Food, consumption and health

Transcription

1 Social Studies Collection 4 No. 24 Food, consumption and health Cecilia Díaz Méndez and Cristóbal Gómez Benito (coordinators) Javier Aranceta Bartrina Jesús Contreras Hernández María González Álvarez Mabel Gracia Arnaiz Paloma Herrera Racionero Alicia de León Arce Emilio Luque María Ángeles Menéndez Patterson

2 Published by the la Caixa Foundation Av. Diagonal, Barcelona GOVERNING BODIES OF LA CAIXA SOCIAL PROJECTS SOCIAL PROJECTS COMMITTEE Chairman Isidro Fainé Casas Deputy Chairmen Salvador Gabarró Serra, Jorge Mercader Miró, Manuel Raventós Negra Members Marta Domènech Sardà, Javier Godó Muntañola, Inmaculada Juan Franch, Justo B. Novella Martínez, Magín Pallarés Morgades Secretary Alejandro García-Bragado Dalmau Chief Executive Officer of la Caixa Juan María Nin Génova Executive Director of la Caixa Social Projects José F. de Conrado y Villalonga BOARD OF TRUSTEES OF THE LA CAIXA FOUNDATION Chairman Isidro Fainé Casas Deputy Chairmen Ricardo Fornesa Ribó (Deputy Chairman 1st), Salvador Gabarró Serra, Jorge Mercader Miró, Juan María Nin Génova Trustees Ramon Balagueró Gañet, Mª Amparo Camarasa Carrasco, José F. de Conrado y Villalonga, Marta Domènech Sardà, Manuel García Biel, Javier Godó Muntañola, Inmaculada Juan Franch, Juan José López Burniol, Montserrat López Ferreres, Amparo Moraleda Martínez, Miguel Noguer Planas, Justo B. Novella Martínez, Vicente Oller Compañ, Magín Pallarés Morgades, Alejandro Plasencia García, Manuel Raventós Negra, Leopoldo Rodés Castañé, Luis Rojas Marcos, Lucas Tomás Munar, Francisco Tutzó Bennasar, José Vilarasau Salat, Nuria Esther Villalba Fernández, Josep Francesc Zaragozà Alba Secretary (non trustee) Alejandro García-Bragado Dalmau Deputy Secretary (non trustee) Óscar Calderón de Oya Managing Director José F. de Conrado y Villalonga Social Studies Collection Director Rosa M. Molins Coordinator Mònica Badia

3 Social Studies Collection No. 24 Food, consumption and health Cecilia Díaz Méndez University of Oviedo Cristóbal Gómez Benito UNED (Coordinators) Javier Aranceta Bartrina Spanish Society of Community Nutrition Jesús Contreras Hernández University of Barcelona María González Álvarez University of Oviedo Mabel Gracia Arnaiz University Rovira i Virgili Paloma Herrera Racionero Polytechnic University of Valencia Alicia de León Arce University of Oviedo Emilio Luque UNED María Ángeles Menéndez Patterson University of Oviedo Electronic edition available on the Internet:

4 Cecilia Díaz Méndez and Cristóbal Gómez Benito (coordinators), Javier Aranceta Bartrina, Jesús Contreras Hernández, María González Álvarez, Mabel Gracia Arnaiz, Paloma Herrera Racionero, Alicia de León Arce, Emilio Luque and María Ángeles Menéndez Patterson The la Caixa Foundation, 2008 Responsibility for the opinions expressed in the documents of this collection lies exclusively with the authors. The la Caixa Foundation does not necessarily agree with their opinions.

5 JAVIER ARANCETA BARTRINA MD, is a specialist in Preventive Medicine and Public Health and doctor in Medicine and Surgery for the University of the Pais Vasco (UPV). He has coordinated the Work Group on Epidemiology for the NAOS Strategy (Nutrición, Actividad Física y prevención de la Obesidad) of the Ministry for Health and Consumer Affairs. He is the technical coordinator for the PERSEO programme (Spanish Food Safety Agency) for the promotion of physical activity and healthy eating in the Spanish population. JESÚS CONTRERAS HERNÁNDEZ PhD, is a Professor of Social Anthropology at the University of Barcelona. His most recent research focuses on the study of the relationship between changes in lifestyle and food changes. Among his numerous publications stand out, Los aspectos culturales en el consumo de carne [Cultural aspects in the consumption of meat] (2001), La obesidad: una perspectiva sociocultural [Obesity: a sociocultural perspective] (2002) and, together with Mabel Gracia, Alimentación y cultura. Perspectivas antropológicas [Food and culture. Anthropological Perspectives] (2005). CECILIA DÍAZ MÉNDEZ PhD, is a Professor of Sociology at the University of Oviedo and specializes in the Sociology of Consumption. Her research is done through the Sociology of Consumption Research Group that she directs at the University of Oviedo. She completed the study Cambio en el consumo alimentario en España [Change in food consumption in Spain] ( ) and among her publications are The sociology of food in Spain: European Influences in Social Analysis on Eating Habits, (Comparative Sociology, 2006) and the book Cómo comemos? Cambios en los comportamientos alimentarios de los españoles [How do we eat? Changes in the eating behaviour of the Spanish] (2005). MARÍA GONZÁLEZ ÁLVAREZ has a degree in History from the University of Oviedo (2004) and is completing a doctorate in the programme in History and Social Analysis, Methods and Sociocultural Analysis. She is preparing her Diploma in Advanced Studies entitled La industria agroalimentaria en España a través de la publicidad. Transformaciones en los conceptos de salud y alimentación ( ) [The agrifood industry in Spain as seen through advertising. Transformations in the concepts of health and food], under the direction of Dr. Cecilia Díaz Méndez. MABEL GRACIA ARNAIZ PhD, is a Professor of Social Anthropology at the University Rovira i Virgili. She has been a visiting researcher in various foreign research centres (CNRSEHSS, in Paris; CIESAS in Mexico and CETIA in Toulouse) and has coordinated numerous studies on the sociocultural dimensions of food, health and gender. Among her most recent publications is Alimentación y Cultura. Perspectivas antropológicas [Food and culture. Anthropological Perspectives] (2005) and two books she co edited: Comemos como vivimos. Alimentación, salud y estilos de vida [We eat how we live. Food, health and lifestyle] (2006) and No comerás. Narrativas sobre comida, cuerpo y género en el nuevo milenio [You won t eat. Narratives on food, body and gender in the new millennium] (2007). CRISTÓBAL GÓMEZ BENITO PhD, is a Professor at the National University for Distance Education. He has participated in different research projects on food related themes. Among his publications in this field stands out the coordination of the monograph Consumo, Seguridad Alimentaria y Salud [Consumption, Food Safety and Health] in the Revista Internacional de Sociología del CSIC (2005) in collaboration with Cecilia Díaz Méndez.

6 PALOMA HERRERA RACIONERO PhD, is a professor of Sociology at the Polytechnic University of Valencia. Currently she forms part of a team of researchers in the field of the Sociology of Food, Rural Sociology and Sociology of the Environment. She is the author of diverse works centred on the study of food behaviour and its transformations from a social perspective and on the analysis of perceptions and attitudes toward genetically modified foods. ALICIA DE LEÓN ARCE PhD, is a Professor of Civil Law at the University of Oviedo with a specialization in Consumer Law and Private Environmental Law. She is the author of numerous publications centred on the protection of consumers and food safety and has directed diverse research projects in this field, the most recent being Responsabilidad civil derivada de daños causados por nuevos alimentos [Civil responsibility derived from harm caused by novel foods] ( ). EMILIO LUQUE PhD, is a professor of Human Ecology and Environment and Society in the Faculties of Political Science and Sociology at the National University for Distance Education. Among his areas of research and his publications are works on the political sociology of food, citizenship and ecology and the impact of the built environment. MARÍA ÁNGELES MENÉNDEZ PATTERSON PhD, is a Professor of Physiology at the University of Oviedo. In 2002 she received the Grande Covián grant from the Prince of Asturias Foundation. She co-directs the Masters in Food Biotechnology and has formed part of the Work Group on Nutrition and Physical Exercise of the Council on Health and Health Services of the Government of the Principality of Asturias.

7 Contents Presentation 9 Introduction 11 Part one: FOOD AND INSTITUTIONS I. The evolution of institutional recommendations on health and food Introduction Development models and food models Evolution of the agrifood system, agricultural policy and dietary recommendations Conclusions 44 Appendix I 46 II. Scientific advances in nutrition and food Introduction Evolution of nutrition and food Future perspectives Conclusions 73 III. Food policies and consumer safety Introduction: Does every cloud have a silver lining? Antecedents: The Spanish Food Code and the General Law for the Defence of Consumers and Users The admission of Spain into the European Community and the food crises Conclusions: better to prevent than lament 96

8 IV. Industry and Food: from referential advertising to functional foods Introduction Analysis of Advertising Advertising by decades: from the 1960s to Conclusions: food advertising, a complex and problematic path toward food modernity 114 V. Obesity, beyond the consumer: structural roots of the food environment Introduction The built environment, physical activity, obesity and inequality A political economy of obesity The «foodscape» of the consumer: the hypermarket and the hamburger The consumer s limited capacity for control The triple invisibility of the agrifood system Intervention models Conclusions 138 Part Two: THE CONSUMER S RESPONSE VI. Preferences and food consumption: pleasure, convenience and health Introduction Food preferences and criteria of choice Description of the eating day Current food trends: new lifestyles and new ways of eating Conclusion: health, convenience, pleasure depending on the circumstances 175

9 VII. Learning to cook: culinary do-it-yourself, letter soup, and the audiovisual stew Introduction The kitchen: a traditional place of feminine knowledge and oral transmission The alphabet kitchen or letter soup Secondary orality or the electronic recuperation of talking Moral cooking Conclusions 199 VIII. Childhood obesity: new eating habits and new health risks Introduction Criteria for the categorization of weight of the child population Impact of childhood obesity on child and adult health Obesity in children, adolescents and young adults in the Spanish population Evolution of obesity in children, adolescents and young adults Analysis of the causes Actions to prevent obesity in Spain Conclusions 229 Conclusions: current problematics related to food, consumption and health 231 Bibliography 250 Index of Graphs and Tables 268

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11 Presentation During recent decades, western societies have reached a level of abundance in the provision of food which is reflected in the general health of the population and consequently, in the increase in life expectancy. Parallel to this, social concern related to health and nutrition has been growing. Concern about having a balanced diet, sensitivity toward internalising healthy habits, growth in the practice of sports at all levels of society and rigour in control over diet are all aspects that demonstrate the social importance this subject has acquired. However, despite public sensitivity and the availability at this time of more than enough food and scientific knowledge on nutrition and health, it is not clear that we are eating better. On the contrary, new disorders such as childhood obesity have appeared, and we find ourselves before a profusion of alternatives about what a balanced diet really is, placing us at a crossroads where it is difficult to make correct decisions about what we ought to eat. Today more than ever, food has an important social basis and is intimately related to the modernisation of societies in all areas of life, which leads us to the idea that an exclusively medical focus is not sufficient to understand and deal with the new problems which have appeared in relation to food. This is how Professors Cecilia Díaz Méndez (University of Oviedo) and Cristóbal Gómez Benito (UNED) have understood it, and as a result, as coordinators of this study they have turned to experts not only in medicine and biology, but also in anthropology, sociology and law. 9

12 The multi-disciplinary focus of this new edition of the Social Studies Collection permits a broader analysis of the relationships between health, consumption and food in advanced societies. In this way, the la Caixa Foundation hopes to stimulate debate on these issues and as far as possible, offer elements to reflect on that can help in the design of public and private strategies oriented toward correcting existing problems. Isidro Fainé Casas President of la Caixa and the la Caixa Foundation Barcelona, February

13 Introduction Cecilia Díaz Méndez (University of Oviedo) Cristóbal Gómez Benito (UNED) (Coordinators) Food and Health in Modern Societies During the second half of the twentieth century food took on a new meaning within Europe, one which developed parallel to the continent s economic take-off and to the origin and development of consumer society. In Spain this great change could be described as the transformation from a society with food shortages to a society with an overabundance of food. At the least, this means two types of relevant changes for the study of contemporary food: on the one hand, objective changes in eating habits, and on the other hand, changes in perceptions related to what it means to «eat well.» These changes share a common characteristic: a growing and novel problematization of food happening in a context where curiously, for Spain, the insecurity associated with a lack of food is no longer a part of the daily life of the Spanish people. Food moved into the background of citizens concerns with the development of consumer society and as Spain improved its economic situation and moved away from hunger and the post-war world. However, the new problematization of food, which forcefully emerged at the end of the 20th century, reveals the social aspects of habits that are increasingly disconnected from the satisfaction of basic biological needs. Today food problems appear connected to social phenomena that have little to do with scarcity and much to do with abundance and globalisation. Nonetheless, in these years of economic and social development, people s ideas about food have gone through different phases, which only a detailed exploration will permit us to understand in all their dimensions. This study will deal with some of them. Food problems did not end with the post-war period and the disappearance of hunger, nor did the new problems from the globalisation of food suddenly emerge with the INTRODUCTION 11

14 change in century. Between these two periods there have been changes in the concept of health and eating, changes in the perception of security and risk, changes in the profile of the consumer, and changes in the role of institutions. All these changes contribute to demonstrating what could be called «a new food order,» but one which continues to be a product of the past and the political, economic, social and cultural development of Spain. These changes have taken place parallel to the genesis, development and consolidation of consumer society in Spain. At the same time, food has gone from necessity to desire and has evolved with the changes in the characteristics of consumers in an opulent society. It is necessary to clarify that the social sciences have participated in a marginal manner in the analysis of contemporary food and have focused on the exploration of food inequalities in times of scarcity. These sciences moved away from the study of the different phases of modernity the moment that hunger stopped being a socially relevant problem and food came to be a strictly domestic consumer issue. However, food has recovered its prominence now that scientists in the natural and health sciences, responsible for analyzing the diet of the population, are finding eating problems linked to an excess of food, the origins of which are more social than biological. In addition, the social sciences themselves have changed their objectives, and feminist studies (demanding a critical look at the domestic sphere) as well as the development of the sociology of consumption (demanding for itself the academic attention previously monopolized by the field of production and work) have permitted the recuperation of sociology and anthropology for the study of food modernity. The health sciences have a particular relevance in social studies of food. Historically, the dietary recommendations of doctors and nutritionists based on food science have been the basis for changing certain practices and habits considered by these experts to be unhealthy. These recommendations have included not only what is to be consumed, but also how, when, where and how much is to be consumed. When we speak about practices and habits, these are not only a result of ideas, values, knowledge and judgments related to food, but also needs, situations and social conditions. To understand these factors in the current diet, the social sciences have taken on a special prominence, as it has been demonstrated that policies directed toward improving these practices 12 FOOD, CONSUMPTION AND HEALTH

15 and habits through the diffusion of healthy diets and dietary recommendations, need to be based not only on solid scientific knowledge about food and nutrition, but also on a sociological understanding of food in human groups. Still thinking about the need to introduce an historical perspective in this analysis, it is necessary to recognize that food has taken on importance in recent decades, in particular, starting with the global food crises. In addition to this new risk situation, there are new pathologies today, such as anorexia, bulimia or orthorexia. Psychological studies on these pathologies have been done, but there continues to be a limited understanding of the social aspects that generate them or intercede in them. There is also growing public concern about the loss of traditional diets and the relation this has with the maintenance or the loss of what is understood as good health. Foods are also appearing that are offered as medicines or products capable of helping one achieve the ideal weight and a svelte figure that contrast with the images of health and body from the past and with the effort of governments to preserve the good health of their citizens. Interest in maintaining health through diet has also grown, as has the impact of the beneficial effects of the Mediterranean diet or the social relevance of cuisines «d auteur.» These and other behaviours show the unusual importance of food, only comparable to the past concern for scarcity of food. In this setting, it is understood that new food problems have important social roots and are intimately related to the changes that modernisation has produced in other areas of people s lives. In the daily food choices that people make, factors and actors intervene which cannot be completely controlled and with diverse dynamics that reveal the complexity of what is known as the «agrifood system:» the path food travels from the soil to the plate. The study presented here offers the possibility of understanding some of the problems involved in «eating well» today. Our purpose is to offer an analysis of the food issues causing the greatest concern at this time, prioritising the consideration of the social dimension of these problems and the motives for their recent appearance in public discussion. We will investigate the concepts of «good diet,» food safety, food risk and health, as well as the mutable character and new roles of public and private institutions in relation to the consumer, and the consumer in relation to new problems associated with the consumption of food. It is possible that the underlying concern of this study INTRODUCTION 13

16 has to do with a paradox: never before has so much been known about food and nutrition; never before have consumers had so much information on these subjects, and never before have food safety and health associated with food been the object of so much attention (and regulation) from diverse public and private authorities; and yet, never before have consumers been so disoriented and confused before the proliferation of dietary recommendations and advice, still not knowing or understanding what «good food» is. Although this study has taken the most recent problems of food modernity as the starting point, nevertheless, it will enable us to understand that we are not facing a completely new situation, or one that suddenly appeared in this new century. This situation has emerged from the evolution of Spanish society itself, from its integration in the social dynamics common to economic development and globalisation, and from its path toward maturity as a consumer society; in short, from Spain s entrance into what analysts of social change call modernity. We have considered it important to explore food issues with two frames of reference: the first focused on institutions and the second, focused on the consumer. This orientation is in response to a dynamic and holistic conception of the scenarios in which the exchange of food is produced, but also to the idea described before, the problematization of food as modern consumer society has advanced. These scenarios consist of diverse pieces, like a puzzle. The consumer is the final destination of food and the agent responsible for choosing the products in order to feed him or herself well. Production is the responsibility of farmer and livestock farmer. But the agrifood chain is a long and complex one and throughout modernity the most important sources of power and decision-making have changed. A clear example of this has been the growing importance of the food industry and the transfer of power to the large distributors, with the relegation of agricultural producers to secondary importance. The growing distance between consumer and producer is another example. And no less important is the growing role of the media as an intermediary among the different agents in the agrifood chain. Because of all of the above, we have taken an analytical approach that emphasizes an historical analysis of contemporary food and diet. This allows us to place the two elements on which we have based our line of argument, the institutions involved in food issues and consumers, into an historical context. 14 FOOD, CONSUMPTION AND HEALTH

17 We know that the existing analytical separation between production and consumption is one of the most questioned aspects of social research on contemporary food. The real separation between those who produce and those who buy and consume has been gradually broadening throughout recent decades. It has been consumers who have demonstrated this by their clear rejection of certain products and certain food situations, or by their support of alternative small-scale producers. These unexpected responses by consumers who have been considered passive and uncritical have been a challenge for the analysis of consumer behaviour. These same actors have demanded institutional intervention in the agrifood chain. The uncertainty of consumption has, curiously, given greater prominence to the consumer in society. The consumer has become more central, more dynamic, more critical and less open to manipulation. We are also aware that this starting point, this historical perspective on the changes in the agrifood chain, has limitations. It is based on a vision of social change as a unilinear process with successive phases. It is easy to fall into a homogeneous and linear vision of food changes in which diversity remains hidden. But we think that it is worthwhile to look at it in this way in order to establish the links between different periods and different actors in the agrifood chain. These links can be causal or non-causal, but without a doubt they offer a panoramic view of the situation and enable us to understand the present by looking at the past. We will try to ensure that the consumer is not presented in the analysis as a mere passive agent of this process of change, and we also hope to show the dynamics of consumer action as consumers face and respond to different situations. For all of these reasons, this study contains two different parts, and an evolutionary treatment of food change in many of its chapters. The first part provides an analysis of the form in which food has been dealt with by public and private institutions and the impact of their actions on consumer behaviour. The evolution in the actions of these institutions and the changing character of their role in different historical periods will allow us to focus on the current debates related to food. The primary role of the institutions involved most directly in food and diet in modern societies has been to preserve the population s health through making recommendations for eating correctly. Nevertheless, over the years this role has been changing INTRODUCTION 15

18 and has turned more toward the field of food safety. In this process we can see an increase in the regulation of food, which reveals the growing intervention of public institutions throughout the food system, even in the eating habits of the public. Institutions, at first, gathered information from experts in the field of medicine and later from the field of nutrition. It was these experts who replaced dietary uncertainty with guidance based on scientific studies, offering reliable information on how to maintain or improve the good eating habits of the population. Agrifood businesses have also played a part in the food changes of consumers and have contributed to these changes by offering information through advertising that has promoted food consumption with the same marketing strategies used to promote the consumption of other products. These strategies, characterized by an in depth knowledge of the consumer, have made it possible to respond to consumer expectations by offering foods that are further and further removed from the world of production. Controversy permeates a large part of the information exchange between consumers and institutions and among institutions themselves. Friction results from changes in the roles of experts with a resulting distrust of scientific information; changes in dietary recommendations from government agencies which confuse the public; and changes in food legislation as a formula for regulating the areas of food production and distribution, not always well received by business when this restricts their actions. These are only some of the frictions that can be detected among institutions. In addition we are witnessing another problem with particular impact on the consumer: everything is pointing toward a progressive distancing from healthy eating habits in spite of the growth of institutional controls, the increase in regulations and greater scientific attention being paid to food. In «The evolution of institutional recommendations on health and food,» Cecilia Díaz Méndez and Cristóbal Gómez Benito highlight the changes in dietary recommendations and in the concept of a healthy diet. The basic idea of the chapter is that these changes are closely related to, among other factors, the conceptions of development and modernity (and within modernity to food modernity) and the evolution of agricultural policy and the agrifood system. 16 FOOD, CONSUMPTION AND HEALTH

19 Through the analysis of the conception of food modernity, according to the first three Foessa Reports ( ), and the analysis of dietary recommendations from diverse government agencies between 1960 and 2000, the authors show empirically not only the mutability of dietary recommendations, but also their close connection with certain aspects of the wider social context. But this mutability of what we consider «good to eat» also has to do with the evolution of scientific knowledge about nutrition and dietetics. In the chapter by Professor María Ángeles Menéndez Patterson, «Scientific advances in nutrition and food» we can see how scientific advances in the middle of the twentieth century impacted on the classical concepts of nutrition, changing the traditional idea of an adequate diet. In this sense, the emphasis of recommendations initially oriented toward the prevention of diseases caused by deficiencies and malnutrition has shifted to the study of the potential for foods to promote health, improve well-being and reduce the risk of diseases associated with excess eating typical of developed countries. This chapter ends with some thoughts on the future of the nutritional sciences which pose new challenges such as the development of «nutrigenomics,» which will lead us to make the leap from general dietetic advice to individualized diets. The paradox between the perception of food safety (which, as has been said, is full of uncertainty and distrust) and the extensive and ample regulation of all aspects of food (from production to consumption, including processing, transport and sales) is confirmed by studying the evolution of food policies in Alicia de León de Arce s chapter on «Food policies and consumer safety.» This chapter takes us on a historical journey of food safety policies in Spain from the second half of the twentieth century until the present. The changes in policy since Spain s entry into the European Union (1986) are highlighted. The author hopes to establish the achievements and gaps in food protection for the Spanish consumer from a legal perspective and to demonstrate how certain events (such as the problem with adulterated rapeseed oil or recent food crises) have led to a legal approach to food safety for consumers and increased their protection. Looking at the contexts that affect eating habits, we find two areas of particular importance: food advertising and the structural context of eating disorders. Regarding the first, Cecilia Díaz Méndez and María González Álvarez in INTRODUCTION 17

20 «Industry and food: from referential advertising to functional foods,» show us how through advertising we learn about dietary recommendations from the agrifood industry, which are transmitted to consumers to capture their attention and influence their preferences. Analyzing the evolution of Spanish food advertising from the 1960s until today, not only can the food models of each period be seen, but also the dominant values related to food and health. Regarding the second issue, in «Obesity, beyond the consumer: structural roots of the food environment,» Emilio Luque responds to certain questions: Who is responsible for the pandemic of obesity declared by the WHO? Is it a private problem whose solution is based on education, or is it also a public issue, of a structural nature? The general trend toward obesity reveals some of the contradictions of a pathological agrifood system that has shaped an «obesogenic» food environment. Subsidies for overproduction, interests of the industry in the wide distribution of the most profitable products (typically those most inclined to encourage excess weight), and the fragile role of the consumer in the context of powerful marketing pressures are some of the issues dealt with in this chapter. The second part deals with the study of the consumer. Although it is impossible to establish a causal relationship with the actions of the institutions dealt with in the first part, the consumer is at the centre of decisions, controversies and problems. The chapters in the second part focus on describing consumers eating behaviours and their universe of attitudes, values, preferences, knowledge and habits related to food. The intention of the authors is to understand the motivations for food consumption and with this, the background of consumer food decisions. Each of the chapters deals with some of the most controversial issues: the problems of the reproduction of the traditional Spanish food culture and the implications this has on the preparation of the daily diet; eating disorders and problems of childhood obesity as a consequence of the inadequate eating habits of the population; or the growing distrust of consumers and the origins of the perception of risk and its evolution in moments of great uncertainty about food. We ll observe the bases of these behaviours, as well as how some habits are declining while others emerge. All of this will enable us to respond to some of the most worrying questions related to inappropriate eating habits and investigate more thoroughly the origin of these new ills affecting society. Controversy is also evident in the field of the consumer. It is complicated to 18 FOOD, CONSUMPTION AND HEALTH

21 know what diverts consumers from dietary norms considered to be appropriate. It is also complicated to determine the factors which could offer an explanation of those food behaviours that could be improved. Curiously, it is easier to analyze the network of actors present in the agrifood market (producers, distributors, retailers and public institutions) than consumers, possibly because the final decisions on food consumption are primarily produced in the private environment of consumption, in the home. From this perspective, Jesús Contreras Hernández and Mabel Gracia Arnaiz describe for us in «Preferences and food consumption: pleasure, convenience and health,» the eating tendencies of the Spanish population today. They analyse different aspects of life (social, family, work, economic, organisation of time, health and value system) to explain the diversity of food behaviours within the different situations and functions in which food plays a part. In this chapter we have a wide and detailed picture of the socio-anthropology of food behaviours. Another area of interest in food changes is focused on what is happening in the kitchen. In Paloma Herrera s «Learning to cook: culinary do-it-yourself, letter soup and the audiovisual stew,» the movement from forms of expression and communication based on orality and imitation to others based on writing and abstraction has induced drastic changes in all orders of life, from economics and politics to daily life. These changes have also radically affected the world of food and have been accelerated by the irruption of new communications technologies. Three forms of transmission of culinary knowledge (oral, written and electronic) overlap and mix together today, leading to the coexistence of different forms of authority and legitimacy (tradition, the written word, medical prescriptions, the health ministry, advertising, audiovisual chefs, etc.). The messages, often contradictory among these authorities, place the modern food consumer in a permanent state of confusion and anxiety given the lack of criteria from which to evaluate and resolve the cognitive dissonance generated. This second part ends with a chapter from a perspective outside the social sciences but which completes our vision of the complex relationship between health and food. Childhood obesity is an emerging problem in all developed societies and one which has grave individual, social and public health INTRODUCTION 19

22 consequences in the short and medium term. In «Childhood obesity: new eating habits and new health risks,» Javier Aranceta Bartrina shows us that it is possible that for the first time in the recent history of humankind, children may live fewer years than their parents. The author talks about premature mortality induced by the early appearance of degenerative diseases, many of them related to excess weight and inadequate eating habits. In this chapter he reviews the clinical and epidemiological concepts of overweight and obesity, the evidence for their potential repercussion on health and quality of life, and the data on their impact in Spain and in other countries of the European Union. Supported by the contributions of the enkid Study, the determinant factors related to childhood and juvenile obesity are reviewed, and the chapter ends with a look at current institutional initiatives to reverse the trends in the coming years, particularly those connected to the school community. In the closing chapter of the book, «Current problematics related to food, consumption and health,» taking the previous chapters as a starting point, Cecilia Díaz Méndez and Cristóbal Gómez Benito set out several lines of thought on the relationship between health, consumption and food. They inquire into conflicts existing among the different agents involved in the problematization of food, and make some predictions about what may happen in the future with food and diet. 20 FOOD, CONSUMPTION AND HEALTH

23 Part one FOOD AND INSTITUTIONS

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25 I. The evolution of institutional recommendations on health and food Cecilia Díaz Méndez (University of Oviedo) Cristóbal Gómez Benito (UNED) 1.1. Introduction The relationship between food and health is based on the assumption that we know the effects of foods, eating practices and habits on health. The nutritional sciences and dietetics seem to provide us with a base of scientific knowledge about the effect of eating and diet on health. Based on this knowledge, numerous public and private authorities make recommendations about what foods we should eat, in what quantities, with what frequency and in what way they have to be consumed. Consequently, if people follow these directions, there is no doubt that the health of the population will improve. From this perspective, the problem is a question of information and education about food. The proliferation of television and radio programs, of specialised magazines and public agencies dedicated to the relationship between food and health is proof of the social acceptance of this way of approaching the problem. At the same time it reveals the existence of health problems associated with food in our opulent societies and the existence of a growing social concern over this issue. However, the relationship between health and food is very complex, and there is a lot of evidence that we are still far from a scientific consensus on what is good or harmful for our health in regards to food, in spite of the unquestionable advances in scientific knowledge in this area. What is more, not only is there a definite lack of consensus on many questions related to these issues, but we can also see that the concept of a «healthy diet» is very mutable, which translates into constant changes in dietary recommendations. In contrast to what one would expect from scientifically based knowledge from nutritionists and food scientists, what is understood as a healthy diet is THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 23

26 as changeable and contradictory as any other social construction, and to such an extent that it confuses the consumer. Anyone, for example, who remembers the dietary recommendations which have come to us in the last two decades from scientific authorities and the media on the benefits or dangers of certain foods, diets or culinary practices can confirm for themselves the «volatility» of expert opinion. It is precisely these changes and contradictions which are responsible to a great degree for the uncertainty that characterises the modern food consumer. This uncertainty and confusion has also come about because of the crises in food safety of recent years (chickens contaminated with dioxins, mad cow disease, etc.), which have not only called into question the modern food production system but also the system that regulates and controls the healthiness and quality of food. As a result, what is placed in doubt for the consumer is the capacity of this system of experts to propose consistent dietary recommendations and to guarantee health and the quality of foods. The changes, which are often contradictory, in dietary recommendations are much more evident when observed over a long period of time. We will have the opportunity to offer some evidence of these changes in the concept of a healthy diet in our country. One could think that the mutability of the concept of a «healthy diet» and the dietary recommendations associated with it are due to the limitations of scientific knowledge in a given moment regarding the physiology of foods, of food sciences, and of dietetics, and that therefore the advance of scientific knowledge in these areas will eliminate incorrect assumptions. Without a doubt this is true. Professor Menéndez Patterson s chapter in this study shows us this, while at the same time exposing the limitations of much of scientific knowledge that was at one point in time accepted without question. But it is not only a problem of scientific knowledge. There are other factors that powerfully influence the mutability of what is understood as a healthy diet. It is in the analysis of these other factors and of the social conditions that lead to the social construction of the healthy diet where sociology can contribute to the study of the relationship between health and food. Other than the level of scientific knowledge of nutritionists, what are the other factors that could explain these changes in the concept of a healthy diet? The hypothesis that we put forward is that the changing concepts of a healthy diet are due not only to logical adaptations to a society changing its food 24 FOOD, CONSUMPTION AND HEALTH

27 needs, but that needs and food problems also change with the society as it develops. The social context explains a good part of what in any moment is understood as a healthy diet. In this work we consider the social context from two perspectives. The first refers to what in each historical period is understood as modernisation (and in particular, food modernisation), and we will see how many things besides information from nutritionists intervene in this conception. The second refers to the context of agrifood production, and concretely to the evolution of agricultural policy and the development of the agrifood system. With respect to the first, what in each period is understood as food modernisation is closely tied to the general theories of modernisation dominant in each historical period. And both the general theories of modernisation as well as those of food modernisation are based on reference models to which behaviours and social values have to be adjusted. To see these reference models we can turn to the diagnosis of the social sciences (sociology in particular) regarding the social situation of Spain since the 1960s in its process of development and modernisation, and how what we understand by development and modernisation has been changing. These sociological works have analysed the state of nutrition, eating habits or even in a partial manner the food culture of the Spanish in each period, as part of the Spanish social situation and as an indicator of the level of development. Analysing these sociological studies on the Spanish diet is justified because, on the one hand, they help to define the social context of each period (they are even part of the context) by showing us some aspects of the Spanish social situation relevant to our analysis, but also because in some way they illustrate for us how sociological analysis is socially constructed and becomes incorporated into the opinions of the experts (in nutrition and diet) as a sort of speculative mirror image, in such a way that more than being analysts of the situation they are part of the situation. Looking back in time, the validity of the statements and recommendations of these sociologists is shown to be as ephemeral as many of the dietary recommendations that we are going to look at, as they are products of very conventional, simple and unidirectional (typical of the times) theoretical schemas of economic and social modernisation. In debt to the opinions of food experts and to an already obsolete theory of modernisation, their diagnoses of the food situation and the social conditioning of the Spanish and their proposals THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 25

28 for improvement are projected on the official dietary recommendations and they inevitably become another factor to explain them, another part of the system of experts. Regarding the second perspective, it must be said that studies on food behaviours, especially the consumption of food, often look at these behaviours as phenomena in themselves or as related to other aspects of culture or to the cultural and social characteristics of consumers but rarely do they connect food behaviour to the evolution of the agrifood sector and to agricultural and food policies; in other words, the production and consumption or supply and demand of food is rarely connected. (1) The supply of food is provided by the agrifood system, composed of the agricultural or primary sector, the food industry and the distribution sector. The first two, in particular the agricultural sector, are regulated by agricultural policies. In this sense, we think that the changing dietary recommendations are also related to the evolution of the agricultural sector, the agrifood system and agricultural policies. The evolution of both sectors and policies has to be seen not only as an adaptation to the changing needs of the population and the preferences of consumers, but also as shaping their needs and preferences. For example, the advertising campaigns of the Ministry of Agriculture, Fishing and Food on the consumption of bananas (from the Canary Islands), sugar, olive oil or sardines are better understood as an attempt to stimulate the consumption of these products as a way of promoting national agricultural production (or fishing) rather than as recommendations made for their dietetic or nutritional values, even though their nutritional qualities or disease preventing qualities are often backed by the opinions of experts. The participation of professional organisations in these campaigns (made up of all the agents in the food chain, from primary production to distribution, and from government to professional organizations) demonstrates this point. Therefore, we think that the situation of the agricultural sector (and the subsequent process of industrialisation of the agrifood industry) and the objectives of agricultural policies explain many of the dietary recommendations, and an in-depth sociological study of these recommendations, should take this into account. (1) This is not the case of sociologists that deal with food who come from agricultural sociology and some economists of the agrifood system. On this theme see Díaz Méndez and Gómes Benito (2005: 21-46). 26 FOOD, CONSUMPTION AND HEALTH

29 In this work we cannot analyse in depth the relationships between food and health from the perspectives pointed out; that is, their relationship with changing conceptions of modernisation and food modernisation in particular and in relation to the evolution of the agricultural and agrifood sectors and agricultural policy. We can only mention some examples to support our hypothesis, but we think this will be enough to make clear that what has been understood as a healthy diet in different times has had to do with diverse social factors and not only with the state of scientific knowledge on nutrition and food at each moment. (2) We do not defend a strong relativism regarding the scientific fundamentals of what is understood as a healthy diet; rather we want to highlight the influence of other factors that are often behind dietary recommendations and that are almost always ignored. To do this it is necessary to widen our critical look to find the logic of these changes in what is understood as a healthy diet in each period. On these issues, as in everything, there are ideologies, beliefs, values and interests involved which condition the reach of the models of a healthy diet and the dietary recommendations associated with them Development models and food models Since the middle of the 1960s many different reports on the social situation of Spain have come out. The first among them were the Foessa Reports, (3) awhich were the most well-known and complete and which also had the greatest social impact at the time. They were followed by other reports from diverse institutions. (4) The first of the Foessa Reports (begun in 1966, when the First Development Plan was barely two years in running) was a study dealing with social problems (with methods of positivist sociology) in order to understand the social reality of Spain and its emerging problems as a developing country. Hence, it paid special attention to the study of the life circumstances of the population, in particular the most disadvantaged sectors. The food situation of the population of a still underdeveloped country appeared as a primary (2) It should also be added that scientific research itself is socially conditioned and oriented, which reinforces our argument. (3) Between 1966 and 1995 five Foessa Reports were completed. (4) Such as the De Miguel Reports about Spanish society for the Complutense University (De Miguel, 1994, 1995 and 1996), among others. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 27

30 problem in the form of shortages and food imbalances. In what follows, and for reasons of space, we will only take into account the first three Foessa Reports, but they are enough to illustrate and support our argument. In these reports we find the first sociological studies on food consumption (not on the general phenomenon of food) done in Spain, as the first three reports (1966, 1970 and 1975) (5) include chapters on the diet of the Spanish. (6) All of them took the construction of a «rational diet» as defined by experts in nutrition as the starting point (citing in particular Gregorio Varela and his school), and this was accepted without discussion. But what is most important is that in this concept of the «rational diet» there was an explicit ideal referent; in other words, the unquestioned dietary model was that of the developed countries (as occurred in general with other aspects of the conventional conception of development and modernisation then in use). The model of development that Spain had to reach was provided by the richest countries (the United States, Germany, France, England, etc.). Their food model was synonymous to the modern developed food model (the so-called «Mediterranean diet» had not been invented, as we will see), and this model had to be adopted in Spain and in other developing countries. The diet of the developed countries (as if they were all the same) both in qualitative terms (types of products that form the diet) and in quantitative terms (absolute and relative quantities of them) represented not only an objective but also a referent to measure the degree of development regarding food of a country. Thus, these eminently empiricist studies, implicitly based on a now obsolete functionalist and univocal conception of development, tried to describe (and barely to explain) the food situation of the Spanish while at the same time using food as an indicator of the development of the country. In this sense, food was not of interest as an object of study in itself, like any other aspect of social reality, but rather for its being an indicator of the well-being of the population. These reports (especially the first two, directed by Amando de Miguel) followed practically the same developmentalist ideology as the Plans for Development (the First Development Plan was from 1964 to 1967). They were closely related and in (5) The third report was directed by Luis González Seara, who substituted Juan Díez Nicolás. (6) In 1967 the same foundation edited a work by Amando de Miguel, called «Tres estudios para un sistema de indicadores sociales» [Three studies for a system of social indicators] in which section 2.8 was dedicated to indicators related to food. This study is of interest because of its quantitative methodology and theoretical approach to the study of food consumption. 28 FOOD, CONSUMPTION AND HEALTH

31 a certain way mutually reinforced each other. In what follows we will see the most interesting aspects of these reports having to do with our argument. The nutritional state of the Spanish as deficient and imbalanced In the first two reports (1966 and 1970) the nutritional state of the Spanish was diagnosed as deficient and imbalanced, as it did not reach the level of caloric intake of the developed countries (3,200 calories per day). In addition, serious imbalances in the components of the diet appeared, affirming that Spain «is at an acceptable level, although there are still great differences regarding the distinct participation of diverse social sectors in this average dietary level and above all, in the distribution of foods, and the diet is very far from being rational» (Foessa 1966: 102). (7) There is no doubt that in those years the nutritional state of the Spanish still presented notable deficiencies, especially in the form of imbalances in basic nutrients and among the different food groups. But along with the verification of nutritional deficiencies the report went a step further and described the average Spanish diet of the period as «irrational:» «A deficient level of nutrition and irrational distribution of food» (Foessa, 1966: 102). The irrational distribution of food was attributed to cultural factors, (8) more than to the acquisitive capacity of the population. In the case of Spain these cultural factors consisted of the «traditional importance that is given to eating,» «that it is not easy to make the midday meal disappear,» «that canned and frozen products are not easily accepted,» that «being fat» or «eating a lot» was socially valued, and in «the social importance of gatherings such as wedding and baptisms, or gastronomic societies,» etc. (Foessa, 1966: 103). In other words, with this slightly folkloric way of expressing it, the study was recognizing the importance of cultural factors in the models of food consumption, which do not necessarily closely follow levels of income. (9) As can be seen, apart from the doubtful causal capacity of those habits, it is (7) As was recognized in the second report (Foessa, 1970: 716), these indicators have to be considered as relative cultural standards and not so much as biological levels «always difficult to foresee» (because what is really not known is if the underdeveloped countries are under eating or if the rich are overeating). (8) The second report says the same thing (Foessa, 1970: 717). (9) Which in a certain manner contradicts the analysis of the evolution of spending on food in the process of development, which affirms that the greater the level of income, the smaller the percentage which is dedicated to food. In Spain, in % of the national income (of family income) was spent on food, 35% in 1963, 33% in 1964 and 27% in The proportion of spending on food has been habitually used as an indicator of development. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 29

32 curious and surprising from our current perspective to relate bad eating habits to the lack of consumption of canned and frozen products. (10) Cultural factors and spending on food Given that the irrational diet was due more to bad cultural eating habits, they said that it was very possible that spending on food would not decrease as incomes increased, and that it would stay above the levels of other similar countries. Nevertheless, the progressive decline in family spending on food meant that the food problem moved from the level of nutrition to that of distribution in the diet. But in this lack of rationality there were not only objective food imbalances (derived from hunger and from bad nutrition that still affected an important part of the population), but there was also a lack of standardisation in relation to the eating habits of the most industrialised countries. Criticism of the modern industrial food system had still not appeared. This imbalanced and irrational average diet of the Spanish population with lower incomes (it is assumed that those with higher incomes had an adequate and rational diet) was characterised by (Foessa, 1966: ) a high consumption of bread (11) (at levels common to countries with low caloric intake, because of the weight of consumption of the rural population), although inferior to that of countries such as Italy, Portugal and Greece and similar to that of France; a high consumption of potatoes, similar to that of Portugal and superior to Italy and Greece; a very low consumption of milk, very far from the levels of the rich countries, and similar to the consumption of Italy and Greece and superior to that of Portugal; (12) a middle to low consumption of meat (similar to Portugal and somewhat inferior to that of Italy); a consumption of fruits and vegetables superior to the majority of countries; (13) a high consumption of fats and fish; a high consumption of legumes, at levels of poor countries, and low consumption of eggs (but growing, due to the incipient development of (10) There is not doubt that the incipient development of the agrifood industry and the domestic technology for freezing began to affect consumer demand for food products. It makes sense, but what we want to highlight is that this type of consumption was presented as desirable and recommended by «experts.» (11) Data was used from the Commission for the Plan for Economic and Social Development, based in turn on studies by Varela. (12) The study echoed the opinion of Casado on the influence of cultural factors on the low consumption of milk, which was explained by the «low valuation of milk.» (13) The increase in consumption of these products is associated with the expansion of new irrigated crops. 30 FOOD, CONSUMPTION AND HEALTH

33 industrial poultry farms) and sugar, quite inferior to that of the countries of central Europe but similar to other Mediterranean countries. (14) Small food shops as part of the problem In the first report (1966) part of reason for the high family spending on food was seen as the responsibility of the retail food system, at that time still dominated by small food shops that according to the report still employed almost half a million persons. This was reflected in the prices of foods in certain places and explains in part the still high percentages of family spending dedicated to food. We wouldn t see the expansion of supermarkets until the second half of the 1960s, and the phenomena of the hypermarkets until the 1980s. (15) Although the changes in the food distribution system (which has consolidated the hegemony of the large stores) has affected the prices of foods, today the opinion is growing that this distribution system has a good part of the responsibility in the formation of bad eating habits. (16) Bad eating habits The study of eating habits and the social factors which determined those habits was considered to be «an aspect barely analysed and one which the sociological point of view can, without a doubt, help to outline quite a bit» (Foessa, 1970: 715). (17) As mentioned above, the change toward a more balanced and «rational» diet required that bad eating habits be eliminated. The reasoning was correct but what it raised was the issue of what was understood by bad habits. In these reports, the starting point was that the change in eating habits found irrational obstacles «in the sense that they are not foreseeable through the law of supply and demand. In other words, using only the classical model, the people are not as sensitive to price as would be imagined,» therefore change depended on many other economic, social and cultural factors (seen as problems). (14) The third report (Foessa, 1976) insisted on this comparative perspective. According to the report, in those years Spain was ranked in an intermediate position in the consumption of total calories and calories of animal origin, in other words, «Spain is reaffirmed as a nation of intermediate development» (Foessa, 1976: 244). (15) Contreras, 2000: 311 and ss. (16) On the return of some developed countries to promoting small businesses and the effects of large-scale distribution on bad eating habits, see Mauleón (2007). (17) The third report recommends doing nutritional surveys to support local or national campaigns to correct food habits and to prevent nutritional deficiencies, such as doing educational campaigns in schools and in the media to teach consumers (Foessa 1976: 526). THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 31

34 As a result, «the most interesting analytical problem is to determine the motivations for assimilating new products into the diet» (Foessa, 1966: 112). As an example of the influence of these factors the study analysed the cases of frozen fish and meat, products whose consumption was recommended as components of a more rational diet. (18) The increase in their consumption was not only dependent on price, but rather on other social and cultural factors. In those years, the consumption of frozen fish and meat was associated with modernity, (19) status (high) and social class (upper-middle and upper) (Foessa, 1966: 114). After analysing these cases, the authors concluded that to support a change in eating habits it was necessary to promote the following: spread of dietetic education, principally through the media and among primary school teachers; the expansion of systems of refrigeration as much in productive and distributive industries as in homes; contact with foreign dietary models, through travelling; programmes of complementary food (milk in the schools); and progress in the preserving of many perishable or exotic foods. Given the difficulty of putting these factors into action in rural zones, they proposed specific campaigns directed at children and young women as part of community development in rural zones (Foessa, 1970: ). (20) Progress and modernity in food The 1970 report (Foessa, 1970: 716) (21) explicitly stated what was understood by food progress: 1) Proportional decrease in the budget destined for food. 2) Increase and balance in the level of food consumption in calories, proteins, minerals and vitamins. 3) Increase in the percentage of foods of animal origin, which means a greater nutritive richness for the quantity consumed. (18) It should be noted that fish was introduced in a general and massive way in the Spanish diet in the years of rationing, as, until then, fresh fish was almost unknown in the interior of the country, while frozen fish didn t spread until the beginning of the 60s and its development was conditioned by the lack of diffusion of refrigerators (Foessa, 1966: 112). (19) We won t go into the concept of «modernity» here. We have worked based on the suppositions raised and discussed by Solé (1998) and with the suggestions from these concepts on food raised by Poulain (2002). (20) Which is being done now through Agents of the Household Economy of the Agricultural Extension Service, as will be seen. (21) Also in the third report (Foessa, 1976: 512). 32 FOOD, CONSUMPTION AND HEALTH

35 4) Balance in the cultural interpretation of food, in its conception as a reasonable means to restore energy, but also conserving as far as possible aesthetic values, of human relations, etc. which distinguish the function of food. Behind this progress was, without a doubt, the food model of Europe and North America, high in proteins and fat of animal origin. (22) In contrast the average diet of the Spanish in those years was still far from that model. It was described as having: 1) Consumption of cereals at an intermediate level between central Europe and southern Europe. 2) A very high level of consumption of potatoes. 3) A fairly high level of consumption of legumes with a decreasing tendency and quite a bit less than in Portugal. 4) A high consumption of vegetables and low consumption of fruit. 5) An intermediary consumption of meat, between the extremes of Portugal and France. 6) Very high consumption of fish, almost at the level of Sweden and Portugal. 7) High consumption of fats, almost at the level of France. 8) Rapidly growing consumption of eggs. 9) Low consumption of milk, below that of Italy and Greece, and somewhat above that of Portugal. In general, the evolution of the Spanish diet was close to the Italian model. But food modernity was also associated with an urban phenomenon: «It is the fact of living in cities which determines in all social groups the probability of having a more balanced and modern diet» (Foessa, 1970: 718). But habitat and income combined in the models of diet: the urban middle classes were those that had a diet most similar to the European, while the urban working (22) The third report (Foessa, 1976: 514) continued proposing an increase in the consumption of animal proteins. The report says: «the essential components of the Spanish diet have varied in form in recent years. Between 1960 and 1970 we have gone from 75 to 85 grams of protein (of animal origin) per habitant per day,» and later: «Nevertheless, in comparison with other European countries Spain consumes more bread and less meat, milk and butter» (Foessa, 1976: 514). THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 33

36 class and the rural classes were those which maintained the «stereotypical» elements of the Spanish diet. The improvement in the diet of the Spanish in those years was still conditioned by what was called the «food potential.» (23) The potentials expressed the changes in the agricultural sector (expansion of crops, dairy factories, intensive poultry installations, etc.) as well as the changes in foreign trade of agricultural products. Nevertheless, the existence of some obstacles, such as the delay in refrigeration capacity, impeded the more rapid growth of the availability of some products, such as milk. In summary, the Spanish food potential was growing beyond forecasts, although it was still below that of similar countries. But it was already reflecting changes in the structure of agricultural production in the country, which would allow the acceleration of change in the model of diet in the second half of the 1970s (Foessa, 1970: ). It must be said that productive changes in the agricultural sector (agricultural and livestock production) and in the agrifood industry, propelled by agricultural policies and by the agrifood market itself, were oriented by earlier models of consumption, not so much (or not only) by demand. The case of the consumption of vegetable oils and fats, distinct from olive oil was a clear example of this orientation. It is interesting to see how modernity in diet was understood in these reports. It was demonstrated in the consumption of certain foods, which supposed greater aesthetic taste, greater ease, better quality, etc., such as frozen fish, prepared soups, instant coffee, frozen meat, juices, loaf bread, etc.; in other words, typical products from the supermarket, (24) and less frequently available in rural areas. However, it is interesting to note that, given the advantages of these products («their greater rationality,» sic), they were not consumed more among the urban middle classes. Rather it is the families with higher incomes that bought more of these (rational) products. The consumption of these products was considered in the second report as an example of rational eating, and their low consumption among the lower classes was an example of bad habits: «While they subsist [referring to the low consumption of these products] it can t be said that the modest classes achieve a rational and sufficient diet. In any case, what (23) In other words, the balance of production plus or minus the trade balance with the exterior plus or minus self-consumption, losses, etc. (24) In expansion in those years in which hypermarkets still did not exist. 34 FOOD, CONSUMPTION AND HEALTH

37 is evident is that the diet that we could call modern appears to be the norm almost exclusively among the comfortable urban classes» (Foessa, 1970: 724). For the report, the product of greatest power of class distinction was loaf bread: «The wealthiest classes permit themselves what is still, in reality, a luxury, in other words, the use in their diets of more manageable, storable, nutritious, and most of all, more varied products» (Foessa, 1970: 725). Another aspect of this qualitative change was the increase in the consumption of beverages of all types: soft drinks, nutritional drinks, stimulants, etc. Compare this «modern and rational» diet with current preferences and dietary recommendations and we can see their peculiar relationship. The gradual move toward the European diet can already be observed in the third report (Foessa, 1976: 515), which said, regarding the relative decline in consumption of cereals and potatoes, that «these declines reflect a substantial improvement of diet thanks to the lesser relative importance of these products, considered to be of inferior nutritional quality,» and that the value of proteins had increased almost 10 percent, while consumption of animal proteins as a percentage of all proteins had gone from 30 percent to 45.7 percent. However, the report still insisted that the Spanish diet continued to be «[ ] lacking in what are referred to as nutritive substances (proteins, minerals and vitamins), given that the diet is principally composed of legumes, fats, cereals, beverages, etc.» (Foessa, 1976: 244). After affirming that the quality of food was improving, the problem was relegated to the poor classes or to rural areas where less animal protein, fats, minerals and vitamins were consumed and more vegetable proteins and carbohydrates: «It presents, therefore, a type of diet of very inadequate composition.» The role of the household economy The second Report (1970) was an advance on the study of food culture and habits compared to the 1966 report. For the authors of this Report, what was important was to confront the problems that determined the adaptation of the diet, the change of certain eating habits, the acceptance of new foods, the diffusion of certain rudiments of food science, etc. (Foessa, 1970: 722), and all of this with a practical end: to know the determinants of eating behaviours and, in this way facilitate change toward a more rational diet. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 35

