December 1

Fattening the French


The December issue of the Journal of the American Dietetic Association contains an article about the changing eating habits of the French that shows how an ingrained bias prevents seeing the forest on account of the trees.
The author of the commentary, France Bellisle, DSc., is a Frenchwoman who is obviously a proponent of the low-fat diet. Let’s try to follow her thinking as she rambles through her piece entitled “Nutrition and Health in France: Dissecting a Paradox.” She tries valiantly to make her case, but as we dissect her reasoning we’ll see that once again the low-fat diet comes up with the short end of the stick. Even in France.
Dr. Bellisle starts out describing the state of health and longevity of her countrymen.

France has the longest life expectancy in the Western world (second only to Japan among developed countries). Prevalence of obesity and overweight is relatively low. In French adults, the frequency of obesity (body mass index >30 [calculated as kg/m2]) in adults was 11.3% in 2003. Overweight (body mass index between 25 and 30) was present in 41.6% of adults. These figures are lower than those of many developed countries, particularly those of the United States. [In the US the rates are 30.5% and 64.5% respectively]

She describes a large epidemiological study, the Supplement en Vitamines et Mineroux Antioxidants (SUVIMAX) study, that has followed 12, 741 middle aged French men and women for over 8 years. (The objective of this study was to determine whether a daily supplement of antioxidant vitamins and minerals given to one half of the subjects would make a difference in terms of rates of development of heart disease and cancer.) During the course of this study subjects were evaluated nutritionally once every other month to determine any change in diet or nutritional status. As a consequence the findings of this study reflect the changes in eating habits of middle aged people in France over the past 8 years. And what were the changes?
In the SUVIMAX population, the daily energy intake observed in 1995 was about 1,900 kcal in women and 2,500 kcal in men. Total daily energy intake has decreased linearly since the beginning of the study, not only when considering the same subjects longitudinally, but also when comparing same-age groups over time. This decrease in energy intake parallels a decrease in total fat. In 2001-2002, the percentage of participants who ingested

Intake of fruits increased regularly over the course of the SUVIMAX study in both men (from 235 to about 250 g/day in 2001-2002) and women (from 217 to about 230 g/day in 2001-2002). While intake of vegetables did increase over time in longitudinal comparisons of the same individuals, the comparison of same-age groups at different moments of the study indicated a decrease in vegetable intake. Over the time of the study, the percentage of participants ingesting the recommended five fruits or vegetables a day increased from 1995-1996 to 2001-2002 (14.6% to 22.5% in men; 17% to 27.5% in women). Over time, the intake of cereal products, legumes, milk and dairy products, and alcohol remained stable. In contrast, intake of animal products (meats, fish, and eggs) decreased in both men and women, while consumption of added fats was dramatically reduced (25.6 g to 15.2 g/day in men and 20.3 to 12.8 g/day in women).

Let’s summarize.
Over the course of the 8 years the following dietary changes took place:
Energy intake decreased (fewer calories consumed)
Fat intake decreased
Carbohydrate intake increased
Fruit intake increased
The number of subjects including 5 or more servings of fruits and/or vegetables increased.
Intake of animal products decreased
Added fats were dramatically reduced.
These changes are enough to make any mainstream nutritional expert fairly giddy with joy. And so they do to the good Dr. Bellisle as she babbles on for the next few pages extolling the virtues of these dietary changes and taking credit in some measure for them by virtue of her position as a public health authority.

The striking dietary changes over time reported in the SUVIMAX participants were the large decrease in dietary fats and the increased proportions of people ingesting five fruits/vegetables a day. These changes clearly reflect nutritional recommendations made to the French public, suggesting that the efforts made by public health authorities had the desired impact…

All should be going so swimmingly, but there seems to be a fly in the ointment.

One very disturbing fact about the French nutrition and health situation is the very rapidly increasing rates of overweight and obesity. Although France lags behind most other countries, the rate of increase is extremely alarming. In 1997, the prevalence of obesity in the adult population was 8.2%; in 2000 it was 9.6%, and it reached 11.3% in 2003. This corresponds to a 5% increase per year. Overweight in adults rose from 36.7% to 41.6% in 6 years. Morbid obesity (body mass index >35) doubled between 1997 and 2003 (from 0.3% to 0.6%). All age groups are affected, with a particularly rapid deterioration in people over 65 years of age. Children are also a very vulnerable group. Children in France are not as fat as US children, but they are catching up rapidly.

Let’s summarize again.
Everyone is fatter.
Dr. Bellilse, totally ignoring the irony of the situation, offers hope for the future:

More remains to be done, as vegetable intake could be increased and the proportion of saturated fats could be decreased in this same population.

Carb intake goes up, fat intake goes down, waist size goes out. We can watch this same movie over and over again in as many languages as we want but it’s always going to have the same ending.

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