Earlier this week I expressed some concern for a new health campaign by Hershey and the American Dietetic Association. The campaign website is now launched as of Wednesday.
Among my initial concerns that the number of people that will be reached by Hershey’s donation for initial consultations is simply too low to make a significance in the long run. The initial consultation is free, but will they pay for follow-up sessions? Does one consultation make a measurable difference in health choices? I doubt it. Also of concern was Hershey’s name on all of this, down to the local level in grocery stores, as well some of the nutrition information given by the Registered Dietitians on the advisory board.
Now that the site is launched, here are some further thoughts.
First, the website www.TheModerationNation.com redirects to www.hersheys.com/moderationnation. Clearly this campaign is run by Hershey and not a joint effort on an independent server. The goal reads as getting people to associate moderation, chocolate, and Hershey’s.
On the About page, they write:
Studies have shown that restricting particular foods can lead to feelings of deprivation and actually contribute to weight gain. The goal of MODERATION NATION is to help people learn that no single food or meal makes or breaks a balanced diet – it is the overall pattern of eating that is the most important focus.
Restricting certain foods can contribute to weight gain? One study (2) that looked at this, using chocolate as one of the foods, finding that because chocolate is difficult to substitute compared to other foods, depriving it lead to an increased craving for it and consumption when it was available. However, this study was only 1 week in length and did not measure weight. Other research points to the possibility that depriving chocolate may lead to periodic binging, threats to self-control, and possible overeating. However, this body of research does not seem to justify this campaign. We must consider secondary and long term effects such as a health halo effect as discussed below, or food-cueing. In another study (3), exposure to the sight and smell of pizza increased subsequent intake and altered prospective portion size of other foods, suggesting that cueing is not specific to the pizza they were exposed to. Indirectly, they cite evidence of exposure to cigarettes causes a physiological reaction in addicts. Might the exposure to the Hershey brand and products under this campaign (or others with an influence from food companies) influence consumers’ intakes of other foods?
I’ll agree that the overall food pattern is most important, but if moderation and balance is not well defined for consumers, they may get the most important message that whole/real foods should be priority. I think the campaign fails here for reasons discussed below.
- Both dark and milk chocolate provide health benefits in moderation – milk chocolate is to dark as a latte is to an espresso* (Source: HERSHEY CENTER FOR HEALTH & NUTRITION)
- Both dietitians and consumers agree that up to 100 calories of chocolate can be consumed daily (Source: HERSHEY CENTER FOR HEALTH & NUTRITION, 2010)
What? Hershey is now an authority to make health claims? Just like food label claims should be regulated, so should this as it would have a “health halo” effect. Research continues to accumulate that suggests even simple words like “low-fat” or “organic” skew our perceptions on energy content or healthiness of foods. Much of this work is being done by Brian Wansink. If people associate food companies with professional associations or health campaigns they are likely to downplay their unhealthiness. The perceived healthiness of Hershey products goes up, and this would cause people to consume more of it (1).
One good thing about their campaign, is that they recognize the new “inactivity physiology” paradigm; sedentary time has been consistently linked with negative outcomes independent of the amount of exercise in observational studies. For more information see a post at ObesityPanacea or the most recent study.
- Over the past few years research has suggested that being sedentary (e.g. sitting) for extended periods of time has a negative impact on your health.
- In other words, no matter your body weight or how much you exercise, if you also spend a lot of time sitting, you are likely to have higher health risks than someone who performs the same amount of exercise but spends less time sitting.
- MODERATION NATION offers tips and tools for taking daily “balance breaks” – small “activity snacks” throughout the day to boost your energy and health.Click here for the Balance Break app
As of Wednesday evening the free “Balance Break” app was in Apple’s app store, and it seems like a good idea- you can set it to remind you to get up periodically and move around. I am unable to find other apps that do this.
Under the “Moderation Eating” tab, we are told that:
All foods can fit within a healthful eating pattern if consumed in moderation with appropriate portion size and combined with regular physical activity.
Will consumers understand what this means? I had to do some digging to see if consumers understand what moderation means and if they care. From an ADA position paper (4):
From their inception in 1980, the Dietary Guidelines for Americans have recommended moderation for certain dietary components, such as fat and sugar, while continuing to emphasize nutrient adequacy.
The Dietary Guidelines 2010 contains 10 mentions of the word “moderation” but no definition outside of the vague:
A balanced grouping of a variety of foods among all the food groups, consumed in moderation, that are culturally appealing will offer pleasurable eating experiences and promote health among Americans.
The term variety, equally vague, has actually been well studied from animals to humans and implicated in the obesity epidemic. People eat more with a variety of foods available because of they aren’t able to habituate to so many choices. This will be the topic of a future post, but for a review of most of the literature see (5). With tens of thousands of foods in grocery stores because of the proliferation of food companies, how are people supposed to understand what variety is? This is a concern with “moderation” as well.
