Podcast Episode 64 Transcript – Are Dietary Guidelines Contributing to Obesity?

Leah (00:09):

Hello, and welcome to the Ideal Nutrition Podcast. I am Leah Heigl and I’m here with my co-host Aidan Muir and today we’re tackling a bit of a controversial question and is that our national dietary guidelines contributing to obesity? So, we are going to be mainly focused on the Australian dietary guidelines here, but there’s going to be some mention of the American national guidelines as well because it’s important part of the overall narrative that we’re going to be telling, but it’s clearly a super complex topic. We’re going to try to cover it to the best of our ability with the time that we have and see how we go.

Aidan (00:48):

So, starting off with the simple stuff, so the definition of obesity. So, the definition of obesity is BMI greater than 30. And obviously there are flaws in BMI. That’s just the metrics that’s used for these stats, so that’s the metric we’ll go with. Based on that definition, close to 30% of Australians fit that criteria for obesity. For comparison, around 36% of Americans do. And for going with the timeline of have obesity rates changed over time alongside the dietary guidelines, we obviously have to answer the question, have obesity rates changed? Since 1995, they have increased quite a bit. So they were 19.1% in Australia, as I mentioned before, 30% now.

And then we’ve got to ask the question, how did the dietary guidelines fit in with this timeline? So, the US dietary guidelines were released in 1980 and the Australian ones were 1982. There’s been a lot of charts, I don’t think anyone these days is really on Twitter, but I’m on Twitter and I see these kind of charts everywhere. Obviously I’ve got a visual in front of me that I don’t know if I can communicate well over podcast, but basically the chart shows obesity rates or the percentage of the population that overweight slash obese, so BMI 25 or above, starting in 1960. So, there was around 45% of people were overweight or obese, whereas by 2007 it was about 73%. So, it’s a pretty significant increase over that time. But this chart showed 45% at 1960 and then there’s a very slow increase to about 20 years later, 1980, it was still under 50% and then 1980 dietary guidelines released and it just takes off. And it’s like this massive upswing until around that almost 75% number from about 2007 onwards. And that chart looks very compelling, but there are other ways you can look at it as well.

I’ve seen other people try and make fun of this chart by saying instead of putting a thing there saying dietary guidelines released. So, if somebody put a chart that was like, “Atkins diet became popularized,” so the low carb diet and then a timeline of other stuff alongside it, just being like, you can make the chart look like other things caused this, and then the other obvious questions that go alongside this is, it’s like, okay, the dietary guidelines were released around there when there spike increase, but were there other aspects that changed at that time? For example, did it become more easy to be more sedentary around that time? Did we get more access to higher calorie food? Was there changes in food advertising, access to food? There’s so many things that we can consider alongside that. So, even though that chart exists and looks compelling, there’s so many other questions that come alongside that to be considered too.

Leah (03:39):

Absolutely. And you wonder why, I mean, I guess the governments were like, “Let’s make these dietary guidelines.” Were there things occurring that they’re like “This is going to maybe impact people’s intake and then they decided put these guidelines in obviously maybe not had the best impact looking at this graph. This graph’s crazy, it looks so compelling when you look at it and then you think about all the other stuff that could be coming into play and you’re like, “Ah, okay. Maybe not so compelling.” So, let’s take a look at some of the criticisms just generally surrounding the guidelines. So, the major criticism that we wanted to chat about is just this focus on low fat. That was very much the basis of those original guidelines released in the ’80s, both in America and in Australia. And people criticized this in saying that, “Well, this may have led to an increase in carb intake because everyone was trying to be really low fat. So, did everyone then just increase their intake of these carb-based foods. And did that have an impact on obesity percentages?” It’s worth noting that the current Australian dietary guidelines do not have this huge focus on limiting total fat intake. Instead they say just limit saturated fat intake, which I think anyone could agree that saturated fat intake, probably don’t want too much of.

Whilst it’s not part of the guidelines. We have this separate acceptable macronutrient distribution range. And that states that 20% to 35% of total calories should be coming from fat. And that’s the government advice that we have at the moment around fat intake. So, not necessarily low, 20% to 35% of your calories coming from frat is a decent amount. So again, they’re not part of the guidelines now, but one of those early criticisms of those first ones was around that low fat approach.