38 From this perspective, the second report centred on the family, (25) because this was the most important and most useful sociological context for understanding the social situation. In this context the problem of the household food economy had an extraordinary importance (Foessa, 1970: 722). The report introduced the concept of «food culture,» although it recognised that this was an abstraction not taking into account regional diversity and urban and rural differences. The European referent was also explicitly present in the analysis of this food culture, for example, in relation to meal-times. The typical timetable for the three meals was quite different from the general European timetable, the Spanish generally eating much later (with a trend toward being even later) (Foessa, 1970: 722). In the family sphere it was the «bromatological culture» which also explained the changes, once a certain determined level of income had been reached (Foessa, 1970: 726). The report produced an «index of food education» which revealed that the highest values were in the urban strata: housewives with secondary or higher education, the upper middle-class and upper class, non agricultural classes, those with the highest incomes. They made various recommendations to improve eating habits including having an earlier and complete breakfast, a lighter lunch at mid-day, most often out of the house, and an earlier and more complete dinner in which the whole family would meet once again, the European model. Connections with the agrifood sector and the institutional framework The third report (Foessa, 1976) went a step further in relating the food model with the food production system, in such a way that the changes in the structure of final agricultural production went hand in hand with the changes in the structure of food consumption, as in the case of the consumption of meat especially chicken and also eggs, milk, sugar, fish and fruit, while the consumption of cereals, legumes and vegetables barely grew. However, Spanish agriculture still had grave structural problems to the extent that the national agricultural sector could not satisfy the growing internal demand caused by the increase in income and population growth. (26) The report insisted on the need to adapt supply to demand, which became one of the objectives of the chapter on food of the Third Development Plan. (25) Following also the orientations of the CCB Plan and the work of Demetrio Casado (1967). (26) As a contrast, the study mentioned the poultry sector, «which is the only branch of our agriculture that has managed to reach international levels difficult to surpass» (Foessa, 1976: 510). 36 FOOD, CONSUMPTION AND HEALTH

39 The report also highlighted the structural deficiencies of the Spanish food industry: small in size and atomized, lack of hygiene and with deficiencies in marketing channels. For these years, the importance of food in the growth of GDP was still very high (55 percent), revealing characteristics of an underdeveloped country, and with the attendant high prices of agricultural products and food as a consequence of these structural problems. New problems: fraud and the adulteration of food Innovative compared to the previous reports, the third report gave attention to «one of the grave problems affecting the food system of our country,» the adulteration of foods (Foessa, 1976: 522). After the development of the industrial system of food production during the decade of the 1970s, problems associated with this system appeared. The authors expressly said: «It is curious that as a country develops and the system of the provision of food becomes more complex, biotic contamination (food infections) and abiotic contamination become more frequent; the first because the food production chain is longer and the second because in order to preserve food, because of its presentation or because of it being the object of fraudulent trade, the addition of diverse substances or their substitution for other similar ones is required.» The authors didn t spend much time on this question nor on its implications for the analysis of industrialized food systems, although they introduced (probably spontaneously) terms such as «chain» to refer to the successive handling of food, though not so much to refer to the concept of a «food chain.» Considering that these problems were inherent in the food system, they demanded better legal regulations such as the elaboration of a food code and greater control over inspections, in addition to making businesses «conscious» (Foessa, 1976: ). Thus, it is in those years when problems with the modern industrial food system first began to be perceived, although some of the old problems still persisted. In this sense, the report picked up on the need to elaborate a Spanish food code. (27) (27) The code was approved in 1967, but it wasn t put into effect until six years later. Its parts are 1st, General principles; 2nd, General conditions of the materials, treatment and personnel related with foods, food establishments and food industries; 3rd, Foods and beverages; 4th, Additives and impurities of the materials directly related with foods (the 5th part is not mentioned). (See the chapter by Alicia de León in this book). THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 37

40 1.3. Evolution of the agrifood system, agricultural policy and dietary recommendations If we observe the evolution of dietary recommendations (DR) (28) from a certain historical perspective we can see that they not only followed changes in Spanish society but often very closely followed agricultural policy and the evolution of the agrifood sector. As we said in the introduction, this parallel demonstrates the influence of non-scientific factors on the changes in DR and in the concept of a «healthy diet,» changes that increase the contingency of many of these recommendations and the concept of a «healthy diet.» Given the limitations of space, we only want to highlight some of the relationships that support our argument. (29) During the decades analysed we can see the changes that took place in the social context as well as in dietary recommendations. Many of the social factors of change in our most recent history constitute a reference for understanding the way in which the recommendations and the concept of «appropriate diet» itself have varied. We are going to highlight several aspects considered to be independent variables in explaining the changes. In the 1960s and 1970s in the context of a still very rural society and one with a majority of the active population in the agricultural sector, dietary recommendations were exclusively in the hands of agricultural institutions. (30) In those years the Ministry of Agriculture was responsible for spreading a new food culture in which we can see the close connection with the direction of agricultural policy. With a tone of paternalism, they transmitted a conception of appropriate diet focused on the objective of improving the diet of a population which coexisted with underdevelopment and which still remembered shortages and hunger. In this period the role of Home Economics (28) We understand dietary recommendations (DR) to be guidelines made by public and private authorities to change the food consumption habits of the population by recommending certain practices and consumption of certain foods and advising against others. The DR are broader than nutritional recommendations (NR), given that they refer to all aspects of eating and not only diet. (29) These aspects are dealt with at greater length in an unedited and more extensive version of this section (Díaz Méndez and Gómez Benito, 2006). The principal aspects of this evolution are presented synthetically in Appendix I. (30) In 1960 Spain was still a very agrarian society, with 40% of the active population employed in agriculture, and with almost 58% of the population living in towns with less than 10,000 inhabitants. 38 FOOD, CONSUMPTION AND HEALTH

41 Agents in the Agricultural Extension Service (SEA), created in 1955, was very important. (31) Organisations in charge of health and subsequently consumption were gradually increasing in importance. The Ministry of Agriculture, decisive in the beginning of the 1960s for the expansion of the basic concepts of adequate diet, was slowly relegated to the promotion of national agricultural products. Its secondary role in the field of foods was more noticeable after Spain s entrance in the EEC. The institutions oriented to consumption became the basic referents. They related consumption to health through information which came from the Ministry of Health and Consumer Affairs. In this context food became a specialised field for action. Institutions, such as the National Consumer Institute were created, more focused on the role of the consumer and his/her education and protection and distant from the institutional sphere of healthcare. Changes in Spanish society itself were reproduced in the field of consumption. In the beginning of the 1960s information was oriented toward the urban population as the trend toward urbanisation of the Spanish population after the rural exodus was being consolidated. Later, in the middle of the 1980s, after the crisis of the adulterated rapeseed oil, (32) protection of consumers deepened. If at first it was about recommendations of an informative nature instructing the citizen as a consumer (to read labels, choose establishments carefully, etc.), in the 1980s the confidence of all that which was state regulated was offered, clearly highlighting the character of the state as protector in food related themes. The 1990s, however, reveal the advertising-like character of institutional recommendations under the auspices of businesses and nongovernmental organisations that contributed, together with the state, to the diffusion of dietary information about national products within the European market in which they compete. Curiously one can see the change from a decade in which the government showed its interest in the Europeanization of Spain, to the period subsequent to Spain s entrance in the EEC, with an (31) Because of this, dietary recommendations were often associated with problems of the home and of the rural household economy, with the objective of attaining better use of the resources of the family garden, of improving the household economy and of improving the diet of the family. The recommendations were not only made from a nutritional perspective, but also with the goal of creating a demand for the new products that the agrifood system was putting on the market. (32) See the chapter by Alicia de León in this book. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 39

42 orientation toward the stereotypical Mediterranean diet and characteristic national products. (33) Some of the advertising campaigns of the Ministry of Agriculture, Fishing and Food on the consumption of bananas from the Canary Islands, sugar, olive oil or sardines, among other examples, are better understood as a stimulus to consume these products in support of national agricultural production rather than as recommendations for their dietetic or nutritional value, even though their nutritional qualities or ability to prevent diseases is backed by the opinions of experts. The participation in these campaigns of interprofessional organizations (integrated by all the different agents in a productive sector for example, sugar from primary production to distribution, from government to professional organizations) reveals what we have said. Therefore, we think that the situation of the agricultural sector and subsequently, the process of industrialisation of the agrifood industry, together with the objectives of agricultural policies explain many of the dietary recommendations, and an indepth sociological study of them has to take this into account. The variations in the target of dietary recommendations are also meaningful. If in the 1960s the recommendations were directed at rural housewives, going into great depth on their jobs as sole caretakers of the family diet, this target was gradually changing. The traditional role of the woman as housewife changed in the 1970s as recommendations began to be directed at the urban woman. But the image of the woman as the person responsible for the feeding and care of the family and home persisted. Although in the 1980s the society showed signs of demanding gender equality, and women were starting to work outside of the home, the recommendations still continued to respond to a stereotype of a hardworking woman taking care of her family, but who now was offered the possibility of spending less time cooking. In the 1990s the target of the recommendations acquired a more individual and depersonalised character; that of a consumer who seemed to have no objectives and concerns other than feeding him/herself and taking care of his/her body. At the end of the decade family responsibilities regarding food and eating reappeared, although (33) It is not by chance that the regulative and protective character of the state returned at the beginning of the 21st century, after two new food crises (mad cow disease and dioxin contaminated chicken) that would be dealt with institutionally by the creation of a specific body with the object of assuming control over the situation: The Food Safety Agency. 40 FOOD, CONSUMPTION AND HEALTH

43 with a new character; now the family had to take on the role of co-educator in order to bring about the convergence of the educational orientation of the state regarding diet with that of the family, as they appeared to have grown apart. This was perhaps a late return to the domestic after a period in which the decline in women s responsibility for food and eating had been in part made up for outside of the home (by school lunchrooms in particular). The referent for the reliability of dietary recommendations also underwent important changes; from the town doctor in the 1960s to the researchers who analysed human nutrition in the following decade. This trend was consolidated in subsequent years through continual references to specialists in nutrition, medicine and pharmacy accompanied by institutional guidance on correct eating. Beginning in the 1980s we see these experts more technical side, as researchers whose advice is based on the findings of the experimental sciences. First, general information on the nutrients in foods is presented in simple and easy to understand pictures, like the food wheel and later the pyramid, and then other more elaborate messages appear. In the 1980s guides to food and diet with a clear educational character came out, not only to provide nutritional information on food, but rather to assure that this information would be accepted and adopted as the dietary recommendations of reference. But perhaps what has changed more is not the expert but the role of the recipient in relation to the expert. In the 1960s people were told that they had to consult their doctor for correct dietary guidelines, and rural women were asked to forget traditional knowledge based on experience. This orientation is understandable given the low educational level of these women, as well as the little value given to their skills and knowledge on the part of the government of the time. The higher educational level of the recipients can be perceived in the following years through the more elaborate messages aimed at them, including abundant technical information on the nutrients in food. They had acquired a well-rounded education which meant that dietary decisions in the home could be based on nutritional knowledge attained from scientific experts. Rationality was the appropriate norm, although curiously in some cases what at that time was considered a rational diet has subsequently come to be considered irrational. In the same way, what was in days gone by traditional and therefore reviled, by the end of the 1980s and in the 1990s came to be considered part of correct dietary norms; what was before considered a luxury THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 41

44 is today popular and what before denoted low social status is now associated with the diet of the elite and most educated. But perhaps the most significant changes were precisely those which referred to what was appropriate to eat and to what should not be eaten. The conception of diet and health promoted by government institutions in these different periods was implicit in these changes. The recommendations of the 1960s were a reminder to an (underfed) population of the appropriate guidelines, instructing them to leave their monotonous diets and incorporate new products into their menu. Here quantity, in the interest of bringing variety to the diet, was more important than any other recommendation, whereas in the 1970s the effects of this could be seen through guidelines to eradicate the idea that being healthy meant being fat. They insisted on breaking this association through recommendations that promoted the consumption of industrial products and fish to complete a diet based on animal fats. The institutional objectives of the 1960s and 1970s were finally achieved, as the diet grew in variety and quantity, but there were also effects on the composition of the diet, as a greater preference for meat, a product of superior status, was notable. At the end of the 1970s and in the 1980s the recommendations tended to incorporate new products into the diet substituting for traditional ones; pasta, rice and industrial sweets came to occupy a space left by legumes, and were status symbols of the lower classes. But also as a result of this social symbology, new positively valued products emerged such as new vegetable oils, white meats and a series of products that denoted modernity in measure of how far they were from those considered traditional and rural: red meat, animal fats, pork, chicken, stews, etc. Everything related to the backward rural world was what the urban population desired to get away from, and this was promoted by the government. From the period of scarcity the society quickly passed to a period of overabundance with no sense of continuity. Obesity, which in the 1960s and beginning of the 1970s was raised as an issue that affected children crossed the borders of age. The developmentalism impregnated in the recommendations and the eagerness to introduce more expensive higher status industrial products into the diet marked the middle of the 1970s. Dedicating little time to cooking, eating prepared products, moving away from the natural and the rural marked the beginning of the 1980s. All this led to the appearance of new food problems and the beginning 42 FOOD, CONSUMPTION AND HEALTH

45 of institutional concern about cholesterol and excess calories, without a doubt the result of the recommendations of previous decades and marking the period from the beginning 1980s up to the beginning 1990s. In this sense there was notable interest in reducing the consumption of sugar and sweets, eating less meat or opting for lean meats, controlling the consumption of carbohydrates including bread, and reducing the consumption of eggs which were considered to be dangerous because of their effects on cholesterol. The expansion of low calorie products was exploited by agrifood advertising ad nauseam. (34) If at the beginning of the 1980s the concern was about cholesterol and calories, by the end of the decade and after Spain s entry into the EEC, we detect an expansion of products of a national character, products previously questioned but that now made possible a different and «identity-linked» diet in the context of a free-market and the loss of national differentiation. Olive oil won terrain over animal fats, although to achieve this, negative assessments of some other products (in particular vegetable seed oils) had to be introduced. In the return to the roots and to traditional diets, references to previous times, now positively valued appeared, while developmentalism seemed to have reached its limits. The promotion of the Mediterranean diet had its maximum expansion in the 1980s and the 1990s, in an attempt to recover the foods which came from the more traditional rural past, such as legumes, fruits and vegetables. Thinness emerged as a value to pursue, and these foods aided in achieving it. In addition a certain national identification was offered through their consumption. In the 1990s what we could call a certain medicalization of dietary recommendations appeared. The association between health and food was fostered by establishing a causal relationship between the consumption of certain products and the absence or presence of certain illnesses. The recipient of information about this relationship would then know how to achieve optimum health and avoid or correct illnesses through the consumption of certain foods. If recommendations of earlier decades included non-dietary aspects about the care of the home, the (extra) dietary norm of the 1990s was physical exercise as a decisive element to accompany an adequate diet. But perhaps this was (34) At this time preoccupation with being thin increased. Little by little the recommendation to not gain weight was accepted at a time of generalized access to food products and of huge expansion and acceptance of industrial foods. In this context of overabundance any excess could lead to obesity. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 43

46 the only common element regarding what the consumer should do, as the relationship between diet and health had reached such an extreme between those products that were good for you and those that were not. By then, the capacity to follow the path toward health or illness was left in the hands of the consumer. Behind the recommendations for the perfect body, meaning thin and shapely, was the idea of having control over one s own body and also the capacity for self-control in diet. Perhaps for this reason the beginning of this century has culminated with the insistence, as an institutional slogan, that there are no good or bad foods, but rather correct or incorrect diets. This would seem to indicate that the recommendations of the previous decade have been taken to an extreme. Consumers have controlled their eating in order to lose weight, even to the point of becoming unhealthy. We can observe an institutional preoccupation with the effects of «miracle diets,» in particular in the search for the ideal weight at whatever price (this is the era of institutional concern for anorexia and bulimia), reminding us of the importance of excesses as much as deficiencies. The slogan now might be, «You have to eat some of everything,» which reminds us a lot of the 1960s, then because of shortages and deficiencies and today because of an excess of foods. It is a demonstration of the concern for what is now being called «the epidemic of the 21st century,» obesity, but also for being overweight. Without a doubt we can expect an institutional campaign against obesity based on the important association established by researchers between the increase in body weight of an overfed population and the development of a great number of diseases. The overweight children of the 1960s, now mothers and fathers, seem today to have the «moral» obligation of ensuring the ideal weight of their children and themselves, with the same responsibility they had in the past to communicate values of another nature Conclusions As we indicated at the beginning of this chapter, it is not easy to establish an unquestionable causal relationship between dietary recommendations and the factors that make them vary. But we believe that this study gives a good 44 FOOD, CONSUMPTION AND HEALTH

47 account of the existing relationship although it may be difficult to specify the complex connections. The dietary recommendations (DR) of each period play with a conception of adequate diet that is very mutable, and they are constructed to respond to social changes and to the convenience of institutions. They follow sometimes very closely the dominant conceptions of development and modernity. In addition, the parallels between the DR and the evolution of agricultural policy (first) and the agrifood system overall (after) is evident. It can be stated that a large number of the food problems that we see today were forged in the past, and came about as unintentional effects of the actions of institutions pursuing the modernisation of Spanish society. The stimulation of the move away from the traditional diet, its products and knowledge, is apparent today in a set of dietary habits far from the traditional diets of days gone by. The search for variety to break with the dietary monotony of periods of scarcity has been accompanied by the appearance of new products. Though not always bringing the expected health, they have nevertheless, replaced previous foods. The «common» culture reclaimed through the Mediterranean diet seems to have fallen on deaf ears in some homes where traditional patterns are no longer the reference for action or of status. The proposal to recuperate these habits is today a complicated or even impossible task, not only because much of the past is lost or unknown, but rather because of a greater number of interests. The agents of these new interests guide the recommendations today toward an optimum diet, on occasion with greater insistence and influence than the institutions themselves and, above all, not always in the same direction. All of this points out the importance of analyzing in-depth the factors that we have mentioned here as generators of the changes in the concept of the healthy diet. Each of the aspects evaluated here can be analysed separately. However, without a doubt there are still areas to explore which can enrich our analysis of what we might call «a social history of the Spanish diet,» and that could help us to understand and face what is now being called «food destructuring.» THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 45

48 Appendix I What should we eat to be well fed? FIRST PHASE: the beginning of the consumer society (1960s) HISTORICAL CHARACTERISTICS OF THE PERIOD INSTITUTIONAL REFERENTS AND THE PROFILE OF THE RECIPIENT OF INFORMATION DIETARY RECOMMENDATIONS CONCEPTIONS OF FOOD Agricultural modernization following the model of the Green Revolution. Growth in the productivity and development of industrial livestock farming. Institutions: MAPA through the SEA and INC. Experts: Agents of household economics of MAPA. Family doctors. Food sciences. Recipient: Rural housewife, role of the mother and caretaker of the family and the home. Take care of the diet of the family to achieve optimal nutritional state. Incorporate variety to a diet poor in products. Look for balance in the nutrients in the daily diet. Basic hygiene recommendations (special reference to milk) in reference to handling and conservation. General information about vitamins and their importance in diet. Keys: to eat more variety. The diet of the rural population is poor and needs to include more products. The rural woman, caretaker of the family and the home, needs better nutritional information to achieve this objective. Information is offered about the nutrients of foods and some concrete deficiencies (vitamins) for their integration into the diet. The guidelines for the handling of foods are deficient for their productive origin within the families themselves. These guidelines must be modified. 46 FOOD, CONSUMPTION AND HEALTH

49 SECOND PHASE: development and urbanization (1970s) HISTORICAL CHARACTERISTICS OF THE PERIOD INSTITUTIONAL REFERENTS AND THE PROFILE OF THE RECIPIENT OF INFORMATION DIETARY RECOMMENDATIONS CONCEPTIONS OF FOOD Expansion of irrigation, new crops oriented toward national and international markets. Increase in supply and decrease in prices. Growth in demand faster than growth in supply. Petroleum crisis. Institutions: INC and MAPA through the SEA. Experts: Family doctors. Food sciences. Recipient: Urban housewife, only purchaser of foods for others, also busy outside the home (without specifying the labour role). Reports on the nutritional components of foods through the food wheel and the Spanish food code. Information about the advantages of products that include some industrial phase in their treatment (obvious examples in the pasteurization of milk and in frozen fish). Promotion of habits that ease housework through technology so that it is easier and more simple to cook (promotion of precooked meals and the use of pressure cookers). Traditional home-cooking makes one gain weight. Careful with calories, if you eat too much you will gain weight (fewer eggs, less sugar, less bread, less animal fat). Being fat doesn t mean being healthy. The nutritional education of the housewife must be improved so that she can feed her family correctly. The rural origin of dietary practices is detrimental to the expansion of modern eating habits and slows down their diffusion. Industrial products are better than products that come directly from the country as they are safer to consume. The conception of food is integrated in the food wheel and the creation of the Spanish food code. Obesity is a public health problem. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 47

50 THIRD PHASE: modernity (1980s) HISTORICAL CHARACTERISTICS OF THE PERIOD INSTITUTIONAL REFERENTS AND THE PROFILE OF THE RECIPIENT OF INFORMATION DIETARY RECOMMENDATIONS CONCEPTIONS OF FOOD Decline in the agricultural labour force and increase in the urban population. Entrance in the EEC: productive change and change in agricultural supply. Development of the State of autonomous regions. Promotion of the Mediterranean diet associated with Spanish foods. Toxic syndrome from adulterated rapeseed oil. Institutions: INC for recommendations for consuming. MAPA oriented to the promotion of Spanish products. Autonomous and or municipal bodies oriented toward consumption. Experts: Family doctors. Nominal reference to experts in nutrition at national level. Recipient: Urban housewife. With diverse roles between the traditional housewife and mother with other characteristics less centered on the home. Specific orientations inside the home for members of different ages (children, adolescents, old people). Significant increase in recommendations related to the handling and sale of foods: hygienic measures within and outside the home (bars and restaurants). Growth in state control over foods to guarantee consumer safety. Concern for childhood obesity and for cholesterol. A balanced diet is necessary, eating some of everything, not only what one most likes. Consumption of that which is accepted (white meats, sweets) has extended to excess, while other products are consumed less (legumes). Eating more fish and meat with less fat (pork) is recommended, along with fruit, vegetables, olive oil: recommended to follow the Mediterranean diet, composed of Spanish products. Recommendations for responsible consumption that is not manipulated by advertising or other demands to buy. Recommend reflection in consuming. It is necessary to eat some of everything to find nutritional balance in the diet. If one product is consumed a lot and another is missing the diet is not correct. Consumption of quantity and variety based on age, work, sex and place of residence. The ingestion of fat is excessive, a sedentary lifestyle doesn t require as much caloric contributions. It is recommended to count calories in the diet and in different products. The consumer must know how to choose what is best to eat and to do this must shop well, store appropriately and follow guidelines for responsible shopping. The characteristics of the Mediterranean diet are extolled, in relation to the products which integrate it (fruit, vegetables, olive oil, fish) showing, in addition, the national referents of these products. The state guarantees safety of foods through controls. 48 FOOD, CONSUMPTION AND HEALTH

51 FOURTH PHASE: the individualization of diet (1990s) HISTORICAL CHARACTERISTICS OF THE PERIOD INSTITUTIONAL REFERENTS AND THE PROFILE OF THE RECIPIENT OF INFORMATION DIETARY RECOMMENDATIONS CONCEPTIONS OF FOOD Diversification and globalization of the food supply. Food crises: mad cow desease and chickens with dioxins. The importance of the food industry and food distribution. Appearance of food related health problems: bulimia and anorexia. Promotion of the Mediterranean diet associated with health. Institutions: INC, MAPA, according to previous specialization, Consumer NGOs. Institutional collaboration with agrifood businesses. Recipient: Individualization of recommendations. Greater orientation toward the general population. Traditional roles coexist with other models. Precaution in eating as there are good diets and bad diets. The Mediterranean diet is extolled as a guarantee of health. Regulated weight control through specialists on diet. Obesity is a serious health problem and and action must be taken based on the individual. Health comes from diet. Poor eating leads to illness. The Mediterranean diet is the healthiest diet and we have lost the knowledge we had of it. Return to the goodness of the traditional diets and eating habits. It is necessary to take care of the body, to control one s weight, to think about being healthy. It is necessary to exercise to increase energetic expenditure. Medical control of obesity. Educate the consumer with dietary guidelines. THE EVOLUTION OF INSTITUTIONAL RECOMMENDATIONS ON HEALTH AND FOOD 49

52 FIFTH PHASE: the beginning of the 21st century HISTORICAL CHARACTERISTICS OF THE PERIOD INSTITUTIONAL REFERENTS AND THE PROFILE OF THE RECIPIENT OF INFORMATION DIETARY RECOMMENDATIONS CONCEPTIONS OF FOOD Institutions: Specialization of the institutions responsible for production, consumption and health. National Food Safety Agency. Experts: Appearance of the educational role of food recommendations and their entrance in the school environment through specific educational programmes. Recipient: Orientations toward parents and educators to promote healthy lifestyles for the public. Source: Díaz Méndez and Gómez Benito, Strengthening of the recommendations of the last years of the 1990s regarding problems related to obesity. There are food risks and we must protect ourselves with information and by following the recommendations of the state. Concern about food disorders. There are food risks and state protection and controls are not sufficient to help the consumer. The consumer doesn t know enough about foods and must be educated in the acquisition of healthy habits. The consumer must be well-informed to lead a healthy lifestyle. 50 FOOD, CONSUMPTION AND HEALTH

53 II. Scientific advances in nutrition and food María Ángeles Menéndez Patterson (University of Oviedo) 2.1. Introduction Human nutrition can be considered as the science of the interrelationship between human beings and food. Its essential characteristic is the integration of data acquired thanks to fundamental and applied inter and multidisciplinary research. The methodologies used are diverse and pertain to numerous scientific disciplines. The relationship between human beings and food varies greatly, as it concerns the behaviour of the healthy or ill individual in relation to foods, the forms of metabolic use of ingested nutrients, or the influences the foods available have (expressed in terms of quality or quantity) over the biological destiny of the human being. Since the appearance of our species on the Earth we have had to acquire, if not a science, at least some empirical knowledge of foods. But we are largely ignorant of how many deaths and how much suffering was caused by this long investigation to discriminate among useful harmful and useless food. Nutrition as a science emerged in reality at the end of the 18th century and the beginning of the 19th. Studies on nutrition search to understand the physiology of foods and their components, as well as the quantitative and qualitative food needs of the human being. The journey to attain this knowledge began in 1785 when Lavoisier identified respiration with combustion and oxidation. Applying the law of conservation of energy he determined and quantified the energetic and material interchange between living beings and the environment which surrounds them. Soon would be known the vital role of proteins and amino acids and the distinction between plastic substances and respiratory SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 51

54 substances, according to their function in the formation of matter or in caloric and energetic needs. At the end of the 19th century it was thought that all of the secrets of nutrition had been discovered. Foods seemed to be a question of proteins, lipids, carbohydrates and water. There remained some minimum residues that seemed like dregs (ashes), something disposable in the energetic and plastic use of the organism. It was then thought that it would be possible to feed laboratory animals with a mixture of all the components then known of a particular food such as milk. This idea was even expressed by a researcher who ended up stating that «in the future man will eat from packets of pure chemical, that he will carry in his vest pocket» (Carpenter, K. J. 2003a). Evidently, the pleasure of eating was forgotten or disregarded. It was in the beginning of the 20th century when the presence, functions and need for minerals in our diet became clear, as they are indispensable mediators in chemical reactions that are key to the maintenance of organ functions. Some of the minerals were discovered in those ashes. Certainly vitamins constituted one of the most interesting chapters of nutrition research in the first half of the 20th century. In this sense, if we analyze the first two volumes of The Journal of Nutrition, published in , 40% of the articles are related to this subject. In 1933 Leslie Harris wrote his first review about vitamins in the Annual Review of Biochemistry and verified that in twelve months one thousand articles had been published about vitamins (Carpenter, K. J. 2003b). In 1948 the last vitamin was discovered, Cobalamin or B12, whose chemical structure was established in The discoveries in nutrition in the period between 1912 and 1944, understood by some authors as «the golden age of nutrition,» were so many and so important that some researchers thought that the theme of nutrition had been exhausted. The University of Oxford closed its nutrition group with this justification. However, there were still important discoveries to come from the lines of research still under way, for example, essential fatty acids. Currently, the considerable progress made in scientific knowledge on nutrition and its relationship with human health has been accompanied by a growing 52 FOOD, CONSUMPTION AND HEALTH

55 interest in contemporary society on such questions. But this has also been accompanied by a proliferation of a series of erroneous ideas about the nature of nutritional processes, the properties of foods and the magical virtues of the most varied dietetic systems, while often forgetting about the scientific knowledge we do possess. The consequence of this situation is the state of confusion which many members of our society find themselves in regarding the relationship between nutrition and health. In this chapter, we will analyze how the discoveries in the field of Food and Nutrition in the second half of the 20th century permitted spectacular advances in knowledge about the role of diet in the development and prevention of the most prevalent pathologies in developed countries: cardiovascular diseases, cancer and obesity. In addition, we will study the change made by nutritionists in the sense of evaluating the role of those chemical compounds that exist in foods which don t provide energy or essential nutrients but that do have an important role to play in the health, well-being and longevity of individuals, the bioactive compounds. Taking into account the interest of consumers in their health, the food industry has developed new types of foods, called functional foods. One of the objectives of this chapter is to evaluate the nutritional advantages and possible disadvantages of these new foods. Probably today and in the future one of the most promising fields in nutrition is the study of the way in which diet in general, and some nutrients in particular, can affect the functioning of our genes. This is developing into a new science, nutrigenomics, which in a not so distant future may bring us diets made to measure based on information contained in our genes Evolution of nutrition and food The science of nutrition and the search for improvements in the human diet has experienced a quiet but very important transition in the second half of the 20th century. The first half of that century was centred on the discovery of essential nutrients: vitamins, amino acids, minerals, and fatty acids. These discoveries deeply influenced the focus of applied nutrition, which at first tried to define the required minimum of essential nutrients for humans, what today we know as Recommended Daily Allowances (RDA) or Recommended SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 53

56 Daily Intake (RDI), and subsequently to assess the diets that provide these minimum quantities required to maintain health, all of which led to dietetic guidelines. In this manner they were trying to avoid the diseases caused by scarcity and malnutrition. The indicators to assess the suitability of diet were at first biochemical and clinical indicators associated with deficiency or absence (rickets, beriberi, scurvy, pellagra, etc.). Public programs about nutrition were generally dedicated to increasing the consumption of milk, meat, eggs and practically any foods in the typical diet. They preached security through abundance and transmitted the idea that excess is preferable to limitation. In the second half of the 20th century environmental factors began to gain in importance as determinants of human health. Fed in part by the emerging evidence of the role of tobacco in lung cancer, the lack of physical activity in cardiovascular illness and other associations, scientists began to explore the relationship between diet and illness from a wider perspective, that is to say, an ecological perspective. This vision changed the diet-illness association with the clinical syndrome caused by insufficient ingestion: 1) Many of the new associations were related with non-essential constituents of diet, such as fibre or cholesterol. 2) Some health problems were not related to deficiencies, but rather with excesses, such as obesity. In fact, after the Second World War it was found that in developed countries what were considered «good diets» by definition seemed to be causes, to a great extent, of arteriosclerosis, diabetes, some types of cancer and other noninfectious diseases. Among the discoveries which marked this transition is the relationship between the ingestion of lipids and cardiovascular disease. Cardiovascular disease One of the primary causes of death in developed countries is coronary heart disease, caused by the decrease in blood flow to a portion of the heart muscle and 54 FOOD, CONSUMPTION AND HEALTH

57 causing its necrosis or heart attack. Through autopsies, more than one hundred years ago medicine had demonstrated the narrowing of the coronary arteries due to arteriosclerosis, in other words, the deposit of plaque rich in cholesterol on the walls of the arteries. In 1984 in a classic book in medicine, Strumpell s Lehrbuch der speziellen Pathologie und Therapie der inneren Krankheiten, dietetic recommendations had been made directed toward reducing cardiac illness based on these clinical observations. In 1934 Rosenthal published an article in the journal Archives of Pathology (Carpenter, K. J. 2003c) in which he wrote, «The literature contains a multitude of works correlating arteriosclerosis, with diet, blood pressure, race, etc.,» and later, «Where the ingestion of fat is low, arteriosclerosis is not prevalent.» Despite the great interest of researchers, above all pathologists, to know the causes of coronary heart disease, this pathology did not get the attention of nutritionists before the Second World War. One of the characteristics of the diet of developed countries is the high quantity of energy coming from lipids, above all of animal origin. It was thought that the problem of coronary heart disease could have been related to the high ingestion of cholesterol. To confirm this numerous experiments were performed on animals and humans with different types of lipids. Starting in 1950, Ancel Key and his collaborators began to study and compare aspects of coronary heart disease in the United States and different parts of Europe the North and Mediterranean as well as Japan. This gave rise to the Seven Countries Study, thanks to which the «Mediterranean diet» became known. This study had a multinational prospective design composed of 12,763 men of 40 to 59 years of ages from seven different countries: Yugoslavia, Greece and Italy (Southern European and Mediterranean countries), Holland and Finland (from the north and centre of Europe) and the United States. In addition, Japan was included (Keys, A., 1970). Twenty cohorts were monitored for thirty years. This study confirmed: 1) That mortality for coronary heart disease was lower in Mediterranean and Japanese populations than in the United States and north and central Europe. 2) That a relationship existed between the consumption of saturated fats and coronary heart disease, demonstrated as much by the occurrence of coronary SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 55

58 events as by the rates of mortality. The percentage of energy from saturated fats was an average of 19% in the countries from the north of Europe and the United States, while in the Mediterranean countries it was 10% and in Japan, 3%. From the point of view of nutrition in cardiovascular pathology, the possible beneficial role of other fatty acids in diet was assessed - the polyunsaturateds, substituting for saturated fats. Thus the effect of some vegetable oils could be demonstrated, but above all, those that came from fish of the omega-3 series. The 1977 Framingan Study (Gordon, T. et al., 1977) allowed the clear differentiation of the role of the lipoproteins, LDL (bad cholesterol) and HDL (good cholesterol); from these discoveries the study of the influence of distinct components of diet on lipoproteins began. During recent years other components of the diet have been evaluated in relation to the cardiovascular problem. Research has included looking at the adverse effect of ingesting elevated levels of salt, saturated fats and trans fats, and the potential protective effect of monounsaturated fats, omega-3 fatty acids, anti-oxidants, alcohol and wine, fruits, vegetables, fibre, folic acid and homocysteine, and the uncertain role of the omega-6 fatty acids. In light of all this knowledge, various public entities published specific guidelines for preventing heart attacks, some for the general population like those from the Ministry of Health and Consumer Affairs and The Spanish Arteriosclerosis Society from 2000, and others aimed specifically at women (Mosca, L. et al., 1999). Nutrition and cancer: a complex relationship Cancer is one of the health problems of greatest importance in western societies and constitutes the second-leading cause of death. Based on data from the Spanish Cancer Association in 2004 deaths from cancer were percent of the total deaths in Spain. Of cancer deaths, 63 percent were males and 37 percent females. The search for connections between diet, nutritional and metabolic factors and the aetiology of cancer is an area of research which, in the last two decades, has received increasing attention both from the scientific perspective as well as from a public health perspective. This growing interest can be explained 56 FOOD, CONSUMPTION AND HEALTH

59 by important scientific developments and their perception by the broader society. In 1964 the World Health Organization concluded in an examination of behavioural and environmental factors in cancer that «the greater part of cancers is potentially preventable.» Since then, epidemiological and experimental research on the relationship between diet, nutrition and cancer has expanded enormously and rapidly. In 1980 the European Union created the Europe Against Cancer Programme, which immediately identified nutrition as one of the areas of high priority in the search for a cure and prevention of cancer. It was decided to subsidize two parallel lines: first, to formulate recommendations for Europe for the prevention of cancer that included nutritional advice and, secondly, to promote extensive epidemiological studies on nutrition and cancer. Doll and Peto (1981) were the first researchers to quantify the contribution of a series of environmental factors to cancer, among them diet, tobacco, alcohol, job and radiation. They estimated the proportion of deaths from cancer attributable to diet at 35 percent; diet, after tobacco being the most important preventable cause of cancer. In addition, they identified distinct types of diets that contributed to increasing the risk of cancer. Diet is a set of chemical substances that can influence in a direct or indirect manner the development of or prevention of cancer. In some cases this can be through natural carcinogens and existing contaminants in foods, or as a result of the cooking or preservation of foods; in others because the activation or deactivation of carcinogens is induced by the diet. The biological formation of carcinogens in vivo, through the intestinal flora, is also possible. Sometimes, a nutritional imbalance is produced which could alter immunity, affecting the capacity to respond to an aggressive neoplasm. We should not forget chemoprevention agents against cancer (among others, antioxidants, retinoids, vitamin D and folic acid,) that are found in foods. Fruits and vegetables are a very rich source of anti-oxidants, among which should be mentioned the carotenoids, vitamins C and E, selenium and the polyphenols. The antioxidants in the diet exercise a protective action against oxidative stress, through the blocking of free radicals derived from oxidation and/or the interruption of the peroxidation chain. The retinoids participate in the normal SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 57

60 process of cellular growth and differentiation. As chemoprevention agents they act in the phases of promotion and progression of the carcinogenesis process, in contrast to antioxidants which act in the initiation phase. In 2002 Lancet published a review of the studies from the previous 30 years which analyzed the effects of diet on the risk of cancer (Key, T. J. et al., 2002). The authors arrived at the following conclusions: 1) Dietetic factors that seem to increase the risk of cancer: Alcohol cancer of the oral cavity, pharynx, oesophagus, larynx, liver and lung. Obesity cancer of the oesophagus, colorectal, endometrium, breast and kidney. Salty foods nasopharyngeal cancer, stomach cancer. Red meats and processed meats colorectal cancer. Very hot drinks cancer of the oral cavity, pharynx and oesophagus. 2) Dietetic factors that seem to reduce the risk of cancer: Fruits and vegetables cancer of the oral cavity, pharynx, oesophagus, stomach, colorectal and lung. Fibre colorectal cancer. Waiting for the results of various epidemiological studies about cancer and diet that are being completed, today it seems prudent to advise maintenance of a healthy body weight, restriction of the consumption of alcohol, and selection of a diet that is balanced and assures the ingestion of adequate amounts of fruit, vegetables and whole grain cereals (Riboli, E. and Norat, T., 2003). The role of diet in the control of obesity Obesity constitutes one of the principal nutritional problems in the developed countries, and it is growing on a world level. This situation has led some authors to consider it the epidemic of the 21st century. Obesity is defined as an excessive accumulation of fat in the organism which is associated, to a considerable extent, not only with an increase in the risk of diabetes and cardiovascular disease, but also in certain types of cancer and other very prevalent illnesses (digestive, respiratory, osteoarthritis, etc.), to such an extent that it has become the second leading cause of premature and avoidable 58 FOOD, CONSUMPTION AND HEALTH

61 mortality after tobacco. In addition, it is an aesthetic and body image problem with serious psychological and social repercussions. Social attitudes toward obese persons have gone through cycles throughout history. In periods of poverty and scarcity of food resources obese people enjoyed prestige and represented opulence and well-being. In periods of abundance it has been the contrary what is prized is the image of the thin person. The economic costs generated by obesity are those derived from the treatments for associated illnesses and for social adaptations. It is difficult to evaluate them. Data referring to health costs exist and the numbers vary in industrialized countries between 2% and 8% of total spending on health. In Spain the number is around 6.9%. Obesity is a manifestation of a disruption in the control of the balance between energy ingested and energy consumed in metabolic processes. As F. Grande Covián said; «obesity is an accumulation of surplus energy.» Obesity is heterogeneous in its origin, depending on physiological, metabolic and genetic factors, and also the ingestion of excessive energy and inadequate physical activity (a sedentary lifestyle). For this, a problem with one or several of these elements can lead to obesity. In any case, changes in foods, and also the new habits and lifestyles of developed societies, are the definitive trigger, as the organism does not have sufficient control to face the excessive energetic offer and/or sedentarism. To a certain extent, obesity is the «payment» of our society for the globalisation in the food sector, the fruit of recent trends in the world economy. During the second half of the twentieth century and in particular, starting in 1962, when the first nutritional surveys in Spain were done, we can confirm the increase of the percentage of calories contributed by lipids, passing from 30 percent to 44 percent in We should remember that the recommendation in Europe and in the United States is 30 percent. The opposite has happened with carbohydrates, whose caloric contribution in 1962 was 58 percent while in 2000 it was down to 41 percent. The recommendation is 60 percent. Regarding proteins, the recommendation is 10 percent and the increase in the Spanish diet has been from 12 percent in 1962 to 15 percent in These changes are the result of the evolution in the consumption of foods of animal SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 59

62 and vegetable origin during this period (Moreno, L. A. et al., 2002). In brief, we should point out that the percentage of foods of animal origin grew from 24 percent to 43 percent; a result which clearly confirms the idea that, «The greater the economic level of a country, the greater the consumption of meat and foods of animal origin.» Spain is a clear example of this. The increase in foods of animal origin explains, in part, the increase of lipids in our diet. Some authors (Golay, A. and Bobbini, E., 1997) have put forward the hypothesis that this elevated ingestion of lipids, together with a genetic predisposition, can lead to obesity. For many researchers behind obesity is a series of genes that were moulded during millions of years of evolution. These scientists state that the answer to this phenomenon is found in what has been called the hypothesis of the thrifty genotype, proposed in 1962 by J. V. Neel. The cycles of hunger and abundance that our ancestors went through during millions of years of evolution in an environment in which the availability of foods was limited, selected for a genotype that would allow a rapid gain of fat during periods of food abundance, as these deposits of reserve energy provided advantages for survival and reproduction. But today, in the developed countries where there exists a permanent abundance of foods, this genotype leads to obesity. Among the external factors which influence obesity, the changes introduced in diet, with the frequent presence of refined foods of a high energetic density, have contributed to establishing and perpetuating a positive caloric balance. A diet rich in simple carbohydrates, with a high percentage of energy supplied by lipids particularly from saturated fats, together with low contributions of fibre and elevated contributions from alcohol, are the most prominent dietary elements which can have an influence in weight gain. It is evident that weight loss programmes should combine a nutritionally balanced dietary regime with exercise and lifestyle modification. Diet has to be varied, agreeable to the palate and in harmony with the culture and eating habits of the individual. Following monotonous or strange diets to control weight is neither justified nor will it work over time. In fact, many of the so-called miracle diets can be harmful to health. In this sense the Ministry of Health and Consumer Affairs, through the Spanish Food Safety Agency (AESAN) on its webpage recently posted information on this issue (June, 2007). 60 FOOD, CONSUMPTION AND HEALTH

63 The best treatment for obesity is primary prevention. The Spanish Society for the Study of Obesity (SEEDO) published in 2007 a consensus document which gathered together the strategies for the evaluation of overweight and obesity and the establishment of criteria for therapeutic intervention (Salas- Salvadó, J. et al., Grupo colaborativo de la SEEDO, 2007). Though my intention is not to be pessimistic I would like to point out that traditional strategies for the prevention and treatment of obesity have frankly been demonstrated to be ineffective as they rely almost exclusively on individualized prescriptions or recommendations for change in the behaviour of affected persons. The recommendations to eat less and to have a more balanced diet and to do moderate exercise clash with multiple aspects of our westernized culture, which in fact promote obesity: the greater energetic density of meals, fast food, the relationship of food with social activities and with the rhythm of life, stress, lack of physical activity, automobiles, TV, etc. Given that the problem is known, and its economic and social consequences are now very apparent, it would seem that the keys to the success of any public health and food policy in this area would be to focus not only on promoting changes in individual behaviour, but also on examining the complicity of all the social actors involved (businesses, legislators, consumers, the media, educators, etc.) and, in particular, on the need for a considerable increase in funding scientific investigation, as much is still unknown (Palou, A., 2006). Bioactive compounds of foods The foods that we consume daily contain hundreds of chemical compounds, some of which are known and well quantified, others only poorly described and many others completely without description and currently difficult to measure. The chemical compounds that are in our foods can be placed into the following not mutually exclusive categories: essential nutrients, nutrients as sources of energy, additives, chemical contaminants coming from agriculture, contaminating microbiological toxins, inorganic contaminants, chemical compounds coming from cooking and processing of foods, natural toxins, other non-nutrient chemical compounds from food, and with a beneficial role in health, the bioactive compounds. SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 61

64 Just as in the first half of the 20th century the focus of nutritionists centred on the essential nutrients as sources of energy, from the end of the 20th century and up to now, bioactive chemical compounds have attracted a great interest. These compounds don t fit into any of the categories of known nutrients (essential and energetic), but their protective role is being confirmed in cardiovascular illnesses, stroke, cancer and neurodegenerative diseases, and they even have a great importance in the ageing process. Bioactive compounds are defined as those constituents that are not nutrients and that are typically found in natural form in small quantities in plants (fruits and vegetables) and in foods rich in lipids (Kitts, D. D., 1994). Sometimes the bioactive compounds which come from vegetables are called phytonutrients or phytochemical substances. These compounds vary a lot in their chemical structure and function and are grouped according to such characteristics. Within the phytonutrients we can distinguish four large groups: phenolic substances, terpenic substances, sulphuric substances, and nitrogenic substances. Of these four groups, the first three are the most important as constituents of fruit and garden produce. The phenolic compounds are found in general in all food of vegetable origin. There are more than 8,000 phenolic structures and they are present in all plants, and have been studied in-depth in cereals, legumes, dried fruit and nuts, olive oil, vegetables, fruit, tea, cocoa, chocolate and red wine. From the point of view of biological activity, many phenolic compounds have free radical capturing properties, which confers on them antioxidant activity, and some studies have shown their favourable effects on the prevention of thrombosis, on some types of cancer, on many illnesses related to ageing, and it has even been hypothesized, given that oxidative stress can contribute to the pathogenesis of Alzheimer s, that the risk of suffering this disease could be reduced by the consumption of antioxidants that counteract the negative effect of oxidative stress. But results obtained up to now are still not definitive; more clinical study is needed. There also exist substances with estrogenic or antiestrogenic activity: the phytoestrogens, some of which are present in soy, and also in linseed oil, grains of cereals and fruit and vegetables. They possess antioxidant properties and some studies have revealed beneficial effects on cardiovascular risk factors and in models of cancer in animals and cell cultures. Nevertheless, as the 62 FOOD, CONSUMPTION AND HEALTH

65 phytoestrogens act as much like agonists and antagonists of estrogens, their effects on cancer are probably complex. We should not forget their possible role in the prevention of osteoporosis, improvement of the symptoms of menopause and the possible decrease in blood cholesterol levels. A great part of the bioactive compounds have been analyzed and discovered in foods typical of the Mediterranean diet (olives, olive oil, dried fruit and nuts, vegetables, garden produce, citrus fruit, red wine, etc.) and, to some extent, they explain the benefits of this diet. In a period of approximately 50 years we have advanced from epidemiological evidence countries where the Mediterranean diet is followed have a lower mortality from cardiovascular problems to demonstrating why this is so, based on the chemical compounds which exist in the foods typical of this diet. As we have observed in short, many bioactive compounds seem to have beneficial effects on health, but although epidemiological studies have been done which seem to provide the evidence of an association between their consumption and the prevention of some chronic illnesses, much more research is needed before we can turn these results into dietary recommendations. However, it seems that we can affirm that a healthy diet must fulfil two fundamental conditions: 1) Provide an adequate and balanced quantity of energy and nutrients (as is currently recommended). 2) Provide a determined quantity of fibre and bioactive compounds for the prevention of chronic and degenerative illnesses. With this in mind, many governments like that of the United States have developed campaigns to increase the consumption of fruit and vegetables and foods derived from them, whether through a food pyramid or through associations which have emerged to promote the consumption of fruit and vegetables due to their healthy properties. This is the case of the «5 per day» Club in Spain, which has its equivalents in the majority of developed countries. Simple recommendations for consumers have also been elaborated (Tomás- Barberán, F. A., 2003) such as consuming 400 to 600 grams per day of fruit and vegetables, advising that they be different colours because the majority of phytochemical compounds are of different colours and have different beneficial functions. SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 63

66 Consumers, health and the food industry Global food trends in recent years indicate an accentuated interest by consumers in certain foods, which in addition to their nutritional value contribute physiological benefits to the human organism. We have gone from stressing negative aspects of foods (elevated concentrations of lipids, cholesterol, salt, nitrates, etc.), to recognizing that diet, beyond its nutritional contribution, can have beneficial physiological and psychological effects. The basic concepts in nutrition are undergoing a significant change. The traditional idea of an adequate diet as one that contributes sufficient nutrients that assure the survival of the person, meets metabolic needs, and pleasantly satisfies hunger, is being replaced. Today, in addition to these things and concern for food safety, the emphasis accentuates the potential of foods to promote health, well-being and reduce the risk of diseases. Hence the concept of adequate nutrition tends to be substituted by the concept of optimal nutrition, above all because in developed countries in the 21st century there exists a tendency toward a considerable increase in the cost of healthcare and loss of labour activity due to illnesses. This is happening parallel to increasing life expectancy, the ageing of the population and the desire for a better quality of life. Both governments and consumers try to take care of health through diet. In Spain this trend is clearly reflected in the study, «Health products. A market that continues evolving,» completed in 2003 by International Research and Taylor Nelson, and based on interviews with a sample of Spanish consumers in hypermarkets and supermarkets. The study stated that «healthy and wholesome is the key,» and concluded that the current trend will continue into the future with a gradual substitution of spending on curative health care for spending on preventative health care and healthy diets (Botey, L. J. and Murillo, F. I., 2006). I would like to point out that the old idea that foods and medicines have much in common is being revived and we have returned to what Hippocrates said almost 2,500 years ago: «Let food be thy medicine and medicine be thy food.» 64 FOOD, CONSUMPTION AND HEALTH

67 The added value of food today is health. (1) The three Spanish «B s» Bueno (good), Bonito (beautiful) and Barato (cheap) will have to be replaced by the three Spanish «S s» Sano (healthy), Seguro (safe) and Saludable (wholesome). As a result of the new lifestyles that began to develop at the end of the 20th century and continue today, consumers conscientious about their health have appeared. (2) These conscientious consumers, the so-called baby-boomers, are persons born after the Second World War, between 1946 and 1963, who look to maintain their health through diet and who have economic means. With these consumers in mind, the food industry has developed a series of foods called «functional foods» based on the latest scientific advances in nutrition, biotechnology, genetic engineering, etc. This industry has placed, and will continue placing on the market a great variety of foods which have eliminated or added some chemical compound. The aim is to affect targeted functions of the organism in a specific and positive way, and to promote a physiological or psychological effect beyond the food s traditional nutritional value. The food industry is very interested in these foods; in fact a survey done of the heads of 100 large American companies on the order of priorities for investment in the food sector resulted in the following: First, the development of products within the category of health foods. Second, food safety. Third, the development of natural foods. A large quantity of products is being generated, and although currently they only represent a small percentage of total food consumption, statistics show that their consumption is spreading. In fact, the inclusion of these functional foods is increasing each year by 16 percent. Currently in Spain there are now some 200 functional food products being sold. Ninety-five percent of homes have them in their refrigerators or kitchen cabinets, although many times they (1) The father of illness could have been anything, but there is no doubt that the mother was bad diet» (Chinese proverb). (2) «In the sixties we all wanted to be free; in the eighties, to be rich; and in the nineties, to be healthy» (Ang Lee). SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 65

