Tuesday 24 February 2015

Bull sperm and ‘poor parents’: the role of myths in public health practice

Posted by Stephen Crossley, Research Assistant on the Fuse HYPER! Energy Drinks research project and a PhD student at Durham University

One of the most interesting themes, in my opinion, emerging from the current research into young people’s consumption of energy drinks, is the way that different messages about energy drinks – who (supposedly) consumes them and how – circulate and often deliver contradictory images and information. Not only are young people targeted by a range of clever advertising strategies from the companies that produce and sell these drinks, but they also receive information from teachers, parents, public health practitioners, media outlets (including social media) and their peers. Adults also receive information from similar sources.

By way of example, many people are aware that lots of energy drinks contain Taurine. Some people, no doubt helped by internet search engines, social media and classroom rumours, also believe that the taurine that is in energy drinks is extracted from bull sperm. This info lies firmly in the realm of ‘urban myth’, although you can perhaps understand where it originated from, given that taurine was first isolated from ox bile and it is present in bull sperm. It can also be found in fish and meat, and in breast milk, although we’ve yet to come across any young people who believe there is industrial scale maternal ‘pumping’ going on in an effort to give the population wings. Somewhat predictably, the taurine in energy drinks in synthetically produced in labs.

Urban myths, although they contain a degree of plausibility, are relatively easy to disprove due to a lack of robust evidence. But there are other types of myths which are sometimes harder to disprove, despite similarly lacking credible evidence bases. Christopher G. Flood (2002) identified ‘political myths’ as coherent narratives which orient discourses in the one ideological direction rather than another. He argued that political myths:

can be said to exist when accounts of a more or less common sequence of events, involving more or less the same principal actors, subject to more or less the same overall interpretation and implied meaning, circulate within a social group.

Contemporary political myths include there being ‘no alternative’ to austerity, the need to crackdown on ‘skivers’ who are ‘welfare dependent’ and the dangers posed by migrants acting as ‘benefits tourists’ or ‘health tourists’. The idea of a group of ‘poor parents’ (in both senses of the phrase) representing a major public health risk to their children as a result of problematic parenting behaviours is, I would argue, another such political myth. These parents are often marked out as being different from ‘us’ by virtue of their residence in ‘deprived’ areas and by their ‘inferior’ parenting practices. In Flood’s words, therefore, the same principal actors are subject to more or less the same overall interpretation and implied meanings.

During the course of our research, we have encountered a small number of stories about parents blending a MacDonald’s ‘Happy Meal’ or a ‘Sunday dinner’ and putting it in baby’s bottles or parents filling milk bottles with energy drinks or other inappropriate drinks/liquids. Previous experience within the research team suggests that similar stories will probably be familiar to many people working in public health and/or nutrition.

Views about ‘poor parents’ have a long and undistinguished history, stretching back to at least Victorian times when there was concern about a ‘social residuum’ (see John Welshman’s fascinating book Underclass for a comprehensive history). Public health practitioners also have a long history of involvement with these ideas and the roles of Chief Medical Officers in propagating ideas about a ‘social problem group’ in the 1930s and ‘problem families’ in the 1950s are particularly sobering, given that they were influenced and supported by The Eugenics Society. Despite over a century of social scientific research, there is no credible evidence of a large number of families with different cultural values or behavioural norms from ‘the rest of us’.

As noted above, many of these ideas originate from politicians, who are keen to differentiate between ‘skivers’ and ‘strivers’ or ‘troubled’ and ‘hard-working’ families and who would have us believe that there is an ‘underclass’ whose parenting deficiencies are ruining the lives of their children. Unfortunately, some public health practitioners do little more than repeat and embellish these political myths, giving them more credibility and potency than they perhaps deserve.

I am not denying that there may well be a parent - or maybe even parents - who have blended a Happy Meal or given their child an Energy Drink. What I do doubt is whether the potential, but as yet unfounded, actions of an extremely small number of parents is worthy of repetition from some - though not all - public health practitioners on the scale that we sometimes see. Shouldn’t we be setting the bar a little higher than second or third-hand anecdotes in terms of ‘evidence-based’ practice and policy making? Not believing, or at least questioning, some of things we read on the internet or that we are told by politicians and, in some cases, colleagues, would be a good place to start. Failure to challenge such stereotypes leaves the way clear for the wider political myth that, in the words of Stanley Cohen (1985), ‘the deprived are not much different from the depraved’.

Cohen, S. (1985) Visions of Social Control, Cambridge: Polity

Flood, C.G. (2002) Political Myth, Abingdon: Routledge

Welshman, J. (2013) Underclass: A history of the excluded since 1880, London: Bloomsbury

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Thursday 19 February 2015

Thunder, thunder, Thunderclap: when a blog post hits the campaign trail*

Posted by Mark Welford

A nationwide viral campaign to remove junk food from supermarket checkouts has been launched on the back of the success of a post on this very blog.