Some other criticisms would be the high amount of dairy. So again, vegans like love to point this one out. So, the guidelines state that adults should be consuming 2.5 to four serves of calcium rich food per day. And then within that group, there is quite a lot of dairy products that are recommended. I think it’s important to note that you don’t have to have dairy to meet these requirements, you can have-

Or alternatives, yeah. So, in Australia, a lot of us get a lot of our calcium through dairy. So, it makes sense that the guidelines would have this focus on things that we’re already doing and then just kind of slightly pulling that up to where we need it to be. But yeah, it’s not just dairy that you can get these calcium foods from, it’s other foods as well. The guidelines do also mention this focus on reduced fat dairy. So, a lot of people are like, “Well, if you have a ton of high fat dairy, is that not going to make the chance of weight gain worse?” But the guidelines do state that you should get most of your dairy from reduced fat sources. And then third thing would be the high amount of whole grains recommended as part of the dietary guidelines is something that is often criticized.

And this one I don’t typically understand, just because I don’t feel like it is a very high amount of whole grains, from where I’m coming from. So, it typically recommends, well it recommends four to six serves per day, depending on what age group you’re in. And then one serve is equal to one slice of whole grain bread. So, it could be as simple as like having half a cup of cooked porridge for breakfast, a sandwich for lunch and a cup of cooked pasta for dinner. That would be your five serves. I don’t think that is a whole ton of food.

Aidan (07:35):

I’ll paint a picture for people who would be on the other side of the debate and trying to cherry pick to make it look bad. With the whole grains, the way you could cherry pick it is by saying six serves per day, is the equivalent of six slices of bread per day. The government’s telling us to have six slices of bread per day.

Yeah, yeah. Yeah and cherry pick, like you said. And then the same thing with the dairy where it’s like 2.5 to four, where four is above a certain age or whatever. You could picture like a 75-year-old grandma being like, “Well, four serves is the equivalent of a liter of milk.” Are you telling me that grandma should be having-

Leah (08:10):

I need to drink a liter of milk.

Aidan (08:12):

… a liter of milk per day? You can make it sound quite bad when you word it like that.

Leah (08:14):

When you’re using like that one food. But if you’re going to get four serves of dairy, it could be like a cup of skim milk in your morning coffee. It could be a good serve of yogurt as a snack, some cheese on your dinner and you’re getting there.

Aidan (08:29):

And then it’s a very different perception.

Yeah, yeah, for sure. So the next part, I guess we’ll look at, is if the criticism is that diet guidelines are contributing to obesity, does anybody actually follow the guidelines to start off with? It would have to be suggesting that the guidelines are influencing our intake. So, the first counter argument that I would have is that the average person doesn’t know the guidelines well, which makes sense to me. I don’t know, it’s a very boring topic. I obviously was looking through it earlier and it’s literally 226 pages long and it’s a hard statement to be like, “Oh yeah, the average person has dramatically changed their intake,” when we don’t really know the guidelines.

Maybe you could say that, say the food pyramid or something like that, people have seen the food pyramid, have seen that carbs are at the bottom and that’s influenced their thinking. Or they’ve seen the recommendations for low fat. You could say that, but as a whole, not many people really know the guidelines. Inside that as well, there are a lot of recommendations, like limit intake of foods containing added salt, or limit intake of foods containing added sugar. And those pieces of advice are very clearly not followed closely at a population level.

The population on average, has a relatively high salt intake and a relatively high added sugar intake. It’s very much cherry picking to say that we’ve listened to the low fat piece of the guidelines and that’s led to us increasing our sugar intake. Where it’s like, “Well, the guidelines have always said from the first iteration limit added sugar as well.” And then the other one, a standard piece of advice that everyone’s aware of is, eat two serves of fruit and five serves of vegetables. And technically for guys, if we go that eat for health serves, it’s actually six serves for guys, so it’s even higher of vegetables. Eat two serves and five serves of vegetables, though statistically speaking less than 6% of Australians meet that recommendation. And that’s the one that I always point to because I’m like, well, if only 6% of Australians are doing that one aspect of the guidelines, what percentage of people are doing anything that remotely follows the guidelines in any way, shape or form?

Then the final thing about how much do dietary guidelines influence these things is something I was looking at earlier today, is that when you look at the dietary guidelines between countries, they’re often very similar, there is a lot of overlap between them. If you got up each country’s equivalent of the food pyramid, or their healthy plate, or whatever variation they do, they all look incredibly similar. There’s only a few small differences between them, but obesity rates are significantly different between countries. And example, and I’m obviously cherry picking the most extreme examples, but the guidelines of South Korea and Qatar are very similar, but South Korea has an obesity rate between 1.5% and 4%, depending on which stats you look at risk Qatar is just above 40%. They both have very similar guidelines, but very different obesity rates.