68 are acquired unconsciously. It is predicted that in some years the demand for functional foods will grow by 22 percent. For many of these foods there isn t always scientific evidence identifying a beneficial interaction between the biological activity of some component in the food and a particular function in the organism. In addition, we should not forget about problems related to dose and toxicity. The phrase of Paracelsus, «the dose makes the poison» is applicable to these foods. To make things clearer I will provide an example. The omega-3 fatty acids are often employed in the production of functional foods, with all their health benefits appearing on the labels. Yet excesses of omega-3 fatty acids can lead to the following: 1) Increases in bleeding time. 2) Increase in the risk of hemorrhages. 3) Formation of biologically active oxidation products from the oxidation of the omega-3 fatty acids. 4) Increase in the level of LDL cholesterol. 5) Reduced control of glucose in diabetics. The Food and Drug Administration (FDA) of the United States in 2004 (ADA Reports) concluded that the use of omega-3 fatty acid supplements is healthy, but their daily ingestion, provided by foods plus supplements, should not exceed 3 grams. It is evident that the labels do not provide any information related to this recommendation. Because of this, regulatory bodies must closely control the use of statements about health, both positive and negative ones, which appear on the labels of said foods and, in the case of positive statements confirm that stated positive effects are properly validated. In this sense, in the Official Journal of the European Union of 18 January 2007, Regulation EC (No) 1924/2006 of the European Parliament and of the Council of 20 December 2006 was published and came into effect on July This regulation was in regard to the nutritional statements about the health properties of foods and to harmonize the legal, regulatory or administrative provisions of member states, with the aim of guaranteeing an effective functioning of the interior market as well as providing a higher level of consumer protection against food claims that are exaggerated or false or that have no basis. The social impact of these new foods is undeniable and confirmed by the fact that many consumers assume that products containing antioxidants, omega-3, 66 FOOD, CONSUMPTION AND HEALTH

69 prebiotics, «bifidus» effect, phytoesterols, polyphenols, etc., are beneficial even though they don t understand their biological actions, nor do they know what the original sources of the active compounds are. The role the media has played in the spread of these foods must be highlighted. In fact, the world of health and specifically that of food have taken on special relevance in the media, which in many cases has become a reference for the public and for patient s associations. Everything related to food occupies a privileged place in this new informative space which has focused on the issue of health. Changes in food are not simple. The arrival of new elements like functional foods, which can contribute many positive things, is not being accompanied by an effort to incorporate them intelligently into our diet. Attention is needed on this issue, as a certain lack of scientific consensus and rigor can on the one hand end up taking credibility away from functional foods and on the other, hold back their development and innovation. The application of the new regulation could resolve these doubts. Functional foods provide benefits to health in states of deficiency, for intolerances to specific foods or for chronic deficiencies-aiding in the prevention of some illnesses and in balancing diets with specific nutritional deficits- but we need to know how to better maximize the benefits that they contribute in combination with conventional foods. It has been shown that a correct, varied, balanced and pleasurable diet is the best strategy for the prevention of illnesses 2.3. Future perspectives The range of possibilities in the field of nutrition is immense and lines of research are opening which relate nutrition to immunology, genetics, ageing, sport and more, which can lead to the division of the discipline. Probably today, one of the most promising areas of research in nutrition is the study of the way in which diet in general and some specific nutrients in particular, can affect the functioning of our genes. This new developing science, nutrigenomics, is defined as the study of the molecular relationship between nutritional stimuli and the response of genes. SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 67

70 In the past, genetics and nutrition were considered to be two competing forces nature versus nurture in the shaping of the development of the individual. Today we know that it is the interaction of genes and nutrients together with other environmental factors which determine the phenotype and development of individuals. A basic concept is that the progression from a healthy phenotype to a chronically dysfunctional phenotype can be explained by changes in genetic expression or by differences in the activity of proteins and enzymes, and that the components of diet directly or indirectly regulate the expression of genetic information. Everyone knows that eating the same foods some people will gain weight, some will develop heart disease or allergies, etc., while with others none of these things will happen. In agreement with Marti et al., (2005) the conceptual grounds of this branch of genomic research can be summarized as: 1) There are actions of components of foods on the human genome which directly or indirectly can alter the expression or structure of the genes. 2) In some individuals and under some circumstances, diet can be an important risk factor for a number of illnesses. 3) Some genes regulated by diet and their normal common variants, probably play a role in the onset, incidence, progression and/or severity of chronic illnesses. 4) The degree to which diet has influence on the duality health-illness can depend on the individual genetic constitution. 5) Intervention based on knowledge of nutritional requirements, nutritional state and genotype can be used to prevent, mitigate and cure illness. There are examples that illustrate the fact that people respond in different ways to diet. The protective effects of phytochemical compounds such as isoflavonoids, flavonoids and resveratrol, differ from one person to another. Sodium increases the arterial pressure of some people and of others no, and the capacity of dietary fibre to reduce cholesterol is also subject to genomic influences. The studies in this field may in the future lead us to eating the «correct» foods for our different genetic constitutions, and to the elaboration of more personalized diets through which we can achieve a healthier way of eating that 68 FOOD, CONSUMPTION AND HEALTH

71 will result in favourable phenotypic changes with a consequent reduction in the incidence of mortality from distinct diseases. To achieve this objective, it will be fundamental to develop new strategies for nutritional education and for new functional foods that respond to the particular needs of each one of the subgroups of persons identified as genetically similar. These new points of view are in contradiction with current public health policies, which establish a group of general dietary norms for the whole population based on studies which do not reflect the individuality of populations. In other words, it is often assumed that all individuals respond equally to dietetic intervention and benefit equally from dietetic guidelines and nutritional policies. It could be that in the not very distant future, it will be normal that health professionals will recommend diets made to measure in function of the needs of each person and starting from information based on the genes. Individuality will take preference over generality. In this sense it is important to remember the statement of Miguel de Cervantes; «I will die old and I ll never understand this two-legged animal called man, each individual is a variety of this species.» But this is not an easy task. We can take as an example cardiovascular diseases. There is no single gene responsible for the functioning of our cardiovascular system; at least 20,000 genes are involved. Although each gene has only a small effect, some genetic markers can give us an overall indication of a concrete risk factor associated with the development of heart diseases. Thus, a gene that is related to control over the level of cholesterol in the blood has been identified. In addition to the most common variant of this gene, there exist two other variants that either raise the risk of the individual having high cholesterol or protect the individual. Another potential use of research on genes and nutrition is helping to find the way to develop special individualized foods to make healthy diets appear more attractive, improving the taste of foods, both raw and cooked or even choosing foods that are easier to cook, process, more economical, healthy or nutritious. For example, there are potatoes with high levels of starch that absorb less oil when they are made into chips or crisps, or fruit and vegetables that maintain their nutritional properties and their taste despite transport and storage. Studies on plants and microorganisms could also lead us to the discovery of new components for our health and determine what functional ingredients have an effect when we consume them isolated from other nutrients and which SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 69

72 need to be ingested as whole foods. In this way new ingredients and foods with beneficial properties for health could in the future be found in the supermarkets thanks to the development of the techniques of biotechnology. In Europe, the European Nutrigenomics Organization (NuGO) has been created and is facing the challenge of putting the data coming from nutrigenomics into practical use through precise predictions on the beneficial or adverse effect on health of the components of diet (Hesketh, J. et al., 2006). It is important to remember that the ethical and social questions associated with genomics also apply here (Bergmann, M. M. et al., 2006). One of the most important challenges that we must face in the nutrition and food sciences is how to insure that scientific advances in this field reach the public. Thus, knowing nutritional needs yet not knowing the best strategy for the public and society to accept dietary advice from the field can be the result of our own naivety. Clearly, messages about foods will always be better understood than those about nutrients. It is easier to recommend the consumption of blue fish or oily fish to decrease the risk of heart disease than omega-3 fatty acids, despite it being this nutrient in the fish which causes the beneficial effect by inhibiting the formation of tromboxane, and thus reducing the tendency to form intracoronary thrombi. In addition, focusing on providing information about a nutrient within a food and forgetting the rest of the nutrients it contains may sometimes only serve to detract from it. One example of this is the egg, which for many persons is thought of as pure cholesterol and should not be eaten, forgetting that eggs are an important source of essential amino acids, rich in micronutrients and relatively low in saturated fats. As an example of how the results of research in nutrition have been communicated to the Spanish population in the last 50 years, we can look at the evolution of the so-called Food Wheel, a resource used to promote a healthy and balanced diet. This model was promoted in Spain by the EDALNU programme (Programme for Education in Diet and Nutrition). The programme began in 1961, sponsored by the FAO, WHO and UNICEF, and with the participation at the highest level of the Health and Agricultural Services of the country. It was developed with a special focus on schools. Beginning in 1973 the programme came under the General Direction of Public Health of the Ministry of Health and Consumer Affairs. 70 FOOD, CONSUMPTION AND HEALTH

73 The Wheel was divided into 7 sections (each one representing a food group) all of the same size and using 5 different colours: Group 1 (red): milk, cheese, cuajada (a yogurt like dairy product). Group 2 (red): fish, eggs and meat. Group 3 (orange): potatoes, lentils, dried fruit and nuts. Group 4 (green): vegetables and produce. Group 5 (green): fruit Group 6 (yellow): bread, rice, sugar, chocolate. Group 7 (yellow): oil, butter, lard. Red (groups 1 and 2) refers to foods rich in proteins and calcium, the plastic foods. Green (groups 4 and 5) is for elements rich in vitamins and minerals, the regulatory foods. Yellow (groups 6 and 7) covers the energetic foods that are rich in calories. Orange (group 3) is for foods with multiple functions, «a little bit of everything.» The Wheel was used to explain adequate diets, in fact a pamphlet from 1984 by the General Direction of Public Health entitled «Eat better for less money» asked the question, «How to organize a diet» and answered, «To have an adequate diet one has to choose one or two foods from each one of the sectors of the wheel of the seven food groups. After, they should be distributed in the different meals that are going to be consumed; for example, breakfast, sweet milk, bread and butter; lunch, lentils with potatoes, two fried eggs with tomato sauce, bread and an orange for desert; dinner, baked fish, a portion of cheese, bread and an apple for desert.» In 2005 the Spanish Society for the Dietetic and Food Sciences (SEDCA), taking into account the new knowledge about food and nutrition, published a New Food Wheel. It can be found on the website of the organization at, Some changes in comparison with the previous wheel have been made: 1) The Wheel has gone from 7 groups to 6; the orange group has disappeared, and the foods of this group have been put in others. Potatoes have been incorporated into the yellow group of foods rich in carbohydrates. The SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 71

74 nutritional value of legumes and dried fruit and nuts has been re-evaluated by incorporating them into the red sector of meat, fish and eggs. 2) The groups on the wheel no longer have the same size; in that way the relative importance in our diet of the foods belonging to different groups is emphasized. For example, the yellow group of oils, butter, etc., like the red group of milk and milk products is smaller, while the yellow group of bread, pasta, potatoes, etc., is much larger, and in fact occupies more than 25% of the wheel. The importance of fruit and vegetables in our diets is illustrated by the increase in size of the two green groups. The sum of both groups now accounts for more than 45% of the wheel. In addition, the need for variety in consumption is highlighted, while in the old wheel 4 types of fruit and 4 types of vegetables and produce appeared, in the new one 9 types of fruit and 8 vegetables or produce are represented with the most varied colours possible. 3) The wheel indicates which foods should be consumed only occasionally or in small portions. These foods are pictured as smaller than foods that should be consumed more frequently. For example, bakery items of occasional consumption are smaller than bread which is consumed daily, cured cheeses are smaller than milk or yogurt, and oil is larger than butter or margarine. 4) The new wheel also explicitly mentions physical exercise and the need to ingest water in sufficient quantities. As a guide that helps in achieving a balanced and healthy diet it recommends that «menus and diets should be planned in such a way that during a one week period the same number of servings of foods belonging to each one of the groups of the wheel is chosen. Of those foods represented in reduced size, occasional consumption is recommended.» In a further step toward updating knowledge, using the didactic model of the food wheel, a Wheel of Antioxidant Foods was elaborated. It is based on research about the antioxidant capacity of existing chemical compounds in foods and their beneficial effects on the pathologies of developed countries. Proposed by the SEDCA in 2005 (available at it graphically represents the need to ingest specific daily quantities of the foods that have this capacity: fruit, bread, potatoes, vegetables and produce, cocoa, legumes, dried fruit and nuts, and olive oil. The following are the recommended quantities: 72 FOOD, CONSUMPTION AND HEALTH

75 Fruit (the most varied possible): 3 pieces or a glass of juice and one piece a day. Bread: 100 to 180 grams a day. Potatoes: 1 or 2 a day. Vegetables and produce (the most varied possible): a serving of vegetables 5 to 7 days a week and a serving of salad a day. Cocoa: 1 or 2 soups spoons or their equivalent per day. Legumes: 1 serving, 2 or 3 times per week. Dried fruit and nuts: 1 portion (30 grams) a day. Olive oil: in sufficient quantities to dress the dishes and/or cook Conclusions In conclusion, it is important and based on recent research it would seem necessary to update concepts and ideas about nutrition that come from the beginning of the past century, which at times make more difficult or restrict the development of the science. As an example, it is enough to analyze the classification of vitamins into water soluble and fat soluble. It seems a bit absurd to group some nutrients based on their solubility (in fat or in water) and not based on their function. But the reality is that this classification comes from the past century, when the first vitamin was isolated (thiamine or B1) in 1912 by Casimir Funk by extracting from rice bran an organic base (an amine) that was capable of curing beri beri (and therefore «vital») (Patterson, A. M., 2005). Currently it would be more logical to talk about vitamins from the perspective of their function, as today we know that the functions of vitamins go beyond that of preventing deficiency. In this sense, we could talk about vitamins with coenzymatic function in intermediate metabolism: thiamine, riboflavin, pyridoxal, niacin, pantothenic acid, cyanocobalomin, ascorbic acid. Vitamins and cellular proliferation: folic acid, cyanocobalomin. Antioxidant vitamins: ascorbic acid, tocopherols, beta-carotene. Some vitamins could even be classified based on their action mechanism as steroid hormones: retinoic acid (active metabolite from vitamin A) or 1alfa-25-hydroxycholecalciferol (active metabolite of vitamin D). Some treatises on nutrition have now begun to focus on vitamins from this other perspective (Mataix Verdú, J., 2002, Gil Hernández, A., 2005). SCIENTIFIC ADVANCES IN NUTRITION AND FOOD 73

76 Similarly, taking into account what was previously explained about Nutrigenomics, it is necessary to redefine the term nutrient. In this sense and in agreement with Gil Hernández and Chagoyán Thompson (p. 1043, 2005), the term nutrient should be applied to «[all] constituents of the diet, completely characterized (physically, chemically and physiologically), natural or designed, that serve as energetic substrates, precursors of molecules or other necessary components in the differentiation, growth, renovation, reparation, defence and/or maintenance of cells, or all that which functions as a signalling molecule, cofactor, determinant of some function, molecular structure and/or as promoter of the integrity of cells and organs.» With this long definition, in addition to the metabolic function that nutrients fulfil, the influence that they have in processes of transcription, post-transcription and translation of the DNA is emphasized, as well as resultant functions. In addition, it is necessary to remember that we consume foods, and that the human diet is not only the product of our knowledge of human physiology and the metabolism of food; it also responds to, on the one hand, the socioeconomic and geoclimatic reality (the role of socioeconomic level, production and trade, preservation of foods, technology and agriculture, etc.) And on the other hand, it responds to very deep and implanted anthropological realities such as customs and rites, taboos and religions which have to be taken into account when considering diet and the pleasures of the table. (Contreras, J. 2007). Nor should we forget gastronomy, as humans are animals that cook their food. Other animals feed and nourish themselves but their ingestion of foods is not a cultural phenomenon. Lévi-Strauss said that «cooking is a language through which society translates all of its structures.» For this reason we find it in books, oral traditions, memories, objects and dishes prepared throughout the years by different groups. 74 FOOD, CONSUMPTION AND HEALTH

77 III. Food policies and consumer safety Alicia de León Arce (University of Oviedo) 3.1. Introduction: Does every cloud have a silver lining? Consuming food is the only necessity which all living beings share. It is not by chance that food has been employed as a weapon in military conflicts and that the concept of food safety gained in importance after the Second World War, when Europe suffered indescribably for lack of food. The current situation is different, as economic progress and globalization bring a multitude of foods to the market. The network of international trade distributes the products of countries from all over the world, each country with its own legislation on matters of food safety control. For this reason, the creation of common markets must take into account the potential danger to health that this constant exchange implies, as the globalization of food distribution also means the globalization of health problems. According to data from the World Health Organization (WHO), two million children die each year from diarrheal illnesses caused by contaminated water or foods. Despite the fact that the application of rigorous technological processes and high standards of hygiene in the industrialized countries has drastically reduced the incidence of illnesses caused by food, it is thought that between 5 and 10 percent of the population suffer at least one episode of a food-borne illness during their lives. The globalization of food refers to a broad set of activities that runs from production to making available to the public the necessary and adequate goods to satisfy their nutritional needs. It is intimately connected with agriculture, livestock, fishing, biology, chemistry, processing and distributive industries, and above all, with health. It therefore has a multidisciplinary character and includes concepts and facts of an economic, technical, health-related, political and legal nature. During the whole process, a plurality of agents intervenes FOOD POLICIES AND CONSUMER SAFETY 75

78 and participates in the activities that bring producers and consumers together; their interdependence means that each and every individual decision affects and has repercussions on everyone. In the legal sphere, food must be subject to preventive regulations that simultaneously consider nutritive, sanitary, economic and technical aspects. Nevertheless, the evolution of food and consumer protection policies in the European and Spanish context responds to the saying «every cloud has a silver lining,» as it cannot be denied that both on the community and national level, policies for food safety have been reactive and not preventive, the fruit of food crises which have led to action by the authorities. Food safety is a global problem which affects everyone, which means that in a globalized market, the intervention of public powers is fundamental to guarantee to each person, from one end of the world to the other, that the foods they consume are really healthy and safe. Consumers have the right to know how food is prepared and produced, above all with the incorporation of new foods whose origin or techniques of preparation are unknown. For this reason, it is advisable to consume foods that are locally grown and seasonal, those for which control is always easier. It is said that people who consume locallygrown products are helping to save energy, reduce greenhouse gases and to assure the sanitary and quality control of the products consumed. (1) The food crises which took place in the 1990s provoked consumer insecurity. Consumers perceived a loss in quality of foods as they learned of contamination problems from chemical products, intoxications from salmonella, lysteria or dioxins, mad cow disease, swine fever and hoof and mouth disease. Industrial production, retail, and safety systems have been put in doubt and are subject to unprecedented pressure with repercussions for their operators and in the economic, administrative and policy sectors. Consumers have become suspicious of food safety and are demanding more information and control so that they can eat well and safely, but also in a way that is environmentally healthy. It must also be remembered that in a large part of Europe, the economic and sanitary importance of food is joined with the importance of food as one of the bases of culture and civilization. (1) Report State of the World 2005, World Watch Institute FOOD, CONSUMPTION AND HEALTH

79 The increase in production, the growth in trade, higher standards of living and food crises have altered the concept of diet, giving rise to changes in the traditional diet, the appearance of new eating syndromes and a more demanding consumer. Within sociology, food encompasses different dimensions: economic (it has a price that can make it accessible or not to the population group that wants to consume it); physical (its external aspect is determined by the colour, smell, texture, shape and taste); social (it is a part of codes of prestige and opportunity for consumption fixed by the group); psychological (the acceptance or rejection of food in function of its inclusion or not in a catalogue of common foods of the consuming group, being sanctioned by the food culture itself); food safety (guaranteeing the suitability of consumption by good hygienic-sanitary conditions) and the ease of use (must respond to consumer demands for simplicity in handling). (2) Food demands special procedures regarding its control, as it can directly provoke massive health problems that immediately impact on markets. The 21st century scenario of the globalisation of the international food trade necessitates a common framework for the food system because of the increasingly close connections between health and consumer confidence. As a result, it is advisable to analyze the evolution of food policies at the national, community and international level that have led to existing food law. Health problems bring about supranational legal protections through the actions undertaken by the WHO, the Food and Agricultural Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), The International Plant Protection Convention (IPPC), the World Trade Organisation (WTO) and, above all the Codex Alimentarius Commission. At the start of European construction, food safety was already a concern, and it continues to be so today, although with a change in perspective. In a few short years, the common market made hunger and food scarcity a thing of the past. This was a result of the Common Agricultural Policy (CAP), the industrialization of the agricultural sector, the elimination of tariff and phytosanitary borders and, above all, growth in the market and consumption, which put economic interests above consumer health. What began as a fear (2) Nutrición saludable y prevención de los trastornos alimentarios, at docs/guia_nutrición_saludable.pdf, p.19. FOOD POLICIES AND CONSUMER SAFETY 77

80 of not having enough food to feed the population became over time a concern for the quality of foods and their effects on the health of consumers (Sobrino, 207: 13). Community policies, after following a complicated path through multiple obstacles originating in conflicting national interests and economic challenges, are now trying to reconcile a higher level of health and consumer protection with the functioning of the internal market, adopting supranational guidelines in defence of food legislation which defends the lives and health of persons and animals. In Spain, between the enactment of the Food Code and the General Law for the Defence of Consumers and Users, a series of intoxications occurred which left the lack of protection of consumers clear. The subsequent incorporation of Spain into the then European Community in 1986 coincided with the beginning of the food crises and the necessary incorporation to its national law of the acquis communautaire, as well as subsequent acceptance of Community food law. This has meant that Spanish food policy has been influenced by numerous factors which have led to the legal reality which we will examine below Antecedents: The Spanish Food Code and the General Law for the Defence of Consumers and Users During the 1950s the work developed by the WHO, the FAO and the International Commission for Agricultural and Food Industries (CIAA) was disseminated, which led to numerous countries drawing up their respective national food codes. In 1960 Spain created a Sub-commission of Experts within the Interministerial Health Commission with the objective of drawing up a food code to be presented to the government. This project would be sanctioned through Decree 2519/1967, 21 September, which approved the text of the Spanish Food Code although its entry into effect was delayed until the publication of Decree 2519/1974, of 9 August, about the entry into effect, application and development of the Spanish Food Code. It was the first compendium in our country that systematized the basic regulations regarding foods, condiments, stimulants and beverages, as well as for their corresponding raw materials. It established definitions, determined the minimal conditions foods had to meet and the distinct procedures for preparation, packaging, distribution, transport, advertising and consumption. 78 FOOD, CONSUMPTION AND HEALTH

81 For its practical application, this body of food regulations needed the previous development of its articles through specific provisions. This does not mean that the Code was not directly applicable in regards to its general provisions and with respect to the precepts which regulated concrete products. This code has been partially repealed, modified and developed with the objective of adapting it to new scientific, social, political and legal realities. (3) The enactment of the Spanish Constitution on 6 December 1978 marked a milestone in reference to the protection of the health and safety of consumers (as in other aspects), furthermore establishing titles regarding powers on the matter of food safety. Article 15, placed within the fundamental rights (Chapter II of Title I), proclaims that «everyone has a right to life and physical integrity.» Among the guiding principles of social and economic policy gathered in Chapter III of Title I, three precepts are framed which, together with the previous, form the constitutional basis of Spanish food safety: article 43, which recognizes the right to preventative health protection; article 45, which establishes the right of all to enjoy an adequate environment; and article 51 which introduces the defence of the consumer. The distinct location in one or another chapter has important effects, as the first and second sections of article 53 determine the rights and liberties recognized in Chapter II of Title I, among which are found the right to life and physical integrity, binding for all public authorities and which may be regulated only by law which shall, in any case, respect their essential content, although any citizen may assert his or her claim to protect their rights and liberties by means of a preferential and summary procedure in the ordinary courts and, when appropriate, by submitting an individual appeal for protection to the Constitutional Court. While according to what is established in section 3, recognition, respect and protection of recognized principles in Chapter III (right to health, an adequate environment and defence of the consumer) will inform the substantive legislation, judicial practice and the actions of public powers, but only can be invoked in the ordinary courts in the context of the legal provisions by which they are developed. The state of autonomous communities proclaimed in the constitution has made it necessary to distribute powers, a distribution that on matters having (3) See Código Alimentario Español y disposiciones complementarias (2006), en Legislación Alimentaria, Seventh Edition, updated by Deleuze Isasi, P. Madrid, Tecnos. FOOD POLICIES AND CONSUMER SAFETY 79

82 to do with food has raised interpretive difficulties that the case law of the Constitutional Court has had to resolve, highlighting the 7th Legal Basis of the STC 71/1982, of 30 November which states that «the regulation of food products, objects of specific regulation applicable in all the national territory, pertains to the area of state competence, because on the indicated rule on the definition and regulation of the use of ingredients, components and additives, and on the precision of this rule with respect to food products with a market that exceeds the area of the Autonomous Community, one of the main points of the system of health protection related to food is established.» From all this it can be deduced that basic legislation corresponds to the state, and legislative development and execution of this basic legislation to the autonomous communities within the framework of their respective statutes of autonomy. The local government can regulate some matters on food safety through ordinances. In 1981 a series of intoxications occurred that made the deficiencies of Spanish food policy clear. In May, the death of a child marked the beginning of the tragedy known as the «Colza Case» or toxic syndrome and represented the appearance of a new illness in Spain that affected a growing number of persons. In the first few days, diverse hypotheses about the cause of the epidemic emerged, but then the government announced that the cause was found in a batch of denatured rapeseed oil distributed by street vendors. (4) It is believed that around one thousand people died and 25,000 became ill from «atypical pneumonia» from consuming the oil with no apparent clinical solution. (5) In September of that same year a massive case of food poisoning from mussels affected 5,000 persons. As an immediate reaction, the Government enacted Real Decree 1945/1983, 22 June, which regulates infractions and sanctions on matters related to the protection of the consumer and agrifood production, stressing that the Congress had agreed to a plan of urgent measures to protect the health of (4) The rapeseed oil that presumably caused the intoxication was imported from France for industrial activities, for which it was tinted so that it could be differentiated from oil destined for human consumption. It underwent a chemical treatment to return it to the color of the edible oil and with this transformation it was put into circulation in Spain. It seems that this process of tinting and de-tinting damaged it, making it harmful for human health. See: perso.wanadoo.es/webde1981/sociedadnot3.htm. (5) See Moreno, S. (1987) «Juicio de la colza. Kafka en la Casa de Campo.» Magazine Cambio 16, no. 800, 30 March 1987, and Faber-Kaiser, A. (1988) La ocultación de la verdadera causa del Síndrome Tóxico impidió la curación de miles de españoles, at 80 FOOD, CONSUMPTION AND HEALTH

83 consumers, among which would include the revision and updating of all regulations in force in matters of inspection and surveillance of food activities and sanctioning of infractions. To achieve this mandate, a series of regulations and provisions were updated on distinct matters, which were related to the protection of public health, consumer protection and the legitimate demands of industry and trade. The new legislation also took into consideration technical, economic and social conditions that surround the products and services that are provided to consumers and that need a clear demarcation of obligations and responsibilities in their provision to avoid the defencelessness of individuals and collectives before fraud, adulteration, abuse or negligence. However, it was the coming into effect of Law 26/1984, 19 July, General Law for the Defence of Consumers and Users (LCU), which responded to the saying «every cloud has a silver lining,» as this was a response to the lack of protection of the Spanish consumer. Formally, its aim is to fulfil the constitutional mandate of article 51 CE that requires government to guarantee the protection of consumers and users, protecting by means of effective procedures their safety, health and legitimate financial interests, giving the necessary legislative development to this guiding principle. This law has only recently fulfilled its institutional task with the support of subsequent provisions fomenting the protection of the consumer and above all supported by the position adopted by the Spanish courts which in general have been favourable to the protection of consumer rights. Throughout the years, there have been various modifications to the articles of the law in order to fit its mandates, either to the interpretation of some of the precepts of the jurisprudence of the Constitutional Court, or to the transposition of European Community directives focused on the protection of the consumer after Spain s admission into the European Community. The LCU, together with other complementary laws, was abrogated by Real Legislative Decree 1/2007, 16 November, which approved the revised text of the General Law for the Defence of Consumers and Users and other complementary laws (TRLCU). This new law entered into force the first of December 2007 and merits separate treatment to highlight community influences on food matters. FOOD POLICIES AND CONSUMER SAFETY 81

84 3.3. The admission of Spain into the European Community and the food crises The admission of Spain into the European Community in January 1986 was a factor in the modernization of the whole of Spanish law because as a previous condition for entry, Spain, like the other countries, had to accept as a whole the «acquis communautaire» or the total body of existing community laws (which included food laws that were not at that time too comprehensive). From the start, the Community accepted the importance of food safety due in part to the economic importance of the agrifood sector. It was recognized that the application of different legislation in each country would slow down trade and the flow of goods, particularly when health problems were used as an excuse to protect national markets. In a first stage, the Community tried to base the free movement of foods on a policy of harmonization based on article 100 in the Treaty of Rome (TCE). The formula used was to submit foods to the same rules referring to their denomination, composition and presentation; in that way harmonizing the norms relative to chocolate, sugar, honey, fruit juices, coffee, jellies and jams, mineral waters, and oils and fats. This situation raised some problems as it did not include all foods and because many of the norms that formed the basis of the CAP (6) as an important part of the incipient Food Law had a clear economic vocation and were not based on a food policy protective of consumers. Though there may not be a contradiction between the rights and needs of consumers and the economic objectives of the market, their final aims are divergent in many respects. The establishment of the free movement of foods starting 31 December 1992 obligated a period of adaptation of the different national food laws, whose harmonization was essential for the free movement of foods in the European economic space. But how could this be achieved? (6) The first CAP (1958) has identical objectives as the Agreement made by the FAO. The reform made in 1962 coincided with the new round of GATT negotiations which announced the beginning of the WTO. The CAP of 1998 was justified to have a better negotiating position before the following round of the WTO and for the first time the safety and quality of foods was included among its objectives. Since the approval of the Agenda 2000, scandals and food crises have cast doubt on the productive model of the CAP and the CAP itself, incapable of dealing with the loss of consumer confidence. In 2003, the ministers of community agriculture reformed the CAP in-depth, changing the way the EU supports the agricultural sector, centering on the consumer and tax-payers and giving liberty to European farmers to produce what the market demands. See index_es.htm y Costato, L. (2007), «La progresiva descentralización de la PAC y la concentración de competencias por la Unión Europea en materia de producción y comercio de alimentos», in Derecho Agrario y Alimentario español y de la Unión Europea, Coord. Pablo Amat Llombart, Valencia, Tirant lo blanch, p FOOD, CONSUMPTION AND HEALTH

85 European food legislation and consumer strength The TCE contains no direct mention of consumer protection. It is only referred to in an indirect form in setting the objectives of the CAP which was intended to assure the supply of food to the consumer at a reasonable price. Nevertheless, although it was not foreseen in the treaties, the time for consumer protection had to arrive. Only when the Single European Act (1986) was approved and introduced article 100 A into the founding Treaty was it possible to talk about a true European consumer policy; in section 3 of this article, true legal support for the creation of an internal market based on the harmonization of member states national legislation appeared for the first time. The Commission was given the task of formulating proposals on matters of health, safety, environmental protection and consumer protection with the goal of achieving a high level of protection. It is vague and imprecise regarding the role of the Commission, but it has undeniably strengthened the subsequent development of consumer protection. The Maastricht Treaty (1992) treated health as a priority that must be guaranteed through a high level of protection in the definition and application of all community policies and activities. Therefore the Community must act toward this end. To do so the pre-existing legal base was reinforced through the incorporation of Title XI dedicated to the protection of consumers and users, whose article 129 A meant the adoption of actions which would support and complement the policies developed by member states within the framework of the principle of subsidiarity (so that member states could adopt or maintain measures that meant a greater level of protection), and according to the codecision procedure that demands that Community provisions must now be adopted by the Council in cooperation with the European Parliament. The Treaty of Amsterdam (1997) recognized consumer policy in its own right to a much greater extent than before, and the currently in force Treaty of Nice (2003), without ostensibly changing the previous situation, dedicated Title XIV to consumer protection, reflecting in section 2 of article 153 its transversal or horizontal character, stipulating that «in defining and executing other community policies and actions the requirements for consumer protection will be taken into account.» The promotion of the interests of consumers is now found at the core of all community policy aimed at improving the social and economic well-being FOOD POLICIES AND CONSUMER SAFETY 83

86 of the citizens. But consumer policy will also have to take into account more general concerns related to the environment to guarantee measures that promote sustainable guidelines for production and consumption. Although economic motives initially made food safety an object of special attention, the crises suffered in the last decade of the 20th century revealed the existing legislative fragmentation and the lack of an overview of the needs arising from this situation. The shadow of food insecurity loomed over Europe despite the progress achieved and the availability of advanced technologies in relation to human and animal foods. The social impact of the crises tested control systems and the capacity of national and European authorities to watch over the safety, hygiene and healthiness of foods. They revealed the lack of harmonization in national control systems, the shortage of analytical and technical resources, and most importantly, the risks for the health of the consumer, who saw how his/her spending power could have grave economic consequences on the food sector (De León, 2007: 67). Consumers questioned the actions of the European political class before the inexistence of a unified food control in the internal market. They demanded a regulatory scheme and stricter actions for compliance on the part of all operators in the food chain. They also demanded more information on the evaluation and management of short term and long term risks and on methods of production, demanding the right to participate in the decision-making process for policies regarding the harmlessness and quality of foods. They asked for the possibility of requiring a series of obligations from the producer, distributor and retailer of foods bearing directly on product safety so that only harmless products are placed on the market. They insisted that measures be adopted in case of risk for the consumer such as identifying product batches, or establishing instructions, warnings and indications about preventable risks. The situation led to reflection on the part of the European Commission and member states. They wanted to detect and localize errors to correct them, complete regulations on matters that still had not been dealt with, establish mechanisms for effective and rapid action and adopt a common organisational model on matters of food safety, with the aim of restoring consumer confidence. But they also wanted consumers to perceive public powers as effective in carrying out regulations and in watching for and sanctioning market deviations. To achieve this, they needed a structured method that integrated the application 84 FOOD, CONSUMPTION AND HEALTH

87 of anticipatory systems and reactive control systems. In addition, they imposed new models for relations between the distinct interested parties of the food chain so that there would be intercommunication between public powers and consumers themselves with the objective of maintaining control over food quality. With these premises, the Commission included among its political priorities a reform of the sector that would increase safety and that would eliminate the differences among member states legislation on the matter, as well as existing gaps in previous regulation. Economic development and consumer food behaviour There are also factors of social change which are determinants regarding the orientation of European food production, such as the influence of economic development and the increase in the standard of living, the appearance of new eating disorders, the inclusion of new foods and the development of an ecological consciousness. These factors affect directly or indirectly the formation of opinion, which results in changes in consumer behaviour. Economic development establishes models for the behaviour of citizens in relation to the consumption of food, which in turn influences food production. The increase in the standard of living of families, due in part to more members of the family working, implies greater purchasing power which determines the type of demand for food and transforms eating habits. Families dedicate and have less time for cooking, which increases the demand for foods produced for immediate consumption and the number of meals eaten in restaurants. (7) This situation also raises some problems related to health and bad eating habits in specific social collectives. This is due in part to the aculturalisation produced in the «global village,» where the pressures from multinationals that make advertising a powerful instrument of persuasion establish uniformity in dietary habits, especially among young people. The most common example of this is fast food. (8) New pathologies have emerged like anorexia, bulimia, obesity, or (7) There is an increase in demand for foods considered to be healthy for being a part of the «Mediterranean diet,» which is living through a great time, candidate to be included on the list of Immaterial Cultural Heritage of Humanity of UNESCO, supported by the Spanish Ministry of Agriculture, Fisheries and Food (see the electronic journal Consumer.es Alimentación, 28 June 2007, at (8) The documentary Super Size Me by Morgan Spurlock is about the experiment of the director: he spent one month, under doctor s care, eating only what was offered at a fast food hamburger chain to test the effects this would produce on one s health. During this we see the deterioration of his physical and emotional condition. See: FOOD POLICIES AND CONSUMER SAFETY 85

88 orthorexia, eating disorders capable of damaging physical and mental health, whose incidence is on the increase. The inclusion in the market of new foods, many of them the fruit of genetic engineering, has created fear in the consumer over their potential danger, due in part to organised campaigns against these foods by some special interest groups and the lack of information about their utility and effects. Many consumers are also conscious of the environmental repercussions from food production due to the contamination of raw materials, the effects of bad practices, and the consequences resulting from certain types of farming. They are therefore demanding a return to a better balance with nature through revising the role played by agriculture, livestock and fishing in the conservation and maintenance of the environment and through the application of nonaggressive food practices integrated with the environment. We are seeing a new importance given to traditional and organic farming. The consumer of reference in community regulations and in the doctrine of the Court of Justice of the European Communities Before examining the unification of community regulations on matters of food safety, it makes sense to try to specify exactly who this protected subject called the consumer is. In the community sphere, there is a general lack of definition of the concept of the consumer, and in the case of the consumer of foods, this is worrying. From the analysis of regulations regarding consumer protection in which there exists a definition of a protected subject, we can deduce that the concept that they refer to has common characteristics that include all physical persons, that acquire property or services for their use or final consumption with the objective of satisfying personal or family needs. Since the beginning of the 1990s, according to consistent case law of the Court of Justice of the European Communities (CJEC), consumer protection is established through the information that consumers receive through advertising, labelling or other procedures. This is considered to favour free trade in an internal market open to competition which makes it possible for consumers to inform themselves on their own about the nature, qualities and characteristics of products so that they can make intelligent choices. The free 86 FOOD, CONSUMPTION AND HEALTH

89 circulation of goods between member states constitutes a principle foundation of Community law, so that a measure of protection against the risk of consumer fraud can only prevail over the demands for the free movement of goods if the risk is sufficiently serious and therefore justifies the obstacles to trade. Who is the consumer of reference to determine if a mention on a food label can lead him or her to error? The CJEC Gut Springenheide, of 16 July 1998, establishes the now famous concept of the «average consumer,» by indicating that to determine if said information can induce an error, it must be taken into consideration that «the average consumer of the category of products concerned is deemed to be reasonably well-informed and reasonably observant and circumspect,» an interpretation that seems to be based on a high opinion of the average consumer and it seems that «the European Court of Justice is interpreting the notion of consumer in a way which ignores the protection of the most vulnerable, the illiterate or poor consumer» (Hondius, 2007: 89). For this reason, one of the fundamental aspects of food protection is the information that must be included on the label of commercialized foods. The label information must be legally established, both in regards to general regulations about labelling, presentation and advertising of the products, and in relation to warnings about risks, advice, handling, conservation and consumption of the products, and in particular, about the raw materials used, the form of production, the origin of the products and the controls carried out over them. It is assumed that this generates a greater degree of confidence and safety. Consequently, the labelling is constantly in transition, as it goes through small continuous changes to adapt to all the modifications that are produced, both from technological and legislative perspectives, as well as from advertising (Carbonell et al. 2003: 111). Modification of European food regulations: Regulation 178/2002 Community institutions began to consider that the pair formed by food chain and consumer confidence is equal to comprehensive food safety in two ways; first, in relation to supply through the increase in production and improvements in logistics, and secondly, in relation to health. Thus food safety is not only about looking for technical solutions, but food safety must be perceived by the consumers to gain their trust. This sense of food safety is more complex FOOD POLICIES AND CONSUMER SAFETY 87

90 and demands close coordination between all the agents of the food chain. For this reason the new focus of European food policy is radically distinct from previous policy. Its focus is now on trying to guarantee a high degree of food safety to recover the trust of consumers regarding food products, as the free movement of safe and healthy foods is considered an essential aspect of the internal market because of its contribution to the well-being and health of the citizens. To do this it is necessary to harmonize food legislation to arrive at a high level of safety that bears directly on the quality of foods, while at the same time assuring the free movement of goods. Community regulations on food safety have acquired a qualitative and quantitative importance, as although up to the year 2000 legislation did exist which covered the primary production of agricultural products and the industrial production of processed foods, in analyzing this legislation it can be seen that there was no harmonization of the concepts and processes of food safety. As a result member states could start from different concepts of safety and also have distinct safety processes. The first attempts to write a single regulatory text that would establish the fundamental principles of food legislation were at the end of the 1980s. However, it would take more than another decade for the idea to become reality; a decade marked by food crises which would be the trigger for the reforms (again, «every cloud has a silver lining»). Reforms which would follow the consultations and debates brought about by a Green Paper and a White Paper from the European Commission and culminating in the adoption of Regulation 178/2002 which established the general principles applicable in this area at the community and national levels. The Green Paper on the general principles of food law in the European Union (1997) reviewed the existing food legislation and proposed its simplification, rationalization and improvement. It was not a draft of community legislation, as its fundamental objective was to initiate a public debate over the future of food law that would allow the Commission to propose measures to be developed and establish as basic rules of functioning the principles of independence, excellence and transparency. The White Paper on Food Safety (2000) introduced the legal framework through which future modifications of community law would develop. Its 88 FOOD, CONSUMPTION AND HEALTH

91 principal objective was to guarantee a high level of food safety and recover the trust of consumers. Aspects considered essential were instituting food traceability procedures and laying the foundation for the definitive modernisation of safety mechanisms for consumer protection through a plan of legislative actions with the goal of improving and making the existing legislation coherent, covering diverse areas such as food for animals, the well-being and health of animals, food hygiene, contaminants and waste, novel foods, additives and flavourings, packaging and irradiation of foods through a comprehensive and global focus on the whole food chain, that takes into consideration all the phases of a foodstuff (production, processing and marketing and sales) to answer the needs of new forms of industrial production in matters of hygiene. It raised the need to have a competent body that would provide solutions in situations of crisis, anticipating «the establishment of a European Food Authority responsible for providing scientific advice on all aspects related to food safety.» The European Commission proposed a series of legislative measures to be passed within a period of three years. This legislation would concretise the principles of food safety, the responsibility of different economic operators including the manufacturers of animal feed, the analysis of risks and the application of the precautionary principle. It would be done in a way that would lead to the gradual implementation of a new legal framework with a comprehensive, integrated approach throughout the food chain. The objective is the provision of exclusively safe foods and would include taking measures to protect the environment because of the effects its lack of protection can have on human health. The concepts, principles and procedures of food legislation must converge throughout the community, with the aim of achieving an identical and high level of protection «from farm to table» while ensuring the effective functioning of the internal market. From this moment on, community institutions developed new and broader food legislation, opting to a large degree for the Community Regulation as a unifying vehicle of the new regulations. The Community Regulation is the most complete and effective of the range of instruments available as it has general application; it is binding in its entirety and directly applicable in all member states after its publication in the Official Journal of the European Union. This instrument has rarely been used on matters of consumption. FOOD POLICIES AND CONSUMER SAFETY 89

92 The enactment of Regulation (CE) No. 178/2002 of the European Parliament and the Council, on 28 January 2002, which established the general principles and requirements of food safety, created the European Food Safety Authority and laid down procedures in matters of food safety; it had as an objective to complete the mission of unifying all of the European Union, placing food safety on the agenda of priorities of the member states and the European Commission through the introduction of basic elements of food law, among which standout the following: The establishment of definitions that gather together prior conceptual divergences among member states, unifying the concepts of food, food law, food business, food business operators, animal feed, risk analysis, evaluation of risk, risk management, risk communication, hazard, or traceability. This means the possibility to track foods and their ingredients throughout all the stages of the human or animal food chain, with the aim of establishing a safe process «from farm to table.» When a danger emerges (for example, a toxic food infection), those in charge of risk management must be able to locate the dangerous food, proceed to its rapid withdrawal, inform the consumers and the food control officers and, if it comes to it, search the whole food chain to determine the origin of the problem and resolve it. By rapidly identifying the products that pose the risk, the exposure of consumers can be limited, and the economic effects that these measures can have on businesses can be limited as well. The operator of a food business is considered to have primary responsibility for the lack of product safety (9) But this responsibility extends to all the sectors implicated in the food chain (farmers, producers of animal feed and the food industry) and to government, in such a way that although the operators of food and animal feed businesses are the first in responsibility for food safety, member states have to supervise and control them and the Commission has to put to the test the effectiveness of the capacities and aptitudes of member states to carry out this control through inspections and audits. (9) The conclusions of the Standing Committee on the Food Chain and Animal Health, of 20 December 2004, point out that the responsibility of the operators of food businesses must derive from the failure to comply with a requisite of the specific food regulation and the regulations related to civil or criminal responsibility of the national legal system of each member state, basing the proceedings on responsibility on legal grounds included in the legal system and in the specific legislation that has been infringed. 90 FOOD, CONSUMPTION AND HEALTH

93 One of the wisest decisions of the EU was the creation of the European Food Safety Authority (EFSA), the maximum community authority on matters related to food safety with headquarters in Parma, Italy, and which controls the safety and health policies of the Member States. Included among its missions are, the adoption of the precautionary principle, traceability, admissibility of novel foods or the evaluation of the principal risks of novel foods that need to be assessed. It was constituted as an autonomous and independent source for scientific evaluation, serving as a point of reference in regards to assessment of food risks. It is a coherent and centralised authority with credibility, which responds when a problem or food emergency erupts by putting into action a response network, whose objective is to inform member states of possible risks in the least time possible, so that they can rapidly and effectively adopt safeguarding measures to face food emergencies. It has also laid the foundation for a new system of rapid response, modifying the one in place since 1978 by setting in motion a response system in the form of a network, with the aim of notifying of any direct or indirect risk for human health resulting from food products or animal feed. The EFSA works in collaboration with diverse institutions and scientific bodies of member states, as the creation of national food safety bodies was also planned with its establishment. (10) These national bodies have to adjust their powers in function of the requirements of the EFSA, as well as adapt the concepts, principles and procedures on food safety in their respective regulations. The Regulation establishes the general principles of food safety. To this end, it contains a set of explicit principles that are imposed on public authorities, in addition to other principles whose existence is implicitly confirmed and reinforced. Among the explicit principles there is the precautionary principle, based on the philosophy that in the case of doubt it is better to wait, and which is applicable when definitive, conclusive or sufficient scientific data is not available, and (10) Member states have established their own Food Safety Agencies (in Spain within the autonomous regions also) with the aim of establishing a single state body responsible for all of the issues related to the health of foods. Through DF 8 of Law 44/2006, 29 December, on the protection of the consumer rights, the law through which the Spanish Food Safety Agency was created (Law 11/2001, of 5 July), was modified and that agency has now become the Spanish Food Safety and Nutrition Agency (AESAN), broadening its powers to plan, coordinate and develop strategies and actions to promote information, education and promotion of health in the field of nutrition and, in particular, in the prevention of obesity. FOOD POLICIES AND CONSUMER SAFETY 91

94 when preliminary scientific evaluation concludes that there can exist potentially dangerous effects for the environment, human, animal or plant health, according to the criteria of established protections; the principle of transparency, which is divided into the principle of public consultation about food legislation and into the principle of communication to consumers about certain risks; the principle of risk analysis based on the evaluation of risks grounded in available scientific proofs that are made by the EFSA; and the principle of consumer protection, given that food legislation must assure that consumers are provided with a base of knowledge of the foodstuffs they consume, avoiding fraudulent practices and any other practice that can lead to consumer error. Among the implicit principles should be stressed the prevention principle and the principle of harmlessness of foods and of protection of health. These principles should prevail over the free movement of goods, as although the determining parameters of the safety of a food are going to be related to its harmlessness and its aptness for human consumption according to criteria established by specific regulations, and although its sale will be prohibited if it does not comply with said regulations, the safety of a food does not exclusively depend on its accordance with the applicable provisions as even in such a case it may still be taken off the market if the competent authorities consider it to be unsafe. As much from the perspective of consumer protection as from that related to the correct functioning of the internal market, it is critical that the law is applied on an equal basis and, in this sense, the choice on the part of the community law maker of the instrument of the Community Regulation instead of a General Directive (as was at first considered) is significant. Also critical is the uniform application and interpretation of its mandates on the part of the competent authorities of each member state. With this aim the Guidance on the implementation of articles 11, 12, 16, 17, 18, 19 and 20 of Regulation (EC) No 178/ 2002 on General Food Law was published at the end of 2004, approved by the Standing Committee on the Food Chain and Animal Health. But it has not been as useful as hoped for, as it is an informative document that is not binding, which permits the continued existence of distorted interpretations in different member states. The so-called novel foods are included in the Regulation and those which are derived from the application of biotechnology (genetically modified) became the object of a moratorium, specifically on permits to introduce GM crops in the European market. This has been an issue of on-going intense public debate. 92 FOOD, CONSUMPTION AND HEALTH

95 The biotechnology industry argues that genetically modified crops involve little risk and offer huge potential benefits; ecological associations denounce a lack of knowledge and understanding of the environmental risks, and consumer associations complain that such products have been imposed from above and that the labelling system is not transparent which makes choice difficult when shopping. European consumers, in the majority, are against the approval of genetically modified foods and crops. Official surveys of the European Union show that 94.6 percent of citizens want to have the right to choose, 85.9 percent want to know more about GMOs before consuming them and 70.9 percent simply do not want to consume genetically modified foods (11) for fear of possible side-effects. Consumers are demanding to be adequately informed about these products, about their composition as well as the techniques used for evaluating them and their safety, and they want ethical, environmental, social and economic considerations be taken into account. For this reason, the authorisation procedures and supervision of products intended for human or animal consumption that contain GMOs are the object of specific regulation from various perspectives, either to permit member states to protect their conventional and organic crops from the risk of contamination by GM crops, or through the incorporation on the label of specific, clear and complete information, as demands Regulation (CE) No. 1830/2003 of the European Parliament and the Council, 22 September 2003, regarding the traceability and the labelling of genetically modified organisms and the traceability of foods and animal-feed products from them, for which Directive 2001/18/CE was modified. This means that all foods that contain in any of their ingredients more than 0.9 percent of GMO must be presented as such through the inclusion on the label of statements such as; «This product contains genetically modified organisms» or «This product contains genetically modified [name of the organism];» which also must be reproduced in advertisements or elements of product presentation. Information on the effects of a specific food or category of foods intended for consumption is an essential element in the prevention of food risks, and this is communicated to the consumer through labels that contain more and more precise information and data. The label is considered to be an important means of (11) See europa.eu.int/comm/research/press/2001/pr0612en-report.pdf. FOOD POLICIES AND CONSUMER SAFETY 93

96 food safety control. Regulation (CE) No. 1924/2006 of the European Parliament and Council, 20 December 2006, in regards to statements about nutritional or health properties of foods, states that the use of nutrition and health claims may only be used on condition that such claims are based on generally accepted scientific data and these claims cannot be false, ambiguous or misleading. Food safety and the revised text of the General Law for the Defence of Consumers and Users and other complementary laws The TRLCU fulfils the prevision set out in the fifth final Provision of Law 44/2006, 29 December, for improvement of the protection of consumers and users, which authorized the government within a period of 12 months to proceed to consolidate into a single text the LCU and rules of implementation of Community Directives dictated on matters of protection of consumers and users that bear on regulated aspects in the LCU, with the intention of clarifying and harmonizing the legal texts that have been consolidated. Article 8 of the TRLCU establishes the basic rights of consumers and states that among them are (in section a) «protection against risks that can affect consumer health or safety.» Article 9 emphasizes that public authorities will protect «first and foremost» the rights of consumers and users when it has some direct relationship with goods or services of common, ordinary or generalised use or consumption, such as foods. Chapter III of Title I of the first Book of the TRLCU is specifically dedicated to the protection of the health and safety of consumers and contains articles 11 and 16. Article 11 establishes the general responsibility for safety at a «high level of protection of health and safety of persons,» demanding from business the following precepts: the duty to inform consumers about the risks of the goods and services put on the market through appropriate means, such as instructions or indications for their correct use or consumption, warnings and foreseeable risks, also including additional obligations regarding the maintenance of necessary controls, in such a way that the origin, distribution, destination and use of potentially unsafe goods can be confirmed rapidly and effectively, those that contain substances classified as dangerous or those subject to obligations of traceability, with the aim of establishing a safe process «from farm to table» in clear allusion to the demands of Regulation (CE) No. 178/ FOOD, CONSUMPTION AND HEALTH

