The Public Health Collaboration UK: Wrong about energy intake

Yesterday saw the launch of a funding campaign on indiegogo to establish a new charity called the Public Health Collaboration UK.

Without wishing to pre-judge, this group of doctors and low carbohydrate diet proponents who aspire to:

……collaborate our efforts into one singular organisation to inform the public and empower the medical community on the science and solutions of health. 1

……seems to look suspiciously like a thinly disguised lobby group who’s activities will produce opinion papers which will – inevitably – be sexed up to the level of fact on the BBC Breakfast sofa and in press releases, by the media savvy members to promote their diet de jour.

So what are they claiming?

…….in the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down. Together they cost the NHS £16 billion a year and the UK economy at large £47 billion a year. 1

Strong start.

These perilous percentages and shocking statistics have presented themselves despite the fact that as a population we are closely following the dietary advice that is being recommended to us. 1

Forgive me just one argument from incredulity, but really? We’ve followed the guidelines closely? 

I’m going to need some evidence for that.

Based on the latest National Diet and Nutrition Survey published in 2014 by Public Health England, our total food consumption is on average 383 calories below the recommended……1

Jesus. They appear to have taken the data literally.

A quick skim through the National Diet and Nutrition Survey report itself reveals the following:

Dietary surveys are reliant on self-reported measures of food intake. Misreporting of food consumption, generally underreporting, in self-reported dietary methods is a well-documented issue. The under-reporting of energy intake (EI) is known to be an issue in past and current NDNS, as for all dietary surveys and studies. This is an important consideration when interpreting the findings from this survey.2

The energy and nutrient intakes presented in this report have not been adjusted to take account of underreporting 3 

It is not possible to extrapolate this estimate of underreporting to individual foods and nutrients because they may be affected differentially. 3

The report also discusses how the doubly labelled water technique was used to validate the figures for a sub set of the surveys and it highlighted potentially large discrepancies between reported energy intake (EI) and total energy expenditure (TEE):

In the NDNS RP, estimates of EI from the four-day diary were compared with measurements of total energy expenditure (TEE) using the DLW technique in a sub-sample of survey participants. The results of this analysis indicated that reported EI in adults aged 16 to 64 years was on average 34% lower than TEE measured by the DLW technique, 12% lower in children aged four to ten years, 26% lower in children aged 11 to 15 years, and 29% lower in adults aged 65 years and over.  3

In short, these figures might show trends or where intakes of certains aspects of diet are below recommended levels but they are not robust enough to conclude that the UK is getting more obese and (T2) diabetic despite eating less. And if you must use the data state the level of uncertainty in the data. I raised the issue on twitter with the collaboration of experts but none were willing to acknowledge or correct the erroneous claim on energy intake which does not bode well for a wannabe charity.

It is also quite surprising to see the collaboration citing this as evidence when Exit Door favourite Aseem Malhotra has previously stated on national television that this type of survey is:

….heavily flawed because it relies on personal reporting which we know classically under reports calories consumed….

I’m not detecting much of a collaborative effort here – did Aseem even read this before release, and if so – did he recognise the mammoth level of hypocrisy involved in putting his name to this?

The call for funding goes on make further broad, unsubstantiated ideologically driven claims without even attempting to evidence them:

…..the Eatwell plate and simple calorie restriction, that have been used for the past 20 years with no improvements in public health 1

All of which is irrelevant conjecture until you have completed the monumental first step of demonstrating that the population have been following the guidelines throughout this period (good luck with that one).

I sense entertainment lies ahead – it will be interesting to see who of the experts are willing to be a trustee of a charity which is already playing fast and loose with the evidence, and more interestingly one whose begging bowl approach to funding seems to places their dubious claims within the remit of the Advertising Standards Authority.


References

1 https://www.indiegogo.com/projects/public-health-collaboration#/

National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012) p74 

National Diet and Nutrition Survey Results from Years 1, 2, 3 and 4 (combined) of the Rolling Programme (2008/2009 – 2011/2012) p75 

 

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