Leah (11:33):

Drastically different. So a few points to summarize, I suppose, our defense of the guidelines. The first one is, well, who are the guidelines actually designed for? So, they’re for healthy individuals without medical conditions or in situations that require any kind of individualization. So, it’s really for the general population that don’t have any other confounding variables in regards to their medical history. So, I think one thing that often gets left out of the discussion is the fact that it is for those people. It’s not for people with diabetes, for example, is one aspect I see brought up all the time in terms of isn’t that a lot of grain-based foods for someone with diabetes? And yeah, it could be it’s not for them.

Aidan (12:19):

There’s a saying that I hear a lot is that the guidelines are making us fatter and sicker. A lot of people in that crowd will say that saying, and I’m like, “Well, they can’t be making us sicker if they’re not designed for-“

Leah (12:31):

Because you shouldn’t have been sick and following them. You might need more individualized advice. Another aspect of the guidelines is that they do actually contain physical activity recommendations. And that is aiming for at least 30 minutes of exercise on most, if not all days, there are a lot of people not doing that. So, if you’re following the guidelines and you’re very sedentary, you’re not meeting that minimum amount of exercise, then probably not for you either. You do need to be doing that component with the rest of the stuff, in which case maybe your intake should be reduced slightly from the guidelines, because you’re not meeting that particular part of the guideline.

The guidelines, as you said, have always recommended limiting added sugar. So, when they’re telling us to consume more grains, they don’t necessarily mean things like Cocoa Pops. It is mainly whole grains that don’t have a lot of added sugar, that’s always been a part of those guidelines. So, in Australia, a third of our calories, or even over a third of our calories come from discretionary foods. So, these are the highly processed, junk quote unquote junk foods, I always do this under the table thinking people can see me the quote unquote, the people that can’t see me. So, that’s part of the guidelines as well in terms of limiting your discretionary intake. Totally, if you were to take the guidelines, do a 100% of the food group staff get in all of that, but you’re still consuming that high quantity of discretionary foods, yeah, you probably will gain weight because that’s going to be a whole lot more calories than the guidelines recommend. So, it’s not just this assumption that you add in all these foods and you’re not replacing some of the discretionary foods you were having with these other foods.

Aidan (14:23):

Yeah. I think that’s actually part of the criticism that a lot of people have. It’s not really factoring that in terms of like a lot of people see what is perceived as a high amount of whole grains and a high amount of dairy, but then are also not factoring in the stuff that is consumed. That is not part of the guidelines and how to affect calorie intake. Even alcohol is another factor in this being like alcohol is limited in the guidelines. It doesn’t say don’t drink alcohol. It does say limit them. But it’s like if you drink every weekend, for example, that would reduce the amount of room you have for whole grains and dairy stuff during the week as well.

Leah (14:56):

Yeah because even going back to your crazy examples that we’re using with, if you were to drink a liter of skim milk a day and six pieces of whole grain bread, that actually doesn’t sound crazy if you were eating very minimal processed foods.

Leah (15:10):

But on top of processed foods. Sure, that sounds a bit crazy and wacky.

Aidan (15:15):

So yeah, I agree with everything from the defense of the dietary guidelines. I want to go and do, I guess what I’ll call a balanced perspective, trying to be like, “Well, what’s the other end of the spectrum that people are arguing and stuff as well?” And go somewhere in the middle there. So, the first question that I really think is something worth thinking about, but does it make sense that our guidelines are designed for people who are healthy and fit and exercising 30 plus minutes per day when that description doesn’t fit our population? I don’t think that’s really a criticism I have, but it’s more being like a lot of the criticisms that people have stems from people assessing the quality of the guidelines for situations they’re not really designed, then often thinking about it for people who are relatively sedentary or people who do have medical conditions and stuff like that, when the guidelines are designed for people who are healthy and doing quite a lot of exercise as well. Which leads them to the next point about higher carbohydrate intake. There is a bit of an emphasis on higher carbohydrate intake, but in the context of an active lifestyle, that fits a lot better than it does in the context of an inactive lifestyle.

Another point that’s worth acknowledging is that consumer trends particularly did switch in the ’80s towards wanting lower fat products. And that led to a lot of companies reducing the fat content over their products. And you could also say increasing the sugar content or the refined carbohydrate content as well. A lot of people who claim guidelines led to obesity claim that this change was due to the guidelines. But once again, that leads to the question of consumers, yes, they did want this, but was that because of the guidelines or was that because of other reasons? I personally lean towards it being for other reasons but-

Leah (16:53):

Sugar, wasn’t the thing that was demonized just yet, it was fat. So, people were cutting all the fat out of their diet yeah and eating sugar instead because we hadn’t made the link yet so much with sugar intake and overweight, obesity.