The ‘Chuck out the checkout junk’ campaign was born out of a Fuse open science blog post, which described the ‘pester power’ difficulties faced by parents in supermarket checkouts, what supermarkets are or aren’t currently doing about it, and why they should be doing more in the midst of a growing obesity epidemic.

Written by Mel Wakeman, senior lecturer in nutrition and applied physiology at Birmingham City University and Fuse academic Amelia Lake, dietician and public health nutritionist based at Durham University, the post has received more than 500 views and sparked debate on Twitter.

Mel has now started a campaign using the social media tool ‘Thunderclap’ that has already reached close to 30,000 people.

Thunderclap will simultaneously post the health message on social media feeds
On the Thunderclap page Mel writes: “We are still in the midst of an obesity epidemic; poor diet is to blame for overweight and obesity, tooth decay, type 2 diabetes, high blood pressure, cardiovascular disease, cancers and more.

“As a nation we should be reducing much of the added sugar in our diet but we often need help to do this. Making positive changes to our diet is not easy; cutting down our sugar intake is difficult when it is present in so many everyday foods (like sweets and chocolate) and being constantly tempted to pick up confectionery at the checkout undermines much of our efforts to be healthier. Small changes can lead to big differences however, so let's ask more stores to adopt junk free checkouts.

Marks and Spencer, Morrisons, Asda, Sainsbury's Local and Iceland Foods as well as WHSmith and other non-food stores need to take more responsibility for the products they promote. Many stores have signed up to the Government's Voluntary Responsibility Deal but they could do so much more if they want to demonstrate they are truly committed to promoting healthier diets and improving public health.

“The evidence is irrefutable. Asking stores to replace confectionery with healthier foods will be a huge step forward in helping protect the future of the British public.”

Mel is also writing to the above stores, asking them to seriously consider this proposal.

Show your support

If you want to share your support for the campaign visit the Thunderclap page and click the red ‘support with’ buttons (via Facebook, Twitter or Tumblr).

“Let's make Britain healthier. Please remove all sweets from all tills and make EVERY store take responsibility.”

Thunderclap will simultaneously post the message above on your feed along with other supporters on 9 March when the campaign will ‘go viral’.

Still unsure? Below are six points that explain why this campaign is so important:

1. The UK has one of the highest levels of obesity in Western Europe: 67% of men and 57% of women are either overweight or obese.

2. More than half of men and women are at an increased risk of multiple health problems.

3. The level of childhood obesity is a huge concern. In the UK, 1 in 10 children are obese when they start school. By the time they leave primary school, nearly 20% of children are obese with a 75-80% risk of obese adolescents becoming obese adults.

4. According to the latest diet surveys, children and teenagers consume around 40% more added sugar than the recommended daily allowance; much of this coming from snacks and sweets. We are now seeing diabetes, high blood pressure and signs of heart disease in young children.

5. In 2014 Public Health England reported 12% of children under three have tooth decay and an average of three teeth in these children are decayed, missing or filled.

6. Obesity can reduce life expectancy by 8-10 years. This is equivalent to the effects of lifelong smoking.

*A headline for children growing up in the 1980s

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Thursday 12 February 2015

Could your partner be bad for your health?

Posted by Amelia Lake

With Valentine’s day approaching, what better time than this to discuss the potential effect that moving in with your loved one could have on your health, and in particular on your eating habits. In 2006 I wrote an article for the nutrition publication Complete Nutrition summarising the evidence around the co-habitation effect. In 2006 I was not co-habiting nor was I a mother - how times have changed! Following on from last week’s Fuse blog and my mini rant about supermarket tills, I can feel a whole body of research emerging about the ‘children effect’ on eating, but for now, back to co-habitation.

My 2006 publication was based on research findings from the UK, North America and Australia which looked at the eating and lifestyle habits of co-habiting heterosexual couples, including married couples. Women eat more unhealthy foods and tend to put on weight when they move in with a male partner. On the other hand, a man’s diet tends to become healthier when he starts co-habiting with a female partner - and her influence has a long-term positive impact.

The reason for the change in dietary habits is that both partners try to please each other during the ‘honeymoon period’ at the start of a co-habiting relationship, by adjusting their routine to suit their partner and eating food that he or she likes.

However, women have the strongest long-term influence over the couple’s diet and lifestyle, mainly because the majority of female partners still assume the traditional role of food shopper and cook. Many of you will now be thinking about your own domestic (bliss) situation and who has made more changes and where. I can reflect on the issues we have, especially around portion size! In those early days of co-habitation, it was hard not to have a second helping as I sat at the table waiting for my much more active and taller husband to finish his first helping.

But this co-habitation thing isn't all bad news, or is it? A recent study of around 4,000 older married and co-habiting couples participating in the English Longitudinal Study of Ageing, reported a more positive spin. The participants - aged 50 and above - were more likely to make a positive health behaviour change if their partner did the same. There is an important message from this research, that involving partners in behaviour change interventions may help improve outcomes. However, this study didn't explore the negative effects.

So negative effects aside, it’s that time of year for love and romance. Hold that partner tight and let them know what an amazing team you can be for making positive lifestyle changes. When you are working up public policies, or if you are practitioners seeing your patients/clients or designing interventions, don’t forget about the co-habitation effect and the importance of partners.