Results from the USDA’s 1994-96 Diet and Health Knowledge Survey of 5,649 people over age 20 who provided 2 days of dietary intake found that 86.3% considered “using sugars only in moderation” very important to somewhat important vs. the remaining 13.7% thinking it is not too important or not at all important. Clearly most already understand and consider moderation important- yet in the very important and somewhat important categories, the mean intake of sugars as a % of total calories averaged 14.3%, a high amount- about 72 grams. Is that moderation?
MyPyramid does not appear to have any information on moderation.
We don’t in my opinion need a campaign for the moderation of everything. People know the word moderation, they just might not understand exactly what it means, or really care.
Of exception, alcohol has consistently improved in its definitions of moderation consumption with each dietary guideline, though public perception of this is still less understood (6). Food groups in the pyramid are too loosely grouped for moderation to be a good tool to select from- refined and whole grains should not be in the same group for example. Maybe guidelines for more specific food types can go the way that alcohol recommendations are heading.
Also under the “Moderation Eating” tab on the website, is a “meal balancer tool.” It is pretty simple and just puts a few food options together for a meal and offers a link to some Hershey’s products for dessert. The “Moderation Menus” offers menu plans that frequently contain processed items and of course Hershey’s products. I understand that they are trying to be realistic and typify an American diet but cereal, muffins, and granola bars are not what I would consider ideal choices. They offer 2 featured chocolaty recipes, a “Chile Con Cocoa” which contains 270 Calories per serving and some “Chocolate Ginger Spice Muffins” at 140 Calories per serving. Other “Featured Celebrity Recipes” on the side include a lot of energy dense chocolaty concoctions. Hershey managed to get their products into almost everything on this website.
And the website does not offer any more substance than that. There is almost no information except vague statements that include moderation and balance. The whole thing reeks like a marketing tool for Hershey.
Going back to health claims, Hershey links to a short PDF that suggests their chocolates have antioxidants, some of them improve blood flow, and provide essential nutrients. On their website, they show off the ORAC values of chocolate, a measure of antioxidant activity in vitro. ORAC alone is really a worthless measure of any effects that the phenolic compounds might have on any health outcomes in the body, as I have described here.
While chocolate has a lot of research on it, and I can’t comment on the majority, an interesting commentary published earlier this year (7) questions the ability of chocolate/cocoa to lower blood pressure. Studies that were double-blinded tend not to lower blood pressure, while in open-label studies they do, suggesting a possible placebo effect. Other differences in methodologies, brands, preparation, etc may effect results. Questions remain on dose, length of consumption needed for effects, mechanisms, and more. Dark chocolate is of course not an essential food, and it deserves further study before claims are made. Even though most researchers remain cautious, this doesn’t stop Hershey’s from making certain health claims.
The message that the ADA in my opinion should be sending is that our food environment needs to be changed (even the new stubborn Dietary Guidelines admits this), not that all foods can be consumed. Partnering with food companies is heading in the wrong direction. Health campaigns should carefully consider the scientific evidence and work with multiple independent organizations and scientists who understand it to design one that is effective.
As Marion Nestle puts it about this campaign: “The mind boggles.”
1. Provencher V, Polivy J, & Herman CP (2009). Perceived healthiness of food. If it’s healthy, you can eat more! Appetite, 52 (2), 340-4 PMID: 19071169
2. Polivy J, Coleman J, & Herman CP (2005). The effect of deprivation on food cravings and eating behavior in restrained and unrestrained eaters. The International journal of eating disorders, 38 (4), 301-9 PMID: 16261600
3. Ferriday D, & Brunstrom JM (2008). How does food-cue exposure lead to larger meal sizes? The British journal of nutrition, 100 (6), 1325-32 PMID: 18466651
4. Freeland-Graves, J. (2002). Position of The American Dietetic Association Total Diet Approach to Communicating Food And Nutrition Information Journal of the American Dietetic Association, 102 (1), 100-108 DOI: 10.1016/S0002-8223(02)90030-1
5. Raynor, H., & Epstein, L. (2001). Dietary variety, energy regulation, and obesity. Psychological Bulletin, 127 (3), 325-341 DOI: 10.1037/0033-2909.127.3.325
6. Dufour MC (2001). If you drink alcoholic beverages do so in moderation: what does this mean? The Journal of nutrition, 131 (2S-1) PMID: 11160585
7. Egan BM, Laken MA, Donovan JL, & Woolson RF (2010). Does dark chocolate have a role in the prevention and management of hypertension?: commentary on the evidence. Hypertension, 55 (6), 1289-95 PMID: 20404213