97 The right to information acquires essential importance, because as we have pointed out, from community judicial proceedings the average consumer is considered to be informed and an «observant and circumspect» consumer who can decide knowledgeably about his/her consumer options. In this sense, article 18.1 requires that the labelling and presentation of goods and services and methods to carry them out must be of such a nature that they do not lead the consumer or user into error, especially regarding the characteristics of the good or service and, in particular, about its nature, identity, qualities, composition, quantity, duration, origin and mode of fabrication or of obtainment; or attribute effects or properties that the good or service doesn t possess, in reference to what is indicated in Regulation (CE) No. 1924/2006. The label of foodstuffs must include the following information: origin, nature, composition and end, authorized additives that are incorporated, quality, quantity, usual category or usual designation or commercial description if it has one, expiration date, and instructions or indications for its correct consumption, warnings and foreseeable risks. Globalisation of food safety: the Codex Alimentarius In 1963 the Codex Alimentarious Commission was created (12) by the FAO and the WHO, with the aim of attaining globalised food safety through the standardisation of the quality and forms of food production according to scientifically tested techniques. This would be achieved by eliminating contaminating elements from the productive process through the development of food standards, guidelines and other related texts under the Joint FAO/WHO Food Standards Programme (ALINORM), a process in which 168 countries, the European Union, numerous entities representing the food industry and nongovernmental associations representing the interests of consumers participated. The main purposes of this programme are protecting the health of consumers, ensuring fair trade practices and promoting the coordination of food standards agreed on by governmental and non-governmental organisations. From its beginning, the Codex Alimentarius Commission, together with its auxiliary committees, has been responsible for the elaboration of standards related to food products which assure fair trade in food trade at national, regional and (12) See FOOD POLICIES AND CONSUMER SAFETY 95

98 international levels, and which are used as a reference in all agreements that are adopted about food trade Conclusions: better to prevent than lament Food policies at all levels have been more reactive than preventative. Sanitary problems have brought about the supranational legal protection of the WHO and the FAO. Food intoxications such as the «Colza Case» led to the Law for the General Defence of consumers and users in Spain. Food crises have been the trigger for European food policies as they generated distrust in consumers, who through their spending power put the internal market in danger. Consultations and debates brought about by a Green Paper and a White Paper of the European Union culminated with the adoption of Regulation no. 178/2002 which established the general principles applicable in this area on the community and national levels. The concept of food safety is an evolving concept that necessitates an analysis that goes beyond the strictly technical-scientific. Concern for the safety and healthiness of foods must be placed within the overall protection of the consumer in an increasingly dynamic and international market. The 21st century, scenario of the globalization of international food trade, needs a common regulatory framework for the increasingly narrow connection between health and consumer confidence. It is the power of the consumer which has made it possible to change the premise «every cloud has a silver lining» to the more effective «better to prevent than lament.» 96 FOOD, CONSUMPTION AND HEALTH

99 IV. Industry and Food: from referential advertising to functional foods Cecilia Díaz Méndez y María González Álvarez (University of Oviedo) 4.1. Introduction Many papers have been written on the relationship between advertising and consumption, and some of these specifically explore food advertising. (1) Interest in this type of research has usually been sparked by the importance for businesses of adjusting their supply to the changing demands of consumers. But from the sociological perspective there have been attempts to show the link between advertising and change in the society, as well as the origins and subsequent development of consumer society in Spain. (2) It is well known that businesses grant advertising the role of disseminating information about their products or services (or their presentation in the media) with the aim of influencing the purchasing behaviour of the recipient in acquiring the products of the business. As Santamaria says, (2002:83) advertising is «the privileged voice in the world of goods.» Among other objectives, sociologists have tried to offer an explanation about the relationship between the changing aspects of society in different periods and the images that advertising projects about the consumer. With this orientation in mind, we would like to put the emphasis on the changes in the profile of the consumer by looking at the advertising discourse offered to him/her. In order to do this, we will analyse the most characteristic features (1) It s more a theme of marketing but it has been examined in relation to food by Gracia Arnaiz (1996), who has reviewed the European literature in this field. This was in the first diachronic study (1960s-1990s) carried out in Spain on social change, food advertising and the evolution of discourse and practices. Gracia Arnaiz has done several studies on food advertising (Gracia Arnaiz, 1998, 2002). (2) Among others there is Arribas Macho (1996), who describes advertising in the periods prior to industrialization in Spain; Callejo (1994) and Alonso and Conde (1997), a primary reference on the origins of the consumer society in Spain and its later development. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 97

100 of advertising discourse in food advertisements between 1960 and (3) In this way we can come to understand the expectations and motivations of the consumer, who are the recipients of the advertised messages specific to each period. Another aim of this chapter will be to establish the link between values, preferences, and expectations shown in food advertising and the changes that analysts in the sociology of consumption describe as typical of the changes in consumers during this same historical period. It is necessary to place food advertising in the context in which it was and is produced because this recreates (more or less precisely) the context of consumption and the meanings that are culturally relevant for the consumer. Food problems of recent years have raised diverse questions that are difficult to answer without an analysis relating food and social change, something which has not been previously explored. (4) There are important gaps in some historical periods (between the 1960s and the 1980s, in particular), whose clarification can help in confronting some of the food problems of recent appearance. Advertising is the dominant system of representation in the field of food, revealing with its images the totality of food values and conceptions about food, health and well-being in each historical moment. But the study of food advertising is also especially interesting as a way to analyse consumer society in greater depth. In the case of food, for example, the relationship between necessity and desire is more subtle, which makes food products an optimal field of research for understanding the trajectory of the consumer in consumer society (Alonso and Callejo, 1994). Even though food products are subject to specific regulations in production, distribution, consumption and even in advertising, they constitute a good field of exploration in order to find out if their specificity differentiates them from other goods or if, on the other hand, they have similar characteristics to those consumers look for in other products or services. We can t forget that the consumer s response to advertising is not mechanical so that examining the consumer in this way implies a certain bias in the analysis. We are exploring «what advertisers believe the consumer to be.» (3) The period studied corresponds to what is normally considered to be the beginning of consumer society in Spain (Alonso and Conde, 1997). (4) One explanation about the delay in Spanish sociology in the analysis of food can be seen in Diaz Mendez (2006). 98 FOOD, CONSUMPTION AND HEALTH

101 which might not be what «the consumer is.» Contrary to being a problem though, this becomes a starting point. What we are interested in is what businesses (represented here through the advertising of their products) think about consumers. We believe that advertising intervenes in the consumer s decision-making about which foods to buy, and is permeated by the social factors with which it coexists and which affect the consumer Analysis of Advertising The search for material has focused on compiling food and non-alcoholic beverage, (5) advertisements from 1960 to (6) The first source of information was the Internet (pages consulted cited in the bibliography), including 248 images. The second source was books on advertising. (7) which primarily served to correlate the information obtained with the dates of creation of the ads, as well as to broaden the documentation for specific time periods. From these texts we have included the analysis of 63 advertisements. We took 112 advertisements from magazines for the information from 2006 until June 2007, (see bibliography). In addition, we checked the web pages of international food and non-alcoholic beverage businesses, although no references were taken from any of them, and they basically served to confirm the launch dates of the advertisements selected from the other sources. All of the advertising consulted refers to advertisements that appeared in the written press; therefore, we have worked with printed images. The selection criteria were first oriented around a systematic collection of all the food and non-alcoholic beverage advertising presented in the media and were examined without any pre-established criteria. Secondly, a classification (5) Regarding beverages we have also included an analysis of beer advertising. (6) One has to take into consideration certain biases from the start in all analyses of advertising, which are difficult to overcome. Advertising is costly (especially TV commercials). This is an obstacle for small and medium-size businesses not able to assume these costs. We have attempted to overcome this problem, at least partially, by looking at regional magazines (in our case in Asturias) in which one can find advertising from local and medium-sized business. It is also important to remember that fresh foods are generally not advertised. We have found very few advertisements of fresh fruit, vegetables, and fish with the exception of institutional advertising campaigns (with limited presence in the first decades analyzed and associated with institutions starting in the 1990s). Although it is difficult to know the repercussions this has on consumption, it would not be presumptuous to consider as a hypothesis that the decrease in the consumption of fresh food could be intimately related to its lack of promotion in the channels used by the rest of the food products. (7) The book of the Nestle Company (VV.AA., 1992), Una Historia de la publicidad Española: Reflejos de más de un siglo de Nestlé. Also El libro de la publicidad Gráfica (VV.AA., 1995) or the work of Bassat (1993), with his El libro Rojo de la publicidad, as well as that of Campo (2000) on Cien años de Publicidad en Asturias. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 99

102 by decade was carried out. The dominant presence of food products for children and babies made a third selection necessary. The objective was to give differential weight to these types of products and to verify their evolution in terms of number through the years, without reducing the importance of the other products in each period analyzed. We have tried to maintain the same number of images analyzed for each decade, although without losing sight of the comparative importance of advertising in each historical period. Advertising images were analyzed as a whole, considering the written message emitted and using the photographs or pictures in each advertisement to contextualize the sentences and words used. Ads were selected by decade with the objective of observing their evolution and making a comparison among them, as well as doing a year by year comparison to detect the characteristics of the messages in shorter periods of time Advertising by decades: from the 1960s to 2007 The 1960s and the food industry In the beginning years of consumer society in the 1960s, food advertising discourse consisted primarily of introducing modernity through consumption, following the same line used to promote other types of products (Alonso and Conde, 1997). Although this decade is considered by analysts to be the period of Spain s industrial takeoff (even though 40 percent of the active population was still employed in agriculture) and the political situation continued to be practically the same as twenty years before, advertising presented itself as the path to modernity and freedom. In this decade the agricultural sector was still directly and strongly connected to the agrifood system in such a way that the products of the land were still to a great extent goods for final consumption. As the decade advanced and then decisively in the 1970s, as Sanz Cañada (1997: 357) affirmed, «a growing differentiation was produced between agricultural product and food product, adding to the former a whole series of transformations and features that modified it substantially and that brought greater prominence to the food industry and to food distribution.» 100 FOOD, CONSUMPTION AND HEALTH

103 One of the main characteristics of food advertising at the beginning of the consumer society in Spain was the way that it affected the progressive industrialization of food. Advertising had to promote the purchase of manufactured products for a consumer with little training in shopping habits. In this decade advertisements were based on variety, something which fit well with the monotony of the diet of the period. Consumers were encouraged to purchase the products available on the market with words such as «healthy.» «pure» and «natural» in an attempt to avoid their rejection of industrial food. There is a constant reference to flavour in the messages, a formula that demonstrates the fears of the industry more than its potential. Showing the advantages of a new way of eating, far from the land where the food was produced, was a great challenge for the agrifood industry. Food was presented as an inexhaustible source of new sensations for the palate. In 1964, Nesquick was presented as «light, tonic, digestive and so tasty!» In 1965, Knorr talked about «the flavour of the best natural products, the flavour of a well-made soup» and «a delicious and nutritious soup.» In 1965 Tulipan also alluded to flavour, describing itself as a food that «makes everything more appetizing.» Consumers threw themselves openly and unreservedly into the consumption of all these new products, which in their advertising messages offered what was not possessed, the freedom denied by the political regime at the time (Alonso and Conde, 1997). The food industry s hope was to set itself up as the symbol of modernity, and to do so it made use of various marketing strategies. The first was the appeal of industrial manufacturing techniques. The process of modernisation with the increased use of technology by the industry was going to mean a diet «designed by science» and would be a reference of reliability decisive in gaining the trust of the customer. The other strategy, clearly targeted at the housewife, had to do with the use of products in the home, focusing especially on the rapid preparation of food and the practicality of these products. Quick and easy preparation offered the cook more free time and less work in the kitchen, which was very valued by young wives and mothers who also wanted to modernize domestic life and find new uses for their brand new urban homes. Royal in 1966, explained to its customers that its flan «is made by itself» and that «you don t have to bake it, add costly ingredients, or watch it.» Skol Beer, in 1966 said that «it s easy to open, no INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 101

104 can opener needed and it takes up less space.» Along the same lines in 1966, Riera Marsa in their ads for mashed potatoes asked its customers, «Why waste time if Riera Marsa does it for you.» The reference to comfort and convenience also incorporated another characteristic aspect of the decade, large families, by offering products that came in special sizes. In 1967, the Fanta soft drink company offered one of its products in an economy-size bottle, «So familiar (family and economy size), so big, and so economical.» It should be added that the idea of modernity was intimately linked to everything that was not Spanish, a characteristic that was already identified in studies about the beginning of the consumer society (Alonso and Conde, 1997). The quality of being «foreign» was a way of demonstrating the modernity of the product, so foreign brand names were used. There was a clear duality: Spanish was associated with backwardness, the rural, and a lack of freedom while foreign was associated with modernity, the urban and openness. Take a look, for example, at Ritz crackers which in 1967 were sold as «the world s favourite cracker,» denoting worlds faraway from the hard Spanish reality of the times and close to the idyllic paradise of American freedom. Another key to the advertising of the decade was alluding to the origin of the ingredients. The reference to a product s natural origin created trust in the consumer who saw how products were moving farther and farther away from their origin. The consumer was quite knowledgeable about the origins of products (given his or her own rural origin), and his or her dietary references continued to be rural. Therefore, advertising anchored products in their natural origins. It was very common to find the adjectives «pure,» «natural,» «fresh,» to describe a soft drink as well as oil or butter. In 1965 the butter Arias said that it came from «pure cows milk.» In the same year, the oil Vetusta was described as «pure olive oil,» and in 1967 Kas presented its products as «pure fruit juice,» stressing the «real flavour of fresh fruit.» It seems like a basic advertising premise that products must be presented in a way that relates them to purity and authenticity in order to convince customers of their naturalness and distance them from industrial artificiality, but this was especially the case for the consumer born in a rural world who knew very well the products origin and traditional production methods. 102 FOOD, CONSUMPTION AND HEALTH

105 The 1970s: brands as guarantee In the 1970s the separation between the agricultural and the industrial sectors was consolidated, and the food industry as well as the distribution industry acquired a decisive weight in the national agrifood system. Even though the agricultural sector significantly increased its production it could be said, using the words of Sanz Cañada that «a vertical shift occurred in the economic importance and decision-making power from the agricultural sector to industry and distribution that led ( ) to a transfer of income and of participation in the final deman» (Sanz Cañada, 1997: 357). In this new logic, along with the increase of agricultural production, there was also an increase in the mechanization of the food industry that facilitated the presence of new and varied products on the market through the standardization of industrial production. Products with some type of previous processing (such as cut, tinned, cooked, and packaged) and frozen products made their appearance on the market. Homes also improved as the decade of the 1970s was the period of the food refrigeration revolution as it was during this decade that refrigerators became common in Spanish households (Castillo Castillo, 1987). The first references to a lost rural life, full of longing, began to appear in advertising messages. Although there was again the intention to distinguish industrial food from the artificial stamp of the factory, now there was also an attempt to search for the immaterial aspects of the products origin. Hence the return to origins associated with the positive aspects of the traditional rural world. In 1972 the company, Central Lechera Asturiana [Asturia Central Dairy Company], asked its customers «How many years has it been since you drank real milk?» And in 1978, there was an ad to promote Kas Apple that said «We have to go back to the natural.» The change to an adult and more hedonistic consumer was clear in this decade, as messages in which the pleasure of food as the main characteristic of consumption began to appear. The message changed its orientation; if before happiness was offered in exchange for consumption, now happiness came in the act of consuming (Alonso, 2004). Nestle made it very clear in 1972, inviting the consumer to eat something sweet simply «because today is today.» It is interesting that in the previous decade only soft drinks targeting INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 103

106 young people transmitted the notion of joy and happiness in their advertising, but now in the 70s with the consumer society in place, need gave way to desire, and images associated with enjoyment and pleasure were introduced into the ads for all products. One example of this was with coffee, «the good moments, Nescafe» in 1973; and happiness arrived through that star product, Coca-Cola, «the spark of life,» in 1972, (a translation from the original, It s the real thing), that in 1970 had been sold in Spain under the slogan «the flavour of life.» Brands became consolidated during the 60s and the first years of the 70s, appearing at first as guarantors of quality and as a result, security for the customer. This was possible thanks to the referential value that the consumer gave to advertising in its first years and the fact that advertising was considered to be a source of reliable information (Ibáñez, 1985). (8) But later in the 70s this orientation gradually changed as a loss of consumer confidence in advertising messages began to appear. In the 70s, children s food was strongly tied to health, which meant at that time physical strength and growth. Children as well as elderly people and adolescents appeared as a sector of the population that required special diets, and the connection between food products targeting these groups and improvement in their physical condition was strengthened. For this reason advertising focused its attention on the energy provided by products. Sugar performed well in this image of strength, energy and physical development, as expressed in the ad «stronger with ColaCao,» from 1971, or in the dairy products of Danone presenting yogurt as a product to be strong and healthy and grow with the 1978 slogan, «healthy people grow with yogurt: stronger, healthier.» Sweets were advertised as food and it was recommended to mothers that they offer them to their children as afternoon snacks or for breakfast. Bimbo already said it, commenting on their little cakes, Bucaneros, in 1974, «the sweet that nourishes.» Petit Suisse appeared in 1972 and Danone custard in 1974, two «classics» in sweet foods for Spanish boys and girls. (8) Ibañez spoke about referential advertising as that which refers to objects and is characteristic of industrial capitalism. He compares it with «structural» advertising, common to consumer capitalism, in which ads no longer refer to objects (to products), but to what they mean. «Structural» advertising refers to itself and constructs a world of meanings around the object. 104 FOOD, CONSUMPTION AND HEALTH

107 The decade of the 1980s: the television revolution and the definitive expansion of mass consumption A decisive aspect of consumption in the 1980s was the spread of television into Spanish households (Castillo Castillo, 1987). The children born in this decade were the first to be «trained» in advertising communication. Our research confirms that print advertising was a reproduction (sometimes literal, other times versional) of television commercials. This is the period in which democracy was consolidated and important social changes were achieved. The divorce law in 1981, the decriminalization of abortion in 1985, the progressive incorporation of women into the labour force or the entrance of Spain in the (EEC) European Economic Community in 1986 were among the transformations that took place and that had important effects on Spanish society. These references help us to understand the changes that occurred in advertising discourse. In the business sector, food production was moving further and further away from the consumer. Industries that mediated between the two acquired a decisive weight in the supply of food in the Spanish market. In this period the saturation of consumption began to become evident because of low prices and higher incomes but neither of which explain demand. Quantity became secondary to quality for a consumer that «had it all» or rather, «wanted it all» (Callejo, 1994). This consumer was looking for differentiation, and demand became more personalised. Business responded by segmenting the market and offering a growing variety of containers, sizes, brands and packaging (Rodríguez Zúñiga and Sanz Cañada, 1992) for the growing diversity of consumers. The profile of the recipient of advertising changed, and food was no longer targeted exclusively to women as housewives; other profiles of women appeared with more varied roles and also other types of consumers. There was a change from the model of a single type of family (the nuclear family) as the primary target of food advertising messages to the utilisation of new kinds of homes with young people without children, or of single occupant homes. In this period, specifically in 1987, Findus launched the first pre-prepared meals in individual portions or in two portions, «presented in practical individual bags.» INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 105

108 There were also important changes related to the organisation of meals and the limitations imposed by work and school hours. Quick and easy preparation was integrated into food advertising in order to facilitate the new pace of work, the growing increase in leisure time (9) and the extension of schooling years for young people. For quick preparation the slogans of the 60s were reproduced with a different flavour because now they were directed toward a consumer (either man or woman) busy working outside the home and arriving home with little time, tired from a long day s work and with no one to share the evening meal. Maggi s ad in 1985 said: «Five minutes and time to eat, with no need to cook.» In this decade the first worrying symptoms related to eating began to appear, and some businesses began to echo government in pointing out certain eating habits as problematic. This was the case related to the organisation of meals, in which the diminishing importance of the breakfast meal was noted, leading to institutional campaigns promoting breakfast; for example, Nestle in 1986 had a campaign in which they published a book called Good morning breakfast! (10) As society grew further and further away from nature and the world of agricultural and livestock production, businesses began to laud the values of traditional food, particularly by referring to origin. The return to origins was the return to natural products and to products difficult to acquire in a scene in which agribusiness was becoming dominated by the global market (Bonano, 1994). Many products were identified by their origin, and brands were presented to the consumer as offering security based on the origin of the product. Carbonell in 1982 described its oil as «the origin, the original.» Throughout the decade Nestle offered its products through the reference to their origin; in 1981, «Columbia, Africa and Brazil together in Nescafe;» and in 1988, «with a careful selection of cocoa from the tropics.» This type of advertising was reinforced because of consumer distrust caused by the problem with the adulterated rapeseed oil in Another characteristic of advertising discourse of the time was to include the number of calories in the product description. This revealed the consumer s preoccupation with physical appearance and more specifically with thinness as the dominant aesthetic value. In 1981 the first low-calorie dairy products (9) This was the decade in which the so-called «English week» appeared with the Monday to Friday work schedule and the weekend for rest. (10) Arribas Macho carried out a review of Nestle food advertising (2005). 106 FOOD, CONSUMPTION AND HEALTH

109 appeared, from the company Sveltesse. In 1985 Danone launched its 0 percent fat-free product. And in 1987, Findus published a book The most appetising recipes under 300 calories as part of its Light Cuisine campaign. On the other hand, advertising discourse was also becoming more and more scientific and rooted in the fields of health and nutrition. (11) There were ads describing food properties and the nutritional composition of the products. In 1988, Danone launched its first yogurt with active bifi dus «that help to regenerate the intestinal flora,» and La Asturiana in 1983 talked about the properties of legumes in nutritional terms: «For their protein content, legumes are the most nutritional product.» This scientific discourse would enter into the presentation of the products as well with explanations about the advantages of new techniques in industrial packaging such as the tetra brick or the vacuum-packed product. They were offered as a sign of healthiness and quality, but above all as technologies that preserved the properties of the products. The process of the industrialisation of food was associated with something positive, and the decisive role played by industry became obvious; this was a new scenario in which there were no other reliable intermediaries between the consumer and the product other than the agrifood industry. La Asturiana in 1983 said: «Quality, selection and packaging are basic for the product to reach the home in optimum condition.» In 1989, La Polesa spoke about milk in the same way: «Times change. Fresh pasteurized milk in a more practical package.» There was no lack of hedonism in this decade. Judging by advertising, pleasure was the decisive factor in the food choices of the decade. Nescafe in 1980 encouraged people to enjoy life by consuming its products: «The best way to understand and enjoy the pleasure of life.» But moreover, the decade of the 80s was a peculiar period in Spain because of important property developments (in part based on land speculation), and an important idea in society at the time was transferred to advertising, that of obtaining profits easily and effortlessly. Many brands offered easily obtainable gifts; Lion in 1988 with its ad, «you can win a trip to New York,» and Nestle launched one of its most emblematic campaigns with Nescafe in 1985, «a salary for life.» (11) The medical-nutritional discourse had begun in preceding decades (Gracia Arnaiz, 1998) and would become more widely developed starting in this decade. The medicalization of advertising, its direct relationship with the healing properties of the product took shape. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 107

110 The 80s were the years of enjoying consumption with little reflection, but they were also years in which the consumer ended up feeling saturated and seeing him/herself as indulging in excess (Alonso, 2005). These years gradually gave way to a more reflective decade in which businesses began to recognise the role of a consumer who thought about what he/she could attain and about what he/she could reject. However, the development of this new role would find its maximum expression in subsequent years because even entering into the 1990s, the characteristics of the most consumerist period in Spanish history continued to be evident in advertising and consumption. The 1990s and the end of the century: aesthetics as social value and the role of the new consumer If in previous decades the agricultural sector had given way to the food industry, this decade was characterised by the growing power of distribution in the agrifood system. Decision-making and demand came closer and closer together. This situation gave power to large agrifood business, with its effective distribution methods which not only enabled it to respond to high demand but also to variations in demand almost «in real time.» The availability of information technologies (particularly in large companies) combined with the capacity to handle wide distribution changed the roles of businesses in a globalized agrifood system (Bonano, 1994; Sanz Cañada, 2002; Langreo, 2005, 2005a). Social changes in the decade also began to have an effect on eating, and this became visible in the society. Concern about changes in eating habits arose at this time, as the destructuring of eating and dietary changes in some social groups in particular children became apparent. As a result, institutions had to turn their attention to food disorders (Díaz Méndez and Gómez Benito, 2004). It is impossible not to think about the 90s as the decade in which the first global food crisis appeared, with bovine spongiform encephalitis or as it is more commonly known, «mad-cow diseas» in This and other subsequent international crises sparked a general distrust of the agrifood sector, since investigations into the origin of these cases revealed the dubious procedures used in food production and the unethical behaviour of producers and businesses in the handling of foodstuffs. The proliferation of marketing 108 FOOD, CONSUMPTION AND HEALTH

111 strategies at the service of agribusiness also helped to create a general climate of distrust toward advertising during the 90s. However, this would be complemented by businesses taking a closer more attentive look at the consumer and his/her role in the agrifood chain. For this reason, in the 90s there was finally backing for consumer associations (which had first appeared in the 80s), and government also became more active in creating new bodies and implementing strategies with the objective of supporting the consumer. At the end of 1988, The General Advertising Law was passed with the aim of controlling false advertising, and replacing the already expired Advertising Law of It is not strange that in this context advertising discourse sought to recover consumer confidence. Big agrifood businesses positioned themselves in the market by appealing to their long term presence in the Spanish market and seeking through this the support and loyalty of a consumer who had begun to completely distrust everything and everyone. Businesses turned to quality, tradition and to what was known about them in the domestic market. An example of this was the advertisement for La Muyerina legumes in 1991, «Legumes selected through many years of experience ( ) Legumes with nothing more than trust, without problems», or Camy in the same year advertised its products as «the legacy of tradition.» Of course, the traditional Nestle (always a pioneer in advertising discourse trends) didn t stop reminding the consumer of these key points with its 1992 slogan, «Children s Food, Safety and Trust.» They offered advice to consumers through books such as The Child s Book (1992), in which they explained these values as did Danone with The Sport Book (1992). Big businesses took the initiative by creating food institutions that supported their advertising strategies and the position of their products in the domestic market. Danone created the Danone Institute in 1992, and the Pascual Group created the Tomás Pascual Institute for Nutrition and Health in (12) Along with these prestigious well-known brands with seniority in the market, the not so well-known brands were also looking for consumer confidence by (12) In the next decade we would witness the proliferation of organisations of these characteristics, but it would be above all starting in 2005 with the publication of the NAOS Strategy (Strategy for Nutrition, Physical Activity and the Prevention of Obesity), when the majority of agrifood businesses echo the reports of the WHO against the increase in obesity by creating different organisations with the aim of promoting a healthy diet. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 109

112 emphasizing the geographic origin of their products (those that would later be called «products from the land»). The concept of origin represented the experience of know-how and reliability coming from the natural origin of the product; both attributes distanced products from the artificiality conferred on them by industry. Birba biscuits in 1994 described itself as «more country than a plough.» Pizzas had to come from Italy, milk from the north, and oil from Andalusia. The milk company, Granja in 1991 advertised itself as «the most Asturian.» In the field of advertising there was a slogan that marked advertising communication of the 90s and that crossed the frontiers of advertising itself; this was the «Danone bodies» advertisement of Danone. Even though this was not the first time advertising connected eating with one s physical appearance, it was in the 90s that advertising went beyond the more rational aspects in the search for thinness and became submerged in the imaginary in terms of beauty. The «Danone bodies» (a young man and woman, practically nude, sitting beside a pool) that appeared in a yogurt advertisement in 1992 constituted the public confirmation of a new model of beauty. The perfectly formed slender bodies moulded by sport were the standard for men and women. This ad offered at its time an aesthetic model demonstrating the almost obsessive desire of the Spanish population to attain perfect beauty (obviously connected to thinness). The desire to be thin, according to sociological studies of the time, became a generalised value and one that was on the rise in the decade (De Miguel, 1994 and 1996). Eating became connected to dietary restrictions aimed at achieving the perfect body. This was the decade of weight-loss diets, the expansion of light products, the wide diffusion of saccharine and the consolidation in the market of products that stand out for their lower calorie content. In this scenario Nestle came out with its Slender line in 1992; «The new line of foods for diets to lose weight with all the flavour and the minimum of calories.» And the saccharine Suita also in 1994 declared in its advertising «nothing so sweet.» In 1992 Petit Suisse launched its product with «less than 4% fat» and Bimbo, the same year, its wholemeal bread Silueta, «because healthy eating means eating intelligently.» If the previous decade had ended with the feeling of having had enough of consumption, the 90s closed with the sense that control (over the body, food, 110 FOOD, CONSUMPTION AND HEALTH

113 consumption in general) was not only possible but in fact desirable and came about through control over one s own body. In just a few years we passed from waste to restriction; from the pleasure of letting oneself go to the pleasure brought by self-control. However, eating now took on a new dimension as it changed from being a means to achieve something (eating a varied diet, being strong, healthy, thin, depending on the moment) to being an end in itself. The new century: health as the goal The new century has continued to be characterised by consumer distrust of industry and advertising as there have been repeated food crises. Nevertheless, scientific discourse from the health field has entered in the discourse on food to the point that eating has taken the leading role in the consumers desire to achieve perfect and lasting health. In this century concern about being healthy has become as important as the obsession with thinness was in the previous decade. Moreover, the beginning of this century has been characterised by the importance of new values such as solidarity, ecology, and sustainability among others, which have promptly been applied in food advertising. In the year 2000 bananas from the Canary Islands were presented with the slogan, «solidarity with our own,» and the image was of a banana peel forming a bow, like those worn by people to show their support for various causes (the red bow for the struggle against AIDS, the blue one against terrorism). The profile of the new more committed consumer has not gone unnoticed by business. El Ventero cheese in 2007 affirmed that it was «healthy even for those who don t try it because we emit 50 percent less CO 2 in the atmosphere.» In 2005 Nestle introduced a line of products called YOCO with the slogan: «Commitment, nutrition, and growth.» Even the State Ministry of Health with its 2006 campaign «Wake up, eat breakfast,» and Channel Five, from its website «Twelve months, twelve causes,» made eating and diet the cause. Everyone agrees on the objective of confronting the dietary problem that has been branded an epidemic, childhood obesity. The concern about children s diet and the transmission of good eating habits has set in motion new campaigns to make people more conscious, among others the NAOS Strategy (2005), which brought businesses and institutions together in order to face the problem of childhood obesity. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 111

114 Medical discourse has impregnated food advertising in recent years and through arguments on the beneficial effects of their food products and components on health businesses have regained the trust they had lost (Díaz Rojo, 2003; Gracia Arnaiz, 2001). Functional foods have appeared on the market. Perhaps the most typical of these has been Actimel from Danone already present in Spanish advertising in 1995 with the slogan «L. Casei immunitas helps to strengthen your defences against outside attack.» Others came later offering direct and immediate benefits to health; for example, Burgo de Arias in 2006 with the ad, «For low sodium diets,» or Danacol that in 2004 stated «It has been scientifically demonstrated that Danacol reduces cholesterol,» and further added «Danone s investment in reducing cholesterol easily and effectively.» In 2005 Bimbo «incorporates soluble fibre in Silueta wholemeal bread to help the growth of intestinal flora.» Naturlinea a product of Central Lechera Asturiana stated that «thanks to the active ingredient tonalinit, it helps to avoid the formation of fat and reduces fat already accumulated in the body,» or Vivesoy from the Pascual Group, «a source of isoflavons that help to regulate menstrual symptoms and prevent the effects of menopause.» Arguments are reinforced by scientific opinion and testimony from different associations in the field of health and nutrition. For example, the ad for Sierra Cazorla Water in 2006 said, «Do you know what the latest scientific studies say?» Or in 2007, Vitalinea offered the backing of an association with the following ad, «Miracle diets fail 95% of the time, backed by the Spanish Association of Dieticians-Nutritionists.» If experts affirm that it is necessary to eat several pieces of fruit a day, businesses offer the magical portion in a convenient package; if science says that cholesterol is reduced by eating the components contained in blue fish, industry provides food that concentrates in a reduced serving the benefits of these substances and adds «omega 3» to milk, or anti-oxidants to fruit. It could well seem that it is the product itself that achieves the objective of being healthy. Due to the new pace of work and the possible deterioration of diet, highlighted by government and associated with (among other things) the increase in eating out, businesses react by offering products that are a cross between soft drinks, juices, and yogurts and that are offered as a healthy alternative for the hours outside the home. In 2000 Pascual launched the «Yosport,» a liquid yogurt for children, adolescents and/or young athletes. And in 2001 Danone offered 112 FOOD, CONSUMPTION AND HEALTH

115 a new version of «DANUP,» with the slogan: «Your recharger,» promising that it is «enriched with 6 vitamins to increase the energy level of those who consume it.» The natural properties of products, however, have begun to be insufficient for achieving the objectives of optimum health. In recent years, with this trend toward a functional and medicalised diet, there has been no attempt to return to the natural, but rather we are assured that something better than the natural has been attained, as Minute Maid in 2007 stated, «Because Nature is wise, but not so wise.» With the implantation of scientific discourse, the format of advertising has changed significantly. Advertising has passed from the use of the image to strengthen the message to the primacy of the explanation through public information reporting, one of the new forms of media on the rise. In these ads, medical or nutritional discourse is used, and the change that has taken place related to health is palpable. Lengthy advice on how to have healthy lifestyle is offered, such as Vitalinea in 2007 indicating the steps to follow: «(1) Take advantage of good weather and walk to work. (2) Drink water between and during meals. (3) Eat vegetables. (4) Make your salads more delicious by dressing them with light sauces made with Vitalinea yogurt. (5) If you go out for tapas, choose the lightest ones...» On the one hand, in this new context the search for beauty and its connection to food has not disappeared but has become a component of health. Thinness, equivalent to beauty in the 90s, is not enough in itself, but rather it becomes important as a reflection of a healthy body and mind. On the other hand, the consumer acquires a more autonomous character and in this sense he or she is no longer the object of false advertising, nor can his or her intelligence and capacity for reflection be minimised. It is necessary to offer reliable information (more like news than advertisement) supported by scientific findings for a consumer who expects explanation and who reflects on the advertisement s message. A clear orientation toward this new consumer profile was offered in the Danacol advertising in 2007, which gave five reasons to buy the product: «1) Because if I don t, I can end up suffering from heart disease and this will limit my quality of life; 2) Because in the end, health isn t a question of luck but of care; 3) Because fortunately, I have the means at my reach to propose it and attain it; INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 113

116 4) Because taking care of ourselves, we are also taking care of and protecting the ones we love; 5) Because there is no intelligent reason not to do it.» A message directed to the informed and educated middle class, sensitive to the values of solidarity, capable because of their economic situation and social position of finding for themselves what they want and offering it to others, all an argument for the new consumer in a society «where consumption isn t far from citizenship» (Alonso, 2005: 108) Conclusions: food advertising, a complex and problematic path toward food modernity The hypothesis proposed in the beginning of this chapter was whether it is correct to consider food as having been treated similarly to other consumer products in advertising over time and in terms of form, even though it has other specificities which we summarize next. There are three areas that are relevant to understand the changes in food advertising; first of all, we can describe the profile of the consumer to whom the information is directed; secondly, the most significant keys in the discourse of the agrifood businesses in each historic period; and third, the conception of food in each decade. This trajectory allows us to affirm that agrifood businesses have followed the same advertising strategies as other types of businesses in what concerns the consumer to whom their advertising is directed. Nevertheless, there are peculiarities that are only attributable to changes in conceptions about health and diet in each historic moment. First Phase In the 1970s at the beginning of the consumer society, food advertising messages reflected an incipient but growing industry which offered its products to a consumer guided in his/her eating habits by the mother in the family. In this period, characterised by great imbalances in the consumption of goods among the population, (13) the housewife had a limited range of options to vary the diet. Advertising showed new products with extraordinary flavours, which came to represent the possibility of introducing into a homogeneous (13) Based on class, income and geographical location of residence, as shown by Jose Castillo Castillo (1987). 114 FOOD, CONSUMPTION AND HEALTH

117 diet a variety not offered by local agricultural production. But moreover, the food industry presented itself to the consumer as the ideal medium to achieve modernisation, also in food habits, and its products became symbols of a modernity that came about necessarily through the technology used by industry to handle agricultural products. In this way the housewife trusted the messages and possibly felt supported in her expectations of improving her own life and that of her family through these messages loaded with products with new flavours and with the guarantee provided by hygiene and industrial treatment. In this beginning of consumer society, advertising was accepted as a way of providing information about existing products and it was perceived with the confidence that its referential function provided (Callejo, 1994). Second Phase During the initial development of the consumer society, housewives continued for some years in the role of caretakers of the home and their families, and food advertising continued targeting them. (14) For this reason, taking care of children and helping them to grow up strong and healthy formed part of the message of food businesses. The messages offered the possibility of a physical improvement of children and young people of the new generation and encouraged mothers to distance their children from the food deficiencies which characterised their own generation. At the beginning of the decade the quantity of foods represented a stimulus for food consumption, while by the end of the decade, new and more sophisticated products appeared that did not respond to basic food needs, but rather to a clearly superfluous consumption (Castillo Castillo, 1987). (15) For this reason, sweet products did well at this time as they represented abundance (compared to the food deficiencies of earlier periods) and status (an indulgence and not a necessity). Perceptions about food changed, and abundance became the most evident sign of well-being that a family could offer to their children. But moreover, arbitrariness in the selection of some food products would be a sign of economic possibilities for some families still economically vulnerable and who were beginning to see in consumption the opportunity for improvement. (14) Especially food for children, as Gracia Arnaiz reminds us (Gracia Arnaiz, 2002). (15) Important inequalities continued to exist (now particularly in different regions) and an important technological gap (in number of televisions, refrigerators, telephones, etc.) with respect to other European countries (Castillo Castillo, 1987). INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 115

118 The market developed as a space of freedom (Alonso and Conde, 1997) as it offered what the Spanish society did not have at the time, permitting «freedom» in the act of purchasing. Superfluous food products offered the component of whim, indulgence to the diet, far from necessity, but above all they offered families the possibility of manifesting their social status in their community. What was now important was to have everything, even things that were not necessary. (16) Freedom was also offered to women housewives, and businesses made a special effort to promote products that saved time in preparation. Their intention was to show women the possibility of freeing themselves from domestic obligations. Nevertheless, the beginning of loss in confidence in advertising was becoming evident. In this decade quality would be offered in exchange for security, and they would continue focusing on the rural and traditional origin of agricultural products, but in fact food was becoming less and less rural and more and more industrial. Third Phase This framework of pleasure and freedom would be ideal for fully developing consumer society, and one of its most typical characteristics, voracity in consumption (Alonso and Conde, 1997). Gradually, everything seemed to come into reach for everybody. The development of the food industry made it possible to offer everything at a low price which meant that anything could be bought or sold, but moreover there was no reason not to do it. We could say that at that time there appeared in the area of consumption and food what Galbraith called «the affluent consumer» (Galbraith, 1987): «a consumer who has everything and who wants everything» Desire replaced necessity as principal motivating factor, even in food, the «basic» product par excellence and «necessary» for survival. However, trust in advertising began to break down as the proliferation of products made the marketing strategies to gain market share very obvious through the profusion of similar messages, which were confusing to consumers. Advertising followed what Callejo called «the model of semiotic motivation» (Callejo, 1994), in which advertising images, more than actual products are (16) There was an important economic crisis in the decade, but this did not slow down consumption (Alonso, 2004). 116 FOOD, CONSUMPTION AND HEALTH

119 being consumed. Fiction is accepted as part of the rules of the game in the market and valued especially for its aesthetic aspects. Businesses would turn to the support of experts to gain consumer confidence, and advertisements would be filled with doctors and nutritionists. The discourse would become more sophisticated in the form of a presentation, and foods would be differentiated by their nutrients and their capacity to bring about benefits or problems in the health of the consumer. Calories would be seen as the enemy to defeat, and appearance and thinness would be the goal. This was the age of the proliferation of diets and the expansion of light products. The reference to thinness and the consumption of low-calorie products showed an adult consumer who selected food products for him or herself. This consumer obsessively looked for everything that would allow him or her to achieve a desired weight and physical appearance through non-fattening diets and products. The voracious consumer immersed him or herself in the area of health. Weight as an attribute of uncertain or accidental origin could be altered and correctly controlled. It was possible to achieve the perfect body through the consumption of certain products. Nutrition was at the service of thinness (not health), if we take into account the proliferation of messages for products containing more or fewer calories and describing in detail the nutrients they provided (Gracia Arnaiz, 1998). At that time the consumer was not as homogenous as in the past and the person of reference (at least for advertising) the traditional housewife who cooks thinking of the well-being of others had disappeared. In an exercise of the imagination advertisers divided the market and offered everything for everybody. The variety of individuals and homes was shown clearly in the way food products were offered: for single young men, for couples without children or for impulsive adolescents; all of them in a hurry, with little time for eating and cooking, with a lot of time spent on work and studying, with no gender differences. But this proliferation of products would be accompanied by a huge number of symbolic attributes allowing the products to be differentiated in an objectively homogeneous market, but with clear distinctions subjectively speaking. Food products would be differentiated according to the profile of the consumer which the product targeted, and values would fit with the desires INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 117

120 of each group through food, making clear that the product and the consumer have something to say to each other, that they are connected in some way. Fourth Phase This period of excess (corresponding approximately to the 1980s and first years of the 1990s) would give way to one that was more contained and rational in its consumption. Advertising messages at this time would connect food and eating to health, but to a different concept of health. Now health was considered to be something attainable (and not something that came about by chance) through knowledge, by making an effort through behaviour that channels consumption toward what is most suitable and paying attention to individual circumstances. Effort, intelligence and individualized care seemed to be the keys to health in this period of Spanish consumer society. Food played a principal role in this conception because through knowledge about its preventative or curative powers one could obtain good health, longevity and well-being. To do this it was necessary to know the healthy properties of food but also the consumer would have to act in order to achieve that desired well-being, giving to food consumption an aspect of self-control, the opposite of the «sadistic ultranarcissism,» in Alonso s words (2005: 84), of the previous years. Businesses offered food as a good at the service of health. The proliferation of «functional food» advertising showed messages in which food contained the formula to attain health. The message was supported by scientific studies indicating the medical properties of the product. This was the beginning of the medicalization of food. (17) Food disorders, the obsession with thinness and diets have not disappeared with the change in how food is presented, nor have the increase in food risks in the first years of this century disappeared. The consumer has reacted by looking for security in the areas where this has not been achieved and by demanding institutional intervention to confront food problems, but also demanding the possibility of acting autonomously in relation to his or her own health. Now (17) A process with important paradoxes, as Gracia has demonstrated (2007: 241): «One of the paradoxes in the process of the medicalisation of food in the industrialised societies is that, although the spread of a balanced diet has penetrated in the social framework and has even given meaning to non-expert discourse about what is considered to be good to eat, it has not been able to change eating habits.» 118 FOOD, CONSUMPTION AND HEALTH

121 we find ourselves before a consumer who asks for support from government to stop or at least control conduct which the consumer has no way of changing but which, through the consumption of food, endangers his or her health. Business has responded to these concerns in two ways: by looking for institutional support (from the government, businesses or prestigious private entities) or by offering messages of solidarity and commitment that show their participation (real or not) in solving these problems. Examples of this include the NAOS Initiative advertisements which count on the collaboration between business and government, or the ads which offer guarantees of respect for the environment and for fair trade, all of which are no more than new strategies by food advertisers to deal with growing consumer distrust. To conclude this historic survey of the different periods in food advertising, we have summarized the most significant aspects in table 4.1. In light of these characteristics that describe the evolution of food advertising, it is possible to consider that the gradual problematization of food is a characteristic that is demonstrated in the whole process of modernisation of Spanish society. It is also interesting that it has happened as Spain has become a society with an abundance of food and distant from hunger and shortage. It is possible that this progressive and persistent problematization of eating is none other than a consequence of the inclusion of food in the dynamics of consumer society. INDUSTRY AND FOOD: FROM REFERENTIAL ADVERTISING TO FUNCTIONAL FOOD 119

122 TABLE 4.1 Characteristics of food advertising in Spain Characteristics of the consumer Guidelines for obtaining consumer confidence Conception of food and of health FIRST PHASE SECOND PHASE THIRD PHASE FOURTH PHASE Rural housewife with sole responsibility for family food. Innovation and variety of products. Advertising as a source of information. Industry guarantees safety through hygienic and safe treatment of food. Urban woman, with main responsibility for food in the home. The brand as a synonym of guarantee. Indicators of distrust toward advertising. Foods offer new generations improved physical fitness. Quantity and variety are key to maintaining health. Source: Produced by Díaz Méndez, C. and González Álvarez, M. Diversity in the make-up of the home, New patterns of leisure, work and study. The appearance of the label and the food composition tables. Advertising as consuming. The importance of thinness as a social value. Foods can aid in being thin. Diverse and individual consumer. New values of commitment and solidarity also in consumption. Scientific support that justifies the functionality of foods. Strategies for collaboration business institutions. The medicalization of foods as a means to achieve health. Foods at the service of health. 120 FOOD, CONSUMPTION AND HEALTH

123 V. Obesity, beyond the consumer: structural roots of the food environment Emilio Luque (UNED) 5.1. Introduction Between the end of 2003 and the beginning of 2004 in the halls and offices of the headquarters of the World Health Organization in Geneva a tough health policy battle was being fought centred on the causes and consequences of obesity. The terrain in which it was taking place was in the diagnoses and recommendations that the WHO would make in its Process for a Global Strategy on Diet, Physical Activity and Health, in the face of a global change toward an unbalanced diet with serious consequences for non-transmissible degenerative illnesses, such as the declared «pandemic of obesity» (WHO, 2004; Popkin, 2006). One of the fiercest disputes was focused on the recommendation of limiting the caloric contribution from added sugars to 10% of the total of daily caloric intake. This proposal to limit added sugar consumption was harshly attacked by organizations close to the producers of sweetened beverages and other large businesses in that sector. The pressure exerted by the agrifood lobby ended up endangering the financial contribution from the United States to the WHO budget (Norum, 2005). The designated NAOS strategy (Strategy for Nutrition, Physical Activity and the Prevention of Obesity), coordinated by the Spanish Food Safety Agency, is the translation of this global strategy of the WHO to Spain. In it the association is made between the growth in obesity and pathologies such as cardiovascular illnesses, type 2 diabetes, high blood pressure and certain types of cancer, and the growing costs in economic and human terms of this trend. When we look at the description of the causes, the analysis of NAOS stresses the dietary «habits» and physical activity of the Spanish population. Nevertheless, they point out that agreements arrived at with the food production and distribution industry have led to industry collaboration in the transmission of «information» OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 121

124 on labels, and in the diffusion of «messages» to those that are entrusted with the task of modifying destructive habits. This relationship between habits, behaviour, information and knowledge in the analysis and prevention of obesity places us in very complex terrain. Dietary habits, like many others, are very resistant to change, precisely for their character as automatic or semiautomatic response within a more or less stable environment (Verplanken and Wood, 2006). In this chapter we will emphasize the structural component of our dietary habits, in other words, the historical and economic logic that has been shaping these stable environments, within which our habits are established. This is not to say that we lose sight of the capacity of individuals to reappropriate the meaning of their activities, also in relation to food, from the social and cultural relationships in which they are inserted; but it does seem that the hegemonic focus, centred on information and education tends to leave these structural dimensions in the dark. One crucial element of the problem of obesity centres on defining the nature of dietary problems as either public or private, two positions that are in conflict in what Kelly Brownell (2003) has called the «food fight.» It is about trying to define the large frames within which we understand the roots and solutions of our shared problems (Lakoff, 2004). The food industry, the huge fast-food restaurant chains and their allies maintain that the achievement of a diet and a level of physical activity which leads to caloric balance, weight control and health is fundamentally a personal responsibility. However, there are reasons to think that, considered as a whole, the recent global trend toward obesity has its roots in an «obesogenic environment» (Swinburn et al., 1999) that promotes the growing ingestion of calories, while at the same time reducing the energetic expenditure associated with physical activity at work and in our moving around, and which to a great extent escapes individual control. From a bio cultural perspective, this environment is also, in terms of our evolutionary and genetic history, radically new and we find ourselves maladapted for it, genetically predisposed as we are with very important inter-individual variations (Friedman, 2003) to prefer foods of high caloric content and their subsequent storage in the form of fat (Ulijaszed and Lofink, 2006). Any detailed description of the global problem of obesity begins by pointing out that this basic arithmetic of calories ingested minus calories burned is deceptively simple (González, 2005). On the one hand, we are just beginning to understand the biochemical and genetic logic of the organism s storage 122 FOOD, CONSUMPTION AND HEALTH

125 of energy reserves. On the other hand, it is evident that the components of caloric balance have undergone huge transformations in recent decades tied to socioeconomic dynamics of a structural character. There are far fewer farm and industrial workers with jobs that demand great physical effort, and the great majority of jobs are more sedentary. The movement of the majority of the population to cities, the reduction in the opportunity to move about on foot within them, and the consolidation of the automobile as a means of transport even for short distances, reduces even more the average daily expenditure of calories. Forms of entertainment based on passive audiovisual reception, in particular television, form part of this pattern of a generalized reduction of physical activity. In the terms that economists use, technological changes have made food cheaper and exercise more expensive (Zywicki et al., 2004). Concerning the forms in which we acquire, prepare, cook and ingest our meals, two important trends have been suggested to explain the presence of excessive caloric levels in our diet: the increase in eating out, particularly in fast-food restaurants, and the use of completely processed meals at home, due to recent advances in the preparation and distribution of foods which puts at our disposal a wide and growing array of prepared meals which require little or no preparation time. (1) The triumphal introduction of microwaves into the kitchens of the industrialised world has also reduced the time spent on cooking, an increasingly valuable time because of the greater monetary value of women s time now integrated into the labour market; all this leads to a greater aggregate consumption of food, which is aggravated by the fact that these prepared foods tend to be more calorically dense than those that are completely prepared at home (Newby, 2007). Nevertheless it is very complicated to visualize all the processes and connections that link this «obesogenic environment,» defined as the «sum of influences that the environment, opportunities, or life conditions have in provoking obesity in individuals or in the population» (Swinburn et al., 1999: 564), with the built environment (2) on the one hand, and with the regulation, (1) In Spain the proportion of these types of foods in spending on food has tripled since 1987 (Sylvia Resa, «Los platos preparados viven su momento de oro», Distribución y Consumo, no. 71 July-August. (2) «The built environment includes our homes, schools, workplaces, parks and recreation areas, business centers and roads. It extends over us in the form of electric cables, under the ground in the form of dumps and underground transport, and in the countryside in the form of highways [ ]. It affects the interior and exterior physical environments (for example, climatic conditions and the quality of interior and exterior air), as well as the social environment (for example, civic participation, community capacities and investments) and therefore our health and quality of life» (Srinivasan et al., 2003). OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 123

126 production, distribution and marketing of foods on the other. It however seems difficult to disassociate the pandemic of obesity from the growing availability of relatively low-cost agricultural raw materials, and the fact that the profits of businesses in the agrifood sector are based on the increase in the price and quantity of products that consumers end up buying and eating. It is important to emphasize that in this area a trend toward the increase in caloric intake sustained over time, even when not very large in number of daily added units, could result in noticeable accumulations of fat. Although the interaction between genetic and metabolic physiology and caloric balance is very complicated, as has been pointed out by authors such as Claude Bouchard, other works point out that a surplus of even only 100 calories a day can produce an increase in body mass of just under one kilogram annually (Hill et al., 2003a, 2003b; cf. Butte and Ellis, 2003). We think that for a person with a height of 1.70 meters that starts from a Body Mass Index (BMI) of 25, at the upper limit of normal weight (meaning a weight of kilograms) at 18 years if age, would at that slow rhythm exceed a BMI of 30 which signals the beginning of obesity at 36 years of age, with almost half a century of life expectancy in front of him/her or more likely, with a lower life expectancy due to the impact of non-transmissible illnesses associated with obesity such as type 2 diabetes. The «food fight» is not the only area in which we find a strong emphasis on the level of responsibility of the individual on the part of agents interested in there being no substantial changes in current structures. The environmental crisis is a paradigmatic example of this individualization of the forms of action and understanding in facing public issues (Maniates, 2001). The role of critical sociology has to be precisely to point out the structural connections that bind us, and make us responsible in a collective manner (Young, 2006), with the objective of opening to public debate and democratic control all of these areas. From this perspective, this chapter will review some of the factors that should lead us to include structural factors in a decisive manner in the analysis of obesity. This broadened focus is immediately relevant to the measures that ought to be taken in relation to obesity. As Marion Nestle points out (2004; 360), «if diet is an issue of individual freewill, then the only appropriate remedy for a bad diet is education, and nutritionists should concern themselves with teaching people to take personal responsibility over their diet and health, and not with how to establish social changes that can make this easier to achieve for everyone.» 124 FOOD, CONSUMPTION AND HEALTH

