Consumers are following the low-fat message that health professionals have been endorsing for years, according to a 1997 National Institute of Nutrition survey1. On average, Canadians are consuming 30% of calories from fat and about 10% of calories from saturated fat. The bad news is that they are not getting enough calcium (found in dairy products) and folate (found in vegetables and fruit).
  “We have lost our concept of healthy eating in our quest for low fat,” stressed Zannat Reza, MHSc, a registered dietitian working with Dairy Farmers of Ontario. When people start eliminating certain foods, “they are less likely to meet all their nutrient needs.” Indeed, only about 20% of Canadians follow Canada’s Food Guide1 and most people simply zero in on cutting down fat instead of choosing a variety of foods and making healthy food choices across and within all food groups, she added. So it’s time for health professionals to change their approach and start telling people to eat a well-balanced diet with foods from all four food groups.
  It is also clear that people are confused about the fat recommendation. According to Reza, it’s common for people to think they should be consuming 30 grams rather than 30 per cent of daily calories as fat. If one applies the 30 per cent rule of calories to the average woman’s diet of 1800 calories, then women should consume about 60 grams of fat. That is far more than people often believe they are “allowed” to eat. Consumers also have a tendency to read labels on food and if more than 30% of calories come from fat, “they don’t eat it. But the 30% fat recommendations were never meant to be applied to individual foods,” Reza noted.

Another common misconception leading to inappropriate restriction of specific foods is that all saturated fats are “bad,” and all poly- and monounsaturated fats are “good.” Again, as Reza told delegates, studies indicate that stearic acid, the main saturated fatty acid in dairy products, has no effect on blood cholesterol levels and in fact may lower cholesterol levels, which is in contrast with forms of other saturated fatty acids2-5.
  Trans fatty acids (TFAs) are likely to increase cholesterol levels to a significantly greater degree than saturated fatty acids, and TFAs also lower high-density lipoprotein levels, as well as increase triglycerides6-8. TFAs are made by adding hydrogen to oil to make margarine spreadable and to increase shelf life of food. The main sources of TFAs in the diet are partially hydrogenated vegetable oils used in many baked goods, margarines and fried snack foods.
Conjugated linoleic acid is a TFA found almost exclusively in animal fats, especially dairy products. Animal studies indicate that this particular form of fatty acid may have anti-carcinogenic properties9-11 as well as protect against heart disease12, clearly desirable properties which conflict with the image of all animal fats being “bad.”
  “The bottom line is that we can’t conclusively talk about the effects of the different types of fat, because research is still ongoing,” said Reza. “If we are going to talk about fat, focus on lowering total fat. It’s more meaningful to patients and we don’t have to worry about conflicting research results.”

When health professionals advise their patients to lower their fat intake, often their first piece of advice is to choose only low-fat milk and meat products, or eliminate them altogether. In fact, most of the fat (39%) that Canadians consume come from “Other Foods” (as categorized by Canada’s Food Guide) such as butter, margarine, mayonnaise, oils and salad dressing, as well as snack foods. These foods are high in fat and low in other nutrients. Here, the key message to patients should be to limit their intake of these foods.
  Even then, patients should be encouraged to make changes by setting small goals. “When people set small goals for change, they are much more likely to be able to accomplish them,” confirmed Donna Weldon, MEd, also a registered dietitian with Dairy Farmers of Ontario, and the more successful they are, the more likely they will be to try it again. Physicians can help them make these changes by offering small, concrete recommendations rather than by broad “cut down your fat” messages. For example, if a patient likes to eat potato chips every night while watching television, the physician can suggest they limit the number of these sessions and replace the potato chips with a more nutritious snack. This would be a more realistic goal for patients instead of telling them to eliminate potato chips completely.

  Another thing health professionals should keep in mind when advising patients about diet is that most people balk at following what they perceive as a complicated food plan. “We need to focus on what people should do, not what they shouldn’t do,” stressed Weldon. This means no more lists of food that patients need to avoid, which they usually cannot follow and end up abandoning. Concrete, individualized and simple instructions are more likely to be understood and followed. For example, if a patient needs to eat more milk products, they must be given concrete examples of how they may add them to their diet, e.g. milk with cereal at breakfast, a café latte during the day, some yogurt with lunch or chocolate milk instead of pop. Also, if they can simply focus on the winning numbers “5-5-2-2,” they will meet the minimum number of daily servings from each of the food groups: five servings of grain products, five servings of fruits and vegetables and two servings each of milk products and meat and meat alternatives.
  “People often perceive that eating healthy is complicated, that it requires hard-to-find foods and that it’s time-consuming,” explained Weldon. “So if you can do anything to simplify messages to patients, they are more likely to follow them.” A companion resource to “How Much Fat Do You Eat,” entitled “Making the Most of You,” reinforces messages from Canada’s Food Guide and offers patients handson, practical tips about how to go about making and preparing healthier food choices.