Fat Confusion

From an energy source to athletic performance to chronic disease risk, dietary fat is a complex topic to cover with clients. On the one hand, dietary fat is essential to health; on the other, too much of the “wrong” type of fat can be detrimental. And if we were to add another hand, it would be that fat is confusing — from reading nutrition labeling to making the right food choices. As with many intricacies of nutrition, it can be challenging for our clients to take science to the grocery store and ultimately, the kitchen — where it matters the most.

Health authorities say what?
Rules on dietary fat can be particularly difficult to apply. There is polyunsaturated fat, monounsaturated fat, saturated fat, and trans fat, and it’s often confusing knowing which type of fat is best. There may also be several types of fat in a single food item, which contributes to more confusion. In addition, limitations on what can be listed on the nutrition facts panel and conflicting messages from the media and health community add to the challenge. Never mind what the media says, even the health and fitness community has several recommendations for how much and what type of fat we should choose, and unfortunately, few recommendations for how this should be implemented.

*Dietary Fat Guidelines for Adults (as a percent of daily calories)*
	DGA 2005^a	ADA—DC^b	NCEP ATPIII^c	AHA^d	IOM^e	FAO/WHO^f
Total Fat	20–35%	20–35%	25–35%	<30%	20–35%	<30%; <35% for highly active
Saturated Fat	<10%	As low as possible	<7%	<7%	As low as possible	<10%; <7% for high risk
Trans Fat	As low as possible	As low as possible	As low as possible	<1%	As low as possible	<1%
Monounsaturated Fat	Most of the fat in the diet	Up to 25%	Up to 20%	Most of the fat in the diet	10–25%	15–30%
Polyunsaturated Fat (N-6)		3–10%	Up to 10%		5–10%	5–8%
Polyunsaturated Fat (N-3)		0.6–1.2%			0.6–1.2%	1–2%

_{a Dietary Guidelines for Americans 2005}
_{b American Dietetic Association—Dietitians of Canada}
_{c National Cholesterol Educational Program Adult Treatment Panel III}
_{d American Heart Association}
_{e Institute of Medicine}
_{f Food and Agriculture Organization of the United Nations/World Health Organization}

Just how confused are we?
Registered dietitians’ experiences will likely reveal that clients/consumers are confused about how to make the right choices when it comes to dietary fat, and their attitude does not always match their actions. In an effort to really assess consumer attitudes about food, their perception, and whether there’s a connection between what they think and the evidence, the International Food Information Council (IFIC) has since 2006 conducted a yearly food and health trends survey. In this survey, they explore consumer knowledge and attitudes towards key nutrients like fat, sugars, and carbohydrates, along with information sources such as the Nutrition Facts Panel and MyPyramid for making dietary choices. Explore any section of www.ific.org, and you will learn about the concerns, awareness, and food perceptions of your clients.

Fat findings
For this article, we’ll focus on fat. Given the IFIC data of 1,000 respondents, you’ll find that there are significant concerns about dietary fat, varied levels of awareness, and different levels of perception. Here is a summary of their findings, to help you gain insight that can help you work with clients.

Fat Finding #1: People are concerned about dietary fat.

70% report that they are concerned with the amount of fat they eat
68% are concerned with the type of fat

Those that are more likely to be concerned are people that:

Are women
Are over age 55
Have no children
Report a healthful diet and their health status as “very good” or “excellent”
Have incomes over $100,000 (versus less than $35,000)
Have made changes to their diet in the past six months
Are concerned about their weight
Are trying to lose or maintain their weight
Perceive themselves as overweight or obese
Are physically active four or more days per week

Fat Finding #2: People are aware that there are many types of fats.

91% have heard of trans fats
90% have heard of saturated fats
85% have heard of vegetable oils
72% have heard of omega 3 fatty acids
78% have heard of unsaturated fats
71% have heard of polyunsaturated and monounsaturated fats

Fat Finding #3: People’s perception of the healthfulness of fats doesn’t match the facts.

Perceived Healthfulness of Types of Dietary Fats How would you rate the healthfulness of each of the following types of fat?
Type of Fat	Healthful	Neither	Not Healthful
Unsaturated Fat	37%	39%	24%
Saturated Fat	4%	16%	80%
Trans Fat	7%	14%	79%
Polyunsaturated Fat	23%	34%	43%
Monounsaturated Fat	28%	34%	38%


Perceived Healthfulness of Oils How would you rate the healthfulness of each of the following types of oils?
Type of Fat	Unaware	Healthful	Neither	Not Healthful
Olive	8%	6%	11%	75%
Canola	10%	12%	20%	59%
Corn	12%	22%	30%	37%
Sunflower	15%	7%	20%	58%
Soybean	15%	6%	19%	60%
Palm	30%	25%	25%	20%

Focus on fat — or focus on food
Consumers are concerned, but they’re confused. The saturated fat message has reached a high percentage of consumers (80% agree that it’s not healthful), but figuring out which are the healthy types remains a challenge. Our national guidelines provide recommendations for grams and percentages of total calories, but we don’t put those things on the grocery list. As dietitians, let’s take it down to the basics and focus on food — tangible, tasty food they can cook — actual food choices.

Here’s my take on where we can start:

1. Help your clients make a “Foods I Love” list. Start with foods they like. Using a list of foods that contain good fats, walk your client through them to identify which ones they love. According to IFIC, taste has the biggest impact on the decision to buy foods and beverages.

Here’s a sample “good fats” list of foods that have less than 2 g of saturated fat per standard serving, and which have more healthful fats.

Almonds, dry-roasted
Pecans, dry-roasted
Walnuts
Sunflower seeds
Flaxseed oil
Olive oil
Canola oil
Soybean oil
Safflower oil
Soft spread, 70% vegetable oil spread
Sardines
Herring
Salmon
Snapper
Trout
Shrimp
Tuna, light, canned in water
Cod, Atlantic
Omega 3-fortified egg

2. Then, make a “Minimize for the Health of It” list with them. Now that you’ve begun with the foods to choose, review with them the foods that should be reduced simply for health reasons.

Here’s an example of a “Minimize for the Health of It” list:

Butter
Whole-fat dairy, such as whole-fat yogurt, whole-fat milk, and whole-fat ice cream
Ground beef with >10% fat
Skin on poultry
Stick margarine
Lard
Deep-fried foods
Foods with >1 gram of trans fat on the Nutrition Facts panel
Potato and snack chips
Shortening
Doughnuts
Store-bought baked goods

3. Now make meal ideas! Take the foods from the “Love List” and the “Minimize List” and create some meal ideas. Consider how they spend their time, with whom they share meals, and what fits their schedule — but make meals.

4. It’s time for a grocery list. Put it all together! A grocery list is probably the most important tool you can send your client out the door with.

Just like many rules and recommendations for what we eat, dietary fat can be a confusing topic for your clients. Keep it simple and applicable, since the national guidelines may be perceived as inconsistent or difficult to implement. We RDs can help consumers apply the national recommendations by focusing on the foods they love, and helping them take that list straight to the grocery store!

References:
International Food Information Council. 2007 Food & Health Survey: Consumer Attitudes toward Food, Nutrition & Health. Last accessed 10/18/08 from http://www.ific.org/research/2007foodandhealthsurvey.cfm.

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