Author: Dr. Sean Wheatley, PhD – Science and Research Lead/21 June 2018
Last week (on the 14 and 15th June 2018) the British Medical Journal (the BMJ) and Swiss Re (an insurance/reinsurance company) co-hosted a conference titled “Food for thought: the science and politics of nutrition” in Switzerland. The purpose of the conference was to try and bring together a number of knowledgeable, and potentially influential, people to discuss how we can drive positive change to nutritional practice and guidelines. The event was heralded in some quarters as being a big opportunity to incite this change, but was it really?
Why are the BMJ working with an insurance company?
Although at first glance this might seem like an odd partnership there is actually a clear alignment of their goals. The BMJ is obviously interested in the health and wellbeing of people, with its priority being to improve patient outcomes through helping healthcare professionals identify suitable lifestyle options and medical interventions. Now whilst the priority of Swiss Re is to make money, something that will automatically make some people wary of their motives, the best way for a company providing health insurance to achieve this is if they don’t have to pay out on any claims. The healthier people are, the less claims they’ll make – simple! Therefore, Swiss Re’s priority is anything that will keep their clients healthy – a good fit with the goals of the BMJ.
So what was good about this conference?
Firstly, the aims and the premise of the event were fantastic. Putting all else aside, the goal of bringing together prominent people in the field in order to explore what we can do to move things forward is a noble one. To a large extent the organisers were successful at doing this, with prominent researchers from a number of fields contributing to the conference and to the journal supplement that accompanied it (available for free at https://www.bmj.com/food-for-thought). It should not be underestimated how difficult it is to organise an event of this nature and to achieve such a good attendance, so the passion and drive shown by the BMJ and Swiss Re to put it all together should be applauded.
Building on the above positive, it should also be noted that there were a number of different viewpoints on show. This is particularly apparent in the BMJ journal supplement mentioned. The authors of some of these articles could be a who’s who of influential nutritional researchers, but bringing together individuals with very different backgrounds and positions to co-author scientific articles is bordering on miraculous. It would have been very interesting to be a fly on the wall when Walter Willett (a professor at Harvard University who could probably fairly be described as part of the “establishment”) and Gary Taubes (a journalist with very outspoken views and strong opinions on nutrition who could probably be fairly described as “anti-establishment”) were discussing the article they contributed to on dietary fat…
Another plus point for me was that there were a number of points that people actually agreed upon, at least for the most part! Much of the debate around diet gets boiled down to over-simplified arguments between two things, for example fats versus carbs or quality versus quantity. These debates often become heated, and they rarely lead to anything positive or useful (regularly because people are too stubborn or biased to concede anything – and that applies to people on ALL sides of these “debates”). These arguments are also usually false dichotomies, suggesting it has to be one or the other that is right all the time for all people. It is rarely that simple. So for people with opposing views to come together and agree on a number of things was reassuring. Points of agreement include the positive roles of fruit, vegetables and fibre – and on the negative influence of trans fats, refined carbohydrate and sugars. There was also broadly a consensus on intermittent fasting and carbohydrate restriction being suitable options at least some of the time, and – perhaps somewhat more surprisingly to some – that the broad demonisation of all saturated fats has been an unfair oversimplification of the matter. The extent to which these last three points are the case and/are appropriate was still the source of some contention for some people, but there was certainly some shared ground for more productive discussions to be built from.
Were there any down sides?
Now I am sure other people who attended or who watched the live feed will have differing opinions, but for me there were some things that could be classed as negatives. One of which is that the event was very academic orientated. Although that might seem like a good thing, and indeed the knowledge and experience of these individuals is clearly essential for helping us understand the matters at hand, the conversion of information into practice and policy is often largely in the hands of other people. Now I didn’t speak to everyone at the conference or know all of their backgrounds (or their potential influence) but in my view the presence of more practitioners and policy makers was needed to help drive real world change. There were many networking opportunities however so it is entirely possible that positive actions will grow from the event. There were also additional meetings over the weekend, that I unfortunately wasn’t able to attend due to prior commitments, which may well have helped build upon any initial agreements and connections made in the first two days.
Another downside was that there was an overall bias towards a low carbohydrate dietary approach amongst the attendees. As a disclaimer, I fully believe this can be successful for many people; especially those with Type 2 diabetes, a condition characterised by carbohydrate intolerance, where there is an argument that carbohydrate restriction could/should be a/the front line approach. This is also one of the dietary approaches offered as part of X-PERT’s programmes, so we clearly feel that there is a strong evidence base to support it. It may also come as a surprise to some of those reading to hear me say this as a negative when Trudi Deakin, the founder and CEO of X-PERT Health, is herself a low carb advocate and frequently speaks in the media and at conferences about its potential benefits. But for me a bias towards any particular dietary approach creates an environment that is not conducive for leading to change. As an example of where biases of this kind could have hindered progress at this conference, the first debate (on the quality of evidence and what forms of evidence we can trust) was essentially hijacked into a carbs versus fat debate (well, an argument really) that was redundant and counter-productive. The audience cheering for pro-low carb points, as happened on a couple of occasions, may well also have reduced some of the credibility of the event too I fear – particularly in the eyes of those who might not be as sold with this option. My position is very much that one size doesn’t fit all, and I’d be happy to discuss the evidence supporting this! I therefore believe that we should be helping people to identify the approaches that work for them, both from a health perspective and in terms of how well they can adhere to it. When any event leans too far towards any individual view this is not the best vehicle to get everyone agreeing on messages and pulling in the same direction.
There was also a little bit of a tone of conspiracy theory at times, with some implication (or even overt proclamation) that we can’t trust large chunks of the published literature. I think we need to be a little bit more pragmatic, acknowledging how difficult and expensive it is to perform high quality research. Yes there are limitations with different forms of research, but if we pool together the available information and consider the pros and cons of each study that isn’t to say that we can’t start to unravel some of the mysteries within. Having said that, there are still plenty of studies out there that are so beset by potential bias and limitations that they probably do not provide us with any useful information whatsoever…
So what’s the bottom line?
This was a fantastic event. It was interesting, it was worthwhile and it brought together a lot of people who do have the ability to frame the debate. But there were some ingredients potentially missing in order to really make a difference. As a starting point though this could really provide a platform to build from, and I truly hope it does as elements of our guidelines right now are too prescriptive and narrow, and do not reflect what the evidence actually shows. Healthcare professionals need to feel confident and supported in helping individuals work out what will work for them.
Those opposed to certain viewpoints are not likely to change their minds with the same points being made by the same people in the same way. We need to start with the things we mostly agree upon and build outwards to include other options that might work for some people, rather than allowing individuals to start from more extreme positions and expect everyone else to align with them. Change can’t truly happen unless people start pulling in the same direction.
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