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Consumer Issues
Chapter 9
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Consumer Issues
• Proliferation of cyberspace information—and
misinformation
• Ever-evolving science of nutrition has
progressed from three square meals a day and
a well-rounded diet to MyPyramid
• Baby boomers
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Information and Misinformation
• Consumers are often confused by nutrition
messages
• Sources of consumer confusion include the
media, the internet, and the food industry
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Information and Misinformation (cont’d)
• The media
– A significant source of nutrition information as well as
misinformation
– Consumers may fail to make the distinction between
correlation and causation and may draw inappropriate
conclusions from study results
– Other types of media inaccuracy
o Generalizing a study to a broader population
o Overstating the size of the effect
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Information and Misinformation (cont’d)
• The Internet
– Vast and ever-growing source of nutrition and
health information
– 49% of those seeking information are looking
at diet, nutrition, vitamins, or nutritional
supplements
– No regulatory safeguards in place to ensure
that the information is accurate
– Junk science coexists with legitimate data
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Information and Misinformation (cont’d)
• The food and supplement industry
– Ingredient listings and Nutrition Facts labels
are reliable and accurate by law
– Advertising can blur the line between false
advertising and freedom of speech
– Ads can fall short of the expectations of
truthful, substantiated, and not misleading
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Information and Misinformation (cont’d)
• Judging reliability
– Test the validity and reliability of nutrition “news”
by asking who, what, when, where, and why
o Who is promoting the message?
o What is the message?
o When was the study conducted, the results
published, the web site updated?
o Where was the study conducted?
o Why was the article written?
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Information and Misinformation (cont’d)
• Combating nutrition misinformation
– Determining if information is valid and
reliable may be easier than persuading a
client that he or she has been a victim of
hype
– If clients’ beliefs are unsupported but
harmless, you may risk alienating them for
no reason by waging a war to convince them
they are misinformed
– Clients may reject you as a credible
reference
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Question
• Is the following statement true or false?
Ingredient listings and Nutrition Facts labels are
reliable and accurate by law.
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Answer
True.
Rationale: Although ingredient listings and
Nutrition Facts labels are reliable and accurate
by law, advertising made to resemble
newsworthy articles or featuring celebrity
endorsements can blur the line between false
advertising and freedom of speech.
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Food Labels
• Nutrition facts
– Nutrition Facts label
o Intended to:
 Provide consumers with reliable and
useful information
 Help avoid nutritional excesses
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Food Labels (cont’d)
• Everything hinges on portion size
– All information that appears on the Nutrition
Facts label is specific for the size portion
listed
– There may be slight differences in the serving
size among different manufacturers
– Food label serving sizes may also differ from
size equivalents used in MyPyramid
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Food Labels (cont’d)
• Percent daily value may not be accurate for
an individual
– It may underestimate or overestimate the
contribution to an individual’s diet, depending
on how many calories the individual actually
needs
– The Percent Daily Value listed on food labels
for fat, saturated fat, carbohydrate, and
dietary fiber is based on a 2,000-calorie diet
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Food Labels (cont’d)
• Percent daily value may not be accurate
for an individual (cont’d)
– Nutrient amounts used to calculate the
%DV are not all based on current dietary
reference intakes (DRIs)
• Ingredient list
– Listed in descending order by weight
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Food Labels (cont’d)
• Nutrient content claims
– Terms such as “Low,” “Free,” and “High”
describe the level of a nutrient or substance
in a food
o Legally defined
o Reliable and valid
– “More,” “reduced,” or “light”
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Food Labels (cont’d)
• Health claims
– Health claims on food labels are legally
defined, such as “calcium may help prevent
osteoporosis” and “low sodium may help
prevent high blood pressure”
– In contrast, structure/function claims, such
as “improves mood,” “relieves stress,” and
“for hot flashes,” can be used without FDA
approval and do not have to carry a
disclaimer
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Food Labels (cont’d)
• Health claims (cont’d)
– Items that make one of these claims also meet
other requirements:
1. They do not exceed specific levels for total
fat, saturated fat, cholesterol, and sodium
2. They contain at least 10% of the Daily Value
(before supplementation) for any one or all of
the following: protein, dietary fiber, vitamin
A, vitamin C, calcium, and iron
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Food Labels (cont’d)
• Health claims (cont’d)
– Additional health claim criteria are specific for
the claim made
– Specific FDA-approved labeling language
must be used for qualified health claims
– Companies must petition the FDA for prior
written permission to make a qualified health
claim
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Food Labels (cont’d)
• Structure/function claims
– Offer the possibility that a food may improve or
support body function
o Examples:
 An example of a disease claim needing
approval is “suppresses appetite to treat
obesity”
 A function claim that does not need
approval is “suppresses appetite to aid
weight loss”
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Food Labels (cont’d)
• Structure/function claims (cont’d)
– Previously used primarily by supplement
manufacturers
– Disclaimer: “These statements have not
been evaluated by the FDA. This product is
not intended to diagnose, treat, cure, or
prevent any disease.”
