The NEEDNT Foods List: Non-Essential Energy Dense Nutritionally Deficient Foods

1. The NEEDNT Foods List: Non-Essential Energy Dense Nutritionally Deficient Foods Jane Elmslie, Ria Schroder Doug Sellman, Frances Carter

2. What is the NEEDNT Foods List? • A list of 50 non-essential, energy dense, nutritionally deficient foods • Key money makers for the food industry • Foods high in fats and added sugars, which together with salt, are the food components most commonly associated with food addiction

3. Why was it developed? • Need identified from : • Clinician and consumer focus groups • WW vs OA study • Desire to test abstinence/moderation paradigm without compromising nutritional health • Lack of movement on traffic light labelling

4. Clinician and Consumer Perspectives of Obesity • Lifestyle change crucial • Confusing/misinformation unhelpful • Treatment must address the emotional component of overeating • Addictive component should be acknowledged. A role for abstinence?

5. Weight Watchers vs Overeaters Anonymous Methodology • 27 obese participants • Attended 6 WW meetings and 6 OA meetings • Randomized order • Asked what they thought of them? • Asked what they thought about the concept of “problem food”?

6. Weight Watchers vs Overeaters Anonymous (n=27) • Majority not satisfied with either • WW – “too structured”, “too complex”, “become obsessed by counting points”, “not sustainable”, “too commercial – too much hard sell of products” • OA – “I’m not as bad as them”, “not comfortable with the Higher Power”, “not practical enough” “too touchy feely” suggesting that differences between OA & WW go beyond abstinence vs moderation • All able to identify 3-4 problem foods • Problem foods only part of the problem

7. What to do now? • Simplify • Clarify which foods contain empty calories • Encourage healthy eating

8. Medscape News July 19th 2011 • “Each day, the average American adult consumes roughly 22 teaspoons, 90 g, or 355 calories, of added sugars, well above health guidelines. Caloric sweeteners in beverages are a key source of excess calories.” • “New U.S. dietary guidelines recommend drinking water instead sugary drinks. Food and beverage companies say they are being unfairly singled out.” • “At various times, states and localities have considered taxing sugary beverages to cover obesity-related health costs.” • In 2009 and 2010, as such proposals became more frequent, the ABA, Coke and Pepsi collectively spent $60 million on lobbying, up from $8 million in 2007 and 2008, according to data collected by the Center for Responsive Politics' OpenSecrets.org.”

10. Barriers to change in clinical practice • “But aren’t sugar and fat the same thing?” • “The citrus slice saga” • “I’m having muesli bars now”

11. Developing the list • Compiled using: • National Heart Foundation and Diabetes New Zealand “Foods to Avoid”, “Stop Eating” and “Optional Foods” lists • CDHB “Supermarket Shopping Guide” • USDA population guidance on discretionary calories. • Foods and beverages were included if they: • contained alcohol, • saturated fat, • added sugar, • were prepared using a high fat cooking method • contained a large amount of energy relative to their essential nutrient value.

15. NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

16. NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

17. NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

18. Feedback to Date • Current research participants • Appreciate the clarity • Have been surprised at some inclusions • Useful as an individual guide to work out own most problematic areas • Useful to choose 5-10 most problematic NEEDNT foods to stop eating completely or focus on reducing significantly • Gives additional focus beyond portion size • Current patients • Appreciate the clarity • Have expressed the view that they are “addicted” to some foods on the list • Have used the list to prioritise non essential energy dense food consumption. • Have achieved their weight loss goals

19. Feedback to Date • Colleagues working in obesity treatment • Think the list is a valuable tool • Would like to use it with their clients • Agree with the items included on the list • Medical Students • Helps reduce confusion • Makes sense • Easy to use and talk about • Members of Overeaters Anonymous • What they would refer to as ‘top shelf’ food • OA members in recovery would never eat any of these foods

20. Where to from here Obesity Treatment • Simple tool to help health professionals initiate conversations about food consumption patterns which may promote and maintain obesity Research • Abstinence vs. Moderation – appropriate list of foods to test this paradigm • Kia Akina – a new concept for participants to contemplate/try in their weight loss journey • NEEDNT Food List Moderation Guidelines • NEEDNT Food List FFQ

21. Acknowledgements • Ria Schroder • Doug Sellman • Frances Carter • Jim Mann