THE National Heart Foundation of Australia plays a valuable role in bringing heart disease to public attention. However, shortcomings of their Heart Foundation Tick program demand caution.
Media releases proclaim that the Tick has been “awarded to” or “earned by” particular foods. These must meet the Heart Foundation’s nutritional criteria, but companies then pay to use the Tick.
For food companies, whose purpose is to make a profit, the Tick is a marketing exercise. By tweaking products (where necessary) and paying for the Tick, companies gain credibility by linking their brand to the positive emotions attached to the Heart Foundation. The extra cost is passed on to the shopper.
Effects on food prices
The cost of food is a particular concern for people on low incomes, who have a higher incidence of diet-related health problems. Processed foods that bear the Tick almost invariably have a higher price, while cheaper products in many food categories may have a nutritional profile at least as good as those with the Tick — sometimes better.
Rolled oats with the Tick are 4.5 times the price of house-brand oats. How can this be justified? A similarly expensive Tick approved product dilutes rolled oats with 20% wheat starch, adding inulin for extra fibre. Why?
The Heart Foundation’s criteria for “earning” the Tick are a cause for concern, especially the variation in its criteria for different product types.
To earn the Tick, tomato sauce must have no added salt, but a similar restriction does not apply to salad dressings. Some salad dressings with the Tick contain more than 600 mg sodium per 100 mL. A much healthier option is homemade dressing, such as olive oil with lemon juice or vinegar — quick and easy to make, with virtually no sodium.
In food categories such as pies, frozen pizza, fast foods, sweet biscuits, rolled fruit confectionery and frozen meals, products with the Tick may represent a slight improvement on similar products, but these food types do not deserve any stamp of credibility.
The appropriate message for an overweight population is to avoid such products. Fresh fruit is a better option than a sweet biscuit or sticky fruit bar bearing the Tick.
Salt and fat
Many diet-related health problems stem from intake of salt, saturated fat and added sugar. The Heart Foundation has been strong in condemning saturated fats, and their lifestyle modifications for hypertension support choosing foods that are processed without salt.
However, while the Heart Foundation quotes the number of tonnes of salt and saturated fat that have been saved by reformulating products to meet Tick criteria, this has little meaning when the proportion of total salt and fat consumption that these amounts represent is not provided. In any case, avoiding consumption of these reformulated products would save even more salt and saturated fat, and reduce energy intake.
The Heart Foundation Tick program’s leniency for added salt is also perplexing. One mayonnaise with the Tick has more sodium than the same company’s regular brand (735 mg per 100 g v 550 mg per 100 g). Some ready-made soups with the Tick have 1280 mg sodium per serve.
To put that into perspective, the adequate daily intake for sodium is 460–920 mg, and 2300 mg per day is the upper limit. Almost 80% of sodium that is consumed comes from processed foods. The obvious solution is to substitute processed foods with fresh foods.
The Heart Foundation’s Tick criteria exclude sugar, claiming that added sugar does not differ from sugars in fruit or milk. However, fruit and milk contain a range of essential nutrients with their intrinsic sugars, whereas added sugar does not, and dietary guidelines for Australia and most other countries recommend limiting added sugar.
Of 44 cereals awarded the Tick in 2011, many contain about 30% sugar. Dried fruit contributes some of this sugar, but some cereals that bear the Tick have “straight” added sugar only.
At any level of energy intake, nutrient density falls as the proportion of added sugar in the diet increases. A recent analysis showed that intake of essential nutrients decreases significantly with each 5% increase in added sugars above 5%–10% of total energy intake, and the World Health Organization recommends that no more than 10% of energy should be from added sugars.
The Tick criteria for cereals stipulate more than 50% wholegrain content. Lower levels of sugar would encourage even more of the beneficial wholegrain ingredients. Breakfast cereals with 97%–100% wholegrain content, and little or no added sugar, are popular and have no need to buy the Tick for credibility. The Heart Foundation should use these as a benchmark.
A recent editorial in the Canadian Medical Association Journal notes that partnerships between the food industry and health organisations can risk jeopardising public health goals, leading to health organisations becoming “inadvertent pitchmen for the food industry”. The authors conclude that “corporate dollars always introduce perceived or real biases that may taint or distort evidence-based lifestyle recommendations and health messages”.
This is a particular problem when fast foods are awarded the Tick. The healthier option lures extra customers, but the bottom line is an increase in sales of regular burgers and fries.
Most Australians need to eat less of almost everything except fruit and vegetables, and the new dietary guidelines for Americans have taken such recommendations on board. It is not a message that pleases the processed or fast food industries, but that is their problem — it is not the role of health organisations such as the Heart Foundation to keep these companies profitable.
Doctors should, therefore, exercise caution when recommending products that bear the Heart Foundation Tick. The important message for Australians is that we need to change our attitude to food — from quantity to quality, and from highly processed foods to home-cooked fresh produce. The Tick is simply a distraction.
Ms Rosemary Stanton is a nutritionist and visiting fellow at School of Medical Sciences, University of New South Wales.
This Opposing Views article appears as a Rapid Online Publication in the Medical Journal of Australia on the Heart Foundation’s Tick program. It is reproduced with permission of the MJA. Please click here to read the opposing view by the Heart Foundation
Posted 1 March 2011