly double the second most popular source, Ms. Schor said. But only 24% of consumers cited the media as "the most believable source" of information about health and nutrition.

To make the point that news is confusing, Ms. Schor offered four headlines about the healthfulness of fish:

1) The New York Times: "More testing of seafood may address mercury concerns"

2) Time Magazine: "The danger of not eating tuna"

3) The Daily Telegraph: "Eating large fish can poison young children"

4) American Dietetic Association: "Fish: It really is brain food."

"Consumers say there is no single or clear recognized authority on the health benefits of good nutrition," Ms. Schor said. "Many state that they will not make positive dietary changes as a result. Consumers need clear and consistent messages about what to do and how to do it."

Data indicate consumers are interested in foods that are healthful. Ms. Schor said 41% of consumers are "very interested" in learning about foods with added health benefits and another 43% are "somewhat interested."

In a question and answer period at the end of the panel, the group disagreed about whether literature should be placed at the fish counter to succinctly explain the health benefits of eating fish together with the risks of excessive consumption. Ms. Schor advocated this approach, but Ms. Harris demurred.

"I oppose this kind of point-of-sale material," she said. "I believe this information should be shared at the pediatrician office. There is too much of this literature in supermarkets. Consumers will see it, will not read it and instead just decide to buy something other than fish."

Ms. Bruhn agreed. "If there is point-of-sale material about fish, it should give a recipe that is really delicious and takes 10 minutes to prepare," she said.

This article can also be found in the digital edition of Food Business News, July 8, 2008, starting on Page 38. Click here to search that archive.

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