127 On the other hand, a wider focus on the obesogenic environment leads us to consider policies and strategies that range from «pigovian» taxes on the products most associated with obesity (González, 2005) to innovative proposals that hold manufacturers of products with a high content of fat and sugars directly responsible for the level of childhood obesity, through «results-based regulations» (Sugarman and Sandman, 2007), or to the necessity of rethinking the design of our cities and towns along with the policies of «commercial urbanism» (Dearry, 2004) and the reorganization of subsidies and aid to farmers (Miner, 2006). The argument presented in this chapter will be developed and organised in the following way: 1) Considering obesity as the result of a «structurally defined» model of diet and physical activity permits us to better understand its relationship to social inequality. We will briefly explore this idea beginning with the configuration of the built environment, and the unequal opportunities for physical activity that it makes available to distinct economic strata. 2) That obesity is associated with lower socioeconomic levels in the advanced countries (Drewnowski and Darmon, 2005; also in Spain see Gutiérrez-Fisac, 1998) also reinforces its connection with a strongly industrialized agrifood system that counts as one of its achievements having put on the market cheap and attractive calories. A fundamental part of the obesogenic environment is the result of agricultural and industrial policies that have raised agricultural productivity and pushed the technologization of the food industry. We can talk about a «political economy of obesity» that leads us to deal with a series of structural dimensions including subsidies for corn and sugar beet production, the extension of soy crops in degraded areas of the Amazon jungle, or the redistribution of power within food chains from the producers to the processors and distributors in continuity with the important processes of change in public health. This does not mean, of course, that the modern agrifood regime is the direct or only cause of the generalized increase in the Body Mass Index of individuals; but it does mean it needs to be introduced into the centre of the overall analysis. The political history of agrifood systems is therefore relevant to our discussion. 3) In the interest of the big distributors, growing protagonists in the food chains, we are seeing the shaping of a «foodscape» in which foods high in sugar and fat predominate, as they tend to be more profitable for the large OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 125

128 stores, to be highly advertised, and to be found in the positions designated as «impulse zones» (in particular, areas near the check-out) (Winson, 2004). 4) Consumers, thanks to the contributions of the sociology and psychology of consumption, the economics of behaviour, and even evolutionary psychology and anthropology, emerge as agents who have difficulties with consciously controlling their caloric intake in their daily environment, and consequently are susceptible to pressure from retailers and restaurants to spend more on food (Wansink, 2006). 5) The sophisticated marketing of the huge food industry is a powerful sociocultural force, which participates in the organization of the symbolic space within which we understand ourselves and others, through foods and their «daily mythologies» (Alonso, 2005). This influence is particularly worrying, and becomes even more objectionable in the case of childhood obesity (Schor and Ford, 2007), in the case of childhood obesity (see Serra Majem et al., 2003, for the diagnosis of the Spanish case based on the study enkid). Several important dimensions derive from this capacity to shape our food culture, introducing what we will call a «triple invisibility.» In the first place, we don t know where our food comes from or how it is produced, and we are forgetting how to prepare it ourselves. Secondly, the imaginary projected by the agrifood industry refers us to a «bucolicpastoral» stage of agriculture and livestock which is radically disconnected from modern industrial processes. Lastly, it makes us distrustful of cultural guidelines, age-old culinary traditions that have regulated our relationship with food, which are now substituted by an external expert knowledge that is offered as the only guide in the food labyrinth, and is at the hand of commercial interests The built environment, physical activity, obesity and inequality The places where we reside and in which we work, study or shop, the roads and transport systems with which we move from place to place, the existence of spaces for exercise or sport, and the distances that separates us from them, all these are elements that are inscribed in the urban weave, and determine our opportunities for physical activity, and therefore the component of calories burned in our caloric balance, and as a consequence our final weight. A recent line of analysis (Gordon-Larsen et al., 2006; Jackson, 2003) points out the association between the configuration of our built environment and 126 FOOD, CONSUMPTION AND HEALTH

129 opportunities for physical activity. According to one of these studies (Frank et al., 2004), for each hour spent driving daily, we have a 6 percent greater possibility of reaching a Body Mass Index above 30; on the contrary, for each kilometre we walk, we will be 5 percent less likely to become obese. The city resident finds him/herself inserted in different urban scenes, in which distinct forms of land use, residential densities and road intersection densities are mixed. If these factors in the urban structure are combined into a «walkability index,» we can explain some of the differences in the time spent on moderate physical activity among individuals that live in distinct zones. In an empirical study done in the North American city of Atlanta (Frank et al., 2005), 37 percent of the people who lived in areas with a high walkability index (those areas that were in the top 25 percent in terms of walkability, in other words, the upper quartile) were able to meet the recommendation of doing at least 30 minutes of physical activity per day. On the contrary, only 18 percent were able to meet this healthy criterion in the lower quartile (areas in the bottom 25 percent in walkability). The inhabitants of the first type of zone were two and a half times more likely to reach the minimum threshold of activity mentioned than those from the second type of zone, even when controlling for other sociodemographic factors. Built environments are also very unequal in factors which are relevant to the composition of diet, with serious consequences for the prevalence of weight gain and obesity. What is most accessible to us: a fast food restaurant, a supermarket, or a «convenience store?» The answer has statistical consequences for our Body Mass Index. In the United States an association has been detected between healthy diets, containing a greater proportion of fruit and vegetables, and the proximity of supermarkets and specialized shops (Cheadle et al., 1991). Persons who live in the poorest areas and from disadvantaged ethnic groups have half or less of the possibility of finding a supermarket nearby than those that live in high and middle income areas although they are three times as likely to have an establishment selling alcohol nearby (Morland et al., 2002) A political economy of obesity Modern agriculture is one of the great successes of modernity in terms of productivity. As an example we can look at Spain. In 1950 a Spanish farmer OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 127

130 produced food for 5 inhabitants; in 2004, his/her production would cover the needs of 43 persons (Gómez Benito and Luque, 2007: 27). This increase in productivity is based on the implacable economic logic of the agrifood system; as in other sectors of the market, economic agents look to increase their profits by maximizing income and minimizing costs. This happens within the framework of a complex environment of public policies, technological and sociocultural changes, intranational and growing international relations between producers, distributors and consumers. Public policies have contributed in a decisive manner historically to shape our current caloric surplus at the population level. We are reminded, however, that for centuries the problem was the reverse; attempts to assure the supply of food have been a permanent part of the guiding principles of state actions, and from this, a good part of the agrifood industries have developed. Beginning approximately in the decade of the 1970s, a contradiction between policies promoting productivity in food production for the market and public health criteria began to make itself evident. For example, while the market provided growing quantities of corn at low prices, boosting intensive stockbreeding (3) and therefore the consumption of meat, nutritional recommendations (4) in some countries began to point out the need to reduce the proportion of animal protein in the diet. An interesting historical example of the association between public policy and food is that of the sugar beet. At the beginning of the 19th century, the British Armada was blockading the European continent, impeding France from receiving imports of cane sugar from its colonies. «Napoleon responded in 1811 by ordering a crash programme for breeding and growing beets. When the cane sugar trade to France was restored after 1815, France restricted imports in order to protect the domestic production of beet sugar. Other European states were quick to see the strategic military importance of having a domestic supply of sugar» (Jenkins, 2001: 2). The shape of the Common Agricultural Policy, with its protectionist barriers for beets is an inheritance of this historic strategic role, which has had a crucial role in the consolidation of important centres of the (3) Nevertheless, animal feed made from corn is not a feed well tolerated by cattle and sheep because it acidifies their digestive systems. This makes them more inclined toward infections, provoking the massive use of antibiotics, which together with the altered ph of their rumens generate strains of bacteria resistant to the antibiotics, such as the unfortunately famous E. coli (Déiz-González et al., 1998). (4) See the article by Díaz Méndez and Gómez Benito in this volume for an in-depth analysis of the sometimes contradictory evolution of dietary recommendations. 128 FOOD, CONSUMPTION AND HEALTH

131 current agrifood industry. This protection is the principle reason that beets have been viable as a crop in Europe despite their lower profitability in comparison with other sources of sugar, such as cane or high-fructose corn syrup from corn. The more recent policy history of the agrifood system is also important for understanding the overabundance in the industrialized countries of commodity crops, marketed and standardized foods of which corn and soy are basic cases. The brief crisis in the United States caused by a rise in food prices in , acted as a catalyst for a new form of regulation of state aid to agricultural production and in a special manner, to corn and is one of the key episodes in this story of agrifood policy. In the fall of 1972, after a series of bad harvests, the then Soviet Union acquired 30 million tons of North American cereals. Combined with bad climatic conditions in the North American «bread basket,» this increase in demand provoked an enormous hike in the price of basic agricultural products, which was being passed on to consumers throughout Protests were organised in supermarkets in view of increases of more than 26 percent annually, and consumers boycotted beef. The Secretary of Agriculture in the Nixon Administration, Earl Butz, initiated a series of reforms that remodelled the American food system, «driving down prices and vastly increasing the output of American farmers. What had long been the dream of agribusiness (cheaper raw materials) and the political establishment (fewer restive farmers) now became official government policy.» (Pollan, 2006: 52). Butz s message was clear: farmers should plant from «fencerow to fencerow.» In terms of the agricultural policy employed to drive this process, the change consisted of dismantling the system of price controls inherited from the New Deal, based on loans and guaranteed purchase of grain by the state and obligating farmers to leave land fallow, and the establishment of a system of direct payments to farmers. This system was enthusiastically supported (5) by the agrifood processing industry from the start, as it depended on a growing flow of cheap raw materials for its expansion (Glenna, 2003). This system, says (5) «The processors of agricultural products united with agribusiness suppliers to demand an end to controls over supply and the expansion of the market for export. In his appearance before the Joint Economic Committee, Vernon McMinimy of A.E. Staley Manufacturing Co. stated that his company, processors of corn and soy, «depended on a reliable supply and a reasonable price for corn and soy as raw materials. Therefore, it is very important that the agricultural program contains reasonable programs for these products.» «Reasonable» here means programs that increase the production of corn and soy» (Glenna, 2003: 22-23). OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 129

132 Pollan, «is designed to maintain high production and low prices. In fact, it is designed to bring prices down, given that giving compensation payments to farmers [deficiency payments] [ ] encourages them to produce as much corn as is possible, and then dump it all on the market without taking into account the price: a practice which inevitably drives prices down» (2006: 62). The result of this complex process of transformation of the U.S. agricultural regime, following the case of corn, is the strongly subsidized production (6) (more than 5 billion dollars annually) of 250 million tons of corn (a bit less than one ton per person a year), which passes through a chain of transformation controlled in great part by only two businesses, Cargill and Archer Daniels Midland (ADM). If at the beginning of the processing chain we find ourselves with an «excess of biomass» (Manning, 2004), by the end we find processed products with high fat and sugar content and relatively low prices, (7) and whose final destiny tends to be the pantries (and fat reserves) of low income persons. «In the general population, consumers select foods on the basis of taste, cost, convenience, health, and variety. However, among low-income households and the unemployed, it is taste and cost that are the key determinants of food choice. Low-income families attempting to maintain food costs as a fixed percentage of diminishing income will be driven in the direction of energydense foods and a higher proportion of foods containing grains, added sugars, and added fats» (Drewnowski and Darmon, 2005: 903). Perhaps now we begin to see the structural bases that historically have generated these enormous mountains of corn, soy and other commodity crops that enter into the world agrifood system (not only in the United States), and which assure great profit to those processors and distributors that are capable of taking advantage of their low prices, converting them into products with a great added value, and managing to sell them to consumers in growing quantities. We can now see from closer up the point at which foods, after travelling long distances and going through an unimaginable level of processing, meet up with the consumer, in particular in «foodscapes» made up of huge retailers and fast food. (6) Although it does not form part of the central argument of this chapter, it must be mentioned that the distortions introduced by the structure of agricultural subsidies, especially in the United States and Europe, go well beyond being a factor in the global obesity pandemic. Among many other effects, the quotas of corn sold beneath real cost impoverishes wide rural areas of other countries (ironically, among them is Mexico, the «parent-country» of corn), provoking migratory currents to the cities within or outside those countries. (7) It would be interesting to observe if the recent increase in price due to the competition from biofuels stabilizes, making the networks of producers, processors and distributors of foods co-evolve in other directions. 130 FOOD, CONSUMPTION AND HEALTH

133 5.4. The «foodscape» of the consumer: the hypermarket and the hamburger Winson (2004: 301) defines the «foodscape» as «the multiplicity of sites where food is displayed for purchase, and where it may also be consumed.» With important variations in different countries, these spaces are made up, to a growing extent, of the large retail chains and fast food restaurants. To adequately situate the relevance of these food distribution channels, we must remember that four out of every five food purchases in Spain are made in a large retail chain. The largest of these businesses controls one out of every four food purchases (Informe Exporetail, 2006). In short, recent years have established the decisive role of the large retailers in the framework of the agrifood system: from the enormous purchasing and logistical capacities of these chains, their technical capacity to manage information, the importance of the financial dimension of their marketing strategy, the eruption of «generic brands,» to the globalization of the supply market, which accentuates the displacement of power within the food chains toward these actors (Langreo, 2002). How do the processing industry and the hypermarkets assure their profitability? As we would expect, they centre their advanced marketing strategies on the products that offer the greatest profit margins. And among these standout precisely those products that concentrate higher quantities of saturated fats, added sugars and salt. The salty and sweet snacks, for example, that are often sold in the so-called «impulse zone» (8) near the check-out line in the supermarkets, are hugely profitable for the retail chains, representing at times more than 10 percent of total profits. The key concepts are those of «high rotation and advertising»: they sell a lot and are associated with enormous investments in advertising which makes them immediately recognizable (also to children, with their «pestering power», one of the great allies of this industrial and commercial segment). They are also products that do not require any special preservation conditions (refrigeration or absence of light, for example), which means somewhat lower costs for retailers. (8) As proof of the relevancy that the strategies based on the psychology of marketing have for these types of products, we can point out that in the course of the control procedures for the corporate fusion (Regulation (EEC) No 4064/89 Merger Procedure), Philip Morris (tobacco company that had acquired food businesses like Kraft Foods and General Foods) and Nabisco (manufacturer of Oreo cookies and Ritz crackers) affirmed that there existed intense competition for its chocolates with sugary and salty snacks. «Consumers choose between all the snacks available at the exit of the stores to satisfy a whim or a small luxury, whether for immediate consumption or to have later at home» (p. 3). OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 131

134 This permanent presence of the most profitable products for retailers and new forms of distribution (vending machines, presence of snack foods in gas stations) shapes a «foodscape» with a growing caloric density. As we will see below, visibility is one of the variables that most directly explain consumption. If we imagine the average consumer following the typical path of the western city dweller, we will see that the last three decades have been characterized by the configuration of a food landscape marked by the primary colours of sugary soft drink vending machines and fast food restaurants, or the increasing number of supermarket shelves full of colourful packages of cookies, crisps and sugary cereals: an obesogenic kaleidoscope. As a high executive of a soft drink business pointed out, «to increase the omnipresence of our products, we are going to put our cold brands in reach of everyone, wherever they look; in the supermarket, the shop where they rent videos, the football stadium, the gas station, everywhere» (sited en Nestlé y Jacobs, 2000: 19) The consumer s limited capacity for control What real conscious control over diet do consumers have? The answer to this question would have to be «high» or «very high» control for us to consider obesity as basically an individual problem, and the conscious reorganization of the now-known components of the expenditure and intake of calories as the adequate strategy to solve it. However, there is an important line of empirical research that underlines the degree to which we cannot control a series of environmental cues, patterns of sociability and implicit norms (you should eat everything on your plate if everyone else does, regardless of how much you have on your plate). In a recent experiment (Kahn and Wansink, 2004), two groups were offered two different assortments of 300 pieces of coloured chocolate candies (M&Ms). The only difference between the two assortments was that in one, the candies were of 10 distinct colours and in the other, only 7. The group that had the candies of greater colour variety consumed 43 percent more (91 pieces compared to 64). It is surprising that just the presence of a greater variety of «colours» the taste was the same could induce such a great difference in consumption. But also factors such as how food containers are grouped can produce great differences in the ingestion of foods, as those in 132 FOOD, CONSUMPTION AND HEALTH

135 charge of marketing for the big retailers know and utilise. In another study, the families that have a greater number of units of food products in the home (typically packets that contain various «tetra pack,» or bags of salted snack foods) consume them on average 112 percent faster than families that have fewer of the same foods at home (Wansink, 2004: 468). These analyses and other similar ones reveal that the real capacity for conscious decision-making by the consumer is much less than we imagine, much less even that what the consumer him/herself imagines. It is important to emphasize that higher levels of information cannot counteract the implicit norms of consumption, those perceptual cues from the environment that we do not process on a conscious level and that lead us to «eat without thinking» as Wansink describes (2006). In one his experiments, in which the subjects were nothing less than members of a university department of Food Sciences and Nutrition, subjects were provided with two sizes of spoons and bowls to serve themselves ice cream. Those that used a larger bowl served themselves and ate 31 percent more than those that received smaller bowls; and those that were given larger spoons ended up eating 14 percent more than those with the smaller spoons. If large bowls and large spoons were combined, the subjects took an impressive 58 percent more ice cream than the others (in all cases, about 92 percent of the ice cream served was eaten). As the authors point out, «small environmental factors can have a big impact on consumption [ ]. What is critical to note, however, is that people even these nutrition experts are generally unaware of having served themselves more. This attests to the ubiquitous nature of these environmental clues» (Wansink et al., 2006). An additional point of interest is that in one of Wansink s experiments on the unconscious effect of the size of portions, plates or receptacles, the subjects had heard a lecture on this very subject a month and a half before. In short, we are pretty disastrous if we count the amount of food we buy, serve and eat, and also its total caloric content. This has paradoxical consequences for the development of «low-fat» or «low-calorie» food technology, whose production is clearly the first line of defence of the big corporations in the sector, together with their promotion of physical activity. In his characteristic line of empirical investigation which calls into question the reassuring affirmations and proposals based on the technology of the food industry, Wansink and his collaborators again show that «foods labelled as low fat increase the quantity OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 133

136 of food ingested by increasing the number of servings, and reducing the anticipated guilt associated with their consumption» (Wansink and Chandon, 2006: 614; see also Geyskens et al., 2007). To sum up, the capacity of the consumer to manage the parameters of his/her own diet is much more limited than what would be necessary for an individualized framework of prevention of obesity to be viable, in which the conscious control of the ingestion of foods would be the only or principal strategy. This does not mean that we consider the average consumer to be defenceless, without skills and social and cultural guidelines to orient him/her in the «food labyrinth,» but rather as an agent submitted to powerful influences that shape in a determinant manner the environment in which he/she finds and consumes food. As we will now see, these influences go beyond the physical organisation of food choices presented by the agrifood industry, large retailers and fast food restaurants, and affect the very way in which we understand ourselves in our social and cultural spaces and the legitimacy of our knowledge about food The triple invisibility of the agrifood system The sophisticated and well-financed marketing of the food and retail industry has completely entered the symbolic terrain and intervenes in the sociocultural fabric, especially through advertising directed at children. The correlation of forces in the field of advertising is enormous: just PepsiCo alone allocated 1.7 billion dollars during 2004 to advertise products such as Lay s potato chips and corn chips. The following year, the Spanish Ministry of Health and Consumer Affairs spent 1.2 million euros (approximately 0.08 percent of the previous figure based on exchange rates at the time) on its campaign to prevent childhood obesity, «Preventing childhood obesity has a prize: health.» Here the contradictions emerge more sharply between the freedom of choice of the consumer and the control of choices at the cultural level on the part of the industry. How do we assign personal responsibility to children who at two years of age can completely recognize McDonald s logo and mascots? As Schor and Ford (2007: 16) note, «The shift to symbolic marketing of food is worth considering for a moment. What it implies is that children are being persuaded to eat particular foods, not on the basis of their tastiness, or other benefits, but because of their place in a social matrix of meaning.» 134 FOOD, CONSUMPTION AND HEALTH

137 Very briefly, we will explain the keys to the «triple invisibility» of the agrifood system in relation to the consumer. The first barrier to the citizen developing competency with respect to what he/she eats is the very complexity of the chains of food supply. The form in which large corporations make the flow of raw materials more calculable, efficient, predictable and controllable, as they are processed and distributed, presents the paradox pointed out in other chapters of this volume, of a system increasingly more reliable, and of a citizen increasingly more distrustful. It seems reasonable, however, that distrust is an expected reaction before the opacity of the commercial and industrial processes that are behind the food that we acquire in any of the huge hypermarkets. We are only conscious in a confused manner that the food we consume has travelled hundreds or thousands of miles, having been disaggregated into distinct components, many now unrecognizable, to later be combined in manners difficult to imagine. This invisibility is of course deliberate, and a second layer of invisibility is added to it in the food system: its idealization in terms of an agriculture and traditional craftsmanship now practically disappeared. «A typical device used by advertisers to hide the real nature of the production process is to present idealized, stereotypical images of some imagined rural past, or of a romanticized ethnicity [ ]. This imagery is intended to introduce a sense of trust, connection and authenticity and to lead us to believe that this food was produced by caring human hands, rather than by the industrialized processes of highly capitalized agriculture and food processing factories» (Jaffe and Gertler, 2007: 154). Lastly, the nature of the food itself is filled with tensions: What are we eating in this toast- bread, carbohydrates, or «lipoactive fibre?» The sociocultural definition of foods has expensive consequences when it translates into changing market quotas. The current privileged framework for public communication of the large corporations in the sector supplants traditional knowledge about food with the expert knowledge of the laboratory. This framework has in reality been operating for decades in other countries, such as the United States. As the social historian Harvey Levenstein sums it up, the food model cognitively dominated by the association of experts, authorities and industry has the following characteristics: that likes and taste are not a certain guide to what we should eat; that one should not simply eat what one OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 135

138 likes; that the important components of food cannot be seen or tasted, they can only be detected in scientific laboratories; and that experimental science has generated the rules of nutrition that will impede illness and promote longevity (see Pollan, 2006: 300) Intervention models Given that the argument developed up to this point has been concerned with pointing out that the problem of obesity is to a great degree of a structural nature, what type of actions against the spread of obesity should be considered? Here we will note only one of the many possibilities, some of which are now being put into action or being studied, such as the prohibition of the sale of «junk food» in schools in Britain or the United States. The so-called «pigovian taxes» (for their first proponent, the economist Arthur Pigou) set out to correct externalities, the negative effects that agents who do not benefit from an economic transaction suffer. The classic example is that of the contamination from a factory that does not include in the price of its products the cost, for example, of the sewage treatment plant down river made necessary by its dumping. If a pigovian tax was applied to these products, their production would be restricted to levels more compatible with their optimum social utility. One evident problem is establishing what would be the adequate tax level; this means that legislators must have very precise information on the consequences of the externality they intend to correct. On the positive side, it is possible to use public money obtained from these taxes to alleviate the negative effects, or even to reduce fiscal pressure in other areas, such as salaries; this is what is called the «double dividend» of taxes of this type, whose most typical application is related to the environment (Bovenberg, 1999). In the case of obesity, fiscal measures could be taxes on unhealthy foods or subsidies to healthier foods (possibly with the income derived from the taxes on unhealthy foods). Mytton et al. (2007), in a recent study analyzed three scenarios for applying these taxes in the United Kingdom. In one of them, the tax was only applied to foods with high levels of saturated fats; however, the researchers detected that these foods could be substituted for others that were almost equally harmful. In the second, an unhealthiness score was calculated 136 FOOD, CONSUMPTION AND HEALTH

139 for all foods (for example, spinach scored a 12, and the chocolate cookies of the digestive type a +29). A surcharge was applied to all the foods above +8. In this case, the model showed that the cost of food for families increased 3.2 percent, but in exchange, they could prevent 2,300 deaths annually from cardiovascular illnesses, diabetes, etc. The third scenario, in which the tax was applied to foods that scored even lower on the scale, was the most effective based on their calculations, preventing 3,200 deaths annually, while increasing family food expenses by 4.6 percent. Other types of structural measures have to do with correcting what we have pointed out as the growing contradiction between two areas of public policy: aid to agriculture and public health, increasingly menaced by non-transmissible illnesses associated with obesity. In Europe the cases of sugar and dairy are paradigmatic. They are both subsidized by the Common Agricultural Policy: «The dairy sector in the European Union is an example of how agriculture subsidies can lead to negative health effects in Europe as well as in developing countries. The European Union spends almost 2bn ( 1.4bn, $2.4bn) a year to maintain production levels at 20 percent above the domestic demand and at prices twice as high as on the world market. Without subsidies, production would quickly adapt to the level of demand» (Elinder, 2005: 1934). Lastly, the novel proposals of performance-based regulation (PBR) (Sugarman and Sandman, 2007) are based on allocating responsibility for the rates of childhood obesity prevalent in a specific group of schools to producers and retailers of foods associated with that obesity (defined as foods with more than 30 percent of their calories coming from fats or more than 40 percent of their calories coming from sugars). Perhaps what is most interesting about this proposal is that it deliberately looks to institutionalise a frame of interpretation of the problem of obesity in which the responsibility is shared with the agrifood industry: «One of the goals of the PBR approach to childhood obesity is to frame this as a problem for which the food industry has an important responsibility, and not a problem for which families alone are responsible» (Op. cit., p.176). OBESITY, BEYOND THE CONSUMER: STRUCTURAL ROOTS OF THE FOOD ENVIRONMENT 137

140 5.8. Conclusions In one of the classic texts of sociology, C. Wright Mills (2000 [1959]) distinguished between individual problems (personal troubles) and public issues. Mills gave examples of this distinction, «perhaps the most productive with which the sociological imagination has worked,» pointing out that the unemployment of a single individual among many was the personal problem of the individual, and the solution would be in his/her character, capacities and immediate opportunities. On the contrary, if 30 percent of a population is unemployed, we would be before a public issue. «The structure of opportunities itself has collapsed. Both the correct description of the problem as well as the range of possible solutions require from us that we consider the economic and political institutions of the society, and not only the personal situation and character of a collection of disperse individuals» (Mills, op. cit., p.19). Obesity is one of those public issues, and its analysis is inseparable from an environment of agrifood policy and economic and industry logic in the face of which, assignment of personal responsibility, and consequent policies based on information and awareness are fundamentally incomplete. On the other hand, the position that privileges personal responsibility in nutrition assumes that sources of information are, at a minimum, available without cost to the consumer, that the consumer has the capacity to process them, and that all the information is reliable and does not contradict itself. Nevertheless what Marion Nestle (2004; 360) points out is true; after accepting that food decisions are in principle the responsibility of the individual, «we do not make food choices in a vacuum. We select diets in a marketing environment in which billions of dollars are spent to convince us that nutrition advice is so confusing, and eating healthfully so impossibly difficult, that there is no point in bothering to eat less of one or another food product or category.» We must confront obesogenic environments with the democratic tools of open debate and the subsequent formulation of public policies that will go beyond the tactics of dietary recommendations and move on to strategic actions similar to those that were so successful in their time at elevating agricultural productivity and consolidating the food industry. 138 FOOD, CONSUMPTION AND HEALTH

141 Part Two THE CONSUMER S RESPONSE

142

143 VI. Preferences and food consumption: pleasure, convenience and health (1) Jesús Contreras Hernández and Mabel Gracia Arnaiz (The Food Observatory) 6.1. Introduction Most of our social behaviour is articulated by norms that tell us what we can or should do at each moment, about what is considered desirable, appropriate, or advisable. This does not necessarily mean that the norms are followed, as sometimes they can be interpreted according to one s own interests. It is the same with eating. In relation to food, our behaviour is articulated through two different and at times contradictory types of norms: social norms and dietary norms. «Social norms» refer to the totality of social conventions social agreements related to the number, type, moment, place, composition and structure of the different types of food intakes and the conditions and contexts in which their consumption is produced. For example: distributing the food during the day in one intake or various; establishing a definite timetable according to the type of food; considering some ingestions as more important than others; adopting particular forms when eating with respect to our physical appearance; eating with the fingers or cutlery depending on the dish or food; establishing a food calendar according to festive occasions, etc. (1) The statistical data that we provide in this chapter comes from two studies carried out by the Observatorio de la Alimentación (Food Observatory) with the motive of the V (La alimentación y sus circunstancias: placer, conveniencia y salud [Food and its circumstances: pleasure, convenience and health] and the VI International Food Forum (Comemos como vivimos: alimentación, salud y estilos de vida [We eat how we live: food, health and lifestyles]), held at Alimentaria 2004 and Alimentaria 2006 respectively. Both studies were coordinated by Jesús Contreras and Mabel Gracia. The principal objectives of the research reports consisted in knowing the factors and circumstances that orient and determine the new ways of eating of the Spanish, characterizing them and finally revealing the existing differences between eating norms and practices. To do this, different but complementary methodological approaches were combined. The first, ethnographic, was done through group discussions (20) and in-depth interviews (20) and the second, statistical, consisted in using two questionnaires given to individuals in PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 141

144 «Dietary norms» refer to the set of prescriptions based on scientific-nutritional knowledge and disseminated through the health media. More or less fluctuating over time, varying according to the discoveries and social influence of those who prescribe them, dietary norms describe, in quantitative and qualitative terms, what is an adequate, balanced diet and how the daily consumption of food should be organized to maintain a good state of health. Dietary norms include the following: eat fruit, vegetables, cereals; consume blue fish, foods with fibre, olive oil; use techniques for cooking the foods that avoid the loss of basic nutrients; avoid the consumption of saturated animal fats or refined sugars; adjust caloric intake to our energy needs; maintain the recommended balance regarding the proportion sugars, lipids and proteins; etc. From the perspective of the norms which exist today, the principal meal is a unit consisting of three categories: first course, second course and a dessert. A more complex version of four or five courses is for special occasions or celebrations (holiday menus, diverse celebrations, etc.), which become festive occasions precisely for their variation from this very simple structure. The first type of structure is the most habitual; we find it, for example, in all school menus, in hospitals, in business cafeterias, in restaurants, in the dietetic-culinary proposals in newspapers and numerous books. Also at home this ternary structure constitutes «the normal meal.» Studies carried out (Fischler, 1995) about dietary behaviour in the United States demonstrated that one of the essential difficulties in gathering data in the food field is precisely the serious difference between what people «declare they do» and what «they really do:» while the number of food intakes in one day can easily be up to 20, nevertheless, the majority of the participants would state that they had «only» 3 meals a day. In effect, regarding a question like «how many times did you eat yesterday?» the spontaneous response refers to «internalized norms» that can be both social and dietetic: 3 instead of 20. The same thing happens different autonomous communities of the Spanish state. One consisted of a weekly notebook of food consumption from a simple of 917 individuals representative of the Spanish population. The weekly notebook of consumption meant the gathering of information regarding 26,811 food intakes. The data regarding these ingestions were put into a data base created with the ACCESS 2002 program from Microsoft. For this article we have taken into account only the data of each one of the intakes of food reported by the individuals regarding food and drink ingested, with a total of 26,811 entries. The other consisted of a questionnaire regarding food tastes of the Spanish population. The questionnaire consisted of a notebook which included a list of food groups, a list of specific foods and a list of ways to prepare those foods. The answers offered were limited to three options; «like», «don t like», «okay.» The questionnaire was given to a sample of 1,040 individuals based on variables of age, gender and place of residency. 142 FOOD, CONSUMPTION AND HEALTH

145 when people are asked what they have eaten. Thus, if they are asked, «What did you eat and how often did you eat certain products yesterday, last week or in the past month?» The typical response would be «a little bit of everything, vegetables, meat, fish, dairy, cereals» Again the spontaneous response refers us to foods and not dishes, to isolated products, without referring to their handling and location in the broader context of food consumption. For all these reasons it is necessary to distinguish between «real practices» (objectified) either through direct observation or indirectly through analysis of socioeconomic variables and «declared practices» (internalized). Comparing the one with the other, we see that declared practices are often subject to change, to semantic restructuring, forgotten, or even subject to negotiation or concealment. Taking these observations into account, we present some of these «declared» or internalised practices of the Spanish population regarding ways of eating. After, we will look at the results regarding «recorded practices,» so that we can see the most outstanding differences Food preferences and criteria of choice Food is a complex and multidimensional phenomenon. Because of this the factors that influence food choices are very diverse. Among these should be highlighted (Eurofic, 2005: 17): 1) biological factors such as hunger, appetite and taste; 2) economic factors such as cost, income and accessibility to different types of foods; 3) social factors such as culture, religion, family, equality and lifestyles; 4) type and degree of knowledge and or skills related to food in general and cooking in particular; 5) psychological factors, circumstantial ones such as mood or guilt or more permanent ones such as character or stress; and 6) attitudes, beliefs, general values and knowledge (tolerance/intolerance, individualism/family, conventionality/informality, the role granted to science and/or religion, etc.) and the attitudes, beliefs, values and knowledge related to food in particular (value of sharing meals, nutritional or dietetic knowledge, etc.). Today, in wealthy countries, the central question about food is no longer can one eat, but rather what to eat. This question What to eat? is a relatively new one for a large part of the population. The fact that individuals «can» choose PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 143

146 what they eat makes the study of their choices and food practices interesting in the context of our current society. But the fact that they «must» choose is also very interesting. In our modern abundant society individuals can satisfy their appetites in many ways and hunger no longer guides our eating. In addition, religious proscriptions (fasting days, days of abstinence), which framed dietary practices in the past, have disappeared or have lost much of their force. At the same time, economic dynamics are unceasingly broadening and diversifying the supply of foods available to increasing numbers of persons. In this context, anything is possible for the contemporary diner. In fact, statistics show that on the one hand, consumers are increasingly fuller (satisfied) as they spend a smaller part of their budgets on food; and on the other hand, it seems they are eating more of what they feel like as the food available diversifies. But although one is free to eat anything, this does not mean that society does not propose «good reasons» for eating some foods instead of others. These «reasons» are constructed within a socioeconomic framework with a huge capacity for adaption to the evolving society. As diverse surveys on food practices carried out in many different countries (Ascher, 2005: ) seem to reveal, we are seeing the abandonment of traditional food models. This results from the consumption of products that are easy to consume anywhere, as well as a reduced consumption of lipids but increased energetic consumption due to the attraction of foods which generate eating pleasure such as sweets and pastries. Independent now of considerations of a more general character about the determinants of food choices, the motives that our interviewees declared when choosing a food or a dish are the following: more than half, 52.8 percent declared that the primary factor they take into account is «health;» 29.1 percent considered the primary factor to be their «personal preferences;» 13.7 percent «the price;» 2.1 percent «caloric value» and 1.9 percent the «ease» of preparation. Although the possible responses offered to the interviewees were not the same, it is worth it to compare the answers obtained in our survey with those of the Pan-European Survey of Consumer Attitudes to Food, Nutrition and Health of 2004 (Food Today, 43 (1)). For the whole European population, the declared criteria of choice were the following: «quality-freshness,» 74 percent; «price,» 43 percent; «taste,» 38 percent; «eating healthy,» 32 percent and «it s what my family likes,» 29 percent. In any case, apparently the Spanish 144 FOOD, CONSUMPTION AND HEALTH

147 population would be more concerned with health than the overall population of Europe (52.8 percent versus 32 percent) and much less concerned with price (13.7 percent versus 43 percent). Clearly, as has been said, one thing is what one says and another is what one really does or thinks, but in any case, the percentages are significant as in both cases they deal with «declarations» not «practices.» A majority of 52.8 percent state that health is their principal criterion for selecting food the answer that responds to the dominant trend in our society today but in second place an important 29.1 percent say that it is personal preferences which determine their choices. This percentage acquires even greater significance when one takes into consideration the 91.2 percent who say that «the foods they consume coincide with the foods they most like or desire» and only for 1.1 percent do they not or almost never coincide; also, a scant 7.7 percent state that the foods they consume only sometimes coincide with what they most like. In relation to the planning of meals, although the majority (64.3 percent) of the sample identify with the statement «we try to plan for the different meals of the week that we prepare at home,» those that supposedly do not plan make up a significant 33.3 percent; 13.3 percent of this group identify with the statement «it is difficult to plan meals because each person has different tastes regarding vegetables, fish, meat, etc.,» 12.4 percent identify with the statement «because we work outside of the home we don t plan the meals,» and finally, 7.8 percent identify with the statement «at home we don t plan the meals, for example, at night everyone gets home and grabs what they can.» When doing the shopping planning is important, although with a certain flexibility depending on the supply of foods available. In filling the basket of goods, 30.6 percent declare that they buy only those products that are on their list, although a similar proportion, 32.2 percent, state that they do buy products that they like that were not previously on their list. The written list, however, is only one of the options, and not always the primary one as there are a considerable percentage of people, 20.8 percent, that do their shopping as they go, buying what they see they need, while another 15.3 percent of the total interviewed state that they only buy what they fancy. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 145

148 From all this the importance of personal «preferences» emerges, and therefore, also personal «likes.» (2) For this reason, it is very important and necessary to know what are the liked and, still more important, the «disliked» or «rejected» foods of the Spanish population to compare them with those foods which are really consumed. Before, however, we will look at some complementary issues. Liking and/or rejecting a specific type of food does not manifest itself in absolute terms, rather it is influenced by other factors, including the mode of presentation and/or cooking. Thus, for example, onions can be liked or disliked in absolute terms, but it is very probable that their acceptance or rejection is affected by the way they are presented or prepared (fried, roasted, boiled, sautéed ). The same happens with many other types of foods such as vegetables, legumes, meat or fish. The role played by taste preferences responds to a very specific cultural logic, connected on the one hand to the expansion of the food supply and on the other to the increase in individual preferences. In effect, food today is not conceived of as an imposition but rather as an activity in which different choices and types of satisfaction are possible. The foods most liked, particularly in the case of children and adolescents, not only do not coincide with nutritional recommendations, but up to a certain point are contrary to them. The most recommended foods from a nutritional perspective (particularly vegetables, legumes and fish) are precisely those that show the lowest percentages of acceptance. For the population as a whole (graph 6.1), the percentage of acceptance («I like it») for vegetables, legumes and garden produce is 56.3 percent, 58.6 percent and 60.9 percent respectively. The importance of personal likes to explain the low consumption of vegetables and legumes is reinforced because of the fact that the «least preferred» ways of cooking or forms of preparation of foods (graph 6.2) are boiling and stews, which are precisely, the habitual ways of preparing vegetables and legumes. They are also the ways which require the most time. The most preferred forms of preparation are «baked,» «roasted,» and «grilled.» This would indicate that the question of likes (acceptance/rejection) is closely tied to the forms of preparation of the products themselves. (2) In agreement with Rozin (1995) we understand that «preference» implies a situation of choosing and refers to which of two or more foods is chosen. «Like» is normally measured on verbal scales and refers to an emotional response to foods and constitutes one of the determinants of preference. 146 FOOD, CONSUMPTION AND HEALTH

149 On the other hand, meals are increasingly less imposed and apparently less structured percent of those interviewed identified with the statement «now our meals are more informal and each one eats what they want, when they want and where they want. We are more autonomous. There is more freedom.» Nevertheless, in 80.6 percent of the homes they say that the meals that are prepared are the same for everyone and everyone eats the same things and regarding meals made at home, 55.5 percent say they eat «what there is» without problems. As a huge majority (91.2 percent) say that the foods they consume coincide with the foods they most like and desire, the explanation for this paradox lies in assuming that the food that is put on the table has been previously consented to or that given that there are multiple meals made at home, on some occasions the likes of some are satisfied, and on other occasions the likes of others. In addition, it is possible to assume that if the majority of Spanish are highly satisfied with their own diets, and 94.3 percent declare that they feel very or quite happy with what they eat, it is because what they normally eat is what they like. All this is not incompatible with the fact that, in 66.8 percent of the cases mothers and/or wives decide on the menu or the different meals that are eaten each day. In effect, it appears that their «authority» or «freedom» to decide is not excessive as it stems from knowing the preferences and aversions of all the members of the domestic group when doing the shopping or cooking. In this way it can be stated that the woman, wife or mother, more than being the person responsible (although other members of the home may consider her in that way) for the food decisions (shopping and cooking), is a negotiator who «looks for a consensus» in the home which facilitates her decisions about food. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 147

150 GRAPH 6.1 Acceptance/rejection of different food groups By percentage I LIKE POTATOES BREAD EGGS FRUITS PASTA SOUPS COLD MEATS AND SAUSAGE DRIED FRUITS AND NUTS CHEESES WHITE FISH SEA FOOD RED MEATS SWEETS CEREALS BLUE FISH PASTRIES/BAKED GOODS GARDEN PRODUCE LEGUMES VEGETABLES HERBAL TEAS ORGAN MEATS Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2006). 148 FOOD, CONSUMPTION AND HEALTH

151 I DON T LIKE ORGAN MEATS HERBAL TEAS GARDEN PRODUCE SEA FOOD BLUE FISH VEGETABLES LEGUMES PASTRIES/BAKED GOODS CEREALS WHITE FISH RED MEATS CHEESES DRIED FRUITS AND NUTS SWEETS SOUPS PASTA COLD MEATS AND SAUSAGE EGGS FRUITS POTATOES BREAD PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 149

152 GRAPH 6.2 Acceptance/rejection of different ways of preparing foods By percentage I LIKE BAKED FOODS ROASTED FOODS GRILLED FOODS FRIED FOODS IN A STEW DRESSED/SEASONED FOODS BOILED FOODS MICROWAVED FOODS RAW FOODS PRECOOKED FOODS Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2006). 150 FOOD, CONSUMPTION AND HEALTH

153 I DON T LIKE RAW FOODS PRECOOKED FOODS MICROWAVED FOODS BOILED FOODS DRESSED/SEASONED FOODS IN A STEW FRIED FOODS GRILLED FOODS ROASTED FOODS BAKED FOODS A pyramid of food likes Based on our data about food preferences, we propose the following «pyramid of likes.» The different foods have been placed in the pyramid from the base to the apex based on the percentages of preferences, from more to less. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 151

154 GRAPH 6.3 The pyramid of likes By percentage <60% 60%-68% 68%-76% 80%-85% >85% Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2006) Description of the eating day The number of daily meals The majority of persons state that they eat between three and four times a day, while 21 percent say they eat five times a day. In the case of those that have three meals, the meals are breakfast, lunch and dinner. When it is four meals, they add the afternoon merienda (a late afternoon snack) in the majority of cases. When there are five meals, in addition to the previously mentioned ones, usually a mid-morning «breakfast» is added. The three meal a day model is strongly internalized as frequently answers would be given in these terms: «I have three good meals and an aperitif;» «three meals and two little 152 FOOD, CONSUMPTION AND HEALTH

155 GRAPH 6.4 The most frequent eating days By percentage Breakfast + large late morning snack + dinner 2.3% 3 meals + mid-afternoon snack 2.3% 3 meals + mid-morning snack + mid-afternoon snack 1.2% Others 13.4% 3 meals 31.2% 3 meals + merienda + mid-morning snack 3% dinner 3 meals + large late morning snack + merienda 8.8% 3 meals + merienda 17.8% 3 meals + large late morning snack 9.3% 3 meals + mid-morning snack 10.7% Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). snacks;» «three meals and an afternoon merienda;» «breakfast, lunch, dinner and extras;» «normally three, and sometimes a merienda;» «three: breakfast, lunch and dinner, although I snack on something midday;» «breakfast, lunch and dinner; sometimes a small merienda, not much;» «three, a little something mid-morning and sometimes an aperitif.» In any case, the most common eating day (graph 6.4) is composed of three meals, followed by eating days that are made up of three meals and a merienda. In third place, there are the eating days composed of three meals and a light mid-morning snack; then, three meals plus a big late-morning snack and finally, three meals plus a big late-morning snack plus a merienda. Other important combinations are: three meals plus merienda plus a light midmorning snack; three meals plus a light mid-afternoon snack; breakfast plus lunch or late morning snack and dinner and, three meals plus a mid-morning and mid-afternoon snack. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 153

156 The average number of daily intakes is 4.19, which means a total average of intakes per week. If we look at the days of the week separately we see that the number of intakes decreases on Sundays to 4.06, while on Saturday the average is similar to the other daily averages. For this reason we cannot speak of a difference between work days and weekends but of a difference between Sundays and other days. Breakfast The ideal ingredients for a good breakfast are milk, cereal, toast with oil, fresh fruit or juice. There is widespread agreement on this. However, when one looks at what the real breakfast of each person is, the nuances and/or exceptions are frequent. For me, I have to have juice, cereal, and fruit, but For me it would be ideal (milk, cereal, toast with oil, fruit ), but I don t eat it because I don t have time. At least I always have the same breakfast. I get up and have a coffee and perhaps I always have some cereal at work if I feel like snacking on something. And, after, breakfast at eleven. In the morning I would like to have a good breakfast but, I, simply have a coffee with milk and a few cookies. Then, mid-morning, maybe I go down to a bar and have a little something or some toast, a coffee with milk, something. I would like to have a good breakfast to avoid this intermediate step, but I can t get up early and have toast, an egg, fruit, I can t Thus, although there exists a general consensus about what is considered to be a «good» breakfast, both in strictly energetic terms and in terms of what is healthy, a majority of persons recognize that they have problems or there are conditions which make it difficult for them to eat such a breakfast. «A lack of time» or, «a lack of time and laziness» make it difficult to have what is be considered a «good breakfast.» Effectively, many people consider the time dedicated to breakfast as time that could be spent sleeping Which has something to do with the «amazement» that is felt for those family breakfasts with all the family sitting around the table. 154 FOOD, CONSUMPTION AND HEALTH

157 GRAPH 6.5 Breakfast foods By percentage PASTRIES/BAKED GOODS, BISCUITS AND SWEETS BREAD AND TOAST CEREALS OIL, BUTTER AND MARGERINE COLD MEATS, SAUSAGE AND CHEESES FRUITS DAIRY PRODUCTS VEGETABLES AND GARDEN PRODUCE CHOCOLATE AND COCOA EGGS MEAT PASTA AND RICE SALADS AND GASPACHO FISH POTATOES SEAFOOD DIETARY SUPPLEMENTS DRIED FRUITS AND NUTS LEGUMES SOUPS PRECOOKED MEALS SAUCES OTHERS Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). Despite what is considered to be a «good breakfast,» the most habitual foods in breakfasts (graph 6.5) are those which fall into the category of «pastries/ PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 155

158 baked goods, cookies and sweets.» In second place, are bread and toast, cereals and oil and butter. The consumption of cheeses and cold meats is less but significant. Despite the dietetic recommendations related to the advisability of having fruit at breakfast and despite the fact that a majority of the population think that a «true breakfast» should include fruit, only 4.7% do include it in their breakfast. The two most habitual drinks (graph 6.6) are coffee with milk and milk and other dairy beverages. Other drinks frequently consumed are black coffee and juices. Again, it is interesting to note, related to the discrepancy between what is considered a true breakfast and what is really consumed, the low percentage that juices represent. All in all, breakfast ends up being a light and sweet meal accompanied with coffee and/or milk. Breakfasts are composed basically of pastries, cookies and sweets and to a lesser extent, bread and toast with oil or butter and cereal. GRAPH 6.6 Breakfast drinks By percentage COFFEE WITH MILK MILK, CHOCOLATE MILK, DAIRY BEVERAGES COFFEE JUICES WATER HERBAL TEAS SOFT DRINKS BEER WINE OTHERS NOTHING Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). 156 FOOD, CONSUMPTION AND HEALTH

159 Lunch To begin with, the disparity in the responses gathered should be pointed out. Some people responded in terms of structure and types of foods for each one of the courses, others, only in terms of products or foods; and finally others simply responded by referring to what would be an «ideal» lunch in terms of quantity or quality. Some people, to characterize a «true lunch,» talked more about forms than about foods, for example, «seated at the table, chatting and sharing.» The majority of people interviewed referred to a ternary structure, in other words, a first course or starter, a second course and dessert. Nevertheless, in numerous cases, they talked directly about the types of products they consider appropriate for the mid-day meal without mentioning any structure, although this could be implicit: «salad or vegetable, meat or fish, fruit and coffee.» It is evident, on the other hand, that it is the principal meal of the day as numerous people made reference to this meal in these terms: «dishes you eat with a spoon and, above all, meat;» «something hot, like potatoes, vegetables, meat or fish;» «a main dish and salad; meat and potatoes, pasta and meat, vegetables and eggs;» «it is the main meal of the day: meat and something made with pasta, with salad;» «a good main dish;» «above all meat, as lunch tends to be heavier;» «something heavy;» «heavier dishes than at dinner: rice, meat;» «a main dish and something light;» «a stew with meat or vegetables, something very solid.» With less frequency, the answers referred to lunch in more directly nutritional terms and more or less in agreement with dietetic norms: «carbohydrates, milk, fats and minerals.» In this sense, the terms employed reveal a certain internalisation of dietetic norms: «a meal that helps you grow: legumes, soups and salads;» «the foods that give you strength, don t increase fats and contain vitamins;» «based on legumes, pasta, or cereals (rice) and that contain proteins and meat, eggs, fish and fruit;» «it has to be nutritious, with an adequate quantity, well cooked and not an excessive quantity;» «a balanced diet that contains all the food groups;» «it has carbohydrates, proteins and fats;» «a good dietary complex that is complete: meat, rice, pasta;» «from proteins, in other words, legumes, potatoes, pasta or soup and fruit.» PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 157

160 Some comments reveal the relationship between the social norms of our food culture and the increasingly present dietary norms or recommendations: «varied foods, solid food;» «salad and something light, but that s good and nutritious;» «healthy things;» «healthy foods;» «above all, varied;» «nonfattening;» «nutritious, or that has vegetables and fish or salad and meat.» Although they represent a minority, there are also those persons that minimize the importance of the mid-day meal. They say that they ll eat «anything» at lunch: «something to snack on;» «something fast and easy to eat like prepared meals, sandwiches ;» «something that cooks fast, soup or pasta, grilled meat, fruit;» «something fast, today there isn t time for anything more.» Related to the types of products respondents say they eat for lunch, we have the following results: For the first course or, starter: the most common food is legumes; followed by pastas and rice; third, vegetables and soups; and finally, salads. For the second course or main course, the most common food is meat (59 percent); followed by fish (44.5 percent). Eggs were mentioned by a very small number, and even fewer mentioned cheeses and cold meats. It is significant that bread is only mentioned by 1.5 percent of the people interviewed. For dessert, the most frequently mentioned food is fruit (37 percent). Only 2 percent of the respondents mentioned dairy products. Independently of the type and/or order of the dish, 19% of the people interviewed mentioned the use of «prepared foods» to deal with the midday meal. Water is the most frequently mentioned drink, together with wine or wine with carbonated water. In second place are mentioned sodas and juices. After the meal, coffee is the most frequently mentioned drink. It is surprising that other alcoholic drinks like beer, champagne, liquors or spirits are not mentioned. In any case, lunches are not thought of nor are they described individually, meal by meal. People are conscious that their lunches are integrated into «cycles» of at least a week, in such a way that the contents of a «true» or 158 FOOD, CONSUMPTION AND HEALTH