Aidan (17:06):

Yeah. For sure. There’s an episode of Seinfeld that I always point to that they were eating low fat yogurt or whatever and they’re like, “It has no fat, it’s not possible for me to gain weight,” and the plot twist as they get it tested and it does contain fat. It gets the end of the episode and it’s like still about fat. I don’t know, anyway. Something that I was talking about with you earlier off air, was that the guidelines actually do specifically mention that they are still relevant for people who are overweight as well, as if they are a solution that would be useful for weight loss as well, which is a point that I wouldn’t say I necessarily disagree with. But from another perspective, during a fat loss phase, I’d almost never put somebody on an approach that was in line with the dietary guidelines if that makes sense?

I typically would reduce the carbohydrate content and increase the protein content in some way, shape or form, even if it’s just for the purpose of maintaining as much muscle throughout the process. Maybe from an appetite perspective, there is a bunch of reasons why I’d look at doing that. But I found that interesting, because as we were both saying to each other, we assumed that the dietary guidelines had always said that they were for people who were in the healthy range, which I don’t know, is just an interesting point.

Leah (18:23):

Because to me the guidelines generally, there’s sustainable approach that you follow for your whole life and then a fat loss phase, if you’re wanting to lose fat, if you’re overweight would not be that approach you follow for your whole life. Although I think underlying, it makes sense to use some of the dietary guidelines approaches in terms of obviously fruit and veg intake and low discretionary foods. But yeah, I had assumed the same thing.

Aidan (18:51):

Yeah. Because I very much see it as something that is useful for chronic disease prevention, more so than body composition manipulation.

And then the last thing is that most people argue that the guidelines are harmful are also trying to build a case with a low carb diet because it comes from a few angles being like, “Well it’s a higher carb diet,” but it also demonizes quote unquote like low fat … Sorry, demonizes higher fat dairy and stuff like that, supposedly. And just wrapping up on that topic, being like if the argument is low carb versus low fat diets for weight management, that is a topic that has been studied pretty extensively, both in controlled situations and in real world situations, which is really useful as well, showing that under both circumstances, both options work equally well. So, not only is it that when the calories are matched in both groups, they get the same results. In the real world, it also does not seem like it matters that much about which one you choose in terms of if people get live sample sizes and they split people into each group, both groups seem to get very similar results. Which is useful, but I would even wager that results would be even better with personal preference in choosing the approach that suits your lifestyle the most.

Leah (20:01):

So, in summary, I think obesity is definitely multifactorial. We can’t say that the guidelines have equated to this increase in obesity rates. I think that’s a very blanket oversimplification of everything that has changed in the last, what, 40, 50 years?

Leah (20:22):

We know a lot in our lives has changed since then even just thinking about technology and how-

Aidan (20:27):

Let’s actually touch on that for a second because yeah, I’ve seen other people talk about that and what has changed? Firstly, measures of calorie intake over the years has shown a small increase in calorie intake. It’s not as much as you’d probably expect. It’s not as much as I expected, but it is an increase in calorie intake or reported calorie intake. But then there’s also a significant decrease in energy expenditure. Don’t quote me on these numbers, but this is from memory, say there’s a 200 to 300 increase in calorie intake per day but then a 300, 400 decrease in energy expenditure because of technology because of even kids playing less outside, people having jobs where they used to do manual labor, but now it can be automated and stuff like that. And the combination of both those, not just dietary, but also the energy expenditure portion of it is a big factor in all of this.

Leah (21:21):

Yeah, I’d say that’s definitely got way more to do with it than any any of the dietary guidelines, which we know most people are not following anyway. We were talking before we even started, I’m like, I don’t understand how this is an argument or a discussion that’s happening when people don’t even know what the guidelines are, let alone are following them. Just generally, we don’t, I mean I don’t, go out of my way to actively promote the Australian dietary guidelines. Sure, they form a small amount of my underlying practice and I do know of them, but it’s not something that I’ll hand someone an Australian dietary guidelines sheet and say, “Do this.” It’s always obviously a personalized approach that I think is going to be much better on an individual basis. But I think the biggest thing to acknowledge is that the guidelines are meant to be followed in their entirety. If you’re just taking little bits and pieces and popping them on top of your current diet, yeah that may cause some issue.

This has been episode 64 of the Ideal Nutrition Podcast. If you could leave a rating or review, that would be greatly appreciated as always, but otherwise thanks for tuning in.