Five-a-day campaign: A partial success

 
Michael Mosley

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One of the best known pieces of dietary advice is to eat five portions of fruit and vegetables a day, but where did it originate? Michael Mosley investigates:

'Five-a-day' is perhaps the best known of all the government's health messages and, as such, it can be seen as one of the most successful.

I'd heard that it was a health message that had originated on the other side of the Atlantic, so I thought I'd start by going all the way back to its origins.

It seems the 'five-a-day' message was first dreamt up on the fields of California in 1988.

Ken Kizer was director of the State Department for Health Services. He says that it wasn't a case, as some have claimed, of fruit and vegetable growers looking for new markets, but a mutually beneficial venture for industry and public health policy.

"It didn't originate from the agricultural community. It just so happens that when we reached out to them and pointed out this would help them, they got onboard and became enthusiastic partners."

He says the evidence behind the campaign was compelling: "Beginning in the mid and late 1970s, the evidence became quite clear about the role of diet in preventing cancer and heart disease and other conditions."

Transatlantic move

Prof Tim Lang was advising the government when it was mentioned in the UK in the late 1980s.

He says: "I was called to a meeting at the Department of Health to discuss whether or not Britain should go down the route of using five-a-day.

"I was a bit sceptical, but I knew the evidence and the policy thinking that unless we got the population as a whole eating more fruit and vegetables, the enormous burden of diet-related health would carry on.

"We needed something."

Despite being officially adopted by the UK government in 2003, people are still eating an average of only three and a half portions of fruit and vegetables a day.

What is five-a-day?

Fruit
  • It equals around 400g of fruit and/or veg
  • A portion (80g) equals two or more small fruits (eg satsumas), one medium-sized fruit, (an apple or banana), or half a grapefruit or one large slice of melon
  • A portion of veg would be two broccoli spears or three heaped tablespoons of cooked vegetables such as carrots, peas or sweetcorn
  • Fresh, frozen, tinned and dried fruit and vegetables count
  • Smoothies can count for up to two portions

Prof Tim Lang says the message has lost its way: "They've lost their health education, radical cultural change emphasis."

Almost all fruit and vegetables count as part of your 'five-a-day' and they don't always have to be fresh. An exception that surprised me is potatoes.

Tom Sanders, professor of nutrition at King's College London says that is a little unfair.

"I think there was a bit of middle-class morality that people like chips and crisps and they didn't want to encourage that.

"Actually potatoes really are vegetables and are okay if they're baked or new potatoes, rather than fried."

'New light'

The five-a-day message has always been tied to health benefits, specifically that eating more fruit and vegetables reduces your risk of heart disease and cancer.

Studies over decades of people's diet and health have thrown new light on the associated health benefits.

Dr Eric Brunner is an epidemiologist at University College London.

He says: "What's turned out in the last dozen years or so is that, although some of these hypotheses have been confirmed, many of them have fallen over.

"The big one was fruit and vegetables in relation to the intestine.

"It turns out that dietary fibre is a protective factor so we're still on the side on unrefined cereals, but the fruit vegetables measured by vitamin C intake turns out to be completely unrelated to breast cancer and to colorectal cancer."

He says the five-a-day message still has value though.

Start Quote

The middle classes did listen, and the supermarkets listened and they tend to respond to the middle class consumer particularly. I think it's been less successful in reaching the disadvantaged.”

End Quote Sir Liam Donaldson Former chief medical officer

"I would certainly not want people to throw the baby out with the bathwater because it is clear that eating unprocessed fresh foods is going to be a good idea, if only because it replaces the not so good nutrients".

'Mashed into goo'

Prof Sanders agrees that fruit and vegetables are not "super foods" that protect against cancer but - like many nutritionists - takes the view that it is better to fill up your plate with vegetables than a lot of the other high-calorie food it's so easy to snack on.

The Food and Drink Federation says all fruit and vegetables count, even if they are in a smoothie or a tin.

But Prof Sanders say that misses the point.

"It's chomping your way through the fruit and veg that has an effect on satiety. Once you mash it up into goo so you can consume much more it doesn't really have the same effect."

So, has five-a-day worked?

The government's former chief medical officer, Sir Liam Donaldson, says he thinks it has been partially successful so far.

"The middle classes did listen, and the supermarkets listened and they tend to respond to the middle class consumer particularly.

"I think it's been less successful in reaching the disadvantaged communities where those levels of fruit and vegetables were already low.

"It's a long-term project. It's the right project."

A spokesman for the Department of Health said: "Getting your five-a-day can help lower the risk of serious health problems, such as heart disease and some cancers, but we know that can be a challenge.

"That is why we want to work with the food industry to help everyone make healthier choices."

I think that, of all the government guideline campaigns I've looked at, this has been the most successful, in the sense that people have at least heard of it even if they don't know what it means.

The downside of such a simple message is that lots of foods most nutritionists wouldn't regard as healthy somehow sneak in under the guise of '5 a day'.

My campaign slogan would be eat more plants!

Accurate but, I suspect, not very sexy.

You can listen to Dr Michael Mosley on BBC Radio 4's You & Yours on 3 January at 12:00.

 

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  • rate this
    +5

    Comment number 41.