161 «acceptable» lunch has to be considered taking into account the contents of the other meals in the cycle. Or in other words, in accordance with the different circumstances or existing conditions of some of the meals, the deficits of some can compensate for the excesses of others. Thus, for example, a «meal served on one plate» can be considered an acceptable lunch, or «when you eat out, a first course, fruit and coffee,» but «for not for every day» or, the opposite: «I have the menu of the day and don t vary it, and normally it includes a choice of four first courses and four seconds, I go changing from one to another, but you get to a point where you want a meal on one plate or you go to a Chinese restaurant or to a pizzeria, but you can t do that every day.» These types of considerations are also valid for the different ways of compensating between lunch and dinner, and likewise they affect the different types of drinks that are considered appropriate for each type of meal. For example: The day for gourmet eating is Sunday In my house, Sunday is chaos. At midday everyone has a good lunch grilled meat or paella, something substantial. But at night, it s chaos. Then, it s take what you like, make yourself a sandwich, open the fridge what I say is: today no work, hey! At night, everyone does what they want. The foods that are really consumed at lunch are the following (graph 6.7): Meat is the food most frequently consumed and together with fruit, these two foods can be considered the most typically eaten at lunch. Next, a fairly high percentage of people have vegetables and produce; slightly fewer have pasta and rice, and salads and soups. Fish, potatoes and to a slightly lesser extent, legumes are all also habitual foods in Spanish lunches. In the graph that follows it should be pointed out that 0.4 percent corresponds to «bread and toast» and refers to the presence of these foods in the dishes and not to bread which complements the meals. As we will see, bread as a complement is present in 86.7 percent of the meals. Water is the drink consumed by the majority of Spanish at lunch (graph 6.8). The second most consumed drink is wine, alone or mixed with carbonated water. Other drinks which accompany lunch, although in much smaller percentages are sodas, beer and fruit juices. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 159

162 In short, the mid-day meal is the meal of the day in which meat and fruit are the most important foods as they are the most regularly consumed, along with water. Other foods which are frequently consumed at lunch are vegetables and GRAPH 6.7 Lunch foods By percentage MEATS FRUITS VEGETABLES AND GARDEN PRODUCE PASTA AND RICE SALADS AND GAZPACHO POTATOES FISH LEGUMES EGGS COLD MEATS, SAUSAGE AND CHEESES DAIRY PRODUCTS SOUPS SEA FOOD PASTRIES/BAKED GOODS, BISCUITS AND SWEETS SAUCES OIL, BUTTER AND MARGERINE PRECOOKED MEALS DRIED FRUITS AND NUTS BREAD AND TOAST CEREAL CHOCOLATE AND COCOA OTHERS Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). 160 FOOD, CONSUMPTION AND HEALTH

163 GRAPH 6.8 Lunch drinks By percentage WATER WINE SOFT DRINKS BEER JUICES MILK, CHOCOLATE MILK, DAIRY DRINKS COFFEE COFFEE WITH MILK HERBAL TEAS OTHER ALCOHOLIC DRINKS SPARKLING WINE OTHERS NOTHING Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). produce, pasta and rice, and salads and gazpacho. Regarding drinks, water is the most common, although wine is also consumed in a high percentage of meals. The most typical lunch is reflected in graph 6.9 Dinner Dinner, although generally not as important as lunch, does have the status of a meal and is one of the ingestions included in the repertoire of almost all of the persons interviewed. In some cases, however, it has the same importance as lunch, although different foods are eaten: «it complements what I didn t have at lunch;» «it complements the foods eaten at lunch.» Many people say that they deal with dinner in the quickest and/or simplest manner. For example, there are many people who say they eat «something,» PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 161

164 GRAPH 6.9 Typical lunch profile By percentage MEATS FRUITS VEGETABLES AND GARDEN PRODUCE PASTA AND RICE SALADS AND GAZPACHO POTATOES FISH LEGUMES EGGS COLD MEATS, SAUSAGE AND CHEESES DAIRY PRODUCTS SOUPS WATER WINE SOFT DRINKS BREAD Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). and only 0.4 percent of the people interviewed say they do not eat anything for dinner; in other words, they skip dinner. Regarding dinner, there are fewer references to the ternary structure, and a binary or even unitary model appears more often. At dinner it appears that there are also a wider range of foods consumed without any apparent order or without a clear structure in terms of first course or starter and second course, for example. Thus things like cereal with milk, or a piece of fruit appear. In short, in dinners we find a much wider diversity of situations and different and 162 FOOD, CONSUMPTION AND HEALTH

165 contrasting combinations: people that only eat vegetables and fruit or on the contrary, those that eat «an omelette of whatever and meat or fish.» If the most frequently used adjective for describing lunch is that it be «filling,» followed closely by «varied» and «nutritious;» in the case of dinner, the most frequently used adjectives fall within the semantic area of «frugality.» The dinner should be eaten with the end of aiding digestion. Dinners should be light, not heavy, not abundant, fast in their preparation (boiled, sautéed, raw ) and varied: «something light (fresh cheese, deli foods, vegetables);» «something that aids in digestion such as fruit, omelette, puree, vegetables;» «nothing heavy, or you won t sleep well;» «something light, that s not frozen such as vegetables, dairy dessert and nothing prepared;» «what you normally eat, but always less than at lunch;» «whatever, but small quantities, almost always some vegetables;» «something easy to digest, that s light to aid digestion;» «make sure they are foods that are easy to digest;» «not too filling or rich.» The concept of «easy» also appears in a more or less direct form. In fact, the reference to «what ever» or «anything» is already sufficiently indicative: «easy to prepare foods, boiled fish and some dairy product or fruit,» «fast.» The types of products most referred to for dinner are notably different from those mentioned for lunch. In general, there is a wider distribution of percentages between the different categories, which makes one think that the products related to dinner are less well defined than those related to lunch. The most frequently mentioned foods are fish, vegetables, and fruit, followed by eggs (in particular in omelettes), cold meats and cheeses. Prepared dishes are mentioned at a similar rate (20 percent). Interestingly, meat is only mentioned in 8 percent of the cases. Legumes don t appear at all and references to pasta, rice, potatoes, vegetables and bread are few (in comparison with the midday meal). However, and contradictorily, there are numerous mentions of the consumption of sandwiches, hamburgers, pizzas and frozen foods. The consumption of dairy products, in particular yogurt, is significantly higher than at lunches. Dinner is the second most important meal. Its composition (graph 6.10) is similar to that of lunch, although fish, cheeses and cold meats substitute meat, pasta and rice. Fruit is by far the most habitual food in Spanish dinners. The foods consumed with certain regularity for dinner are vegetables and garden PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 163

166 GRAPH 6.10 Typical dinner profile By percentage FRUITS VEGETABLES AND GARDEN PRODUCE COLD MEATS, SAUSAGE AND CHEESES FISH SALADS AND GAZPACHO DAIRY PRODUCTS MEAT EGGS POTATOES PASTA AND RICE PRECOOKED MEALS SOUPS WATER WINE SOFT DRINKS MILK, CHOCOLATE MILK, DAIRY DRINKS OTHERS BEER JUICES BREAD Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). produce, cold meats and cheeses, fish, salads and soups, dairy, meat and eggs. Water is again the drink which most frequently accompanies dinner; in 58.2 percent of the cases people drink water. Wine is the second most consumed drink, followed by soft drinks, milk and other dairy drinks, beer and juices. 164 FOOD, CONSUMPTION AND HEALTH

167 This pattern looks a lot like the one observed for lunch with the principal difference being that milk and diary are consumed a lot more at dinners than at lunches. Snacking between meals «Snacking» or «eating between meals» seems to be a relatively widespread practice, although not everyone is conscious of it. There are also different meanings given to these expressions. In any case, to «snack» or «eat between meals» is looked at in different ways by the people interviewed depending on whether they see it from the point of view of the «satisfaction» of the momentary hunger that arises at different moments or from a perspective of nutrition or health. The number and type of daily meals that they consider correct and the spacing between them is also important. The answers to our open questions can be grouped into three distinct groups: 1) Yes: often, always, frequently, often enough, almost always, very frequently, habitually, normally... 2) Rarely, very rarely, occasionally, once in a while, sometimes, almost never, seldom, very seldom, little, not much... 3) No: never, doesn t happen... Based on these groups, 35.2 percent respond affirmatively; in other words, they say they «snack» often, enough, always or very often. On the other hand, a significant percentage of persons, 34.3 percent provide an ambiguous result as they admit to occasional snacking; «once in a while,» «it depends,» «not much,» «only in the late afternoon,» «something around 12.» Finally, 25 percent say they never eat between meals. From this it emerges that, at least for the moment, there is not a precise normative model regarding «eating between meals» as there is for breakfast, lunch and dinner. Hence it would appear that there is a great diversity of acceptable foods for this type of ingestion. Similarly, as there is no single normative model or there is no dietary normative model for the majority, this could explain that regarding snacking there is less discrepancy between what is said to be consumed and what is consumed. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 165

168 There is an enormous range of foods and drinks that seem to be consumed between meals. The most consumed products between meals are drinks, and among these, water is the most consumed with 44.5% saying they drink water. On the other hand drinking water cannot really be considered as «eating between meals,» and its inclusion is due to the insistence of the research team on including any type of product consumed. Other drinks consumed are soft drinks (especially colas), juices, milk, coffee and herbal teas, chocolate drinks, dairy (liquid yogurt and other products derived from dairy); among alcoholic drinks the most mentioned are beer in first place, followed by wine, and in third place vermouth or simply «a drink.» Among solid foods salty products stand out, including nuts, sandwiches, chips, cold meats and cheeses, Spanish omelette, pizza, meat or fish pastries and various Spanish «tapas» olives, fried fish, sausage, etc. On many occasions the people interviewed referred to tapas, going out for tapas or an aperitif. Among sweets, the most frequently mentioned are «candies,» pastries, different types of rolls with chocolate, ice cream, chocolate, cake, cookies and cereals. Within this category, although with very different connotations, fruit is frequently mentioned, in particular for the ingestion that takes place between breakfast and the principal mid-day meal. Regarding products such as «colas,» juice, beer and dairy, some respondents (about 5 percent) add that they drink «light», products, «low in calories», or «without alcohol.» In snack foods, there are clear gender differences. In general, we can say that women prefer to eat fruit or chocolate between meals, while men prefer salty products. In these cases, however, the reasons for «snacking» have to do as much or more with a whim or «vice» as with necessity. Occasionally, a piece of fruit some afternoons but I don t eat more I snack at least two or three times Yes because if I work form eight until three, well I won t eat until 3:45 and then from breakfast until 3:45 I can t go without eating And, then we have something, we snack on something fruit or anything. And after, late-afternoon, many times also some fruit in particular in summer it s good. 166 FOOD, CONSUMPTION AND HEALTH

169 maybe Saturdays and Sundays Yes, because being at home a little bit of chocolate, if there is any, or a cookie, an apple, whatever there is Only 15 percent think that they should eat between meals, while 36 percent believe the opposite. In arguments regarding why one should or should not eat between meals (and what should be eaten) there are important variations. It is curious to note that in some cases the reasons given for eating between meals coincide with those given for not doing so. «Getting rid of hunger» is one of the most mentioned reasons to justify eating between meals, or «to make it till lunch» (or dinner). Some persons understand «eating between meals» as a way to eat smaller but more frequent meals, which coincides with some nutritional recommendations. I snack precisely to avoid eating more calories. In this way, I eat just what I need to not get fat and all these things, getting the vitamins I need and all that, I do it like that because I feel lighter. I don t eat large quantities; what I want to say is that I take the vitamins in the morning and in the afternoon, I manage to organize myself in this way. Other people, on the contrary, when they speak about «eating between meals,» understand that there are «normal times» for eating and, similarly «normal meals.» For this reason, these persons think it is «abnormal» «to snack between meals,» or they may even consider it «poor eating.» Eating poorly because with all the things that you have to have and, nevertheless, you are consuming a lot of calories, and this is not good. I speak from experience. It s time for lunch and I m incapable of eating a dish, a second course and a dessert and, possibly I ve eaten three things that don t provide me with what a meal should provide you with and, nevertheless, I ve eaten all these calories and crazy foods. Among motivations for eating between meals, «health» is the one that is mentioned most frequently: «It s good to eat several times a day in small quantities, so that your stomach isn t empty too many hours, to maintain constant energy, to best take advantage of the calories.» On some occasions, it might be specified that the reason may be «to not gain weight» or «not to be so hungry so that you eat less at the main meal.» There are also reasons related to anxiety, the pleasure of snacking, or to feeling «weak» without it. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 167

170 Among those who say they do not snack between meals, the reason mentioned most frequently is that they do not or should not eat between meals so as to not «gain weight,» «because it causes obesity,» because it means overeating, etc. A bit more vague but similar, is the response that «it isn t healthy.» Also mentioned with some frequency is that it «produces bad habits» (for example, «it damages the stomach», «it s not good for you nutritionally,» «it trains the stomach badly,» «there s no time to digest,» «gives you bad digestion,» «it interferes with digestion» ) or, simply, that «you don t take advantage of foods,» «it s not good,» «it gets rid of hunger,» and «the more you eat, the hungrier you are» Aside from the habits of each person, there does not seem to be a dominant opinion on this issue. The ways in which people understand snacking or eating between meals can be very different. Nor can the opinions or recommendations of the «experts» be understood in the same manner. Thus, there are notable differences, almost opposite positions regarding whether one should snack or not. You shouldn t snack, definitely not. I think you should snack. As I eat at half-past two and have a late dinner, then I can t make it. At six or around then, I have to have a drink or something to eat a snack. I read it in a book that for the stomach, it s better to eat smaller amounts more often and not three meals and a lot. But, it depends on what you eat, so that you don t gain weight... Gender differences and differences in work, as well as the way in which nutritional requirements are understood seem to explain the differences both in how «eating between meals» is understood as well as the positive or negative assessment of this practice. Thus, for example, snacking can be associated either with «eating garbage» something very negative or with satisfying a need for energy, motivated by the specific nutritional requirements that each person feels related to his or her activity. As I normally go out a lot I understand what I shouldn t do but between dinner and having a beer, well, I always eat some junk could be nuts, or chips Because I go out a lot and that s my weakness. 168 FOOD, CONSUMPTION AND HEALTH

171 Snacking is either fruit or some junk. If you eat a little bit of fish or a filet, that s not snacking. Eating nuts,yeah. A bit of cheese Each person learns what his or her body asks for and how. I take good care of my stomach with those yogurt drinks, and now there are all types of these little things, during the day I ll have three or four to satisfy my stomach. Eating between meals is as much part of the work day as the weekend, although there are different motivations. On the one hand, it would seem that working increases energy requirements and also demands periods of sociability, of escape from the work itself. Thus, drinks like coffee, which is energetic and social at the same time, or beer, are habitually consumed on work days. Bottled water also appears to be a drink related to the work day. On weekends, whether you go out or stay at home, in particular «if there s a football match going on,» snacking, eating chips, for example, can be habitual. Once more, gender differences are clear, above all, related to women s greater concern for health and/or avoiding gaining weight. Both concerns can coincide in the desire to avoid eating too much. I don t eat large quantities ever, but I snack during the day. I am sure there are days that I might eat three times; and other days, seven, if you call eating having a yogurt or snacking They say it s what makes you fat, above all in winter, you have dinner and you basically go to bed. [In summer] there s the pool and there s, I don t know. But in winter, there s dinner I have dinner late and, on top of that, I go to bed so everything stays here. It s a habit that I would like to change. And sometimes, I eat a little bit in the late afternoon, I get so hungry I love to have a sandwich or a roll or something in the afternoon The dinners are the worst as I am so hungry. Mid-morning breakfast The mid-morning «breakfast» is somewhat more solid than a breakfast eaten at home. It includes cold meat and cheese and fruit and is accompanied principally by water. The most frequently consumed products in the mid- PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 169

172 morning breakfast are cold meat and cheese, followed closely by fruit and pastries, cookies and sweets and a bit less frequently, meat, vegetables and garden produce and potatoes. This meal is accompanied preferably by water. To a much lesser degree, people consume juices or soft drinks. In this midmorning breakfast coffee with milk is only present in 7.6 percent of the cases, black coffee in 7 percent and other dairy products in 5.8 percent, and beer is drunk in 6.4 percent of the cases. GRAPH 6.11 Typical mid-morning snack profile By percentage COLD MEATS, SAUSAGE AND CHEESES FRUITS PASTRIES/BAKED GOODS, BISCUITS AND SWEETS WATER JUICES SOFT DRINKS Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). The merienda (the late afternoon snack) The merienda (late afternoon snack) is lighter and sweeter than the midmorning breakfast. Pastries, sweets and cookies are the most frequent foods, followed by fruit, cold meat, cheese and other dairy products, which in no other meal have as much importance as in this. Other foods that stand out are dried fruit and nuts and potato chips or crisps. In the merienda, the most frequent drinks are juice and water. To a lesser degree, the Spanish accompany the merienda with soft drinks, milk, dairy drinks and coffee with milk. In 13.4 percent of the meriendas, no drink of any type is consumed. 170 FOOD, CONSUMPTION AND HEALTH

173 GRAPH 6.12 Typical merienda profile By percentage PASTRIES/BAKED GOODS, BISCUITS AND SWEETS FRUITS COLD MEATS, SAUSAGE AND CHEESES DAIRY PRODUCTS DRIED FRUITS AND NUTS POTATOES OTHERS FISH CEREALS BREAD AND TOAST VEGETABLES AND GARDEN PRODUCE SALADS AND GAZPACHO CHOCOLATE AND COCOA JUICES WATER SOFT DRINKS NO DRINK MILK, CHOCOLATE MILK AND DIARY DRINKS COFFEE WITH MILK COFFEE BEER BREAD Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 171

174 The aperitif The aperitif in Spain is a kind of small meal in which people eat potatoes presumably chips or crisps and dried fruit and nuts, accompanied by beer. Apart from the potatoes and dried fruit and nuts, fish is also often eaten. Other foods that may also be eaten are cheese and cold meat or pastries, cookies and sweets. Regarding drinks, apart from beer, the most common ones are soft drinks or water. GRAPH 6.13 Typical aperitif profile By percentage POTATOES DRIED FRUITS AND NUTS FISH COLD MEATS, SAUSAGE AND CHEESES PASTRIES/BAKED GOODS, BISCUITS AND SWEETS SEA FOOD VEGETABLES AND GARDEN PRODUCE FRUITS MEATS EGGS BEER SOFT DRINKS WATER JUICES COFFEE WITH MILK MILK, CHOCOLATE MILK AND DAIRY DRINKS WINE BREAD Source: Observatorio de la Alimentación (Foro Internacional de la Alimentación, 2004). 172 FOOD, CONSUMPTION AND HEALTH

175 6.4. Current food trends: new lifestyles and new ways of eating During the last 30 years «new ways of eating» have developed in Spain as a consequence, above all, of the following: The prolongation of the time dedicated to paid work and work outside of the home on the part of women. This has not resulted in a redistribution of tasks within the home nor has the time dedicated to such tasks decreased in global terms, but the time dedicated to cooking has declined (in France three hours less per week data for Spain is not available). As women say, «We don t ever have vacation!» Modifications produced in the working day and in social rhythms in general: «While one person arrives at one hour, someone else arrives at another!» Changes produced in family structures (progressive decline in the average size of households (from 3.5 to 2.9 between 1970 and 2000) and the growth of households composed of only one person: «For two, I don t use the cooker!» Technological changes which have led to new home appliances (microwaves, for example) that have contributed to «lightening the load in the kitchen» along with «easier to prepare foods:» «You know how good that instant Chinese fried rice is; it comes in a packet, you open it and in three minutes and you don t have to do anything?» A certain «individualization» and «simplification» of meals has happened in three ways: First, there has been an increase in the number of meals eaten alone; second, meal timetables have been extended; and third, the number and diversity of places where people eat, both inside and outside the home, has increased. Thus, food, even «family food» has individualized. This individualization of the system of meals leads to «new forms» (Cf.: Herpin, 1988) such as, for example: Deconcentration «Before we had dinner; now, some fruit and a yogurt!» or the exchange of solid meals at lunch and at dinner for «small» meals (breakfast, a sandwich or a snack in the morning, the merienda and a sandwich at night are the most frequent). At the same time, the menu of the main meals has become more simplified; in this «new style» the main meal is organized around one dish. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 173

176 Deimplantation «There are four of us and we each eat at a different time!» The «new» meals don t have a set time and place; neither the beginning nor the end of the diverse meals are at set times. This impression of the «open borders» of meal times leads to the appearance of hybrid forms like the «merienda-dinner» or the «aperitif-lunch.» Desynchronisation «Dinner? Everyone has a different timetable!» Work timetables are increasingly less coordinated so having communal meals is increasingly difficult.» Delocalization («Eat on the sofa? Never! Well, okay, on Saturdays and Sundays at night.» The «traditional meal» had its place in the kitchen and the dining room. The «new forms» are not as specifically located in the different spaces of the home nor outside. In the home, besides the traditional spaces of the kitchen and the dining room, people now eat in the bedroom (0.9 percent of the meriendas and 0.5 percent of the dinners) and on the sofa (10.6 percent of the dinners). Outside the home, besides restaurants, cafés and the company dining room, there is now the street, parks or gardens (2.1 percent of lunches) and indeterminate spaces within workplaces. The simplification and individualization of the mid-day meals is a common phenomenon, above all in the cities of the large metropolitan areas. The greater the distance between home and workplace, the greater is this trend. It affects women and people employed in the service sector more, while on the contrary, there is no correlation with age or purchasing power. The new ways of eating refer to the number of times we eat during the day and to the modification of the structure of meals, revealing an increasing simplification of meals and an increase in snacking. A lot of eating takes place outside the home, especially the mid-day meal, usually at private restaurants or in company or school lunchrooms. In those cases, the degree of meal structuration appears to be solid, and in comparison with dinners follows more closely the norm of «a true meal.» A characteristic of food modernity seems to be the introduction of food into the workplace; not in the restaurant or company cafeteria, but rather into the office or meeting rooms themselves. This tendency refers to the lunches and intakes outside of the meal times. Eating in the workplace is developing even more in the service sector. Foods are brought from home or purchased near 174 FOOD, CONSUMPTION AND HEALTH

177 the workplace. The motivations for this practice are not economic, nor do they have anything to do with dissatisfaction with the company lunchroom, but rather they have to do with the organization of work time (or time in general). Dinner is mainly eaten at home but doesn t necessarily have the family character of the past. In addition, dinner seems to have become the meal with the greatest degree of innovation in its structure, both in terms of ingredients as in the combinations of foods. The reason for these changes comes from the fact that the majority of people, including children, have lunch which is the main and most structured meal of the day outside of the home, which makes it easier to eat «anything» for dinner Conclusion: health, convenience, pleasure depending on the circumstances Although it would seem that the norms internalized by the majority of the population are testimony to the degree to which nutritional discourses have been assumed, dietary practices continue to be motivated by different material and symbolic constraints in such a way that there does not seem to be a direct correspondence between dietary recommendations with their accepted definition of a healthy diet and actual consumption. In this sense, we can see disequilibrium between socially acceptable eating norms and the attitudes of the population and in particular, between declared practices and observed practices. In addition, the complex process referred to as «globalisation» has brought with it a progressive dissolution of some dietary sub-models related to different socio-professional categories, cultural levels, economic means, geographic origins, etc. This is because these social groups are endlessly diversifying as individuals take on increasingly diverse identities and consumers, motivated by complex and divergent rationales, are making daily food choices that are more and more diverse, specific and irregular so that following a specific food regime involves a very constricting routinisation, and is therefore quite difficult. People s lives are more irregular, dotted with numerous events, changes in planned activities, variations in timetables, trips of all types; all of this breaks down the support offered by dietary routines. There is a big difference between the food eaten during the week and at the weekend, and this is related to various issues such as the number of persons PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 175

178 eating, timetable of the meals and their structure and content. Regarding the number of persons eating, this can increase on the weekend as a consequence of having guests, particularly someone from the family, which often means children visiting parents. Regarding structure, weekend meals can be more complex as a consequence of having an aperitif and the possibility of a second dessert, «a dessert a little more appreciated,» most frequently sweets or ice cream. Regarding the content of meals, weekend meals are of a higher quality and more elaborate; for example, they are accompanied by a better quality wine, or if wine is not drunk during the week, wine may be present at the weekend. At weekends and on holidays, time is not as much of a constraint as on work days, and in addition, meals are again family meals. These two circumstances together make terms such as «whim,» «pleasure,» «relax a bit,» «a special day» appear in relation to those days, while the expression associated with ordinary days is «I m overworked.» At weekends, there can even be «pleasure in cooking.» To obtain pleasure through food continues to be an important end, not on a daily basis, but pleasure is a necessary condition on specific occasions. When the meal is associated with leisure and/or sociability, when we «go out to eat,» «eating well» understood as «eating for enjoyment,» is important for everyone. We look to «enjoy,» eat what we «most like,» and dispense with nutritional considerations. Economic limitations can have an influence but within the means of each person, we try to «eat as well as we can.» Similarly, people that say that in terms of health they are concerned with diet during the week, also say that «when Sunday comes, we have a little extra.» Thus, the «good behaviour» that is maintained during the week, represented above all by vegetables and fruit, is counter posed to the «extra» or the «whim» represented by «rice and everything else,» sweets, ice cream, wine, etc. In terms of cooking, grilling, particularly in the preparation of meat, is usual for ordinary days and also represents both convenience and health. Convenience and health are the objectives pursued on ordinary days. Convenience is important because of constraints on time, and health because people are thinking about healthy eating most days. Thus, on holidays or weekends, the concern for health or a more healthy diet declines, and there is a greater interest in pleasurable food. 176 FOOD, CONSUMPTION AND HEALTH

179 Differences exist, even conflicting ones, in the way in which the relationship between health and pleasure is perceived. For some they can be compatible, for others not. And for yet others, it may «depend.» In addition, the compatibility between pleasure and health can refer to different conceptions. Some say that if they eat «with pleasure» the meal will rarely «sit poorly.» Others associate «tastier» and «more pleasurable» meals with foods that contain fat and require «heavier» preparation, and both categories fat and heavy are considered bad for health. Finally, a third attitude does not base the relationship between pleasure and health on the types of foods and the form of cooking but rather above all on the quantities consumed and the variety obtained during the series of different ingestions. For them it is a question of avoiding excess on the one hand, and deficiencies on the other. Is there a contrast between pleasure and convenience in regards to what we have referred to as ordinary days and holidays? These two aspects seem more compatible than pleasure and health, in part because convenience can be one of the components of pleasure. However, it is clear that there are different ways to understand «convenience» on ordinary days and holidays. On holidays, convenience can mean buying the dishes one likes already cooked and in this way avoid «the inconvenience» of «having to spend the day in the kitchen.» At weekends, there doesn t seem to exist any incompatibility between «pleasure» and «comfort» or «convenience.» Hence, for example, on a Sunday, buying a «barbecued chicken,» one of the symbols of the antithesis of gourmet, can represent the compatibility of pleasure and convenience precisely «because it is Sunday and we have worked a lot during the week.» It is the infrequency, the lack of repetition, being able to maximize leisure time, which is what permits this greater compatibility between convenience and pleasure. During summertime, this compatibility seems to be even more important, as much for the fact that many families can go to the beach or other places of leisure; as because in summer, with the heat, «it is much worse to be stuck in the kitchen.» That cooking is not «an obligation» on holidays or days of leisure is an increasingly important and shared aspiration of women. PREFERENCES AND FOOD CONSUMPTION: PLEASURE, CONVENIENCE AND HEALTH 177

180 VII. Learning to cook: culinary do-it-yourself, letter soup, and the audiovisual stew Paloma Herrera Racionero (Polytechnic University of Valencia) 7.1. Introduction The forms of transmitting knowledge and culinary knowledge in particular, are among the aspects most affected by the modernizing process. As much in that first modernization which occurred in Greece with the «clichéd» change from myth to reason, as in the modernization undertaken in central and Anglo- Saxon Europe beginning in the 17th century, or as in the modernization that is still taking place among the extensive layers of the planet s population where pre-modern habits persist (or, more precisely, amodern). The transit of some forms of expression and communication based on orality to others based on writing induced drastic changes in all areas of life, from the political to daily life; changes that also radically affected the world of food. Food would also later come to be affected by the impact of the new communications technologies, whether in the representation of foods in advertising, or in the new forms of secondary orality (1) and of neomimesis with which the audiovisual media (radio, television, Internet) offer culinary proposals. It would however, be an error to think that the succession of supports in the ways in which culinary knowledge has been transmitted (the voice, writing, electricity and the electronic) have been accompanied by a parallel substitution of the habits and practices linked to that knowledge. Many habits tied to oral tradition, for example, are still maintained in force, and even more so in the area of food, which to a great degree has since time immemorial moved at the margins of the «learned» world from which writing emerged and to which (1) A term coined by W. Ong (1987). He distinguishes between «primary orality,» which developed in cultures that lacked knowledge of writing, and «secondary orality» characteristic of technological cultures in which they maintain a new orality through all types of electronic devices (telephone, televison, computers ) but whose existence and functioning depend on writing and printing. 178 FOOD, CONSUMPTION AND HEALTH

181 it is principally directed. Such is the case of learning to cook by example, a practice typical of oral traditions that writing mimics in recipes in newspapers and magazines, or also the case of teaching by imitation, that television takes up in the current profusion of cooking shows. There is nothing automatic that connects and certainly not by accident the dominant form of the means of communication and culinary practices. These three types of transmission of culinary knowledge (oral, written and electronic) don t follow one from the other, but rather overlap and mix. This leads to the coexistence of different forms of authority and legitimacy (tradition, the written word, medical prescriptions, advertising, audiovisual gourmets, public health administration ) whose messages are often in contradiction, which submerges the modern diner in a permanent sensation of uncertainty and anxiety before the lack of criteria from those that can evaluate and resolve the cognitive dissonance. To this confusion before the enormity and diversity of knowledge that is today required to eat well (medicine, chemistry, biology ) is added the rejection of the knowledge and criteria that the diner was used to managing before, giving rise to a sort of «learned ignorance» that is a determinant of this dietary uncertainty. Despite this (or perhaps precisely for this), although this current period has brought with it a more or less chaotic restructuration of culinary learning as well as a redefinition of feminine responsibilities and roles, it hasn t managed to break the more emotional connections associated with food. The pre-eminence of reason and the practices and institutions which serve it (writing, literacy, schooling, medicalization ) don t seem to have replaced, in the area of food, the numerous traditional reminiscences with which it has always been supported. Despite the strong erosion of traditional ways of transmitting knowledge and practices associated with food, this area has resisted its formalization and rationalization: within it a multitude of experiences, emotions, knowledges and practices are at play; a multitude of circumstances and contexts, always specific and always unavoidable make culinary knowledge a polymorphous and complex knowledge in continuous re-elaboration. LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 179

182 7.2. The kitchen: a traditional place of feminine knowledge and oral transmission Culinary learning and that of domestic knowledge in general has traditionally been based on practice and imitation. Until just a few years ago, in that humble domestic academy, the kitchen, verbal instructions had been intertwined with a whole repertoire of meaningful gestures and small rituals, of implicit codes and different rhythms, of a multitude of miniscule choices and of almost imperceptible routines that the girls of the house would imitate and repeat until they would become their own. As with all oral transmission of traditional knowledge, emotional identification with these small details through their repeated emulation a thousand and one times is fundamental for the chain of culinary knowledge to be maintained, recreated and prolonged. Opposite to learning by abstract concepts and abstracted from context, the traditional way of learning «to see it done» and «to hear it said» again and again becomes indelibly recorded in the memory of the apprentice and associated with a multitude of lived images, emotional situations and concrete occasions. In this way each step in the preparation and handling of ingredients and utensils is registered in the memory of the small apprentice, associated with physical sensations (smells, tastes and colours), with situations and events, and with emotions and impressions (fun, patience, stimulation, boredom, expectation ). It is a very particular type of experience that our participants know well: (2) Q.: Where did you learn how to cook? A.: What? Because I, for example wel ah Okay I remember that when I it s that I was going to be married soon.of course I worked long hours in the street, in those times you did extra hours, and all that. I would get home at eleven o clock at night Then, well, my mother when when it was almost time for me to marry, she said: «listen, you have to learn to cook, the day you get married you won t know,» because Of course, in that time (2) The extracts that are reproduced and analyzed here come from qualitative data semi-structured interviews and group discussions produced for the research project «Cambio en el consumo alimentario en España: factores sociales que intervienen en la transformación de los comportamientos alimentarios [Change in food consumption in Spain: social factors that intervene in the transformation of food behaviours]» financed by the R & D plan of the Principality of Asturias and directed by Cecilia Díaz Méndez (University of Oviedo). The names that appear here are fictitious. In any case, some of the ideas expressed in this chapter have been presented and discussed at the IX Spanish Congress of Sociology, held in Barcelona from the 13th to the 15th of September, in FOOD, CONSUMPTION AND HEALTH

183 it was different, women, they had to know how to do everything when they got married. No? Then I said to her: «but mama, If I m marrying a Catalan I m going to make Catalan food Why do I want Andalusian food?» The things we think, huh? Then no? But my mother she said to me: but it s not a bother, you learn.» Okay, in the end I learned some things (María Dolores, 62 years old, homemaker) Asked where she learned to cook, Dolores answers with when, with how and with why Her apprenticeship is inseparable from the circumstances in which it occurred: her mother, the eve of her wedding, the late hours, the objections she raised, the advice from her mother not limited to cooking, the types of cooking that were in conflict The mother, in any case, is the constant circumstance, the permanent presence in evoking the culinary apprenticeship when the women interviewed answer the question «Where did you learn to cook?» Me, with my mother who said, okay, girls, while I do one thing you I remember that it was a game. (Aurora, 33 years old, management secretary) Before the same question there are more than a few that introduce two features that are of interest: At home, with my mother from when I was small. ( ) I now see myself doing things in the kitchen... unconsciously, that saw my mother doing, and later I realize that... even how to save things, meals, how to organize them, a little with a life with a fast rhythm, which is how she did i. (María, 23 years old, estudent) At home, seeing your mother since you were little. I asked: «Mama, and this, how do you do it» and I would do it. (Francis, 25 years old, accountant) Learning to cook «at home, with your mother, since you were small» is the institutional base over which traditional culinary practice is supported and which at the same time contributes to consolidating it. As with all popular institutions typical of societies where orality predominates, they are also characterized by their overlapping with a multitude of other daily practices instead of being segregated in spaces or figures separated from these practices. LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 181

184 The figure of «the mother,» unlike the teacher, is not a specialist in certain types of knowledge or in certain techniques for transmitting them. The mother teaches how to make the meal as well as and in an inseparable form how to dress, behave, talk or express feelings. Similarly, the space of «the home,» unlike the school, is not a space separated from the places where the other ordinary collective activities develop. Although it is an eminently feminine environment (the dominion of the «homemaker»), in the home many other practices, values (from the criteria of what is «an order» to the way of planning maintenance) and social relations (families, neighbours, visitors ) that become indissolubly associated with the apprenticeship of «the girls» in the kitchen converge: go and ask the neighbour for a little salt, how to impose order on make a dish with the chaos of the leftovers from the previous day, what to do when guests come to eat or when a special day is being celebrated, how to adapt the rhythms of the meals with the rhythms of life. Daughters are like that, «from when they are small,» interweaving their culinary apprenticeship with a multitude of experiences, emotions, knowledge and practices to which they will remain closely tied, whether they reinforce them or reject them. Few things evoke our childhood in us like the smell of «that dish that my mother made» or the disgust of «that liver or those testicles I had to eat.» The second feature that we make reference to is this resort to the image in which the importance of vision in transmitting knowledge of cooking is revealed. (3) But what memory sees are as much objects (these things that María refers to) as a subject (the mother: «seeing your mother»), as much actions (a «see doing»: «I see myself doing,» «I saw my mother doing») as some ways of executing them («how to save,» «how to organize»). They are those sequences of actions that stay recorded and after, «unconsciously,» flow as if they were spontaneous, as if there was no one executing them, as if it were any one or no one: «I see myself doing» as María said. The emotional identification with exemplary figures, situating the transmission of knowledge in a context rich in sensations, experiences and associations, the central role conferred on seeing and, in general, on the practices and the habits instead of the concepts are characteristic features of learning by mimesis typical of oral cultural forms, which is how Gloria also learned: (3) These two features, as we will see, are recovered in this other form of transmission that we call «secondary orality.» 182 FOOD, CONSUMPTION AND HEALTH

185 Q.: Where did you learn to cook? A.: Well, man, what I do here what I do at home is because I saw my mother do it. And, also, the things I do at home, is because I saw my mother [LAUGHS], or in other words, the recipes and the things you do it s because I saw her... Q.: And you do them the same way? A.: And I do them the same. (Gloria, 34 years old, shop clerk) This «and I do them the same» reveals another one of the common features of cultures where the customs and uses are transmitted through collective memory instead of being dictated by a positive written norm: the importance of repetition so that acquired knowledge becomes a habit, like that practice that María says comes out «unconsciously.» Certainly, this «and I do them the same» of Gloria, of María and of many others is an impossibility that only exists in the memory of all of them and of the many that have learned traditional knowledge through mimesis. An impossibility that, however, is the foundation itself of the oral transmission of knowledge, whether it be culinary or any other type. Surely Gloria doesn t cook the same as her mother, nor are the products the same, nor the source of heat, nor the utensils in the kitchen, nor the time she dedicates nor will her daughter be there beside her, seeing her doing while she does, as she will be in school not seeing anything being done but rather reading or writing how things are done or how things are done by whoever does them. The inexistence of a fixed canon, which on the contrary writing does permit (recitations, homogenization of dietetic criteria, expression of the nutritional composition of foods, etc.), together with the material improbability that the same situations are repeated (for variations in technique, in family conditions, in the origin of the foods, etc.), make this «and I do them the same» be more an a posteriori reconstructed identity based on the memories of the subjects than this total absence of innovation, improvisation and research in which many anthropologists tend to enclose these types of practices. The culinary knowledge acquired by oral learning of the practices that compose it seems more like that knowing-doing of the bricoleur with which Lévi-Strauss characterized the «savage mind,» who innovates continually to adapt the materials available in each moment to the uniqueness of each unrepeatable LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 183

186 occasion. How many trials and innovations would have required the creation of mortar or gazpacho? 7.3. The alphabet kitchen or letter soup But the oral transmission of culinary knowledge, where the kitchen is the place of knowledge and women are the almost exclusive depositories and holders of that knowledge, is something that has almost disappeared in the course of just few generations. Practically none of the women we interviewed, now modern women, have transmitted this knowledge to their daughters or sons, often because they didn t even receive it themselves. The modernizing process, that has now gone on for four centuries but in our kitchens has abruptly materialized in only one generation, is closely tied to the passage from orality to writing. And, to the extent to which this passage is understood as progress, it carries with it the consequent loss of prestige of knowledge acquired by oral transmission (and of the subjects that hold and transfer that knowledge) in favour of those knowledges that can be recorded and transmitted through writing. But orality, as De Certeau reminds us (1994), is not only an archaic mode of thought and expression, but also the fundamental form of thought and expression in any society and at all times in history, as the first that any human being develops from infancy. Writing and reading come after, but only after, and situated over expressive, communicative and intellectual habits of a basically oral matrix. The centrality of speaking not fixed in writing promotes a great variety and dispersion of customs, of ways of doing, of ways of cooking and eating, often leaving wide margins for action. With the emergence and diffusion of writing, cooking is also manifested in texts, a form of expression which, opposite to the oral, is premeditated and not spontaneous, a fundamentally individual and solitary activity. While doing the same activity through talking requires the presence of others, involving thought with social life. In particular, writing allows things to be codified, set and disseminated, in an established and recognized repertoire, the practices and techniques elaborated in the heart of determined groups. «Determined» groups because, although the diversity of cuisines corresponds with the diversity of societies, only the complex societies, as Goody argues (1995), were capable of producing a professional cuisine 184 FOOD, CONSUMPTION AND HEALTH

187 different from domestic cooking. And «determined» groups also because even within societies with a writing tradition, such as European societies, written texts have been produced by and for the dominant elite. (4) Opposite the prestige of the form of transmission of knowledge in the schools and their promise of independence, the space of the kitchen and maternal knowledge is today perceived as a place and a knowledge looked down upon, when not simply as no knowledge, as modes of ignorance and submission to a destiny that of the homemaker from which any modern girl flees. Anna expresses it emphatically: I, for example, still haven t made a roasted chicken, No, I told you, I manage, also, on the weekend to go and eat with someone [LAUGHS] in the family that cooks. There are a lot of things that I still haven t done I don t know where I was when we ate tongue and I never did it. Okay, I have no idea how to do it nor and if I can avoid learning it, well I avoid it. (Ana, 46 years old, civil servant) In this way, little by little and subtly, the loss of prestige of informal transmission opens up a space for the demand for a formal education, the theory being added to the practice, the kitchen at home being substituted by the classroom, the cookbook or the medical prescription. During the 20th century, studies regarding dietetic science have been included, with irregular success, in school curriculums in the majority of European countries, published in specialized journals, newspapers, magazines aimed at women, in a whole range of media that gather and disseminate the new nutritional and health knowledge related to food; a part of a wider movement begun in the industrialized countries aimed at the formalization of knowledge (Mennell, 1996: 230). Science entered fully into the diet and all types of experts (doctors, chefs, politicians, journalists ) began to take over the transmission of culinary knowledge from the family. A different language began to be spoken, distant from the physical sensations and common language in which families expressed themselves, incorporating words, concepts and formulas that were far from daily experiences and knowledge. The popular understanding of «eating» transformed its meaning into «nourishing oneself,» into the rational ingestion of those compounds that (4) It s important not to forget that in the 1950s close to 30 percent of the Spanish population was still illiterate; the «cookbook» was stored in the collective oral memory. Currently UNESCO estimates that 800 million people in the world don t know how to read or write. LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 185

188 provide the necessary energy for the maintenance of vital and social functions and for avoiding potential disorders and illnesses. To «nourish oneself» centres on the nutritive substances of food and leaves aside not only pleasure but also concrete products and their preparation and combination in dishes along with who produces or prepares them, the how to do it and the whole complex of symbolic values and collective practices traditionally associated with eating and cooking. Q.: What does eating well mean to you? A.: Well this, balanced eating, you have to eat carbohydrates, vitamins, fibre all that; control the calories, don t fi ll up on chorizo or bacon, don t eat junk... (Pedro, 38 years old, director of a branch of a bank) «Eating well» is, for Pedro, ingesting a series of substances impossible to detect with our senses, while the products that he identifies concretely are curiously «junk.» Pedro now eats ideas («carbohydrates, vitamins, fibre all that»), not food («chorizo, bacon»). Nutritional ideas permit him to calculate proportions («balanced eating») and exercise control («control the calories»), while the habitual food escaping from all measure of this type (5) is associated with excess («fill up on chorizo»). In him the self control that Mennel (1996) refers to manifests itself under the form of this Cartesian rationality, also typical of modernity, which demands analyzing the object (food), breaking it down into its elementary components (proteins, vitamins, carbohydrates ), abstracting them from all context and situation, so that after, through synthesis, they are recomposed to their initial being, the food, but now as a mere aggregate of those essential components. Under this new rational dependency, the diner can no longer turn to traditional dietary guidelines. Although these guidelines have surely been internalized since childhood and, in any case, they are at the diner s free disposition as he or she only has to consult the surrounding environment, they have been by and large systematically discredited by the authority (experts) as mere superstitions and beliefs without scientific basis. With traditional culinary knowledge discredited, and bodily sensations also discredited as a source of information, (5) Traditional measures in the kitchen are effectively difficult to quantify: «a pinch,» «a fistful,» «to taste» not to mention the criteria of Carmen: «Salt, throw it in like crazy!.» 186 FOOD, CONSUMPTION AND HEALTH

189 the diner feels incapable of acquiring all the knowledge (physiological, botanical, medical, chemical ) now necessary to know how to eat. Trapped between one form of ignorance and another, the demand to eat using rational criteria brings him or her toward absolute confusion, a new form of ignorance that could be called «rational ignorance.» The following dialogue maintained in a group discussion gives us some clues about the reasons for this typically modern ignorance: (Group 2 young persons) M.: Okay, it s that now, to begin, it s that I don t know what they these things have. G.: Man! But you more or less know. P.: But she knows that vegetables and legumes have those things, that fruit and fi sh but listen G.: This is interesting to me because I have my bad eaters, in particular the older one, so I have to substitute a lot of foods, and I ve had to learn,, I have the older one who has never tried a pineapple in his life, never in his life tried many fruits, or onions, the older one only wants apples and bananas, and when they re in season, peaches. So then I try to substitute another type o vitamins, that s why I m interested Y.: Of course, that s why my sister has dried fruits and nuts, that s what she uses. G.: Look, the dried fruits and nuts, I don t know any mother at the time for a morning snack who gives her kid a fistful of peanuts. P.: Every afternoon, after lunch M.: Listen, it s that to me, if you bring peanuts to go to school and your schoolmates will laugh in your face, come on, it looks bad to go to school with peanuts, so you bring a donut. Interwoven with the initial discussion about whether the lack of knowledge confessed to by M. is «more or less» a form of knowledge, as G. qualifies, or a diffuse knowledge about certain blurry objects («those things»), as P. says, is this reiterated recourse to the term «things» to allude to food. For M. «these things» is the abstract name under which are grouped, indistinctly, the concrete dishes that she can prepare (a salad, a stew ), the generic categories used by nutritionists that P. mentions («vegetables and legumes,» «fruit and fish» ), concrete and singular edible objects (like the «peanuts»), the packages that you LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 187

190 can buy, and even the food brands (like that «donut» that the child has). This heterogeneous multitude of «things» are characterized not by their smell or function, but rather by their chemical composition: «what these things have.» But there is something more, which G. expresses literally: «I have to substitute a lot of foods» for «another type of vitamins» (with which the word food is identified with a different type of vitamin). In this substitution a complete manner of thought is condensed: substitution of the concrete for the abstract, of the totality (the stew, the dish) for its elementary components. It is in this transition where the «rational ignorance» of the ordinary diner is generated, who is usually not in condition to accede or has no interest in acceding to this type of knowledge, which is in permanent review. «The attitudes toward food that emerged in the beginning of the 60s concluded Tannahill (1989: 347) introduced confusion not only in the logic of the table, but also in the minds of the people that sat at it.» This author pins this «rational confusion» on the permanent obsolescence and reformulation of scientific conclusions about the healthiness of foods. Eating seems to have converted into an authentic discipline, not only in the punitive sense that converts it into a source of suffering (diets, anorexia, obesity ), but also in the academic sense. Eating is now something that you have to study; as G. says, «I ve had to learn.» If we add to this continued obsolescence of the «necessary» technical knowledge for «eating well» the no less systematic obsolescence of the criteria and products promoted by the food industry for introducing nonstop innovations, it would not be an exaggeration to say the diner is subject to double work (scientific and industrial) to maintain a constantly «eroding» dietary competency. Eating becomes a discipline you have to study during your whole life: (Group 1 Senior citizens) Soon buying a yogurt will be like doing a masters, that is to say Low-fat yogurt, creamy, Greek, twenty things, and you say, okay, My God! What do I choose?! You get to where the yogurts are and you say, which do I want! The yogurt I ve always eaten. And the milk? Low-fat, goats milk, The bifidus and those things... Before they put it in the yogurt you always eat. 188 FOOD, CONSUMPTION AND HEALTH

191 But the milk... There are too many things, with fluoride, for cakes, for cheese The whole conversation of this group is marked by a complete sensation of incompetence and uncertainty, both in respect to the expert knowledge required («like doing a masters,» «the bifidus and those things») and with respect to the elementary criteria for consumption («there are too many things,» «My God! What do I choose?!»). Before choosing, there only two possibilities seem to fit. One, to regain the lost autonomy: «The yogurt I ve always eaten.» The other, «do a masters.» But now there is no way to find the yogurt you ve always eaten anywhere, nor will the masters which apart from it being difficult guarantee that at the end of studying for it, you won t have to begin again to update what has been learned. In either case, eating well has become an unreachable goal: Q.: What does eating well mean to you? A.: Hmmm a utopia. (Virginia, 34 years old, university professor) Q.: What does eating well mean to you? A.: Eating well? Something very difficult. I don t know what eating well is, and if it s what the doctors say, something impossible. (Mila, 41 years old, homemaker) To eat well, following all the expert prescriptions is seen as «something impossible,» «a utopia,» and as a consequence, as a perpetual effort to adapt or incorporate a multitude of knowledge and criteria which are often changing and contradictory. From doing the shopping to managing the leftovers, everything converts to work requiring qualifications and previous schooling: to be good with numbers, to decipher and compare miniscule inscriptions, to possess a certain aptitude for the hermeneutical and linguistic, for biology and chemistry all is knowledge that is increasingly inscribed in the dietary process. But nevertheless, the Spanish continue eating every day. What s more, they do so as repeatedly appear in our interviews with the sensation of knowing how to eat, with the impression even, that «they don t eat like in Spain anywhere.» Not only do they eat but they continue cooking, learning how to cook, innovating and even trying to harmonize the rational and universal dietetic ideal with their different concrete situations: money, at LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 189

192 work, likes, time Because, as in any aspect of our lives, our actions are not simply the result of putting into practice information or knowledge, rather, this information or knowledge is incorporated through other inherited knowledge and previous actions of all types and from different areas which interact and acquire sense through this process. The precepts of nutritional discourse are not simply learned, but are integrated within a totality of knowledges or previous practices which are inscribed in ordinary situations and which give them sense Secondary orality or the electronic recuperation of talking Certainly the culinary culture has not formed a part of what has been considered «learned» and respectable knowledge and, therefore, has not merited its inclusion into the school curriculum. Before the dilemma of, on the one hand, the weakening of its informal transmission by maternal channels and, on the other, the difficulty of transferring culinary knowledge by rational and abstract channels, this knowledge has found other channels, also informal, through which it continues its transmission, but now not only to new generations but to the social whole. Other means for learning enter into play: friends, books, the media, the fish shop or the butcher. In a study by the Institute of European Food Studies about sources of information used by the population to achieve a healthy diet, it seems that Europeans, independent of their country of origin, use the same sources: television, radio, magazines and health professionals. The principal source varies however according to the country. In Belgium, France, Greece and Portugal, for example, they more often cite health professionals. (6) This is not the case in the rest of the countries, particularly Spain, where television plays a principal role and is revealed as the fundamental means of oral transmission of culinary knowledge today. (7) But it is no longer that primary orality, that orality where books don t fit, where the contacts are face to face, where both the broadcaster as well as the means become one the mother, the fruit seller, the neighbour, where the message (6) Institute of European Food Studies, Report No. 2. Influences on food choice and sources of information on healthy eating at [in Spanish]. (7) As was confirmed in the General Study of the Media, in 2006 television overwhelmingly occupied first place in audience ranking (88.6%), distantly followed by radio (56.1 percent) and magazines (47.7 percent). An excellent analysis about the different information channels and their repercussion on culinary learning can be found in M. Gracia, FOOD, CONSUMPTION AND HEALTH

193 tries to touch feeling more than reason and diligently attaches to the concrete reality of the moment. In this modern electronic culture, orality and writing are reunited (8) if they have ever been separated leading to new forms of transmission of culinary knowledge, which in a certain sense maintain the fundamental aspects of its traditional characteristics. Perhaps it is here where the success of these television programmes dedicated to cooking comes from, if we judge them by their expansion and audience level. (9) If in other areas, the passage from orality to writing and from this to audiovisual media has followed a slow and explicit sequence, in the area of the communication of culinary knowledge the passage has almost been from the first to the last, with barely an impact from written transmission. (10) The audiovisual media, and especially radio and television, recreate in good measure many of the typical characteristics of this first orality which culinary practices have always possessed. On cooking shows on television, effectively words are presented indissolubly from the images broadcast and the manipulations of the different materials and utensils. Televised culinary communication is also communal, as although it is directed at an anonymous and diverse public, it is received in the privacy of the home and afterwards commented on in small circles of family, work or neighbours. It is also a communication that invites participation, as it combines a certain sensation of naturalness, spontaneity and closeness with conspirational signals to the audience and simulated dialogues. Nevertheless, the secondary orality that is common to the transmission of culinary knowledge through audiovisual media offers some important differences with respect to that orality through which daughters learned from their mothers and grandmothers. These differences suggest, in general, a renewed association of «maternal cooking» with the figure of the bricoleur, (8) A meeting that often follows an inverse direction. If in the past things were passed from the oral to the written, now we are passing from the written to the oral (as can be verified with some of the programmes on food that we analyze next). (9) In the second week of December, 2006, for example, we counted 102 cooking progammes broadcast on 23 different channels. Of these, 10 programmes were broadcast on the five national channels with open broadcasting, 16 on autonomous or local channels and the rest on private channels, among which stand out the Canal Cocina [Cooking Channel], completely dedicated to cooking and whose audience is situated in a middle position in the ranking, above thematic channels dedicated to film, documentaries or sports. (Directory of Cooking Programmes on TV chefuri.net/chefuri_tv/, y Estudio General de Medios). (10) Despite the boom in sales of cookbooks and books about cooking/cuisines in the general and specialized press (between the years 2000 and 2005 these types of publications grew nearly 38% according to data from the INE). LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 191

