Nutritional health message is not getting across, and terms get hijacked for commercial marketing

The general public is confused about how foods provide a mix of nutrients, what the body needs and what a 'nutritionally balanced' or nutritionally complete diet is, according to a new study.

The language used in health promotion campaigns is part of the problem, the study's authors conclude. The study, published in the journal BMC Public Health, found that when prompted with words commonly used in health promotions, almost 90% of consumers associated the terminology with the idea of food as either "good" or "bad" particularly in relation to its calorific and fat content.

How the balance of nutrients positively associated with health and disease prevention could be achieved was rarely mentioned.

Dr Emilie Combet, who led the research at the University of Glasgow, said: "Members of the public are exposed, daily, to a large volume of messages related to food and health from multiple sources with varying reliability and consistency. Our study shows limited understanding of the concepts, and alarmingly, a lot of despondence too."

Professor Mike Lean, a co-author on the study, said: "The popular term 'healthy eating' has been hijacked by the food industry and used to sell low calorie products; it no longer conveys the notion of long-term influence on health and has become synonymous with dieting for weight loss. 

"The word 'healthy' is commonly applied to foods and ingredients which can have no impact on health unless built into a nutritionally balanced overall diet. The simplest way to do that is to have meals which are nutritionally balanced."

The World Health Organisation estimates that at least 80% of premature deaths from cardiovascular diseases could be prevented through a healthy diet, regular physical activity and avoiding the use of tobacco.

Governments worldwide have attempted to improve diets, in order to avoid chronic diseases and disability from diseases such as cancer, diabetes and cardiovascular diseases – diseases of the heart and blood vessels that can cause heart attacks and strokes – and to avoid deficiencies of vitamins and mineral. Nutritional scientists worldwide agree on what the best nutritional balance of nutrients should be, but evidence shows that educational health promotion is insufficient. 

Scotland has more chronic diseases than most other European countries. The 1996 national nutrition policy 'Eating for Health: A Diet Action Plan for Scotland' remains one of the best in the world but public health campaigns to improve eating behaviour have not had significant impact.

Researcher Christina Buckton surveyed 270 adults across Glasgow and Edinburgh, asking them about their perceptions of terms intended to improve eating habits in public health strategies: Healthy Eating, Eating for Health, Balanced Diet and Nutritional Balance. Most people believed these terms equated to 'Foods considered to be healthy' and 'Foods to avoid'. 

Focus group discussions highlighted that Healthy eating is synonymous to 'dieting for weight loss or management'. There was low awareness of nutritional balance and low perceived usefulness of tools such as the Eatwell plate, used by the Food Standards Agency to illustrate what is meant by a healthfully balanced diet.

Dr Combet said: "The four health promotion terms we tested produced different response among participants. People do not understand the concept of nutritional quality, or think about a diet which matches their biological needs for good health."

What the terms actually mean:

• Eating for Health:  This is an aspiration, describing the aim, but without a clear definition.
• Healthy Eating:  This term, and 'Healthy Diet' and 'Healthy Food, have no meaning within nutritional science.  These terms may refer to the presence of certain nutrients (like fibre or reduced fat) which couldcontribute to better nutritional balance, or to the farming methods (like 'organic', which does not confer benefits for nutrition or health).
• The term 'Healthful Diet' means the same as 'Eating for Health', but is too easily confused with 'Healthy Diet'.
• Balanced Diet:  Everybody's diet is balanced, some well balanced, others not well balanced.
• Nutritional Balance: The biological nutritional requirements of healthy humans are set down in tables of 'Reference Nutrient Intakes.  These must be provided from the mix of foods people eat, but without exceeding the reference calorie intake.  A diet which does that is said to be 'Nutritionally Balanced'.