– Structure/function claims now appear on
food labels and do not require a disclaimer
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Food Labels (cont’d)
• Structure/function claims (cont’d)
– Can appear on “junk” foods
– Do not require FDA approval
• Future directions
– Some food manufacturers and retailers have begun
adding symbols to food packages
– Some food companies in Britain have adopted a traffic
light label system that shows by red, yellow, or green
lights if a food is low, medium, or high in fat, sodium,
and sugar
– FDA is considering amending labeling laws
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Question
• What do structure/function claims do?
a. Offer the possibility that a food may improve
body function
b. Show FDA approval of the claim
c. Cannot appear on junk food
d. Include symbols in their claim
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Answer
a. Offer the possibility that a food may improve
body function
Rationale: Structure/function claims offer the
possibility that a food may improve or support
body function, which is a subtle distinction
from the approved health claims that relate a
food or nutrient to a disease.
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Dietary Supplements
• A group name for products that contain one or
more dietary ingredients including vitamins,
minerals, herbs or other botanicals, amino
acids, and other substances.
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Dietary Supplements (cont’d)
• Intended to add to (supplement) the diets of some
people, not to replace a healthy diet
• Taken by mouth as a capsule, tablet, lozenges,
liquid, or “tea”
• FDA estimates there are more than 29,000
supplements on the market with more added daily
• Majority of supplements used are multivitamin/
multimineral supplements
• Scientific research is lacking for many herbal
products
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Dietary Supplements (cont’d)
• Good manufacturing practice requirements
(CGMPs)
– For the first time, identity, purity, quality,
and composition of dietary supplements are
required to be accurately reflected on the
label
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Dietary Supplements (cont’d)
• Significant step in protecting consumers is ensuring
that supplements:
– Are free of contaminants or impurities, such as
natural toxins, bacteria, pesticides, glass, lead, or
other substances
– Contain the stated amount of a dietary ingredient
– Are properly packaged
– Are made from ingredients that were properly
handled
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Dietary Supplements (cont’d)
• Manufacturers must report all serious dietary
supplement adverse events to the FDA
• There are major differences between how
supplements and drugs are regulated and
marketed
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Dietary Supplements (cont’d)
• Supplement regulation
– In their medicinal sense, herbs are technically
unapproved drugs
– Regulated by the FDA as foods
– Do not have to meet the same standards as
drugs and over-the-counter medications
– Supplements differ greatly from conventional
drugs
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Safety and effectiveness are not proven
o Before a drug can be marketed, the FDA must
authorize its use based on the results of
clinical studies
o The regulations regarding dietary supplements
are lax
o Do not require FDA review for safety before
they are marketed
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Manufacturers that want to market a new dietary
ingredient must submit information to the FDA that
supports their conclusion that reasonable evidence
exists that the product is safe for human
consumption
– Once a product is marketed, the responsibility lies
with the FDA to prove danger rather than with the
manufacturer to prove safety
– If a new product is found to be unsafe, the FDA
issues a consumer advisory discouraging its use
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Strength is not standardized
o No legal definition of standardization as it applies
to supplements
o Difference in concentration may be related to
several factors
– Dosages are not standardized
o Recommended dosages vary among
manufacturers because there is no premarket
testing to determine optimum dosage or maximum
safe dosage
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Claims on packaging do not require FDA approval
o Cannot claim to be used for the diagnosis,
treatment, cure, or prevention of disease; they
can be labeled with statements explaining their
purported effect on the structure or function of
the human body (e.g., “alleviates fatigue”) or
their role in promoting well-being (e.g.,
“improves mood”)
o Statements do not require FDA approval
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Warnings are not required
o Supplements are not required to carry warning
labels
o No advisories about who should not use the
product
– Supplements are self-prescribed
o Consumers may misdiagnose their condition
o Clients may not inform their physicians about their
use of herbs
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Advice for supplement users
o Consumers who choose to use supplements
should ask critical questions beforehand
o Consumers should check with the FDA web
site for consumer advisories on supplements
o Only single-supplement products should be
used and the dose should be small
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Dietary Supplements (cont’d)
• Supplement regulation (cont’d)
– Advice for supplement users (cont’d)
o Should be taken at different times from
prescribed medications
o Should be discontinued immediately if
adverse side effects or supplement–drug
interactions occur
o Pregnant or lactating women and children
under the age of 6 should not use herbs and
other botanical supplements
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Question
• Is the following statement true or false?
Dietary supplements are required to carry
warning labels approved by the FDA.
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Answer
False.
Rationale: Unlike drugs, supplements are not
required to carry warning labels about potential
side effects, adverse effects, or supplement–
drug interactions. Nor are there advisories about
who should not use the product.