194 in comparison with an «audiovisual cooking» that shares many of the typical features that come from the «engineer,» according to the opposition that Lévi- Strauss formulated. Thus, for example, where the first imaginatively combines ingredients previously available and often already prepared (those carrots that are going to go bad, that stock left over from yesterday), the second presents before the camera a selection of materials acquired and prepared expressly for the occasion, already weighed and counted to their exact measure for the previously formulated purpose («chick peas with octopus in a Jerez sauce»), which will be methodically manipulated in a pre-established order (according to the show s script) and of which nothing will be missing or unused. This asepsis in the provision of ingredients; the learning of bi-dimensional cooking that they show on the screen excludes the whole range of dimensions that primary orality incorporates: the tactile sensations of the textures and temperatures of the ingredients, the tastes, the smells, the interruptions and the unexpected The audiovisual secondary orality recovers the spoken word, through which cooking has always been taught, but at the price of sacrificing the remaining secondary qualities (smell, touch, taste ) in the interests of a sense of vision whose primacy over the other senses is a characteristic feature of modern society. (11) «Maternal cooking» is indissoluble from its circumstance time, place, end which gives it sense: the meal is prepared just before eating, next to the place where it will be eaten and for those who will come to eat it. «Audiovisual cooking» is, on the contrary, completely abstracted from any pragmatic context that isn t related to the exhibition of the activity itself: the meal is prepared and broadcast on the programme in a time and a space without any relationship to its use. Nor is the meal prepared or taught how to be prepared before eating, nor is the kitchen a kitchen in a house, nor, of course, is the meal prepared so that someone can eat it. Rather, it is a merely self referential activity: cooking to be seen cooking. The same as in the transmission of knowledge in schools, it is not a response to some previously experienced needs and appropriated for the occasion, but instead a programme created in a generic form in an office; the spectator, like the student, doesn t «learn doing» but rather trusts that one day he/she will have the opportunity to put into practice the abstract knowledge learned. (11) For Simmel (1977) the passage to modernity can be seen in the growing prominence of the eye over the ear, of the gaze of the urban spectator over the sound of conversations and greetings in traditional societies. 192 FOOD, CONSUMPTION AND HEALTH

195 Eating, and of course all the activities connected with it (thinking of food, shopping, cooking, conserving what is cooked), is increasingly less a question of learning and more a question of teaching, less a knowing-doing and more a type of engineering knowledge. Two examples should make this clear. One, condensed in the headline of a national newspaper: «Wanted, an Arguiñano of the diet to teach how to eat.» (12) The second, the following conversation that took place in one of our discussion groups: (Group 2 Senior citizens) C.: Me, since I watch television in the morning on channel one, what do you call that show, that one... twith all the doctors to know how to eat, the vitamins? The fibre, The, that s very important B.: And you learn a lot, yeah. C.: I was watching it a lot, but in the end, I was all morning at home watching the TV and that can t be. D.: And you don t do anything else. C.: How do you do your work, But it s very important, there are things that you don t know, and the doctor explains them, how to eat, what has more fibre, what you have to eat or shouldn t eat, what balances. It tells you what you have so that you know what you have to eat or not. Various: It s very good. In food converted into a matter of teaching, and audiovisual teaching, the presence of the mother, and even the TV chef, can be perfectly substituted by «all the doctors to know how to eat,» at the same time that those invisible entities, the vitamins and fibres, can occupy the place paradoxically, in a media dominated by the image of the cabbage and the lentils. Similarly, it is obvious that the distancing between knowing and doing, a distancing to which María opposes that «learning to do, doing» and which could even turn into an incompatibility between both practices, between learning and doing: if you are «all morning watching the TV» to learn how to cook «you don t do anything else,» then «how do you do your work?», in particular, how do you do that work of preparing the meal? It is worth pointing out a final difference between both types of orality, primary and secondary, in the transmission of culinary knowledge: the role of the sex (12) Newspaper Expansión, LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 193

196 of the agents in different cases. (13) The feminine figure of the mother has been replaced except in unusual and significant exceptions by the masculine chef, (14) and in the same movement the physical presence of the daughter, standing together with the mother in the kitchen has been substituted for that of the anonymous spectator seated in the living room. The masculine authority displaces the feminine at the same time as the living room prevails over the kitchen and passive and decontextualized reception occupies the place of upright and active learning and situated in its time and place. In a cooking programme chosen at random, (15) a good part of the specificities of secondary orality considered up to now are synthesized. On the one hand, it simulates characteristic aspects of primary orality, like naturalness, closeness or direct questioning or discussion: «A lot of you will comment now, of course, the beans!» «Kids, you have to eat some of everything!,» etc. On the other hand, it obeys a strict script and production process previously written and elaborated that remains hidden which doesn t stop the show from ending with a totally natural; «Thanks to the scriptwriters and producers!» (16) On the one hand, continual references to the oral and feminine origins of the culinary art are made («as the mothers and grandmothers said»), to the origin, seasonal nature and singularity of the ingredients («beans from Tolosa, harvested in October,» «berries from Beasaín or one of the towns nearby») and to other traditional values that are legitimized when the authority of the television declares them a source of authority. On the other hand, these values are continually in contradiction with modern values that define an abstract diet, a decontextualized nutrition, an ideal diner and politically correct dietary behaviour: «the proteins from the beans,» «once a week, legumes,» «take care of your health!», «Thanks to all those who are fighting against obesity!» In audiovisual culinary education the chef and the doctor play similar and often interchangeable roles. The convergence of both figure can be appreciated in their common pedagogical tone and in the symbolic elements such as the (13) In the last congress of Madrid Fusión, «an important international gastronomic Summit» (El País, ), of the 37 chefs invited, only three were women. (14) This is how the famous chef Santi Santamaría put it: «The references from the home have disappeared, the oral, the matriarchal. They cook less at home. We [the professional cooks] are the representatives of a lost world, that we have to find again» (El País, ). (15) Arguiñano en tu cocina, Tele 5, (16) Writing is also present, although in a secondary form, in the tables that summarize the relationship between the ingredients and their quantities, or in the promotion of the chef/host of his own written work: «Buy my latest book!.» 194 FOOD, CONSUMPTION AND HEALTH

197 white coat through which both dress their authority or the shared practice of the broadcasting of recipes, recipes in which they often interchange their respective roles: if the recipe of the doctor teaches how to eat, the recipe of the chef teaches about healthy nutritional habits Moral cooking Up to now we have seen some of the contrasts that the passage from «oral cooking» to «letter soup» and, from this to the «audiovisual stew» implies, but despite all this, this traditional orality that we have been alluding to seems to be quite strong. Its strength can be clearly observed in the situations of face to face interaction that are established when shopping for certain products like meat, fish or fruit. The habitual interaction between buyer and seller generates a relationship of trust that often moves the buyer to solicit information and knowledge from the seller, about both the state of the food as well as advice for its preparation, preservation, etc. In a context of food abundance, where choice forms part of our daily life, and in a context of ignorance and marked risk as much for the real distance that separates us from all the processes which go with the products we consume as for the periodic development of the so-called «food crises,» the need to trust forms part of the act of eating itself. We need to eat and, therefore, we need to trust. The maintenance of habits and routines as well as the knowledge acquired by our own experience helps us to consolidate a certain sense of security and confidence, but in a culture such as ours, in great measure governed by permanent innovation, these mechanisms fail and there is no time or criteria to create others. Giddens (1999) analyzes how the forms of life introduced by modernity have swept away all the traditional forms of social order provoking a «lifting off» (an «un-anchoring») of social relations from their local contexts and restructuring them after in undefined space-time intervals, something possible thanks to the «reliability» of the information contributed by expert systems. Reliability is not conferred so much on individuals as on abstract capacities and supposes, to a great extent, an act of faith as it is impossible to have access to and/or comprehension of all those knowledges that emerge from abstract rationality, even though we often dominate the rudiments of the principles upon which it is based (ibíd.: 136): LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 195

198 Q.: Do you read the labels? A.: Not usually, not being things that have preservatives. Q.: And you trust the information on the labels? A.: Yes, well I don t have much choice; I don t have any other way of analyzing if what s there is good or not. (Amelia, 55 years old, retired early from a bank) Amelia trusts, «I don t have much choice.» As she can t talk about the foods she buys with the producer or with the distributor, she has to rely (17) on the written information on the labels or packaging. Impossible to know everything some foods contains, she relies on expert systems, a reliability that is based on the proven experience that such systems generally work as they should work (ibíd.: 38). But these systems too often fail (food crises), are in contradiction (scientific debates) or even deceive (commercial interests). In these circumstances the reliability of abstract systems cracks and we find refuge in persons, in face to face relations, as we look for advice but also, someone to take on responsibility: Q.: For example, when buying meat, what do you base it on? One type or another or one piece or another. A.: Hmm As I don t have much control, and I don t know now little by little I m getting to know my butcher, no?; before you knew your butcher and he knew you. But what I do, apart from having looked for a place that everyone recommended to me and that seemed to give you good service, I trust a lot in the butcher. I still don t trust all of my skills [LAUGHS], my qualities, in other words, my my visual skills, no?: to manage to identify if the piece is fresh or not, anyway, I still don t feel capable. So, I confide a lot on the sense of the butcher. The regular butcher, the one you always go to. I think he has no reason to cheat me; and then I tell him, «Give me a filet for breading,» and he gives me one, and if I don t like it, than later I ll say to him; «hey, not much of a filet you gave me!,» no? But I end up taking what the butcher tells me. (Rosana, 37 years old, social worker) (17) We reserve the terms «trust» and «confidence» for those situations in which faith has a collective dimension (confidence), as much for being shared «with» others as for being deposited «in» others. «Rely» and «reliability» refer more to the security that individual and rational scrutiny provides of the characteristics of that which we decide or not to consider reliable. Thus, we «trust» in the butcher, while we «rely» on the labels. An analysis of the distinction between both concepts can be seen in Gidden, FOOD, CONSUMPTION AND HEALTH

199 Rosana trusts in concrete persons in concrete situations: the butcher, «the one you always go to.» From the first she didn t expect to only obtain information and advice; she also expected the concrete responsibility («Hey, not much of a filet you gave me!») that only face to face contact guarantees. (18) We don t want to end without first making a small reflection. Although the family seems to no longer be the privileged place for the transmission of culinary techniques and knowledge it is no longer where «how to make» the food is taught it continues to have a very important role in moral teaching, in the what and how we «should» eat: (Group 3 Senior citizens) R.: ( ) I ve never tried lentils. However, I, I do think they are important in the diet of children, they always eat them in school, and now I still make lentils, but I don t try them, I don t try them, it s something I know how to do, because I ve seen the recipe and I cook them, but they try them, more salt, less salt, but I m incapable of putting a spoon of them in my mouth. That s the way it is and it s an obsession that, that my mother gave to me, then I managed to not transmit any obsession I have about food, they eat everything, everything is good. Various: Of course, of course. N.: That is good, that they eat everything. A.: That happens to me with sardines, the smell now, and I buy them, yesterday for example I bought sardines, and I wash them, and and I have that smell, and I start to get dizzy and it makes me nauseous, and I put them on the table, and there, and I have to eat them, It s like I m on a roller coaster, I can t take it. In R. the traditional chain of transference of culinary practices from the mother has been broken, and she doesn t remember how to make lentils («I ve seen the recipe and I cook them»), only the aversion to them. Nor does she teach her children how to prepare them, but the lentils continue (18) Callejo (2005) asks how consumers can reconcile what he calls, copying Fischler, the «paradox of trust,» in other words, the «necessity for trust in a field [that of food] in which you have to distrust» (2005: 185). Beginning from a qualitative analysis, the persons interviewed, before the awareness of their ignorance, of their «not knowing,» demonstrate a need for trust that they find in personal mediators that they consider experts but, above all, who they consider «trustworthy» persons (ibíd: 186). The same author notices three spaces of trust connected to the form of control over food processes and it is in these spaces where abstract trust and an emotional and strongly personalized trust are reconciled (ibíd.: 194 and ss.). LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 197

200 being a vehicle for the transmission of moral values. If her mother s lentils transmitted to R. an aversion and rejection, those that she prepares for her children have to transmit the opposite: «they eat everything, everything is good,» says R. and N. agrees. As are the lentils for R., so are the sardines for A., nothing but a moralizing pretext. Neither of them strictly cooks a meal, but rather a moral stew. This is how another group reiterates it: (Group 2 Senior citizens) And you eat in front of them, even though you don t like it, so that they say: look, mama eats it, I also eat it. You can t condition yourself, I think that, anyway, the Spanish, we are also animals of habit, if we are used to certain things from when we are small, others can change it, but there are certain ideas that you have very clearly. Of course, because you saw it in your family, they educated you «I don t like it,» well okay, but why don t you like it? Well, because in my house we didn t use that type of oil, or eat lentils, or how the meat is cooked and with all those things it s difficult for me, because you think that what you did during your whole life is what is done well. «We are animals of habit,» «you saw it in your family,» «what you did during your whole life is what is done well» these are expressions that are intimately tied to emotional needs. Not only is the decisive importance of food socialization in the behaviours themselves assumed («look, mama eats it»), but it is also expressed in the decided will to continue this socializing function, «even though you don t like it,» through a process of education and learning. Contrary to an «eating ethic,» for which the good and bad to eat comes from rational criteria and decisions, this gives precedence to an «eating morality» (from mos, moris: «custom») where «what is done well» is dictated by what you have done «during your whole life,» for what you used or «didn t use,» for the habits and customs. The family and tradition continue to be the key institutions in the process of dietary socialization, up to the point that anomic tendencies that are probable in the absence of family bring about rigorous regulated constraints when who experiences them is someone who has responsibility for a family: 198 FOOD, CONSUMPTION AND HEALTH

201 (Group 3 young people) And I can allow myself to not prepare a meal, a dinner, because the only one that s going to complain is me, but you [those of you that have family] you can t change it. I think that the children are a priority, and they can determine a lot; although you don t like to cook you end up cooking, although you don t like something, it determines a lot having a family, because you see yourself as much more responsible, and you try to have a much more Mediterranean diet. Balanced. A menu less precooked, and that s everything, everything Studies such as Bourcier E. Bourcier et al. (2003) have shown how the family, and more concretely the mother, continues being today the principal influence that shapes and defines the likes and culinary habits of the persons under her care. (19) They are her guidelines which have a normative function, as it is from them that other dietary practices are judged, such as those that originate from doctors or dieticians, in terms of knowing or not knowing how to eat. And it is through them that her own practices are governed, as much the directly culinary as those directed to educate who she has under her care. (20) They are norms that, as these authors show and as our interviews also reveal, the persons responsible for diet in the home impose through very intuitive strategies, based on their own previous family experience and not always in accordance with the nutritional canons established by external agents/experts Conclusions In only a couple of generations «modern life» has eroded the ancestral forms and criteria through which culinary knowledge has been transmitted (19) Gracia (1996) also makes, for the Catalan case, this assessment: the mother continues being the principal channel for the diffusion of dietary knowledge and, for this, the author prefers to speak of a generalized disinterest for learning a task that is not socially valued (like all the other domestic tasks) rather than an explicit rupture (ibíd: 138). (20) Díaz Méndez (2005: 88 and ss.) analyzes, beginning from an empirical study within Spain, how the normative substrate which underlies the forms of eating and preparing foods has been profoundly altered as a consequence of diverse factors (work, systems of production, new family situations ). This doesn t mean that the new food world finds itself before an absence of norms, more likely it is the opposite, there appears a heterogeneous mix of norms, fairly stable and recognizable, but that don t function as a shield but rather as a support for action, that is actively and reflexively revised by the diner, as much for feeding him/herself as others. LEARNING TO COOK: CULINARY DO-IT-YOURSELF, LETTER SOUP, AND THE AUDIOVISUAL STEW 199

202 and reproduced. These forms and criteria were basically oral and informal and were in the hands of women. Nevertheless, while this process has led to other areas of knowledge formulated in terms of an abstract rationality, held by experts and transmitted through formal teaching based on writing, the learning of cooking seems to resist taking this step. Trapped between habits now delegitimized (and often impossible to put into practice) and rational dietary criteria difficult to understand and frequently contradictory (no less impossible to carry out), the modern diner is submerged in a sort of «educated ignorance» that leads to uncertainty and anxiety. The current media contributes a heterogeneous synthesis of both forms of culinary teaching, incorporating certain features of oral transmission in the «secondary orality» that characterizes them while adding others that are common to modern and rational nutrition. Perhaps the proliferation of magazines, books and television programmes about gastronomy owe their success to this. But, perhaps also for this, the cacophony of information that they broadcast only contributes to increasing even more the uncertainty and unease on matters related to food. Despite the desire of experts (dieticians, public health administration, doctors, scientists) to make culinary knowledge a deductive knowledge that applies general and abstract principles to concrete cases, culinary knowledge reforms, now under new forms, with a «knowing-doing» in which conversations and observation, recipes and essays, chemistry and flavours, imitation and improvisation and reason and emotion converge. 200 FOOD, CONSUMPTION AND HEALTH

203 VIII. Childhood obesity: new eating habits and new health risks Javier Aranceta Bartrina (Spanish Society of Community Nutrition) 8.1. Introduction Obesity can be defined as the accumulation of excess adipose tissue. In children fat deposits are found primarily at the subcutaneous level, while in young people and adolescents, as in adults, there are also intra-abdominal fat deposits, a pattern associated with a greater risk of metabolic disorders. The phenomenon manifests in an alteration in body composition with an increase in body fat. This increase in the deposits of adipose tissue in the majority of cases is accompanied by an increase in body weight and supposes a considerable increase in risk for secondary health problems that affect the quality of life and life expectancy. Obesity is a chronic disease of multifactorial origin in the development of which genetic as well as environmental factors are implicated. The available scientific evidence reflects that in 95% of the cases of obesity there is a clear environmental component related to a sedentary lifestyle and eating habits that favour a positive energy balance and, as a consequence the gradual deposit of fat. (1) The International Obesity Taskforce (IOTF) and the World Health Organization (WHO) have described obesity as the epidemic of the 21st century because of the dimensions it has acquired, its impact on morbidity and mortality and quality of life and on added health costs. (2) The problem is not limited to developed countries. Also in countries in economic transition and even in specific urban areas of countries in development the progressive increase in (1) Salas Salvadó et al., (2) OMS, CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 201

204 obesity has been described as an emerging problem in recent years; one which coexists with malnutrition in many cases. (3) The growing number of overweight and obese children is particularly worrying. (4) A genetic susceptibility toward the accumulation of fat in the adipose tissue was perhaps an element tied to survival in times of scarcity in the past, but currently its biological expression favours the establishment of excess body weight in an increasing number of individuals. Food transit and the decrease in energy expended through physical activity seem to be the causal factors most implicated. The decrease in vital caloric expenditure is due in good measure to advances in modern society; less effort in the productive process, mechanization of domestic chores and mobility; less expenditure for thermoregulation and perhaps also, less effect from the mechanisms of specific dynamic action from prepared foods. Demographic and cultural changes have affected the habits and lifestyles of children and their families. «Overeating is not a personality defect, It more likely constitutes a hereditary defect in the design of the organism, a weakness that natural selection could not avoid,» (5) says Harris. The WHO has announced that if this tendency continues, excess bodyweight will affect the whole European population by the year 2040, which will without a doubt have grave consequences on all health indicators and the social fabric of the developed world. (6) 8.2. Criteria for the categorization of weight of the child population With the aim of estimating the proportion of body fat different indexes have been employed that relate weight and height. The most used is the Body Mass Index (BMI) or Quetelet Index, calculated as the relationship of a person s weight expressed in kilograms divided by the square of their height (kg/m 2 ). In the adult population, the WHO has accepted this criteria and the IOTF recommend that the value of the BMI be used to define obesity in epidemiological studies that estimate its prevalence, with the aim that results (3) Martorell, (4) IOTF, (5) Harris, (6) WHO, FOOD, CONSUMPTION AND HEALTH

205 obtained from different studies and countries be comparable. (7) Some how an international consensus has been reached, of which scientific societies whose principal interest is centred on this theme also form a part, such as the Spanish Society for the Study of Obesity (SEEDO) and its European (EASO) and International federations (IASO). The WHO and also the SEEDO, consider normal values for the BMI in adults to be between 18.5 and 24.9 kg/m 2. They categorize as obese persons with a BMI greater or equal to 30. The SEEDO (8) considers as overweight values of BMI superior to 25 and also contemplates a risk interval for values between 27 and 29.9 kg/m 2 when accompanied by other risk factors (consumption of tobacco, hypertension, diabetes). However, it is more complicated to evaluate the BMI or the relative weight in children and adolescents because they are in a process of growth and development and both their weight and their height is increasing, which makes it necessary to also take into account age when interpreting the BMI. What s more, due to variations in body adiposity in function of sex, puberty, changes in size and speed of growth, the BMI must be interpreted in the context of specific age and sex. (9) Although diverse methods have been proposed to assess obesity in childhood and adolescence, the estimation of obesity in these age groups from the BMI is accepted both in clinical practice and in epidemiology. The value of the BMI obtained in the child must be compared with a reference distribution, taking into account exact age and sex. (10) There does exist, nevertheless, certain controversy about what should be the cutting off points to employ in defining overweight and obesity in childhood and adolescence and what reference distribution is most adequate in each case. Currently there exists a reasonable consensus, above all in the United States, to define obesity beginning from BMI values superior to the value specific for the age and sex of the 95th percentile in the reference tables, and overweight from (7) IOTF, (8) SEEDO, (9) Freedman et al., (10) Also very useful are skinfolds, especially the tríceps skinfold, and other methods can be useful in specific circumstances, such as electrical bioimpedance, dual x-ray absorptiometry and nuclear magnetic resonance (Rolland-Cachera, 2001). CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 203

206 the 85th percentile. In Europe and Asia they continue using the 97th percentile to define obesity and the 90th percentile for overweight. However, it is obvious that within the same population a percentile X always defines a percentage of population (1-X) in itself. Thus the 95th percentile defines a 5 percent, and the 85th percentile a 15 percent. For this reason, this definition of obesity is very useful in comparing distinct population subgroups in relation to the average (for example, the percentage of relative obesity in distinct regions of Spain around the average) but doesn t serve to quantify the magnitude of obesity in a country or to compare the prevalence of obesity between countries, (11) unless they use BMI tables that serve as a reference. (12) In 1997 the WHO defined obesity starting at 18 years of age with a BMI 30kg/m 2 and overweight for values of BMI starting from 25. Cole et al. (2000) starting from this consensus, proposed redefining the cutoff point that allows an estimate of the rate of overweight and obesity. This work group used as a reference the values of weight and height obtained in a wide sample of boys and girls from countries from six continents. They have developed reference tables from the BMI for international comparisons and they propose defining obesity not from a determined percentile, but rather from the value of the percentile that corresponds to the BMI 30 kg/m 2 at 18 years old (obesity) or the BMI 25 kg/m 2 (overweight) at the same age. In any case, to define obesity in children is not a simple question and the debate continues. Probably what would be most adequate for defining childhood obesity would be combining a BMI value above the 95th percentile in reference tables suitable to the context in which they are used together with another parameter that indicates an increase in the amount of fat accumulated, such as, for example, the thickness of a skinfold. (13) The evaluation of childhood obesity is important because this is the best moment to try to avoid the progression of the illness and the morbidity associated with it. (11) Serra-Majem et al., (12) The problem is raised of what reference tables to choose, as on an international level there are at least four reference tables that can be used for this purpose. The most accepted and recommended tables by the WHO up to now, are those elaborated by Must et al, from the study NHANES I. The tables from the Center for Disease Control of the United States (CDC) have also been used frequently. In their last version, the CDC proposed using z-scores in relation to the reference distribution. (13) The tríceps skinfold is the skinfold used with most frequency for this end. 204 FOOD, CONSUMPTION AND HEALTH

207 8.3. Impact of childhood obesity on child and adult health In childhood overweight and obesity are not associated with elevated rates of mortality in the short term, but they are with greater risk in adulthood. Nevertheless, childhood obesity has repercussions for the quality of life of the child, favours low self-esteem and supposes a greater risk of discrimination and stigmatization. (14) Longitudinal studies where children and adolescents have been followed long term show that the probability that obese children will be obese adults is double that of non-obese children, especially in those that have an important excess of weight and in those that continue being obese during their adolescence. (15) Obesity in childhood, particularly in the second decade of life, constitutes a potent predictor of obesity in adulthood. Obesity has important social, economic and health consequences, and for this, childhood obesity is today thought of as an important health problem both in developed countries and developing countries. In general, childhood obesity in developed countries tends to be more frequent among families at the lowest socioeconomic levels, with worse nutritional and educational level, and that still consider childhood obesity to be an indicator of health and social position. In developing countries, it is persons in the more comfortable socioeconomic levels that tend to have this erroneous conception of childhood obesity. (16) The adverse effects and the risks from obesity on health in the early stages of life include in the short term both physical problems (table 8.1) as well as psychosocial problems (table 8.2). Longitudinal studies suggest that childhood obesity after 3 years of age is associated in the long term with a greater risk of obesity in adulthood and with an increase in morbidity and mortality; the persistence of associated metabolic disorders, an increase in cardiovascular risk and of some types of cancer. (17) Childhood obesity is associated with an increase in cardiovascular risk; high level of insulin (hyperinsulinemia) (18) and glucose intolerance; alterations in the lipid profile of the blood and even arterial hypertension. The observed (14) Dietz, (15) Freedman et al., (16) WHO, (17) Reilly et al., (18) Freedman et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 205

208 TABLE 8.1 Impact of childhood obesity on physical health PATHOLOGY IMPACT OF OBESITY: CURRENT SITUATION Glucose intolerance Hyperinsulinemia: OR: 12.1 Type 2 diabetes Metabolic syndrome Arterial hypertension Dyslipemia Steatosis hepatitis Cholelithiasis Sleep apnea Asthma Menstrual alterations Orthopedic disorders In US, 10 times the prevalence of diabetes in children ( ) Present in 30% of obese children (US) Almost 60% of AHT children are obese SAT: OR 4.5; DAT: OR 2.4 LDL: OR 3.0; HDL: OR 3.4; TAG: OR % of obese children have 1 cardiovascular risk factor; 25% 2 RF In >10% of obese children Approx. 50% of the cases in adolescents are associated with obesity. 75% ( ) 175% ( ) 40% of those admitted to hospital are associated with obesity 30% of the women with polycystic ovary syndrome are obese Flat feet, valgus deformity, Blount s disease, (2/3 of the cases are obese) Notes: OR: Odds Ratio; AHT: Arterial hypertension; SAT: systolic arterial tension; DAT: Diastolic arterial tension; LDL: LDL cholesterol; HDL: HDL cholesterol; TAG: triglycerides; RF: risk factors. Sources: Dietz W. H. Pediatrics, 1998; Reilly J. J. et al., Arch Dis Child, 2003; NAS, Preventing childhood obesity, 2005; Wang G. and Dietz W. H. Pediatrics, TABLE 8.2 Impact of childhood obesity on emotional and social health Emotional Health Low self-esteem Negative body image Depression Social health Stigmatization Negative stereotypes Jokes and bullying Marginalization and isolation Sources: Dietz W. H. Pediatrics, 1998; Reilly J. J. et al. Arch Dis Child, 2003; NAS, Preventing childhood obesity, FOOD, CONSUMPTION AND HEALTH

209 metabolic changes in obese children and adolescents is also known as metabolic syndrome and can be related to endocrine disorders that are observed in obesity, such as growth hormone deficiency or increase in the levels of leptin circulating in the blood. (19) The term «metabolic syndrome» refers to a conglomeration of alterations that include elevated levels of arterial pressure, glycemia and cholesterolemia and in addition, the accumulation of fat in abdominal adipose tissue, which all together means a very important increase in cardiovascular risk and risk of type 2 diabetes. A study done in the United States estimated that approximately one of every 8 schoolchildren has three or more of the risk factors of those that make up metabolic syndrome. A similar situation has also been observed in the United Kingdom. Obesity not only increases the probability of the appearance of metabolic syndrome in adults, but also is associated with the early development of the syndrome in children. Type 2 diabetes is a very common illness in adults which currently is being detected with more and more frequency in children and is an especially alarming consequence of the obesity epidemic. The beginning of diabetes in young patients increases their risk of developing complications from the advanced illness at an earlier adult age, such as cardiovascular illness, kidney failure, visual alterations or even amputation of extremities as a consequence of circulatory complications. A review of the American Diabetes Association suggests that in the United States up to 45 percent of the cases of diabetes at pediatric age correspond to type 2 diabetes not insulin dependent diabetes. Obesity is the most important risk factor associated with type 2 diabetes in children. In another study an excess of body weight was found in 90 percent of adolescents with type 2 diabetes and in nearly 25 percent of children with type 1 diabetes. In fact, the term «diabesity» has been coined to reflect the fact that so many patients with diabetes are also obese. (20) Overweight and obesity are associated with great frequency with the appearance of cardiovascular risk factors. Several studies have demonstrated (19) Wang and Dietz, (20) Cited by BMA, CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 207

210 the relationship between excess body weight in childhood and the consequent increase in cardiovascular risk. (21) Orthopedic problems have also been described that are accompanied by alterations in physical mobility and inactivity; as have disorders in immune response with increases in the susceptibility to infections, skin alterations that reduce the scarring capacity from injuries and infections and nocturnal respiratory problems and even sleep apnea. (22) The psychosocial consequences from the distorsion of the physical image for the obese child can be very important and even greater than the physical consequences. Low self-esteem, social isolation, discrimination and abnormal patterns of behaviour are some of the frequent consequences. (23) There still doesn t exist definitive and conclusive epidemiological evidence regarding the long term effects and persistency of childhood obesity in adult life. Taking into account the possible limitations in existing data, the evidence does suggest that it is more probable that obese children will be obese adults in comparison with children that are of a normal weight, although paradoxically, currently the majority of obese adults were not obese children. Childhood obesity in the second decade of life is an increasingly potent predictive factor for adult obesity. (24) If one or both of the parents are obese the probability that childhood obesity will persist in adulthood is even greater Obesity in children, adolescents and young adults in the Spanish population The enkid Study is a transversal study based on a random sample of the Spanish population with ages between 2 and 24, selected on the basis of (21) In the study by Bogalusa, in the United States, overweight in adolescence is associated with an 8.5 times greater risk for hypertension, 2.4 times greater for the prevalence of elevated values for serum cholesterol; 3 times greater risk of elevated levels of LDL cholesterol (popularly known as «bad cholesterol») and 8 times greater risk of lower levels of HDL cholesterol (popularly known as «good cholesterol») in young adults between the ages of 27 and 31. In addition, a longitudinal study of young people in Finland suggests that cardiovascular risks are frequent in young obese adults that were obese when they were children (hypertension, hypertriglyceridemia, low levels of HDL cholesterol and hyperinsulinemia). (22) Wang and Dietz, (23) Reilly et al., (24) Dietz, FOOD, CONSUMPTION AND HEALTH

211 the official population census. (25) It is the widest study done in Spain up to now with measurements of individual weight and height of a random sample representative of the Spanish population. The protocol of the study examined personal data, analysis of ingestion by means of a 24 hour food log supplemented with a quantitative food frequency questionnaire. In 25 percent of the sample they also collected a second similar log. After, they were homogeneously distributed throughout the year and also during all the days of the week, with the aim of avoiding the influence of seasonal and weekly variations. Information was collected through personal interviews in the home of the surveyed in the presence of the mother or person responsible for feeding the family in the case of children less than 13 years of age. Information was also collected about knowledge and opinions on themes related to diet and nutrition. They used specific questionnaires to gather information about smoking habits, alcohol consumption and physical activity. Based on this data, the rate of obesity for this age group in Spain is estimated to be 13.9 percent and for overweight, 12.4 percent. The total of overweight and obesity is 26.3 percent. Obesity is higher among males (15.6 percent) than in females (12.0 percent), a statistically significant difference. In the male subgroup, the highest proportions are seen between the ages of 6 to 13 and among females between the ages of 6 and 9 (table 8.3). The rate of obesity is higher among boys whose parents have a low level of education, especially if the mother has a low educational level. The level of education of the mother only seems to have influence in the youngest children, up to 10 years of age. No statistically significant differences were observed in the figures for obesity based on the occupation of the mother outside of the home. The proportion of obesity is higher in girls and boys of lower socioeconomic levels. The rates of obesity and overweight are higher in the Autonomous community of the Canary Islands and in the South, among both girls and boys and in all the age groups. The lowest figures are observed in the Northeast and North. The size of the population of residence doesn t seem to reveal a distribution pattern defined by excess weight. (25) Serra-Majem et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 209

212 TABLE 8.3 Prevalence of obesity in the child, adolescent and young adult population in Spain by age and sex Estimates from the enkid Study, AGE GROUP SEX n OBESITY (*) (BMI 97th PERCENTILE) % (CI 95%) Total ( ) 2-5 years of age Males ( ) Females ( ) Total ( ) 6-9 years of age Males ( ) Females ( ) Total ( ) years of age Males ( ) Females ( ) Total ( ) years of age Males ( ) Females ( ) Total 1, ( ) years of age Males ( ) Females ( ) Total 3, ( ) Total Males 1, ( ) Females 1, ( ) Note: (*) The 97th percentile of BMI has been used as the cutoff point in the tables of Orbogozo (Hernández et al., 1988) specifically for age and sex. Source: enkid Study (Serra-Majem et al., 2006). Some antecedents from early childhood also show some significant association with the distribution of overweight and obesity in the child and young adult population in Spain. The rates of obesity were significantly higher in the collective that was born with a weight above 3,500 grams in comparison to those born with a weight 210 FOOD, CONSUMPTION AND HEALTH

213 below 2,500 grams, adjusted for age and sex. Males between 2 and 5 years of age that were breast fed for more than 3 months showed rates of obesity below that of children of the same age groups that had not been breast fed or had been but for a shorter period of time. Regarding lifestyles analyzed, it was observed that, beginning at 6 years of age, the percentage of obese children was higher among children and young people that got a greater proportion of their energy from the ingestion of fat (> 40 percent kcal) in relation to those that ingested lower percentages of fat. This fact is also observed in the female subgroup between 14 and 17 years of age. In males starting at 14 years of age a significant statistical difference could be seen in the consumption of sugary products, pastries, cold meats and sugary sodas between the obese and the not obese. The rate of obesity is higher in boys between 6 and 14 years old that consume cold meats more frequently. The rate of obesity was lower in boys and young people that consume more fruits and vegetables (4 or more servings a day). The boys and girls that have a complete breakfast have lower rates of obesity than those that don t have breakfast or have an incomplete breakfast. Considering as a whole the daily average time spent on sedentary activities (study, TV, computer, videogames), the rate of obesity was higher among boys and girls that spent more time on these types of activities in comparison with those that spent less time. The proportion who were obese was higher in girls that spent more than two hours to watching television than in those that spent less than an hour on this activity. The rate of obesity between boys and girls that usually don t do any sports was higher in comparison with those that usually do sports, especially among boys that do some sport activity three times a week. Analysis of the data suggests that the rate of obesity is currently greater in the school-age population, especially in the years proceeding puberty Evolution of obesity in children, adolescents and young adults Analysis of the tendency of the prevalence of overweight and obesity in Spain can only be done after accepting the methodological limitations CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 211

214 inherent to comparisons made across distinct periods. According to the three latest epidemiological studies on obesity done in Spain: PAIDOS 84 (1985), Ricardin 1992 (1995) and enkid ( ), the BMI of a child of 10 years of age has gone from 18.1 in 1984 to 18.5 in 1992 and 19.8 in , and at the age of 13 from 18.4 (1984) to 20.4 (1992) to 21.1 ( ). Comparing the evolution of the 95th percentile by age with the data contributed by Hernández et al. and the enkid Study an increase is observed even from the 14.6 percent in function of age group, being higher in boys of 6 to 10 years of age, and in girls of 18 years of age and less to those of 2 to 14 years of age, where it actually decreased. In table 8.4 the rate or prevalence of obesity in the child and adolescent population in different countries is gathered. Studies carried out in the United States estimate that the prevalence of obesity in some age groups of this collective have doubled since the 1970s. It is estimated that the rate of obesity has increased by 5 percent in the American adolescent population. In a study done in France, Rolland-Cachera (2001) estimated that the proportion of obese French children has increased 149 percent between 1980 and TABLE 8.4 Comparison of the prevalence of obesity among different developed countries COUNTRIES (%) United States 22.5 United Kingdom 17.0 Spain 13.9 France 12.7 Portugal 12.0 Italy 12.0 Hungary 11.0 Germany 9.0 Switzerland 8.7 Holland 8.0 Sweden 5.0 Finland 5.0 Source: The International Association for the Study of Obesity (2004). Obesity Reviews; 5 (suppl. 1), FOOD, CONSUMPTION AND HEALTH

215 Passing from 5.1 percent to 12.7 percent using as criteria the reference value for the BMI specific for each age group and sex. The PAIDOS 84 Study, (26) carried out by Spanish pediatricians in the middle of the 1980s based on a random sample between the ages of 6 and 13, estimated a rate of obesity of 6.4 percent. In this study obesity was defined as a value of the triceps skinfold above the average plus two standard deviations. In the enkid Study in the year 2000, the prevalence of obesity in the same age group was estimated to be 15.6 percent. This dramatic tendency is similar to that described in France, Switzerland and other countries (27) (graphic 8.1). In the Cuenca Study, Martínez Vizcaíno et al., estimated a relative risk of 2.9 (95 percent CI: 2,21-4,04) that children with overweight at the beginning of the study would also be so six years later. Moreno et al. also analyzed the prevalent tendencies of obesity and overweight in Aragon in schools between 1985 and 1995 and found significant increases, in particular among boys. A report prepared in May of 2004 by the IOTF referred to one in every ten children in the world being overweight; in total they calculated that around 155 million persons between the ages of 30 and 45 are obese. In Europe the rate of obesity in children and young people has increased considerably in the last two decades and currently it is the countries of southern Europe that have the highest figures, with rates for overweight between 20 percent and 35 percent versus 10 percent to 20 percent in Northern European countries. The estimated prevalence in Spain in the enkid Study is among one of the highest in Europe, although still lower than the figures estimated for the United Kingdom or the United States. (28) A compilation made by the IOTF in 2007 of the countries of the European Union shows the highest rates in preadolescent boys between the ages of 7 to 11 to be in Malta, Portugal and Spain. The highest rates among 14 to 17 year old boys are in Cyprus, Great Britain and Spain. Among girls, the highest rates correspond to Portugal, Greece and Italy among 7 to 11 year olds and to England, Ireland, Hungary and Italy among 14 to 17 year olds. (26) Bueno et al., (27) IOTF, (28) Lobstein et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 213

216 GRAPH 8.1 Evolution of the prevalence of obesity in the population between 6 and 13 years of age in Spain By percentage enkid PAIDOS Source: Data from the PAIDOS Study in of this age group and the estimates corresponding to this age interval in the enkid Study in Analysis of the causes The analysis of the causes of obesity is essential for designing effective plans for its prevention. It is important to consider the factors implicated at distinct levels, given that the origin of obesity transcends individual responsibility. Therefore, in addition to individual factors it is important to take into account the family and school environment and socioeconomic level. The results of the enkid Study have demonstrated that obesity in the child, adolescent and young adult Spanish population is acquiring dimensions that merit special attention, especially those factors that can be contributing to the growth of the problem and those elements that could aid in its prevention. a) Genetic factors A question that has raised a lot of interest is the extent to which genetic and environmental factors are determinants of obesity in children, adolescents and young adults. Studies on twins and adopted children show that genetic factors play a role that has been estimated in different studies to be between 214 FOOD, CONSUMPTION AND HEALTH

217 5 and 50 percent, although the genes implicated have still not been identified with exactitude. (29) The genes must act by modulating ingestion or energy expended and therefore increase the probability of being obese or being thin. Cases of genetic origin are rare and the majority of childhood obesity is due to factors related to lifestyles that reflect the combined effects of genetic factors, habits learned in the family and environmental influences from school and the social environment. Without a doubt a relationship exists between dietary habits and physical activities and both are influenced by aspects that transcend the individual. (30) There does exist an association between childhood obesity and the obesity of the parents, although it is not clear that it is an epigenetic phenomenon or simply an indicator of a family environment or lifestyle that favours a positive energy balance. Probably multiple genetic factors explain the variation in phenotype of the adiposity of populations. (31) b) Environmental factor Environmental changes along with changes in diet, physical activity and tendencies toward a more sedentary lifestyle, together with factors in the first stages of life, have all been related to the increased rhythm of the rates of obesity and overweight. An obesogenic environment is probably the primary cause of recent tendencies toward obesity and overweight and their unequal distribution and impact. (32) In what follows we will comment on some of these aspects. Nutritional factors in the first stages of life It is postulated that some periods of development are critical for the appearance of obesity. (33) Since the end of the 1990s research is being done on the possible impact of exposure to certain dietary factors at early stages of life and its repercussion on adulthood. The development of new models of epidemiological (29) Speakman, (30) BMA, (31) Speakman, (32) Swinburn and Egger, (33) «... the first critical period for the development of obesity is the prenatal; however it is not clear what is the relationship of disorders to birthweight and subsequent habits, if they are of genetic origin or of they result from intrauterine programming», states Dr. Angelo Piertrobelli. CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 215

218 research, principally in Great Britain, on the risk of chronic illnesses in the life cycle that take into account the hierarchy and chronology of exposures during life (34) has led to hypotheses like metabolic programming that postulates that situations of nutritional stress in intrauterine life and low birthweight have bearing on the development of fetal tissues and organs and provoke metabolic alterations that last all during life. In concrete, in some studies an association has been seen between these types of situations and arterial hypertension, type 2 diabetes and other factors of cardiovascular risk. (35) Sociodemographic aspects In the enkid Study differences in the rate of obesity in function of family socioeconomic level have been detected. The prevalence of obesity is higher in children from lower socioeconomic levels. Geographic differences have also been observed, with a tendency toward higher rates of obesity toward the south. Clearly, it is the factors related to lifestyle, especially dietary habits and physical activity that determine the principal differences in the prevalence of obesity. The family environment: family habits and customs Studies that have researched the link between the dietary and exercise habits of the parents and the risk of obesity in children (the majority of such studies carried out in the United States) have confirmed the existence of similar lifestyles between parents and children, especially in young children, the relationship weakening toward adolescence. Food preferences in children are to a great extent acquired and learned. (36) Both the preferences as well as eating habits of children are influenced to a great degree by those of the parents and domestic and family customs. Children become accustomed to flavours and the cooking that they consume habitually at home and that they see their parents and siblings eating. In fact, there exists a close relationship over the concern for one s image and following weight-loss diets between girls and (34) Darnton Hill et al., (35) Hardy et al., (36) Wardle et al., FOOD, CONSUMPTION AND HEALTH

219 their mothers. Regarding physical exercise, studies show that in children from 4 to 7 years old the probability that they will be active is double if they are children of active mothers; when the father is active the probability that the children will be active increases 3.5 times and if both parent are active the probability that the child will be active is multiplied by seven. (37) It is important to consider the role of the parents as models that the children imitate, and at the same time, how active parents facilitate, stimulate and support physical activity in their children. Other aspects to highlight in the family environment are the norms that are established in the family in regards to food, the way of educating the children, and type and variety of foods that are at their reach or that are offered at meals (38, 39) (38), (39) or between meals. Some authors have suggested that the incorporation of the mother into the labour market could have some influence on the rate of obesity in the child population, (40) perhaps through changes in family eating habits. In the enkid Study no significant differences in the prevalence of obesity in function of the mother s participation in the labour market has been observed. In a complex society such as ours, in which publicity and the media have a great deal of influence in shaping eating habits, possibly changes in family eating habits and in patterns of consumption in schoolchildren also extends to those families which have a mother that stays home. Eating habits Distribution of ingestion during the day The division of the daily ingestion of food in various servings during the day is currently a controversial theme for how often and what people are eating between the principal meals. In developed societies there seems to be a tendency to consume smaller servings of high density energy between meals, especially among young adults and adolescents. Several authors have also referred to a lower body weight in subjects that eat breakfast in comparison (37) Burke et al., (38) Birch, L. and Fisher, J., (39) Van der Horst, K., (40) Takahashi et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 217

220 with those that don t. (41) The results of the enkid study have demonstrated a minor prevalence of obesity in children and young people that regularly have a greater number of intakes during the day in comparison with those that only eat one or two principal meals, that is, those that eat breakfast, lunch, merienda (late afternoon snake), dinner and even a small mid-morning snack have lower rates of obesity. Even more, the rate of overweight is less when the breakfast consumed is a complete breakfast, that is, one which includes a serving of fruit, dairy and a food from the cereal group. The enkid study demonstrated that 8.2 percent of the child, adolescent and young adult population habitually goes to school or work without having had breakfast. (42) In fact, 4.1 percent don t eat anything all morning, that is, they maintain the fast from the previous night, a more frequent habit in lower socioeconomic classes and among young adults. (43) Characteristics of the diet Rolland-Cachera (2001) referred to percentages of protein ingestion higher in children that had an early adiposity rebound. However, this discovery has not been confirmed by other authors. There seems to be more agreement regarding the relationship between higher contributions of fat in the diet and a higher prevalence of obesity, a fact that was also confirmed in the enkid study and which also emerges from a recent systematic review of the literature. (44) Regarding dietary profile, it seems that obese children and young people more frequently consume bakery items, industrial pastries and sugary sodas; on the other hand, they also consume less fruit and vegetables. This profile of consumption observed in the enkid study is in agreement with findings referred to by other authors. The Chilean company Tagle defines «fast food» as what «you receive within three minutes of requesting it and you consume in 20 minutes or less.» Table 8.5 summarizes some of the dietary habits that have been associated with a higher risk of childhood obesity in some solid studies and over which sufficient evidence exists. (41) Serra-Majem et al., (42) Serra-Majem et al., (43) Aranceta et al., (44) Van der Horst et al., FOOD, CONSUMPTION AND HEALTH

221 TABLE 8.5 Environmental risk factors: other evidence Energetic density FACTOR Fast food consumption in recent years: 300% Association % fat - BMI: Association ingestion proteins early adiposity rebound Fruits and vegetables ( protective effect) Soft drinks: years of age-obesity + other dietary elements Consumption patterns: eating between meals no breakfast Size of portions Source: Produced by author. SOURCE St-Onge et al., Am J Clin Nutr, 2003 Maffeis et al., Int J. Obes, 1996; McGloin et al., Int J Obes, 2002; Guillaume et al., Eur J Clin Nutr, 1998; Tucker et al., J Am Diet Assoc, 1997 Rolland-Cachera et al., Int J Obes, 1995 Field et al., Int J Obes, 2003; Lin et al., Food Rev, 2002 Ludwig et al., Lancet, 2001 Jahns et al., J Pediatr, 2001 Young & Nestle, Am J Public Health, 2002 Elevated ingestion of fat From the enkid study it has been estimated that the ingestion of fat in children and young people in Spain represents on average 39.8 percent of daily energy intake; 13.4 percent from the consumption of saturated fat. (45) More than 60 percent have contributions of fat above 35 percent of their energetic intake and a very high percentage also have contributions of saturated fats that represent more than 10 percent of daily energy intake. The principal sources of dietary fat are added fats, meat, dairy, sweets and pastry products. Low consmption of fruits and vegetables 96.7 percent of the group usually consumes foods from the vegetable and produce group excluding potatoes either raw or cooked, with an overall consumption for this group of 1,4 servings/day, a figure inferior to the 2 servings recommended daily percent of this collective regularly consume foods from the fruit group, principally apples, oranges and mandarins, bananas, (45) Serra-Majem et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 219

222 pears, fruit juices, melons and watermelons. On average it is estimated that they consume 1.85 servings of fruit a day, a figure well below the 3 servings recommended daily. Only 14 percent of the boys and 15.7 percent of the girls consume 3 or more servings of fruit per day. The highest levels of consumption of vegetables, both in cooked form or in salads are seen in families of higher socioeconomic level. Jorge Barguinski clearly sets out the factors which limit weight reduction, (46) but also suggests which factors can be protective elements in facing weight gain: «A food profile based on the consumption of fruits, vegetables and produce, a second level formed by whole grain cereals, legumes and dried fruits and nuts in an overall diet with low amounts of fat (27 percent).» In recent decades a decline in the ingestion of fat in some countries has been described, but at the same time an increase has also been produced in caloric density in the food model because of a lower consumption of fruit, vegetables and legumes. (47) High consumption of pastries, sweets and snacks Boys and girls between the ages of 6 and 17 years of age have the highest level of consumption of pastries and biscuits; between the ages of 10 and 17 we see the highest consumption of candies and salty snacks. (48) The enkid study shows that the consumption of sodas increases significantly beginning at 10 years of age and reaches its highest levels beginning at 18 years of age. Table 8.6 summarizes the prevalence of eating habits of risk estimated in the enkid study for the child, adolescent and young adult population. Overall, the low consumption of fruit and vegetables is the aspect that has the greatest negative impact in calculating the diet quality index, along with the regular consumption of industrial baked goods, sweets and candy. In the 1980s the PAIDOS 84 study was carried out on the initiative of Spanish pediatricians which obtained important anthropometric data and nutritional (46) Braguinski comments on the factors that limit weight loss: «Weight level biologically programmed or set point (set point theory); decline in energy expended at rest and within 24 hours of initiating a weight-loss diet; hyperplasia typical of childhood and adolescent obesity; learned behaviour, harmful but persistent with secondary benefits and life in an obesogenic environment.» (47) Aranceta et al., (48) Aranceta et al., FOOD, CONSUMPTION AND HEALTH

223 TABLE 8.6 Estimation of the prevalence of unhealthy eating habits that place the child, adolescent and young adult population at risk in Spain RISK PRACTICE ESTIMATION OF PREVALENCE Omission of breakfast 8.2% Insufficient breakfast a 32.0% Ingestion of fats > 35% energy 61.0% Ingestion of SF > 10% energy 72.0% Inadequate contribution of folates b 59.0% Insufficient consumption of vegetables c 54.0% Insufficient consumption of fruit d 66.0% Insufficient consumption of dairy e 33.0% Prevalence of obesity f 13.7% Notes: SF: saturated fats; a Ingestion at breakfast < 200 kcal; b In the group of girls from years of age; c < 2 servings/day of vegetables; d <3 servings/day of fruit; e <3 servings/day of dairy; f BMI > 97th percentile of reference. Source: enkid Study, (Aranceta et al., 2003). information on the child population. (49) The comparison of the dietary habits observed in PAIDOS 84 and in the enkid study done 15 years later allows us to appreciate a notable increase in the consumption of sweets and sodas in this population group. The consumption of meat and dairy has also increased. While on the contrary, the child, adolescent and young adult population consumes eggs and fruit less frequently. (50) Diverse studies done on collectives of children and adolescents such as the Cardiac study have demonstrated that the frequent consumption of snacks and other foods between meals or eating outside of the home contribute to shaping diets with a greater contribution of total fat and saturated fats, and therefore a profile of greater risk. Consumption habits of risk in families of lower socioeconomic levels have been identified with greater frequency. The household environment and family (49) Bueno et al., (50) «The variety of foods provokes excitement which for each one of them awakens a specific appetite ( ) and specific degrees of satiation» says Jesús Contreras. «The changes experienced in food consumption does not necessarily indicate dietary progress. Menus are not so much the result of medical recommendations as they are of fashion, customs and ease. An example, legumes are eaten less and less often despite positive recommendations But they have to be soaked and cooked and this takes time» (J. Contreras, 2005). CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 221

