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By K. Dun Gifford, President
Oldways Preservation & Exchange Trust
This Conference was developed over a two-year period by a distinguished group of international experts, during scientific planning meetings in Crete and Madrid in 1996 and an International Symposium in Crete in 1997. Conference planning was jointly undertaken by Oldways Preservation & Exchange Trust and by faculty members of Harvard School of Public Health.
The Conference celebrates a number of anniversaries.
Fifty years ago, in 1947, the Rockefeller Foundation and the government of Greece began a very large survey of war-torn Crete as the basis for a plan for its reconstruction. The survey reached an unexpected result - post-war residents of Crete were healthier than post-war Americans because they had lower rates of chronic diseases.
This startling news piqued the interest of nutrition scientists, especially Ancel Keys, whose investigations led to the seminal Seven Countries Studies that began publishing its findings at the end of the 1950's. These works alerted scientists all over the world to the heart-health benefits of eating patterns that Keys called "the Mediterranean way."
A symposium in Delphi in 1988 tied the Keys and other similar studies together with European nutrition policy experts, and the results, published in the European Journal of Clinical Nutrition, drew increasing attention to the benefits of what by then had become "the Mediterranean diet."
Five years ago, on January 21, 1993 at the 1993 International Conference on the Diets of the Mediterranean, Oldways and the Harvard School of Public Health released a preliminary description of the traditional healthy Mediterranean Diet, together with a pyramid graphic to represent it. This gave rise in the U.S. to what the Washington Post called "Mediterranean Madness," largely because the healthy Mediterranean diet was (in Corby Kummer's phrase) "a diet worth eating."
In June, 1994, a slightly revised official Mediterranean Diet Pyramid graphic and supporting text were released in San Francisco at the 1994 International Conference on the Mediterranean Diet, with the World Health Organization joining Oldways and the Harvard School of Public Health as its developers. Papers presented at the 1993 and 1994 conferences were edited and published in June 1995 in the American Journal of Clinical Nutrition.
During the 1994 San Francisco Conference, Oldways devoted a lengthy and controversial forum session to the issue of total dietary fat, based on the irrefutably positive health profiles of Mediterranean populations that consumed more than 30 percent of their calories from lipids, primarily plant oils and principally olive oil. This forum challenged the prevailing dietary guidance policy which was, the less fat, of any type, the better. It sought to discourage lumping all types of fat together, and to introduce a new focus on type of fat by differentiating between plant oils and animal fats, distinguishing between unsaturated fats and saturated fats, and asking questions about the different metabolic characteristics of each.
The Next Steps
It is useful to return to that magisterial 1991 National Academy of Sciences report Improving America's Diet and Health, where we find a distinctive charge for the Conference: "Having largely met the challenge of achieving consensus on the composition and components of healthy diets, it is now time to face the even greater challenge of encouraging and enabling people to eat better." If it was time to face this challenge six years ago, it is urgent to do so now.
This nutrition science consensus about what constitutes healthy eating and living is unlikely to change significantly anytime soon.
What may change, however, is the treatment of dietary fat by dietary guidance policies. If the current U.S. policies are rooted in the science of the 1980's, for example, and if they have given rise to a "fat phobia" which, ironically, co-exists with an epidemic increase in the body weight of Americans, then it is time that these policies are changed.
This policy change will be an important first step. But it will be an instrument for change only if it effectively encourages people to modify their eating and living patterns. Developing effective policies is the subject matter of the Fifth Anniversary Colloquium.
Human behavior specialists study the psychology of food choice, and biologists study the biomechanics of taste, smell, satiety, and neurotransmission. Collectively, these scientists study the "psychobiology of food choices."
Advertising, marketing and public relations experts devise campaigns that sells their corporate clients' products. There is wide agreement that these sales campaigns have far more influence on individual food choices than do campaigns developed by public health and nutrition specialists.
Public health officials struggle to balance all the resulting variables when they adopt dietary guidance policies.
Unfortunately, the playing field is not level. Compared to the billions of advertising dollars spent by the fast food and processed food industries, funds available to promote healthy eating programs are a drop in the bucket.
The challenge, consequently, is to understand what kinds of campaigns are effective and what kinds are not effective.
Making New Choices
Behavioral scientists generally divide the factors controlling the selection of food choices into three classifications:
Biological factors (for example, innate lactose intolerance or preference for sweetness immediately after birth, or aversion to bitterness),
Individual experience (for example, acquired fondness for chili peppers or ice cream, or aversion to foods that cause illness), and
Cultural factors (for example, fondness for bugs or monkeys, or avoidance of pig meat for religious reasons or all meat for environmental reasons).
Anecdotal and small-scale causes of changes in eating patterns are also well known. Individuals are told by their cardiologists to change their diets or they will likely have another heart attack. Overweight people decide to slim down. Children whine to be taken to the hamburger joints so they can get the latest toy. Food coupons offer large discounts on certain food purchases. Famous people appear in advertisements eating this food or that food.