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Food Quality Concerns
• Retaining the nutrient content of food
– An eating plan may not provide optimal amounts
of all nutrients if the food has been improperly
stored or overly processed
– The more that is done to a food before it is
eaten, the greater the loss of naturally present
nutrients
– Vitamins, minerals, and fiber are particularly
vulnerable to the effects of food processing
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Food Quality Concerns (cont’d)
• Functional foods
– One of the fastest growing segments of the food
industry
– Generally applies to foods that provide health
benefits beyond basic nutrition
– Manufactured functional foods
o A blend of food and pharmacy (“phoods”)
o Food has one or more functional ingredients
added
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Food Quality Concerns (cont’d)
• Functional foods (cont’d)
– New functional foods with unique combinations
of ingredients are being introduced in the
marketplace faster than science can provide
information on their safety
– Adverse effects are brought to light only if
consumers alert the FDA to suspected problems
– It is likely that more foods will be considered
functional and that the supply of manufactured
functional foods will expand exponentially
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Food Quality Concerns (cont’d)
• Functional foods (cont’d)
– Position of the American Dietetic Association
is that functional foods have a potentially
beneficial effect on health when consumed as
part of a varied diet on a regular basis (ADA,
2004)
– Should be viewed as an option in the
continuum of good nutrition, not as a “magic
bullet”
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Food Quality Concerns (cont’d)
• Organically grown foods
– Demand for organic foods has soared over the last
decade
– Organic farming uses “natural” products
– Regulations are also in place for raising organically
grown livestock
• Organically grown foods are comparable to
conventionally grown foods in taste and nutritional value
• Because of production costs, higher losses, and lower
yields, they are more expensive than other foods
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Food Quality Concerns (cont’d)
• Organically grown foods (cont’d)
– The USDA ensures that the production,
processing, and certification of organically
grown foods adhere to strict national
standards and that organic labeling meet
criteria that define the 4 official organic
categories
– Organic food is usually more expensive
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Food Quality Concerns (cont’d)
• Organically grown foods (cont’d)
– USDA maintains that organic foods are not
safer than conventional foods
o The journal Food Additives and
Contaminants showed organically grown
produce consistently had only 1/3 as many
pesticide residues as produce grown
conventionally and that organic produce
was far less likely to contain more than
one residue
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Food Quality Concerns (cont’d)
• Organically grown foods (cont’d)
– Environmental Working Group created a ranking
of produce from worst (most pesticide residues)
to best (least pesticide residues)
– Experts agree that thoroughly rinsing all fruits
and vegetables under running water and
discarding the outer leaves, where appropriate,
are vital to reduce exposure to natural dangers
such as bacteria and manmade risks such as
chemical residues
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Food Safety Concerns
• Foodborne illness
– In the United States, as many as 76 million
illnesses and 5,000 deaths per year are
attributed to consumption of contaminated
food or water
– Transmitted to people from within the food
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Food Safety Concerns (cont’d)
• Foodborne illness (cont’d)
– The majority of foodborne illnesses are caused
by bacteria
– Other causes include viruses, parasites, and
molds
– Foods containing animal proteins are the most
frequent vehicles
– Most common symptoms of foodborne illness
may be mistaken for the flu
– Most cases are self-limiting and run their course
within a few days
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Food Safety Concerns (cont’d)
• Foodborne illness (cont’d)
– Symptoms that warrant medical attention include
bloody diarrhea, a stiff neck with severe
headache and fever, excessive diarrhea or
vomiting, and any symptoms that persist for
more than 3 days
– Infants, pregnant women, the elderly, and people
with compromised immune systems (people with
acquired immunodeficiency syndrome [AIDS] or
cancer, organ transplant recipients, or people
taking corticosteroids) are particularly vulnerable
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Food Safety Concerns (cont’d)
• Foodborne illness (cont’d)
– Major cause of foodborne illnesses is
unsanitary food handling
– Steps must be taken to prevent crosscontamination between raw and cooked
foods and through food handlers
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Food Safety Concerns (cont’d)
• “Mad Cow Disease” (bovine spongiform
encephalopathy [BSE])
– BSE is believed to be caused by prions, an
infectious form of a type of protein
o Prions are resistant to heat and so are not
destroyed by cooking
– Creutzfeldt-Jacob disease (vCJD), which is the
human version of BSE
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Food Safety Concerns (cont’d)
• Food biotechnology
• Combines plant science with genetics to improve
food
• Positive results are numerous and varied
– Healthier crops and greater yields
– Greater resistance to severe weather
– Longer shelf-life and increased freshness
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Food Safety Concerns (cont’d)
• Food biotechnology (cont’d)
– Higher nutritional value
– Better flavor
– Improved characteristics
– New food varieties through crossbreeding
– Potential benefits to alleviate world hunger
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Food Safety Concerns (cont’d)
• Food biotechnology (cont’d)
– The United States is the leader in biotech farming
– Biotechnology has created more than 200 new
therapies and vaccines, beginning with FDA
approval of recombinant human insulin in 1982
– FDA asserts that genetically engineered foods do
not pose a health or safety risk
– Genetically engineered foods do not require
mandatory labeling unless the food contains new
allergens Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Food Safety Concerns (cont’d)
• Food irradiation
– Irradiation is used to reduce or eliminate
pathogens that can cause foodborne illness
– Sometimes referred to as “cold
pasteurization”
– Most extensively studied food processing
technique available in the world
– Federal law requires irradiated food to be
labeled
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Question
• What is one of the positive results of food
biotechnology?
a. Blander flavor
b. Neutral freshness
c. Improved characteristics
d. Enhanced food varieties
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Answer
c. Improved characteristics
Rationale: The positive results are numerous
and varied including improved characteristics
such as celery without strings.
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