    Of course it didn`t work. Most people are not stupid and will eat a balanced diet. Those people stupid enough to live on crisps and fast food takeaways without moderation are likely to ignore advice on what constitutes a varied diet anyway

  • rate this
    +1

    Comment number 40.

    It's a good general piece of advice. 5 portions of different fruit/veg a day (not 5 apples!!) is more likely to be a good thing than a bad thing and is pretty easy to achieve. Bring it on, I say!

    I can't imagine that, in years to come, they'll be saying 'Oh No! stop eating veg, eat a pound of lard a day!'.

  • rate this
    -1

    Comment number 39.

    it is a shame that Donor Kebabs are not on the 5-a-day list we would have the healthiest population in Europe.

  • Comment number 38.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +20

    Comment number 37.

    Coming from an age where we were actually taught to cook & eat healthy stuff at school as a lesson it's just second nature to me & a lot of my generation to eat sensibly without government advice campaigns, the problem with cooking is that it takes a little time & effort, so it isn't really conducive to the current government mantra of thou shalt rush everywhere & work thyself to death!

  • rate this
    0

    Comment number 36.

    @12 especially if you're allergic to citrus fruit.

  • rate this
    0

    Comment number 35.

    Would rather eat my own ear wax than a Mars bar.

    Aside from the after taste the next day it's like moving a wardrobe around.

  • rate this
    +1

    Comment number 34.

    Five a day is a good idea as part of a healthy balanced diet that includes sufficient fibre. If I eat healthily then I go for a number two daily without problems. If I don't eat healthily I go less frequently and what comes out has the consistency of golf balls and are hard to pass.

  • rate this
    +1

    Comment number 33.

    Yes, eat your sickly, tasteless, de-mineralised hydroponic tomatoes, scrape the insecticides off your apples, drink your 'fresh' boiled supermarket orange juice, clean the human waste off your 'new' potatoes, enjoy your genetically modified wheat and rejoice! for you will be healthy - honestly.

  • rate this
    +1

    Comment number 32.

    Just 4oz grapes contains your sugar intake for the day if your dieting.
    It's all about balance. A little of what you fancy does you good :)

  • rate this
    +2

    Comment number 31.

    5-a-day, unusually for the Tories, was an excellent idea and has really made me focus on my diet.

    In my teenage/20-something life, coke and crisps was the bulk of the menu - I must have had lovely breath.

    Now I make every effort to shove the spinach and bananas down. If I don't, any permutation of little maladies soon creeps in: headaches, irritation, muscle sprains, etc.

  • rate this
    +2

    Comment number 30.

    Our family, like many I should think were already eating "5" a day long ago. We had fruit /veg from a young age as did our grandparents growing them anywhere in their gardens. We also walked to school,played outside all weathers inc snow [even at school] luckily no H& S to ruin this. We were much healthier for diet/exercise. When you see parents with trolleys of crisps/cakes/sweets its their fault

  • rate this
    +2

    Comment number 29.

    Its worked as a slogan but not in practice. '5-a-day' is just as catchy as 'a mars-a-day-helps-you-work-rest-and-play' or even 'have a break, have a kit-kat', but whilst the kit-kat is invariably cheaper, more addictive and just as convenient people will probably prefer this. The news reported 25% of people in the UK are OBESE the other day? Hmmmm........now I doubt they got fat on veg!

  • rate this
    +1

    Comment number 28.

    re: 9. The Bloke
    >>>There is still a long way to go. It still seems that a lot of people will always drink soft drinks rather than water, for example.

    Is that so bad? I've read that than 95% of a cola drink is boiled, filtered water.

    re: 14. Merry
    >>>If.."official" advice ...I'm inclined to dis-believe it.

    I agree with questioning information from ANY source, but blanket belief/disbelief? No

  • rate this
    +2

    Comment number 27.

    Eat a bit less and do a bit more.

    Easiest diet on the planet

  • rate this
    0

    Comment number 26.

    If the government tells me I ought to do something then it automatically puts me off because I have zero trust in the government. However back in the 50s/60s I was brought up on the need for and to enjoy a well balanced diet, my mum was a Science teacher. As a Science teacher myself I have taught the needing a well balanced diet where it happens that 5 a day is just part of it.

  • rate this
    +1

    Comment number 25.

    I agree with the 5-a-day ethos. It's worked for me. I just wish that the supermarkets here in the UK would stock a more seasonal variety of produce like on the continent. Doing that might encourage more people to try new things and possibly eat a bit healthier. Just a thought!

  • rate this
    0

    Comment number 24.

    Realist
    2 MINUTES AGO
    No HYS on the Falklands row then ??????

    ---

    Shame, I am dying to hear your views on it.

    Incidentally, why do Heinze spaghetti hoops claim to be one of your five a day? I like the mantra and think it is a great idea in helping to get a point across to kids, but I think that Henize may be exploiting it a bit here...

  • rate this
    -4

    Comment number 23.

    The great unwashed will only be interested in sitting in front of the telly, eating cheap, processed junk. Chavtastic!

  • rate this
    +2

    Comment number 22.

    Fruit and veg go with basically any meal, work as a snack, and are very low calorie, and have a lot of important nutrients and fibre. And they're cheap, frozen or tinned will allow you to get your five a day for under 50p. There are many, many reasons to eat them.

 

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