Happy romancing everyone!

Tuesday 3 February 2015

Time to chuck out the checkout junk?

Posted by Mel Wakeman (introduced by Amelia Lake)

As mum to a toddler I usually avoid any kind of supermarket. I am lucky enough to have a local fruit and veg shop (where I welcome pester power!). However the other week whilst waiting at the till in Marks and Spencer I had to summon all my powers of distraction to keep my two year old son occupied so that he didn’t spot the masses of high sugar, energy dense food and have (another) melt down. Hours later, I started venting via twitter (@lakenutrition) and I vowed to write a Fuse blog post on the topic. I got a standard response from Marks and Spencer but more interestingly I got a response from Mel Wakeman (@MelWakeman2) a Senior Lecturer in Nutrition and Applied Physiology at Birmingham City University. Mel had written about this topic on her own blog. Her piece was eloquent and summed up my frustrations and so I asked her to write a piece for our Fuse blog. Happy reading and let's turn the pester power on the supermarkets!

For over 20 years, supermarkets have been criticised for displaying sweets, confectionary and other unhealthy items at their checkouts. Back in 1994, TESCO was the first British supermarket to remove sweets and chocolates from checkouts but only at the larger stores. As of January 1st 2015, they have finally applied this policy to all their smaller stores, i.e. TESCO Express. Their research revealed 65% of their shoppers wanted confectionery removed from checkouts to help them make healthier choices. 67% said it would help them choose healthier options for their children. It only took 21 years but this is definitely a case of better late than never. So well done TESCO for finally stepping up to the plate! Lidl also carried out similar research and found that 7/10 customers would choose a sweet-free checkout over the traditional one laden with chocolate. 68% of parents reported they were pestered by their children for chocolate at the checkout and 66% gave in some or all of the time. So in January 2014, Lidl committed to clearing out the junk from their tills. Great stuff and Aldi have just followed suit with their ‘healthy tills’ campaign. So we are making progress, albeit pretty slow but it's positive. We can do so much better though!

In 2013 the Co-op stopped displays of high fat, sugar or salt products from their checkouts and kiosks. Waitrose and Sainsbury’s also have a policy of no sweets or chocolate next to checkouts now but not in the smaller Sainsbury's Local stores. Why is this? If you make a decision to do something, just do it! You can’t give with one hand and take it away with the other. To me this screams of a half-hearted commitment, where they prioritise their profits over customer health. We are in the midst of a growing obesity epidemic; poor diet is one thing to blame for overweight and obesity, tooth decay, type 2 diabetes, high blood pressure, cardiovascular disease, cancers.......I could go on. As a nation we should be reducing unnecessary sugar, saturated fat, salt and calories from our diet but we need help to do this. Many supermarkets have signed up to the Government's voluntary Responsibility Deal where they have committed to making some of their ranges lower in sugar, fat and salt. They have pledged to help customers make healthier choices and eat more fruit and veg. Joining the deal implies they accept responsibility for promoting better health, so what's with all the checkout junk?!

One way the supermarkets can make a real difference is to curb our impulse buys. You know the ones - standing in a queue, twiddling your thumbs as they check a price for the customer in front. The three for two chunky Kit Kats or £1 bags of liquorice allsorts are staring at you. They suddenly seem so necessary and such good value too! They effortlessly land onto the conveyor belt. These impulse buys at the checkout can add several hundred unplanned calories to a family shopping basket. Yes, we have freedom of choice but the supermarkets that are sticking with the unhealthy are simply undermining all the efforts anyone is making who wants to follow a healthier diet. And it’s not all about adults either. When it comes to the checkout, colourful character laden sweeties are positioned around one metre from the ground; perfectly placed at eye level of a young child. Crafty. I really don't want to hear it is the fault of the parent and they should just say ‘NO’. If only it was that easy. For anyone that has taken their child shopping and encountered the relentless pestering and lie-on-the-floor-screaming-abdabs as we try to unload, pack up and pay for the shopping on four hours sleep, will appreciate how the whole experience can become impossible. Rather than blame and judge the parents (or grandparents etc.) for this disruptive behaviour (yes I have seen the stares, eye rolling, tutting and suggestions as to why my child is having a massive tantrum), blame the shop!

So let’s name and shame. Marks and Spencer, Sainsbury's Local, Asda, Morrisons and Iceland are all refusing to step up and do their bit. Why?! Their lower calorie, ‘lighter’ and ‘fuller for longer’ ranges obviously sell well. Surely offering healthier snacks at the tills will not cause their annual profit to plummet? It's not as if we are even asking them to stop selling these products; just move them to an aisle (preferably far away from the tills!) This is really not rocket science is it? The Government’s responsibility deal is obviously not working because it’s far too accommodating. Stores are reluctant to change and are getting away with it. If nothing happens soon, another 20 years will go by and we will have moved no further on. It really is time to get the junk off the checkouts once and for all.