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

Jane Elmslie, Ria Schroder Doug Sellman, Frances Carter

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

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

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?

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”?

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

What to do now?

• Simplify• Clarify which foods contain

empty calories• Encourage healthy eating

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.”

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”

10

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.

NEEDNT FOOD REPLACE WITH:Alcoholic drinks Water/diet soft drinksBiscuits *Butter, lard, dripping or similar fat (used as a spread or in baking/cooking etc.)

Lite margarine or similar spread or omit

Cakes *Chocolate *Coconut cream Lite coconut milk/coconut flavoured lite

evaporated milkCondensed milk *Cordial Sugar free cordialCorn chips *Cream (including crème fraiche) Natural yoghurt (or flavoured yoghurt

depending on use)Crisps (including vegetable crisps) *Desserts/puddings *Doughnuts *Drinking Chocolate, Milo etc. Cocoa plus artificial sweetenerEnergy drinks WaterFlavoured milk/milkshakes Trim, Calcitrim or Lite Blue MilkFruit tinned in syrup (even lite syrup!) Fruit tinned in juice/artificially sweetened

NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

NEEDNT FOOD REPLACE WITH:Fried food Boiled, grilled or baked foodFrozen yoghurt Ordinary yoghurtFruit juice (except tomato juice and unsweetened blackcurrant juice)

Fresh fruit (apple, orange, pear etc. + a drink!)

Glucose Artificial sweetenerHigh fat crackers (≥ 10g fat per 100g) Lower fat crackers (≤ 10g fat per 110g)Honey *Hot chips *Ice cream *Jam *Marmalade *Mayonnaise Lite dressings/lite mayonnaiseMuesli bars *Muffins *Nuts roasted in fat or oil Dry roasted or raw nuts (≤ 1 handful per

day)Pastries *Pies *Popcorn with butter or oil Air popped popcorn

NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

NEEDNT FOOD REPLACE WITH:Quiches Crust-less quichesReduced cream Natural yoghurtRegular luncheon sausage Low fat luncheon sausageRegular powdered drinks (e.g. Raro) Water/Diet/Sugar free powdered drinksRegular salami Low fat salamiRegular sausages Low fat sausagesRegular soft drinks Water/Diet soft drinksRollups Fresh fruitSour cream Natural yoghurtSugar (added to anything including drinks, baking, cooking etc.)

Artificial sweetener

Sweets/lollies *Syrups such as golden syrup, treacle, maple syrup

Artificial sweetener

Toasted muesli and any other breakfast cereal with ≥ 15g sugar per 100g cereal

Breakfast cereal with <15g sugar per 100g cereal, > 6g fibre per 100g cereal and <5g fat per 100g cereal (or <10 g fat per 100g cereal if cereal contains nuts and seeds)

Whole Milk Trim, Calcitrim or Lite Blue MilkYoghurt type products with ≥ 10g sugar per 100g yoghurt

Yoghurt (not more than one a day)

NON-ESSENTIAL ENERGY-DENSE NUTRITIONALLY-DEFICIENT FOODS

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

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

Where to from hereObesity 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

Acknowledgements

• Ria Schroder • Doug Sellman • Frances Carter• Jim Mann