FML Tackling Obesity: Determining the role of the food and drink industry in communicating facts about sugar: orange juice as a case study

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Sian Porter Registered Dietitian BSc (Hons) Nutrition MSc Health Economics FML Tackling Obesity: Determining the role of the food and drink industry in communicating facts about sugar: orange juice as a case study 23 rd November 2017

The truth about fruit juice: communicating the facts in a confusing environment Present findings from the UK Fruit Juice and Diet Quality Study Clarification about free sugars portion control & nutrient density Aim to help consumers make informed choices choices based on fact rather than what they read/hear/watch in the media

Confusion muddling the facts Media reporting and perpetuating inaccuracies about sugar, fruit juice sugar content, juice serving size and consumption trends Gotcha! journalism where articles reveal how a healthy food really isn t that good for you/need for extreme content Low level of consumer (journalist/social media /health professional) understanding: Naturally occurring sugar vs. free sugar Labelling of sugar Unsure about which nutrients different foods contain Pure fruit juice included with sugar sweetened beverages

Fruit juice targeted in sensationalist media

Consumer confusion Reality of fruit juice (FJ) consumption 83% of consumers in a recent poll had no idea what the recommend portion size was [1] 38% people questioned in a recent survey* believed that fruit juice contains added sugar People are not over consuming fruit juice: mean FJ consumption is 84mls/day (11-18 year olds) and 49mls/day (adults 19+) [2] [1] 2016 focus group by Porter Novelli in-house research team followed by consumer polling (100 consumers) to assess basic understanding of fruit juice (FJ), London. [2] Gibson S et al. (2015) Ann Nutr Metab 67 (supp1): abstract 149/1262.

The UK Fruit Juice Health and Diet Quality Study Largest-ever study into fruit juice consumption (review funded by BFJA) Analysis of the last six years of UK National Diet and Nutrition Survey data Analysis of fruit juice consumption by region and age group Contribution of 1 portion of fruit juice (150ml) to five-a-day and other nutrients (including sugars) Relationship between fruit juice consumption, BMI and waist circumference

Evidence-based communications to balance the topic Utilised NDNS data to provide facts about: Actual Fruit juice consumption Nutrient intake (contribution from fruit juice and lack of nutrients that are/could be provided by fruit juice) 5-a-day actual v target Any association between Fruit juice and risk of overweight/obesity Shared with the media, health professionals and consumers

Fruit juice and the five-a-day target Consuming fruit juice is associated with a higher not lower, consumption of fruit and vegetables across all age categories Adults and children aged 11+ years who drink fruit juice are about twice as likely to reach their recommended minimum of five-a-day, compared with non-drinkers

Five-a-day falling short One of the best known health education messages [1] A target few manage to achieve In the UK, only 8% of children aged 11-18 years, 27% of those aged 19 to 64 years and 35% of those aged 65 years and over meet the five-a-day target [2] The current UK national average is : under 3 portions (2.8) for children aged 11years + 4 portions for adults aged 19 to 64 years and 4.2 those aged 65 years and over meet the five-a-day target [1]http://webarchive.nationalarchives.gov.uk/20111205225359/http://www.food.gov.uk/science/socsci/s urveys/foodsafety-nutrition-diet/eighthcas2007. [2] NatCen Social Research, MRC Elsie Widdowson Laboratory, University College London. Medical School. (2017). National Diet and Nutrition Survey Years 1-6, 2008/09-2013/14. [data collection]. 8th Edition. UK Data Service. SN: 6533, http://doi.org/10.5255/ukda-sn-6533-7.

Does pure fruit juice cause obesity? SACN report on carbohydrates and health (2015) no evidence that unsweetened fruit juices contributed to BMI, adiposity or weight gain The UK Fruit Juice and Diet Quality study showed adult fruit juice drinkers had significantly lower BMI (by 1.1 units) Adult waist circumference was significantly lower by 3.2cm (women) and 2.7cm (men) in fruit juice consumers 150ml of fruit juice contains around 60-80 calories, which is 4% of total calories in a 2000 calorie diet

Sugar and fruit juice The sugar in fruit juice is naturally occurring and comes solely from the fruit from which the juice is made A 150ml glass provides approximately 15g of free sugars solely from the fruit = 17% of an adult s daily Reference Intake (RI) Fruit juice naturally-occurring sugars come packaged with vitamins, minerals and phytochemicals

Fruit juice as part of healthy, balanced diet Fruit juice is not a major contributor of sugar to the diet (represents 6-8% of adults daily sugar intake*) One 150ml serving provides an affordable and palatable way to get one of five-a-day and helps meet five-a-day target Provides important nutrients and phytochemicals On average in the UK, people who drink fruit juice have a lower BMI and waist circumference compared to those that don t drink fruit juice (correlation, not cause and effect) *https://www.nutrition.org.uk/attachments/article/990/bnf%20looks%20at%20the%20years%205% 20and%206%20of%20the%20National%20Diet%20and%20Nutrition%20Survey.pdf

% contribution of fruit juice to sugar in UK diet (age 11-18 and age 19-64 years)* *Pie charts from Why 5%? An explanation of SACN s recommendations about sugars and health. Source PHE 2015. Contains public sector information licensed under the Open Government Licence v2.0.

Not all sugars are equal Pure fruit juice by law can only be the juice that is derived from fruit, containing only naturally occurring sugars and no added sugars One 150ml serving fruit juice (orange specifically) provides: Vitamin C 149% of DRV (excellent source) Potassium 11% of DRV Folate (vitamin B9) 19% of DRV (source) Phytochemicals flavonoids

Nutrients provided by fruit juice to the diet

Has media started to listen to the truth about fruit juice?

Message evaluation Poll consumer attitudes and perceptions to see message pull through about fruit juice and sugar Monitor news coverage for accuracy, balance of tone Monitor fruit juice consumption Appraise 5-a-day targets Unintended consequences displacement

Any questions?