In the last few years a new factor has emerged as a major influence in food choices: wide press coverage given to conclusions of scientific studies about foods that are healthy and foods that are not. This has inevitably drawn attention to the trees and away from the forest, and the stream of often-conflicting news reports is one of the reasons increasingly cited by consumers who express their confusion about what is healthy to eat and what is not.
The Colloquium's panels and speakers address all these issues. The purpose is to spark a national debate about what works - and what does not work- "to encourage and enable" positive changes in individual and family food choices.
The release of the Oldways "Common Sense Mediterranean Eating Guide" during the Colloquium will help to focus this debate. It will do so in much the same way that the development and release of the Mediterranean Diet Pyramid (as well as the three other Oldways pyramids, the Asian, Latin American and the Vegetarian) have encouraged a rethinking about dietary guidance communications that are effective and about those that are not.
The Common Sense Mediterranean Eating Guide avoids a number of pitfalls embedded in other eating plans.
1.By eliminating serving sizes it avoids the "one size fits all" affliction. For example, people come in all manner of sizes and shapes; have very different metabolic rates and caloric needs; and follow differing exercise regimens. An appropriate serving size for a five-year-old is likely to be distinctly different from the one for her mid-teens brother, her mid-thirties working mother, or her mid-sixties grandmother. Uniform serving sizes cannot work for everyone, by definition. Because they do not work for everyone, they are workable for only a few.
2.By eliminating a specified number of daily servings, it also avoids the "misinterpretation trap" that afflicts monolithic eating plans. For example, the USDA Food Guide Pyramid says to "choose 2-3 servings from the Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group," that a serving is "2-3 ounces of cooked lean meat, poultry or fish," and to choose " variety of foods within food groups." Beef industry groups interpret this language to claim that the Food Guide Pyramid says that
people "should eat 3 servings of meat a day." This interpretation is clearly wrong, though it clearly serves the beef industry's interests.
3.By not lumping animal protein and vegetable protein together into a single food group, but separating them, it acknowledges the very different dietary characteristics of these two kinds of protein.
These distinct departures taken by the Common Sense Mediterranean Eating Guide has positive benefits. The Mediterranean Diet Pyramid makes clear what kind of foods to eat. It is equally clear about what kinds of food to eat more of and what kind of foods to eat less of. It offers suggestions for kinds of foods to eat at different meals and for snacks. It supplies shopping lists to take to the market. It urges variety (try Italian or Greek or French or Spanish or Moroccan).
To encourage people to follow this Mediterranean Eating Guide, Oldways urges them to use their common sense. Most everyone wants to be healthy. Most everyone knows when they're "pigging out." Most everyone knows when they're holding back. Most everyone know when they have gained or lost weight.
But of course not everyone knows these things. These are people with eating disorders or other medical or psychological problems, or genetic predisposition that require treatment or other special care. These people need and should receive a different kind of dietary guidance and supervision.
The Common Sense Mediterranean Eating Guide is based on familiar foods from well-known cultures. It is nutrient-sufficient, balanced, and based on the eating patterns of populations with low rates of common chronic and degenerative diseases. Its dishes can be cooked rapidly and simply, or they can be cooked slowly and make use many ingredients.
Basically, it is a user-friendly eating guide that encourages families and individuals to think about their food and to enjoy talking about it. It asks people to think "Why not cook that Italian pasta we saw in the movie?" Or, "Let's try that dish we had on our vacation, or at that restaurant the other night, or at my cousin's house."
As such, this eating guide adopts a positive attitude towards food that enables people to make changes in their eating habits. It does not scold or lecture. It relies upon helping people do what they want to do - eat healthy and to have a good time doing so.
And it encourages the belief that healthy eating can be fun, full of variety, interesting, and great tasting. People want their food to be fun, as the food processing industry and their advertising people has amply demonstrated. Healthy eating advocates must learn this lesson and put it into practice. If healthy eating is seen as work, or as "munching pasture," it cannot succeed.
The then-Dean of the Harvard School of Public Health, Harvey Fineberg, put all this into context in his welcoming remarks to the 1993 Mediterranean Diet conference: "The risks of the dominant chronic diseases, cancer and heart disease particularly, are profoundly influenced by choices of lifestyle, diet and exercise. It's been estimated that half of all illness could be greatly delayed or prevented altogether if people changed their habits related to diet, exercise, smoking and alcohol consumption. As we all strive to understand and communicate what is to be learned from the diets of the Mediterranean and thus to empower others to make healthier life choices, we will be furthering the cause of public health."
Based on the worldwide nutrition science consensus, we know what healthy diets are. But what we do not know is how effectively to "encourage and enable" people "to make healthier life choices." The organizers hope that this Conference launches a serious national discussion about how to construct effective national dietary guidance action plans. |
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