224 GRAPH 8.2 Comparison of the profile of frequency of consumption of the Spanish school age population (6-13 years of age) in the middle of the 1980s with the years By percentage MEAT FISH EGGS DAIRY CEREALS LEGUMES VEGETABLES FRUIT DRIED FRUITS SWEETS SOFT AND NUTS DRINK PAIDOS 84 enkid Source: Data from the PAIDOS Study from with this collective and the estimations corresponding to this age interval in the enkid Study from consumption habits have influence on the shape of the child s consumption pattern. (51) The risk profile describe in the enkid study also identifies this population group as the collective with the greatest risk for inadequate ingestion. Physical activity and sendentary lifestyle The data from the enkid study reflects that the proportion of obese is higher among boys and girls that spend more time at sedentary activities. On the contrary, the percentage of obese is lower among boys and girls that do some sporting activity 2 or 3 time a week. In addition, children, adolescents and young adults that regularly do sports 2 or 3 times a week eat significantly more fish, eggs, legumes, cereals and dried fruits and nuts, in comparison with those that don t do any sport or do so sporadically. (51) Birch and Fisher, FOOD, CONSUMPTION AND HEALTH

225 Diverse prospective cohort studies have demonstrated that many factors which cause confusion exist which act as artifacts so that the role of diet and exercise in the genesis of childhood obesity can be determined, for example, the obesity of the parents. (52) Although up to now more emphasis has been placed on total intake of energy in the diet, today voices have emerged that point toward the importance of energetic density and the frequency of consumption. Regarding the role of physical activity, up to know it has been analysed with more focus on the importance of vigorous physical exercise; however, today it is accepted that the fact of spending so many hours watching television forms a lifestyle itself that goes beyond a lack of physical activity. Some authors have estimated that in the past 50 years a decrease of between kcal/day in energy expenditure from physical activity has been produced. Between 1975 and 1999 walking (time and distance covered) has declined by 1 percent. While time dedicated to sedentary activities such as watching TV, videogames, computer use, etc., has increased significantly. (53) According to data from the 2001 National Health Survey, 71.7 percent of Spanish children between the ages of 6 and 15 get practically no physical exercise in their free time. The findings of the enkid study were similar: 60 percent of boys and 80 percent of girls do no regular sporting activity. (54) More than 50 percent of Spanish boys obtain low marks in regards to their level of regular physical activity. (55) In comparison with the situation a few decades ago, children play in the street less often and this limits the likelihood that their games imply physical activity. The time dedicated to physical education in the schools has also decreased. In recent years numerous studies have demonstrated an association between time spent watching television and the prevalence of overweight and obesity in children. (56) (52) Canoy and Buchan, (53) BMA, (54) Ministry of Health and Consumer Affairs, (55) Román Viñas et al., (56) Aranceta et al., CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 223

226 Marketing and advertising of food and drinks The more time spent in sedentary activities such as watching TV or videogames, the less time spent doing physical activities. Several studies have found an association between the time spent watching TV and a higher consumption of foods and drinks rich in fats, salt and sugars, in other words a less healthy diet. (57) In addition, more time spent watching TV means a greater exposure to the advertising of foods and drinks broadcast by this medium. (58) Diverse authors have researched the influence of advertising broadcast on television during children s programming on eating habits and have observed a negative (59, 60) (59), (60) effect on diet. Marketing techniques and advertising are very effective in influencing the choices that both children and their parents make, but unfortunately the foods and drinks that are the principal objects of these campaigns and marketing strategies are not the most acceptable from the nutritional perspective for a healthy diet. (61, 62) The majority of children are not capable of critical judgement of the commercials they see. The media play a very important role in shaping attitudes regarding food and nutrition and tools exist so that they can play this (61), (62) role in a healthy sense. A widespread habit is to have the television on during family meals. «When you shop in the supermarket you don t have to talk, and when you eat in a self-service restaurant you get your food in silence, and with the TV on you eat gazing at the picture. We are talking about a silent nutrition,» says José María Bengoa. All the member states of the European Union are subject to the Directive on Television without borders that restricts publicity. (63) Some countries have even gone beyond this directive and have prohibited advertising directed at children. For example, since 1991 Sweden does not permit the broadcasting of (57) Coon and Tucker, (58) Consumer Eroski. October (59) Boynton-Jarrett et al., (60) Vereecken et al., (61) Story and French, (62) Byrd-Bredbenner and Grasso, (63) This European Directive dates from 1989, although it was later updated. The Directive states that advertising can t take advantage of the lack of experience and critical judgement of children and, therefore, cannot directly encourage children to persuade their parents or caretakers to buy the advertised products. All member states of the European Union are subject to this regulation. 224 FOOD, CONSUMPTION AND HEALTH

227 ads during children s programming hours and those that are broadcast in other scheduled times cannot be directed toward children under the age of 12. (64) Other forms of promotion and marketing, in addition to advertising on TV and in other media, also influence preferences, choices and eating habits; for example, promotional campaigns using stickers or collectables, the participation of popular figures from the world of sports, music, cinema or television, the sponsoring of educational materials, special promotions at points of sale, vending machines, etc. The WHO has implicated the aggressive marketing and advertising strategies of foods and drinks as a probable causal factor in childhood obesity. (65) Marketing and advertising can also potentially favour a healthy diet. For example, in New Zealand they have initiated a campaign that promotes eating yummy apples. The campaign includes collectable stickers that can be exchanged for sports equipment for schools. Today yummy apples is the biggest selling brand of apples in New Zealand. On the other hand the food industry has reacted to the growing demand of consumers for healthier products with less energetic density, low in fat, sugars and salt. Related to this, the regulation of the content and form of labels is very important in providing clear, useful and relevant information to consumers Actions to prevent obesity in Spain Those in charge of public health, academics and politicians, are in agreement on the need to take action to reverse the growing tendency toward obesity. Evidence reveals that prevention is potentially more effective than just treatment to keep the problem of obesity in check. (66) The epidemic of obesity has developed during the last two decades and it will take a decade to reverse this tendency. This cannot be achieved only through actions based on individual responsibility. Actions focused on the social, economic and cultural environment are indispensable. The strategies (64) In Canada, the Consumer Protection Act in Quebec, in effect since 1980, prohibits all types of advertising and marketing in any type of media directed at children under 13 years of age. However, the law is not applicable to satellite TV. A study on the effects of publicity in Canada demonstrated that families in which the children watched more satellite TV bought more breakfast cereals advertised on those channels. (65) Hawkes, (66) Swinburn et al., 2004; OMS, CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 225

228 to confront this problem must be directed to the adoption of healthy eating habits and an active lifestyle through the nutritional education of the population and political action that supports making the healthiest options more accessible to all. (67) The IOTF states that to stop the epidemic of obesity «interventions at the family or school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced. Such prevention strategies will require a co-ordinated effort between the medical community, health administrators, teachers, parents, food producers and processors, retailers and caterers, advertisers and the media, recreation and sport planners, urban architects, city planners, politicians and legislators...» (68) These types of interventions must be directed at all age groups, but it is necessary to place special emphasis on the youngest, children and adolescents. Interventions should be integrated and combine actions in the school, family and work environments and with local government. The choice of the most adequate strategies should be based on the evidence available on their effectiveness. (69) It is important to look for collaboration and participation of both public and private initiatives. Ethical aspects raise a challenge and are the focus of a debate on the prevention of obesity, especially in regard to children. The approach to the problem with a focus on high risk groups certainly is cost-effective, but there is a high risk of stigmatizing individuals identified as at risk who are invited to participate in the proposals for intervention. In addition, the focus on high risk populations can fall into the trap of being excessively paternalistic and pointing out the correct options, telling people what is okay and what isn t, even restricting their freedom of choice and individual decision-making power. (70) In contrast, the interventions directed toward making healthier options more easily accessible for everyone don t interfere with individual freedom to choose and, at the same time, especially protect those who need it. They contribute to building bridges that reduce inequalities related to health. In interventions in school populations there is also a need to be especially careful in not generating (67) Doak et al., (68) RCP, RCPCH and FPH (2004) Storing up Problems. The medical case for a slimmer nation. RCP, RCPCH, FPH: London. (69) Doak et al., (70) Holm, FOOD, CONSUMPTION AND HEALTH

229 prejudices and undesired collateral effects with preventative interventions, such as inducing weight loss in those who don t need it. (71) The World Health Organization adopted the Global Strategy on Diet, Physical Activity and Health at the 57th World Health Assembly in May 2004 and invited all member countries to encourage the development and putting into effect of action plans aimed at promoting healthy eating habits and regular physical activity. (72) In this context the Spanish Ministry of Health and Consumer Affairs launched the NAOS Strategy [Strategy for Nutrition, Physical Activity and Prevention of Obesity] in January 2005, the result of the contribution of eight working groups. The NAOS Strategy (73) examines diverse areas of action involving the principal actors responsible in different sectors. It also incorporates normative measures and policies with the aim of achieving a favourable environment for the adoption of healthy habits toward eating and physical activity. Within this strategy particular attention has been paid to the child, adolescent and young adult population and to interventions in schools through the PERSEO Project (Educational Programme of Reference for Health, Physical Exercise and against Obesity) as a primary element. This is a project of community intervention centred on the school environment with the involvement of students, teachers, families and the community. (74) This program is promoted by the Spanish Food Safety Agency (AESAN) and the Centre for Innovation and Educational Development (CIDE) of the Ministry of Education. The Spanish Society of Community Nutrition (SENC) is responsible for the technical direction of the program and counts on the participation and implication of those in charge of Health and Education of the participating autonomous communities, the parent associations, the Spanish Federation of Municipalities and scientific and professional societies related to pediatrics, primary care and the nursing community. The PERSEO Project hopes to achieve a school and family environment that supports healthy eating habits and physical activity in children in primary school. The project is centred on increasing the consumption of fruits and vegetables, reducing the consumption of fat; increasing levels of physical activity and (71) O Dea, (72) OMS, (73) NAOS Strategy, Ministry of Health and Consumer Affairs, (74) Comité Expertos AESAN, CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 227

230 GRAPH 8.3 Areas of intervention and determinants of food behaviour that the PERSEO Project intends to modify through intervention in the school environment with the participation of families and community support ADMINISTRATION Parents Association Awareness Information Reinforcement Rules FAMILY Mother/Father Brothers/Sisters Availability Accessibility Rules, habits Attitudes, Preferences Models to follow MEDIA SCHOOL ENVIRONMENT Lunch room Vending Classroom Workshop Rules of the centre Knowledge Attitudes Preferences Skills Availability Accessibility Rules SCHOOL CHILDREN Eating habits Physical activity Awareness Information Reinforcement HEALTH WORKERS (AP, Pediatricians...) Coordinators Centres of support Awareness Information Reinforcement SCHOOLS Teachers Classmates Knowledge, habits Attitudes/Preferences Models FRIENDS Source: Aranceta et al., PERSEO Project, reducing time spent in sedentary activities, both in school and out. The project proposes working in the school using a series of didactic units which have a practical and logical orientation familiar to all the children, based on the different periods of the day in which they typically consume foods and drink and look for opportunities to do some physical activity (graph 8.3). Other measures adopted include a code for the self-regulation of advertising of foods and drinks (PAOS) and changes in the labeling of foods and information provided to consumers. The PAOS code is aimed at protecting children under the age of 12 from the excessive pressure of advertising of foods and drinks. The 35 most important companies in the sector have signed an agreement. They represent more than 75 percent of the money spent on advertising. 228 FOOD, CONSUMPTION AND HEALTH

231 Compliance with the agreement is overseen by an autonomous advertisers body for the self-regulation of advertising. A system of control prior to the emission of TV ads and all ads in any medium directed at children has been established, in particular for those that will be broadcast at the time set aside for children s programming. Sanctions and fines from 6,000 to 180,000 euros are contemplated. (75) In the first 15 months in force (from September to 31 December 2006), a total of 582 previously reviewed ads were emitted, the majority for television. 73 percent of the ads received a positive report and were approved. In 118 cases changes were advised while 40 received negative reports for not meeting the parameters of the PAOS agreement and therefore could not be broadcast. Between February 2005 and February 2006 a decrease of 60 percent took place in the number of ads for foods and drinks broadcast on television directed at children and in which popular figures participated Conclusions The proportion of persons with overweight and obesity is increasing significantly in all developed countries. This growth is most striking among children and adolescents. Spain is situated in an intermediate position among European countries regarding the prevalence of obesity in adults. However, it is one of the European countries, along with the United Kingdom, Malta, Portugal, Italy and Greece, with the highest proportion of children and adolescents with excess weight. The rapid changes incorporated into our eating habits in the last two decades, together with the increase in time spent in sedentary activities and decrease in physical activity are postulated as the principal factors implicated in the dramatic increase in excess weight in the population. Evidence exists which associates a high energy density diet, rich in fats and sugars with a greater frequency of obesity. Obesity is also associated with low consumption of fruit and vegetables and the absence of breakfast. (75) Código PAOS, CHILDHOOD OBESITY: NEW EATING HABITS AND NEW HEALTH RISKS 229

232 Different studies have documented the association between more time spent in sedentary activities such as watching television, videogames, computers, etc. with a higher frequency of obesity. Obesity is also related to insufficient physical activity. Obesity is more often a problem in groups of lower socioeconomic and educational level in developed countries. It has serious consequences for health in adulthood. There are also important negative repercussions on the emotional, social and physical health of children and adolescents. Obese children are more likely to be obese adults. The NAOS Strategy reinforces actions taken in community nutrition in Spain. Up to now, most of the initiatives have been developed at the autonomous or local level. For the first time a plan of action centred on nutrition and physical activity within the context of public health exists. Integrated strategies which combine different actions with an important commitment and political support for environmental changes are essential today. Ultimately, support of local actions will be what achieves real change. 230 FOOD, CONSUMPTION AND HEALTH

233 Conclusions: current problematics related to food, consumption and health Cecilia Díaz Méndez (University of Oviedo) Cristóbal Gómez Benito (UNED) Food modernization Food has taken on an unexpected significance in modern society. For this reason, it is necessary to deal with food problems with the same rigor as with other social problems and to follow the usual lines of scientific research with which we analyze Spanish society and its changes. But in this case the object is particularly complex as there are so many difficult problems to analyze in relation to food that the approach to it requires knowledge from many fields and perspectives. In addition, the importance of food in society is fundamentally a result of its direct tie to health. Therefore, this has been the point from which we have begun our analysis. In this book we have tried to show some of the different approaches used, offering perspectives from both the health sciences and the social sciences. All the chapters, as well as the themes in this book have to do in some way with what in sociology and social anthropology is called «food modernity,» a concept which, since the beginning of this century, has been a recurring reference in the social sciences to talk about food in societies with an overabundance of food. This concept covers a series of characteristics that have to do with modifications in eating in advanced societies and which describe with more or less detail the problematics associated with food. It serves to describe the changes (and the trends) in industrialized and post industrialized societies related to food and the problems associated with such changes. This book is then, in a certain manner, a product of this approach; in other words, in it we have tried to analyze the most problematic aspects of the current food situation, in particular those related to questions of health. The reading of the chapters gathered here is an invitation to think about the conflictive CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 231

234 relationship between food and health in another way. At the same time the analysis also considers if this relationship is being dealt with in a constructive manner by the agents immersed in these controversies: consumers, business and government. We think that the controversies related to food today revolve around several areas of conflict in which the public s concerns related to food are expressed. As food issues are a part of daily life everyone is affected by them and they form as much a part of political agendas as they do newspaper headlines. In light of the chapters which make up this study, and as its coordinators, we would like to provide a framework to formulate some of the issues related to the problems between food and health; this will allow us to put these problems in a context based on a multi-disciplinary approach. Problematics and food disagreements Three principal agents are involved in the modern food system: consumers, business (the agrifood industry and other businesses related to the distribution and sale of foods) and the state (within Europe including «ministries» or «departments» responsible for matters of food and food safety in the European Union, but also its member governments as well as regional and local governments and governing institutions). We can formulate the problematic of food and health around the relationships among these three agents, relationships which are often fraught with tension and disagreement, sometimes even with outright conflict. These conflicts are close to the daily lives of individuals and often appear in the media. There is evidence of tension between consumers and the different government institutions that has to do primarily with the mechanisms and the institutional framework in charge of food safety. Problems also exist in the relationships between the industrial sector and those same government institutions that have to do with regulation and control of foods in all aspects (production, processing, merchandising, etc.). These are problems that we often see in the media. Finally, of equal importance are the issues that businesses are confronted with in relation to consumers, although these problems are not as visible in the media. The authors of this book have given different explanations and have 232 FOOD, CONSUMPTION AND HEALTH

235 diverse orientations for understanding these three areas of conflict. With their proposals and reflections they help to set out the future of food in Spain. Conflicts between consumers and government Few areas in which public powers intervene are as regulated as food is through agricultural and food safety policies. Although food has historically always been an object of certain regulation by public powers, it wasn t until the second half of the twentieth century that regulation developed and expanded enormously. This development of the mechanisms of regulation and control has taken place parallel to and as a consequence of the development of the modern industrial food system. These developments reveal two things; on the one hand, the complexity of the modern food system, especially in advanced societies and, on the other hand, the problems of food safety associated with this system. The profusion and complexity of regulations related to food safety are a result of the importance of these problems. At the same time, institutional capacity to improve the safety of food consumption means that food has never been so controlled, which in turn demonstrates the objective risks associated with the industrial production of foods. In this sense, the chapter by Alicia de León, in addition to showing us the evolution of food safety policy in all its complexity, also reveals how food safety policy has been more a result of reaction (to food safety crises) than of foresight. As she shows, food safety policy developed to protect the consumer after problems had already become apparent. Therefore, its very existence reveals the problems of the modern (industrial) food system. And this existence is paradoxical: the resulting safety mechanisms are there to deal with risks inherent in the new food system. Thus food crises, which have generated consumer distrust, have been the trigger for European food policies and have given rise to supranational legal protection from bodies such as the WHO and the FAO. Within the European Union they have led to the creation of the European Food Safety Agency and European wide regulations on food safety, as well as their duplication on national levels. Her chapter shows us how the concept of food safety has evolved and how it must be based on an understanding that goes beyond the strictly techno-scientific. Concern about food safety and the healthiness of foods must be placed within the context CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 233

236 of the overall protection of the consumer in an increasingly dynamic and international market. Despite all the effort to regulate and control food safety, there is no reason to think that food crises similar to those of the 1980s (massive intoxication from the consumption of adulterated cooking oil) and 1990s (mad cow disease) have come to an end. But it is also true that states now have better resources to confront food safety crises as they have reacted by creating crisis protocols and bodies specifically designed to confront global food problems. Therefore, although it is likely that the perception of risk associated with consumption will increase, it is also likely that there will be greater state control especially around the sale, distribution and production of foods. Consumers will be increasingly more demanding in this sense. But for this same reason we will find a scenario of future conflicts between those who support the regulation of the processes that intervene in the agrifood chain (from primary production and processing to sale and consumption), supported by a more critical and demanding public opinion, and those who support less regulation, supported by the complex of interests of the agrifood industry, especially the multinational corporations, as is now happening in many countries such as the United States. Insofar as the 21st century will be the scene for the globalisation of the international food trade, it will also be necessary to have a common regulatory framework for the increasingly close connection between health and consumer confidence. This is the only way to minimize the conflicts that exist among the different trust referents, through a convergence between them and their interests. But in any case, it seems necessary to direct collective efforts toward the benefit of consumers. As we have said, all the control and regulation by the state is an attempt to guarantee the safety of foods and maintain and prolong the health of citizens. Nevertheless, the consumer s choice of diet is influenced by diverse factors, among them the recommendations of experts and the public agencies responsible for food and food safety. If these recommendations are examined from a certain historical distance they are revealed to be very volatile and changeable, to such an extent that they diminish consumer trust. In the chapter by Cecilia Díaz Méndez and Cristóbal Gómez Benito we can see how dietary recommendations and the concepts of a healthy diet have changed in Spain since the 1960s (an evolution that is not exclusive to Spain), depending on 234 FOOD, CONSUMPTION AND HEALTH

237 circumstances beyond the development of scientific knowledge on nutrition and diet, and demonstrating a close connection to the rapidly changing concepts of food modernity. But scientific knowledge on these subjects is also constantly changing. Ángeles Menéndez Patterson shows us that it is necessary to update ideas and concepts about nutrition that have been with us since the beginning of the past century and which sometimes limit and impede the development of this science. For example, the criteria for the classification of certain nutrients has been based on their solubility (in lipids or in water) and not based on their function, or the need to redefine the term «nutrient» itself, in light of the new «nutrigenomics.» At the same time, consumers must confront almost daily the variability and diversity of often contradictory dietary recommendations coming from experts and agencies (seen on countless television programmes or in magazines about health), which does not exactly contribute to the generation or strengthening of trust. It also seems appropriate to consider consumers perceptions regarding food risk, as we do not always see their caution corroborated by support from government institutions, and conflict is evident when the pressure and interests of other agents is revealed, as we will see further on. It is clear that even today the interests of consumers are not being fully represented by the so-called «consumer associations.» Although their presence in the media is growing and institutional support for them has increased, such groups still have little capacity for pressure and play a minimal role in the specific area of food consumption. The conflicts and disagreements between consumers and government do not seem very relevant, but this is possibly a consequence of the lack of importance of consumer associations in Spanish society. Disagreements between consumers and the agrifood business The disagreements between consumers and businesses are manifested at another level. It seems evident that the market by itself is not capable of adequately integrating the interests of consumers and the agrifood industry. The existence of public agents that act as arbitrators and regulators demonstrates well the tension between them. There are several aspects to consider regarding this area of potential or real conflicts between both groups of actors. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 235

238 On the one hand, there is the question of whether the relationship between diet and health is an individual issue. In other words, are individual dietary habits based only on factors such as education, lifestyle, likes or food preferences, or do they also have structural roots which affect individual decisions, making it very difficult for individuals to change to healthier habits? The question is important for an adequate diagnosis of the current problems between food and health. On the other hand, there is the economic issue of the relationship between supply and demand. In the economic literature on food consumption, there is no consensus on whether the current food system is based on the predominance of demand (the preferences of the consumers condition the supply of the productive sectors) or of supply (the agrifood industry conditions demand), although opinion seems to tilt slightly toward the first model. But there is no doubt that there are also structural factors that orient eating habits and preferences. In this book there are two chapters that show us this. The chapter by Emilio Luque, which begins with the distinction made by C. Wright Mills between individual problems and public issues, warns us that when an individual problem is broadly reproduced it also becomes a public problem. This implies that both the correct description of the problem and the range of possible solutions require considering the economic and political institutions of society and not only the personal situation and character of a collection of dispersed individuals. This is the case of the problem of obesity for example. The author claims that the analysis of the problem of obesity is inseparable from the context of agrifood policy and the economic and industrial logic of the food system, and thus the assigning of personal responsibility and consequent policies based on providing information and consciousness are fundamentally incomplete. The position that privileges personal responsibility for nutrition assumes that sources of information are, at minimum, available without cost to the consumer, and that he/she has the capacity to process the information, and that all information is reliable and not contradictory. Following a line of critical reflection and analysis of the modern agrifood system, the author emphasizes that we do not make decisions about food in a vacuum. We choose our diet in a commercialized environment, in which millions of euros are invested in providing nutritional advice which is often 236 FOOD, CONSUMPTION AND HEALTH

239 confused and at times contradictory. In fact, this leads to the perception that eating in a healthy manner is so difficult that it is not worth the bother to eat more or less of some food or some category of foods. Thus we must confront «obesogenic» environments with the democratic tools of open debate and the subsequent formulation of public policies that go beyond the tactics of food recommendations. Some experts in economics of health have thought about a direction that we have not dealt with here but which is suggestive: it is the question of whether the obese are ill, which opens a wide field of debate regarding the role of national health systems in providing possible coverage for obesity. We have then, the decisions of the individual about his/her diet, which we talked about at the beginning of this section. These decisions are not only conditioned socially in the general sense (by the individuals social conditions including type of work, structure of the home, education, etc.), but they are also consciously and structurally shaped by an environment which pushes the individual to consume foods of a certain type in a certain manner. Because of this, it is important to look at food advertising. The chapter by Díaz Méndez and María González about the history of recent food advertising shows us that agrifood businesses offer their products with sales and distribution strategies that hinder the consumer s real freedom of choice. Supply does not really meet the interests and desires of consumers. Food products too often have nothing to do with necessity and are distant from the rationality that an adequate diet has. The chapter by Díaz Méndez and Gómez Benito takes this same line of analysis as a starting point. They show the parallel evolution of dietary recommendations and the evolution of agricultural policies and the agrifood sector and how many of the recommendations have been clearly used to direct the consumer toward the consumption of food products of national origin. Finally it should be mentioned that food consumption habits are also very much conditioned by (and not just associated with) shopping habits and places to shop. There is a line of analysis on the role and responsibility of large supermarkets in the food consumption model. Not only do consumers relate to the agrifood industry in a problematic way, but also to the distribution sector, particularly large distributors, as the modern system of distribution forms a CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 237

240 perfectly coordinated part of the industrial agrifood system. It is not by chance that many of the social movements that propose new models of consumption raise in equal measure new models of distribution. Generally speaking, the guidelines of action that are adopted in relation to the consumer, whether on the part of government institutions or businesses, consider consumers as anonymous and passive (to protect them or to sell them products); however, this anonymous person has at different moments given signs of not being so. The new profile of consumers which emerges in the chapter by Díaz Méndez and González, as well as the eating habits and preferences explained by Jesús Contreras and Mabel Gracia, indicate consumers growing interest in the foods they buy and eat. New social values, in particular those related to forms of production and the deterioration of the environment, and to the social consequences and global injustice generated by consumption, emerge as areas of conflict of interests between consumers and businesses. It is not easy to visualize the role of the consumer; first of all, because as we have pointed out, the consumer is not represented by any concrete social group (but is a part of all of them equally). But also because the aggregate effects of their purchases (rather than their rejections) are diffused in the dynamic of the market and remain hidden, and only become present when some phenomenon occurs with visible macroeconomic dimensions, such as the still incipient trend of not buying genetically modified foods. Jesús Contreras and Mabel Gracia have demonstrated that food choices are increasingly more complicated for consumers. What consumers say and do does not always coincide and it becomes difficult to establish a strong tie between their interests and the choices they make from the existing products on the market. It seems that consumers look to reconcile their conception of a healthy diet with their consumption and eating habits, and according to the data of the authors seem to achieve it if we accept the consonance between their definition of health and their real consumption. However, the authors also confirm that the so-called «pyramid of food likes,» which classifies foods in function of the pleasure they provide to the palate, doesn t coincide with the nutritional pyramid proceeding from nutritional recommendations. We could also say that having an adequate diet is increasingly complicated, given 238 FOOD, CONSUMPTION AND HEALTH

241 the irregularities of every day life for the majority of the population, plagued by «micro events» that hinder making eating part of a routine and, therefore putting an adequate diet into practice. Often the interests of consumers are not clear. Consumer associations act in their name, but it remains to be seen how their interests are to be integrated into traditional social movements (unions, political parties) in a society in which everything seems to indicate that consumption is acquiring greater prominence. Consumers have begun to reject matters associated with consumption that are clearly and directly connected with citizens rights, and that are not solely related to their traditional role as purchasers of products in the market. The presence in this global market of fair trade products or organic products is an example of new forms of consumption, but also an example of new forms of self-perception of the consumer. The rejection of transgenics, along with the consequent questioning of the form in which agriculture and livestock raising work, as well as growing environmental concerns respond to this search for a role beyond that of purchaser, which is usually denied to the consumer on almost all levels of the agrifood chain. Ángeles Menéndez Patterson points out that we are now witnessing the appearance of «nutrigenomics,» a field that will soon bring us «made to measure diets,» but which is still largely unknown to consumers. It is likely that consumers will continue to be interested in improving their health through diet, aided by public health agents and encouraged by industry through the marketing of functional foods. But it is also likely that there will be an overload of information about health and diet and that the attitude toward these new foods will be more critical and purchasing behaviour more reflective. Businesses will also see a necessity for greater oversight of their research; otherwise they will be the target of criticisms from the scientific community, at least from those researchers connected to public bodies such as universities and R&D centres. Without a doubt, the issue of food advertising is another area of confrontation between consumers and businesses, as has been shown here in several chapters. We know that governments have supported greater control over advertising, developing laws and regulations about their diffusion and content. This issue is perhaps more related to the confrontation between business and government, which we will comment on below. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 239

242 We have seen how the agrifood industry through advertising incorporates the cultural values associated with traditional foods into industrial food, and that dishes that are not home-made are marketed as «home cooked.» In the future we can imagine that as this trend grows, so will government control of the industry grow, making food advertising subject to increasing government intervention. At the same time, agri-industry will become more conscious of the risks from the industrial production and processing of foods and will take measures in favour of diets closer to the health standards established by professionals in the field. Citizen concerns will also increase, and with this, institutional concern for the problems associated with bad diet, in particular obesity, now defined as the «epidemic of the new century.» This will make governments turn their efforts towards more direct education about what is understood as a good diet by incorporating guidelines about healthy and adequate diets into education curriculums. Efforts will be especially directed toward the child population, a group with growing importance in food consumption. Disagreements between industry and government As Cecilia Díaz Méndez and Cristóbal Gómez Benito set out, during recent decades the agrifood industries have counted on the support of diverse governments and government institutions during the development of the modern agri-industry. It can also be said that the legal obstacles to its development have also been limited; collaboration between business and government stands out more than confrontation, at least in the 20th century. There was strong institutional support for agricultural production at the beginning of Spanish agricultural development (the so-called «green revolution» and the programmes for agricultural and livestock development of francoism), a support which continued with the entrance of Spain into the European Community with the specific promotion of certain emblematic national products (such as oil and bananas) in international and local markets. Entering into the twenty-first century, the Strategy for Nutrition, Physical Activity and Prevention of Obesity (NAOS), mentioned in several chapters, is an example of the collaboration between business and government to prevent childhood obesity, just as the advertising code of conduct PAOS (an industry regulated code for food advertising) shows the growing interest of both business and public institutions in support of a better diet and more adequate advertising information. 240 FOOD, CONSUMPTION AND HEALTH

243 But there have also been disagreements among these agents, which have been visible in the media. The recent controversy about the proposed so-called «Ley del botellón [Law against public drinking],» which was finally withdrawn, as well as the reaction of alcoholic beverage producers to this law, are examples of this. Another example was the Ministry of Health s petition to withdraw an advertisement for a fast-food chain because it was considered to be harmful to health (November 2006). The company continued with the advertisement and even fed the controversy with new ads along the same lines despite also being warned to withdraw it by diverse consumer associations. The recent study promoted by the Ministry of Consumer Affairs to reunify the sizes of women s clothing (October 2007) also shows the need for collaboration between the state and business. In this case, the data is still not available (it will be available in 2008), but if the final objective is to achieve a standardization of sizes in women s clothing based on a model of «healthy beauty,» the debate is served. Some fashion shows like the Cibeles show have rejected using models smaller than a size 34, in accordance with the Ministry of Health proposal, but others have not followed this tendency, and some designers have questioned the measure, considering it interference in their business strategies. We don t think these are merely opportunistic controversies, but more likely they are examples of the repeated conflict of interests between the business world and government. As we saw in the chapter by Ángeles Menéndez Patterson and in the already mentioned chapter about food advertising by Cecilia Díaz Méndez y María González, another area of confrontation is that related to functional foods. In both of these chapters it is pointed out that the applicability of these foods in the prevention and treatment of illnesses is not as evident as advertising seems to indicate. The data on the health benefits of certain substances has been corroborated by scientific research, but there is no certainty that the integration of these substances into foods produces effects as evident as those mentioned in the advertising of functional foods. It is surprising, particularly in the Spanish case, that the pharmaceutical industry is doing more research on foods than public research bodies themselves, and that there is no collaboration between them to help clarify some of the questions which relate diet to the treatment and prevention of illnesses. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 241

244 Multilateral disagreements Although we have portrayed a confrontation «with two sides,» what is typical is that the controversies around food reveal the intersection among the three agents involved: consumers, business and government. In view of this, we must mention the recent controversial case here in Spain in which social services in March 2007 assumed guardianship of a 10 year old obese boy who weighed 100 kilos. A similar case in Britain led to similar actions by the government there in February Without judging all the dimensions of the controversial decision adopted by the local government in these two cases, it is clear that the solutions offered to confront this type of problem were in response to two issues: on the one hand, a biomedical conception of diet that determines what is fat and what is thin; and on the other hand, the belief that there is a food culture which tells us what is good and bad to eat. As Javier Aranceta explains in chapter eight of this study, it is not easy to define obesity, particularly in the case of the children. The standard dietetic norm of fatness in those obese children as well as for thinness in that controversial photo of a skeletal naked girl from an Italian clothing brand is evident. But while it is obvious in these cases (it s enough to see the photos to be shocked), it is not so easy to establish what is considered normal or abnormal in cases that do not make it into the newspapers. However, it must be added that the rulings in the cases cited in which the state assumed custody of the obese children show that maintaining an appropriate diet that guarantees the health of the individual is a private issue, but the responsibility passes to the public sphere (as in these cases) when the individuals (the families in these cases) are incapable of guaranteeing their health or the health of others in the family through adequate diet. Under this supposition, the «not knowing how» is understood as a lack of basic education (in this case, dietary education), and the response is to offer to the children the guidelines for adequate dietary behaviour to maintain themselves within the norm that permits them to be healthy. With these two decisions, the state showed signs of understanding that there is a correct dietary culture, a norm about what it means to «eat well,» but the question should still be asked: when have families been offered education regarding what is understood to be a good diet, one which demonstrates optimum dietary conduct, and by whom? 242 FOOD, CONSUMPTION AND HEALTH

245 The chapter by Paloma Herrera shows the variations in the ways in which homemakers have informed themselves and been informed so that they could acquire what could be called «dietary education.» She confirms that this type of education has always been on an informal level, and that although this knowledge has varied over time, it has not been institutionalized but continues to be part of the process of socialization, first within the family and later more widely; what families understand as adequate diet now comes from diverse agents and is not formalized. What we have today is a profusion of sometimes contradictory messages surrounding families when they are choosing the food products that are closest to their conception of an adequate diet. In short, her reading leads us to question different aspects of the decision adopted by the state to resolve the problem of the excess weight of those children. It is not clear that there exists unanimity about when overweight and obesity can be considered pathologies and what, therefore, public authorities can or should do to avoid it. It is also not clear that families have the resources to face the environmental pressures (in particular the advertising strategies of the agrifood businesses). It is also questionable if this problem can be managed by families, given that there is no education or clear information (neither «officially» nor informally) offering irrefutable guidelines on the most appropriate ways to eat. Being slightly mischievous, we could argue that the state should also intervene if the family has children that are drug addicts, or children that are delinquents or why not even if the children fail in school, given that all of these would demonstrate the family s incapacity to deal with it own private affairs (following the argument questioned here). To sum up, from the point of view of the government, it seems that «eating» is individual, conscious, voluntary and self-modifiable behaviour. In light of this study, we have to ask ourselves if this is in fact the case. Does our daily eating behaviour only depend on the individual? Is the choosing of foods for a correct diet always voluntary and conscious? Do we know today with certainty what is good to eat? Is there a clear consensus on the part of public health institutions on what is an adequate diet for maintaining health? CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 243

246 Other disagreements Continuing to look at disagreements, we cannot ignore those which exist among the sciences. The chapter by Ángeles Menéndez Patterson has made it clear that there is no real intersection of analyses between the social sciences and natural sciences, but rather a great number of questions that are referred to mutually with the hope of a shared answer that seems to never arrive for the lack of will of the questioners. This study is an attempt to create a common space for reflection. We have seen that the biomedical conception of food and dietary disorders dominates in everything related to nutrition. At the same time the intention throughout history to «civilize eating» and the social transformations that are found within our conceptions of health and illness have been demonstrated; this invites us to think about the social effects of leaving issues that connect food and health in the hands of only one scientific field. The chapter by Jesús Contreras y Mabel Gracia highlights the multiplicity of social factors that are behind food choices, and the proposals of these experts are clear; it is necessary to relate food problems to these background social factors, but they are conscious that these are «well-intentioned» words without the interdisciplinary research to back them. Ángeles Menéndez Patterson is looking for a convergence in view of the changes that the food sciences have introduced in the new food wheel. But the data shows that in the food choices of diners there is an important gap between what is pleasurable and what is healthy: we eat more of what we like and less of what is considered healthy a contradiction which reveals that nutrition experts are on one side and diners on another. Will it be possible to bring about a convergence between the two? Is it possible to eat healthy and with pleasure? In any case, it seems necessary to not lose sight of this as an objective, as the trend toward a more hedonist consumption is telling us that if we do not manage to combine the two, we will be on the path toward a diet further and further removed from what is considered to be healthy. 244 FOOD, CONSUMPTION AND HEALTH

247 The social conditions of «healthy eating» Governments fears about the effects of food changes are justified. Data show an increase in health problems derived from poor eating, and obesity is motive for great concern. There is also evidence of recurring food crises that affect consumers, and it does not appear as if such crises are going to disappear; rather it is likely they will periodically appear. The data also show important changes in the ways food is chosen, the organization of the eating day and the structure of the diet; all of which indicate that food behaviours are less homogeneous than they were even just a few years ago and that we could be before irreversible changes that are taking the population away from healthy diets. Before these new circumstances governments have not been passive, but have acted with the objective of promoting healthy eating habits and guaranteeing healthy and quality food to the population. The trade of foodstuffs has been regulated and they have promoted scientifically backed recommendations so that the population has information with guarantees on «healthy eating.» Businesses, for their part, have promoted their products as if health is an inherent value of industrial foods. Hooked into the desires and expectations of consumers, food marketers have known how to unite health and foods. The market today offers the consumer varied products that are easy to buy and cook, at an accessible price and with symbolic elements in harmony with rising social consciousness regarding such things as quality or solidarity. Nevertheless, although both public and private institutions act to offer the public a wide range of quality and healthy foods, consumer behaviour does not always lead to eating habits concordant with what experts understand as «healthy eating.» The fact is that governments are not completely satisfied with the results of their policies to promote better eating; childhood obesity is increasing, and recommendations to prevent food risks are not always followed. Consumers, who are the focus of all the guidelines, do not always act in a way which is understandable to those who have the objective of looking after their health. Information does not seem to help; it is curious that today there is more information than ever, more regulation than ever, but there is also more fear, more concern about food and more confusion in deciding how to eat healthily. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 245

248 For their part businesses also find themselves with problems. Regulations place demands on the whole agrifood chain which generate new costs. The global food crises affect them systematically, inasmuch as the perception of risk on the part of the consumer leads to a situation of generalized distrust that places business at the centre of criticisms. But in addition, the consumer shows a growing distrust toward advertising and toward the business environment that produces, processes, distributes and sells food. This context, plagued with paradoxes and conflicts, is what we have hoped to unravel in this book. Food, consumption and health are three spheres in which businesses, government and consumers interrelate, and this has given us the opportunity to go in-depth into this complexity to contribute through this multidisciplinary study some reflections and guidelines for action that enable us to confront the food problems of modern societies. For any analysis of food today, it is necessary to start from an obvious consideration but one that is still necessary to clarify. Current food problems have little to do with scarcity and much to do with abundance and globalisation. Food safety, in the past centred on shortages, is today focused on guaranteeing the quality and healthiness of the foods we eat. Curiously, this objective is increasingly difficult to meet. New food problems are associated with the growing complexity of the food system which makes it more difficult to know and understand what happens with our foods as they move from the place where they are cultivated to the plate on which they are eaten. In this scenario, the consumer knows less and less about the foods he or she eats. For this reason it is also more and more difficult to choose what is good to eat. The agrifood system has been growing in its complexity as the production of foodstuffs has industrialized. More and more actors are intervening in this system (producers, processors, large distributors and medium and small retailers), which increases the risk inherent in the system because of the added risks of each one of the phases and because of the lack of knowledge (transparency) of what happens in each of them. This growing complexity of the industrial food system has brought about a transformation in the development of regulatory mechanisms and control. Food is one of the most regulated sectors of society. But advances in food safety policies have almost always 246 FOOD, CONSUMPTION AND HEALTH

249 been a response to food safety crises and not prior preventative responses in favour of food safety. Food poisoning such as the «Colza Case» in 1981 led to the General Law for the Defence of Consumers and Users in Spain and also revealed the lack of food policies. Subsequently, food crises (such as mad cow disease, salmonella, listeriosis, swine flu or foot and mouth disease) have been the trigger for the development of food policies in both Spain and Europe. But this regulation has not reduced the concern of consumers for what they eat, perhaps because the loss of both individual and institutional control over foods is obvious. The consumer does not know what he/she is eating (where it comes from, how it is grown, what products are added to it for its preservation, how it is handled for its presentation and sale ); nor does he or she know if the government is capable of controlling everything and suspects not, hence the growing concern. The referents of trust have also changed. Consumer confidence in past periods was tied to nearby sources like the family and tradition. They knew what a «good meal» was, and the products to prepare it were accessible to the consumer. If information was lacking they could call on someone close to them who with their experience and traditional knowledge, would indicate to the younger generation «how to eat well.» Culinary knowledge was transmitted from mothers to daughters, and in this way, one learned how to eat adequately. Today trust and information are based on specialized sources; experts in nutrition and health indicate to the public what is good to eat. Nevertheless, the transmission of culinary information still occurs on an informal terrain, but now through magazines, television programmes, etc. and not necessarily from mothers to daughters. Now it is more diverse, but also more confusing. Currently the public follows the recommendations of doctors and nutritionists who inform the population and advice the government on what is good and bad to eat, based on scientific advances in their fields. However, a historical analysis of the changes in the concept of a healthy diet and the scientific recommendations of institutions reveals that these concepts and recommendations have not been stable over time. Without a doubt, this contributes to the increasing scepticism with regard to «scientific truth» and undermines the confidence in the institutional referents on health and diet. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 247

250 Still, despite the multiple and growing disconcerting situations, everything seems to indicate that citizens of modern societies do trust in society s food control systems. When there are food crises, trust in the overall system of control breaks down, but a process to recover the credibility of the system is generated through new regulations, sanctioning of transgressors, new food advertising campaigns, appeals to experts and their latest research and creation of new bodies to protect the health of the public, etc. As was mentioned previously, consumer habits are also sending out warning signals with respect to food. We have been able to establish some of the factors that influence food choices. In the first place, we should consider personal likes, which are socially conditioned and marked by a trend toward hedonism characteristic of society today. There are food likes which coincide with healthy diets, but there are also those which do not. In view of this, it should not be forgotten that advertising adapts well to likes because it offers consumers desires, not reasons, but healthy diets are based on «nutritional rationality.» In the second place, environmental pressures to consume have to be considered. As we have mentioned, it is not clear if the current models of food consumption are models in which demand predominates, in the sense that preferences condition the supply of foodstuffs; or if they are models of supply, in which the food industry conditions preferences. But we cannot forget that some of the products that are important for a healthy diet, such as fresh vegetables, fish and meat are not promoted through the advertising channels or the marketing strategies of industrial food products. They are, therefore, at a disadvantage. A third factor that conditions consumption has to do with the organization of daily life. Daily life is irregular, plagued by micro events that prevent the routinisation of meals (variable timetables, trips, different diners at different times with distinct routines, etc.). Adapting daily life to eating well is difficult for families, in particular for women that have responsibilities outside of the home yet also have to attend to food for their families. Without a doubt for any person, but more for these women, it is easier, more comfortable and economical to resolve daily eating by buying packaged industrial products rather than fresh ones. The repercussion of these factors on food habits varies in relation to social class. Approaching a healthy diet is also connected to income and educational 248 FOOD, CONSUMPTION AND HEALTH

251 level. The incidence of food crises are felt more in some groups than in others. Behind anorexia and obesity are social factors that are more marked among the more disadvantaged classes. Because of all this, it is important to remember that the appearance of a general improvement in food questions should not hide the presence of what is now known as the «new poor,» disadvantaged social groups whose definition of poverty does not coincide with that of earlier periods of food scarcity. It is foreseeable that the series of problems mentioned here will take on new dimensions in the future, sharpening tensions and polarisation between two food models: one, based on the industrial production of foods and their standardisation, aimed especially at lower income groups; and another, based on quality, organic production, diversity and differentiation aimed at higher income groups. In short, the problem is not only if we are increasingly eating worse, but rather if it is possible to eat well in the society in which we live. It is not only if there is or is not a separation from diets considered to be healthy, but rather if there are optimal social conditions (political, cultural, and economic) so that each and every person can eat healthily. It is clear that policies directed at improving eating habits, through the spread of healthy diets and food recommendations don t work without support, not only in solid scientific knowledge about diet and nutrition, but also in a sociological understanding of the social conditions of food in human groups. We believe that the objective of those who have the obligation to safeguard the healthiness and safety of food is to offer to the public a supportive environment in which to achieve it. Here we have been able to verify that there are many fronts in which problems exist and many doubts about how to adequately confront them. In view of the work presented here we can affirm that neither an exclusively medical conception of health and food, nor the individualization of food problems seem to be the most appropriate ways to achieve this. Without a doubt we find ourselves before complex social phenomena that make understanding difficult, but the multidisciplinary perspectives we have offered here are opening a space to achieve this understanding. CONCLUSIONS: CURRENT PROBLEMATICS RELATED TO FOOD, CONSUMPTION AND HEALTH 249

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270 Index of Graphs and Tables Graphs 6.1 Acceptance/rejection of different food groups Acceptance/rejection of different ways of preparing foods The pyramid of likes The most frequent eating days Breakfast foods Breakfast drinks Lunch foods Lunch drinks Typical lunch profile Typical dinner profile Typical mid-morning snack profile Typical merienda profile Typical aperitif profile Evolution of the prevalence of obesity in the population between 6 and 13 years of age in Spain Comparison of the profile of frequency of consumption of the Spanish school age population (6-13 years of age) in the middle of the 1980s with the years Areas of intervention and determinants of food behaviour that the PERSEO Project intends to modify through intervention in the school environment with the participation of families and community support FOOD, CONSUMPTION AND HEALTH

271 Tables 4.1 Characteristics of food advertising in Spain Impact of childhood obesity on physical health Impact of childhood obesity on emotional and social health Prevalence of obesity in the child, adolescent and young adult population in Spain by age and sex Comparison of the prevalence of obesity among different developed countries Environmental risk factors: other evidence Estimation of the prevalence of unhealthy eating habits that place the child, adolescent and young adult population at risk in Spain 221 INDEX OF GRAPHS AND TABLES 269

272 Social Studies Collection Available on the Internet: Published titles YEARBOOK OF SOCIAL INDICATORS 1. FOREIGN IMMIGRATION IN SPAIN (Out of stock) Eliseo Aja, Francesc Carbonell, Colectivo Ioé (C. Pereda, W. Actis and M. A. de Prada), Jaume Funes and Ignasi Vila 2. VALUES IN SPANISH SOCIETY AND THEIR RELATION TO DRUG USE (Out of stock) Eusebio Megías (director), Domingo Comas, Javier Elzo, Ignacio Megías, José Navarro, Elena Rodríguez and Oriol Romaní 3. FAMILY POLICIES FROM A COMPARATIVE PERSPECTIVE (Out of stock) Lluís Flaquer 4. YOUNG WOMEN IN SPAIN (Out of stock) Inés Alberdi, Pilar Escario and Natalia Matas 5. THE SPANISH FAMILY AND ATTITUDES TOWARD EDUCATION (Out of stock) Víctor Pérez-Díaz, Juan Carlos Rodríguez and Leonardo Sánchez Ferrer 6. OLD AGE, DEPENDENCE AND LONG-TERM CARE (Out of stock) David Casado Marín and Guillem López i Casasnovas 7. YOUNG PEOPLE AND THE EUROPEAN CHALLENGE Joaquim Prats Cuevas (director), Cristòfol-A. Trepat i Carbonell (coordinator), José Vicente Peña Calvo, Rafael Valls Montés and Ferran Urgell Plaza 8. SPAIN AND IMMIGRATION (*) Víctor Pérez-Díaz, Berta Álvarez- Miranda and Carmen González- Enríquez 9. HOUSING POLICY FROM A COMPARATIVE EUROPEAN PERSPECTIVE Carme Trilla 10. DOMESTIC VIOLENCE (Out of stock) Inés Alberdi and Natalia Matas 11. IMMIGRATION, SCHOOLING AND THE LABOUR MARKET (*) Colectivo Ioé (Walter Actis, Carlos Pereda and Miguel A. de Prada) 12. ACOUSTIC CONTAMINATION IN OUR CITIES Benjamín García Sanz and Francisco Javier Garrido 13. FOSTER FAMILIES Pere Amorós, Jesús Palacios, Núria Fuentes, Esperanza León and Alicia Mesas 14. PEOPLE WITH DISABILITIES AND THE LABOUR MARKET Colectivo Ioé (Carlos Pereda, Miguel A. de Prada and Walter Actis) (*) English version available on the Internet

273 15. MOSLEM IMMIGRATION IN EUROPE Víctor Pérez-Díaz, Berta Álvarez- Miranda and Elisa Chuliá 16. POVERTY AND SOCIAL EXCLUSION Joan Subirats (director), Clara Riba, Laura Giménez, Anna Obradors, Maria Giménez, Dídac Queralt, Patricio Bottos and Ana Rapoport 17. THE REGULATION OF IMMIGRATION IN EUROPE Eliseo Aja, Laura Díez (coordinators), Kay Hailbronner, Philippe de Bruycker, François Julien-Laferrière, Paolo Bonetti, Satvinder S. Juss, Giorgio Malinverni, Pablo Santolaya and Andreu Olesti 18. EUROPEAN EDUCATIONAL SYSTEMS: CRISIS OR TRANSFORMATION? Joaquim Prats and Francesc Raventós (directors), Edgar Gasòliba (coordinator), Robert Cowen, Bert P. M. Creemers, Pierre-Louis Gauthier, Bart Maes, Barbara Schulte and Roger Standaert 19. PARENTS AND CHILDREN IN TODAY S SPAIN Gerardo Meil Landwerlin 20. SINGLE PARENTING AND CHILDHOOD Lluís Flaquer, Elisabet Almeda and Lara Navarro 21. THE IMMIGRANT BUSINESS COMMUNITY IN SPAIN Carlota Solé, Sònia Parella and Leonardo Cavalcanti 22. ADOLESCENTS AND ALCOHOL. THE PARENTAL VIEW Eusebio Megías Valenzuela (director), Juan Carlos Ballesteros Guerra, Fernando Conde Gutiérrez del Álamo, Javier Elzo Imaz, Teresa Laespada Martínez, Ignacio Megías Quirós and Elena Rodríguez San Julián 23. INTERGENERATIONAL PROGRAMMES. TOWARDS A SOCIETY FOR ALL AGES (*) Mariano Sánchez (director), Donna M. Butts, Alan Hatton-Yeo, Nancy A. Henkin, Shannon E. Jarrott, Matthew S. Kaplan, Antonio Martínez, Sally Newman, Sacramento Pinazo, Juan Sáez and Aaron P. C. Weintraub 24. FOOD, CONSUMPTION AND HEALTH (*) Cecilia Díaz Méndez y Cristóbal Gómez Benito (coordinators), Javier Aranceta Bartrina, Jesús Contreras Hernández, María González Álvarez, Mabel Gracia Arnaiz, Paloma Herrera Racionero, Alicia de León Arce, Emilio Luque and María Ángeles Menéndez Patterson

274 Design and desktop publishing: Ciutat d Asunción, Barcelona Translated by Jed Rosenstein

275 The objective of this present study is to offer an analysis of the current food situations that have awakened great social concern. Our intention is to focus on the social dimension of these problems and the motives for their recent appearance in public debate. The study is an investigation of the concepts of good diet, food safety, risk and health, as well as an inquiry into their changing character and implications for today. The new roles of public and private institutions in relation to consumers and new eating disorders such as obesity and anorexia are also analysed. The study begins from a paradox: never before has so much been known about food and nutrition; never before has food safety and dietary health been the object of so much attention (and regulation), yet never before has there been so much confusion and concern about what to eat as consumers find themselves faced with a proliferation of recommendations and dietary advice. While for their part, institutions are concerned about dietary changes and their repercussions on public health. This book offers some keys to understanding the social roots of these issues. It is a response to some of the questions raised by this new scenario in which there is no lack of food, but in which, curiously, food has become a problem. Electronic edition available on the Internet: