‘I think sometimes public health get labelled as these whiny woke people who are wanting stuff that isn’t that important,” muses Professor Cliona Ni Murchu. “Or, you know, we’re accused of being very nanny state.”
Just last month, Health Minister Simeon Brown criticised overreach by what he called the “health police”, ordering public health officials to stop commenting on issues such as fast food and concentrate on immunisations instead.
But now Ni Mhurchu, who leads a nutrition research programme at the University of Auckland medical school, finds herself and colleagues in an uncommon alliance with powerful players in the food industry. She notes diplomatically that the public health nutrition community and the food industry often have “quite conflicting views” about the best approaches to enhance nutrition.
“We have rarely ever worked together on anything, but this is the one topic that we are absolutely singing from the same song sheet about.”
It’s really hard to say how to prevent diet-related diseases and improve nutrition if we don’t know what New Zealanders are eating.
She’s talking about the need for a new National Nutrition Survey (NNS). The survey does what it says on the tin: a deep dive into what Kiwis are eating, and how that affects their health, by way of a detailed survey of thousands of people’s diets alongside blood and other testing.
Minister says no
Ni Mhurchu and representatives of the Food and Grocery Council, which represents manufacturers and suppliers, recently got together to write a briefing that called for urgent action from the government. We need a new survey, they said, asap. The most recent survey of adults was released in 2009. In children, the survey hasn’t been updated for more than two decades: it was last done in 2002.
Associate Health Minister Matt Doocey says there are no plans for a new survey. In a statement to the Listener, a Ministry of Health spokesperson said although it has heard the calls, a survey – estimated to cost about $15 million – “needs to be balanced with other health system priorities”.
Eminent University of Otago nutritionist Professor Jim Mann has chaired the advisory committee of every nutrition survey except the very first and is blunt in his assessment of the need for new information.
“When you consider there is a huge body of evidence showing what we eat is the number one contributor to the overall burden of ill health, it is nonsensical to say this is not a priority,” he says. “This is more important to address than smoking.”
Ni Mhurchu and her fellow authors say the country faces a “critical information gap” on what New Zealanders eat and our overall nutritional status, warning that without current data, the policymakers, researchers and food industry are making “critical decisions in the dark”.
The briefing states that with decades-old data to work from, New Zealand is “essentially flying blind when it comes to knowing what and how people are eating, and hence how best to improve population eating habits, nutrition and health”.
The survey, it says, provides vital information on food and nutrient intakes, household food security and the overall nutritional status of the population.
“It’s really hard to say how to prevent diet-related diseases effectively and im-prove nutrition if we don’t actually know what New Zealanders are eating,” says Ni Mhurchu. For example, the experts can’t back a tax on sugary drinks if they don’t know if consumers are getting most of their sugar from sweet drinks.
“We don’t really know where people are getting the most of their sugar from any more, because the data we’re working with is 20 years old.”
School lunch mystery
Another example, she says, is the school lunch programme (see here for the Listener’s January story on the programme). It’s hard to say what impact those controversial school lunches are having on the nutrition of children or their families. A recent independent assessment for the Public Health Communication Centre of some School Lunch Collective meals found they provided only about half the energy expected for a school lunch and less than a fifth of the daily energy requirements for growing teens. The 13 meals for which sufficient nutritional information was available failed to meet the Ministry of Education’s own nutrition standards. Ni Mhurchu says this could have a long-term effect on children’s health.
Experts who create population-level guidelines on how we should be eating face similar challenges. Professor Clare Wall, head of Auckland University’s School of Medical Sciences, was recently appointed by the Ministry of Health to chair the technical advisory group to review official Eating and Activity Guidelines for two- to 18-year-olds – the first time the guidelines have been looked at since 2012.
Wall and her team will have no new nutrition survey data to go on when they make their updates. The group will use the best available evidence, she explains, including looking at the recommendations in other countries. But “it’s very hard not having the National Nutrition Survey, because when we’re writing the document and looking at the evidence base, we can’t put it into that New Zealand context. We are quite unique from a food point of view and a cultural point of view.”
In the past 20 years, the experts note, not only has our population changed, but also the food environment we live in.
“Thinking about our children, the type of food environment they’re being brought up in compared to 20 years ago is very, very different,” says Wall.
Overseas data shows ultra-processed foods now contribute up to 50% of total energy intake in some populations. “It would be really useful to know what that is in New Zealand,” she says.
Community activist Dave Letele runs BBM (Buttabean Motivation) fitness and nutrition programmes in South and West Auckland aimed at people with obesity and other long-term health conditions. He says he’s noticed definite changes in the food available in his community over the 11 years he’s been operating.
“It’s a healthy food desert here,” he says. “I mean, it’s always been bad. We’re surrounded with everything bad. But if anything, I’ve probably seen an increase in the amount of bad stuff that’s available for us.
“People often talk about choices, but it’s a lot harder to make the right choice if you’re surrounded by bad options. Especially if you’re a busy parent; not only are you poor, you’re time poor. So you get what’s readily accessible. It’s always cheap and crap, nasty food that you take home to your family – and round and round the cycle goes.”
Although Wall suspects increased exposure to fast food and junk food might be causing nutritional deficiencies, without an up-to-date survey “we have no biomarkers, so we don’t know what the nutritional deficiencies of children are”.
Nearly 90% of countries worldwide have a huge burden of malnutrition, either under- or over-nutrition, she says. In that light, it seems negligent not to be able to have a really good understanding of children’s nutritional status “because they are our future. If we want to prevent them getting sick and being unproductive economically, then it’s simple: improve their nutritional status.”
Dietary changes
As a researcher, Ni Mhurchu can easily reel off a list of things she’d like to know from new data. “We know there are big disparities in nutrition between Māori and Pacific and other New Zealanders. But we don’t know whether anything has changed [since 2009].”
Though it’s clear that much has changed in what and how New Zealanders eat, it’s hard to know whether that’s been beneficial or not. “Have things like online food delivery platforms and Uber Eats affected the amount of fast food we’re eating? Has the fact consumers have become more aware about sugar – and industry is therefore putting more non-sugar sweeteners into food – been a good thing? Are our sugar intakes dropping, or are we compensating somewhere else?
“We know people are more interested in things like gluten-free diets and paleo diets and keto diets. It’s potentially a good thing, but we actually don’t know [if that’s the case].”
It’s not just the future of younger people’s health that concerns Ni Mhurchu. Older New Zealanders are known to have different nutritional needs and dietary habits, but it’s hard to know whether these raise issues. Overseas research shows deficiencies can be common in older people “but we can’t say anything about our New Zealand older people.”
Public health initiatives such as iodising salt – which Health NZ says has significantly reduced iodine deficiency since the 1930s – and the more recent legislated addition of folic acid to flour used in commercial breadmaking should be monitored, too, she says.
Flour is fortified with folic acid to try and reduce neural tube defects but without up-to-date research, it’s not known if this has been effective or even if it’s actually increased people’s folic acid levels, particularly for the target group, women of childbearing age.
Industry, too
Food manufacturers and food technologists are equally keen to get a clearer picture of what and how we’re eating. says Food and Grocery Council chief executive Raewyn Bleakley. “Many of our member companies have internal nutrition policies to ensure the companies are contributing positively to healthier dietary patterns. The survey would help build a better picture to identify nutritional gaps or risks … which provides the opportunity to develop new foods, or market existing foods to help address those gaps.”
The data would help with new product development and the reformulation of existing products, Bleakley says, noting this is something food companies invest heavily in. Without it, it’s unclear whether product changes have an impact. She cites the addition of fibre to foods as an example. “Being able to understand the impacts on overall diet and specific demographic groups would be valuable.”
Penny pinching
The estimated $15m cost seems to be the major reason a national nutrition survey has not been done in so long. A succession of health ministers has acknowledged a survey is important, but also that it’s too costly.
Associate Health Minister Matt Doocey, whose responsibilities include nutrition, told the Listener in a statement there are no plans to conduct a survey at this stage.
A ministry spokesperson went a little further. “While there is broad agreement across academia, industry and government on the value of a National Nutrition Survey, this also needs to be balanced with other health system priorities.”
Otago’s Jim Mann emphasises the burden on the health system from diseases linked to diet.
It is huge. Cardiovascular disease is our No 1 killer, colorectal cancer is significant, [as are] post-menopausal breast cancer and of course type 2 diabetes. I don’t know how you can say this is not a priority.
The estimated cost is roughly the same as “one medium-sized traffic roundabout”, or about $3 per New Zealander. Compared with the costs of managing type 2 diabetes – $2 billion a year and predicted to rise to $3.5b in the next 20 years – the cost is “miniscule”, says the joint briefing paper.
BBM’s Dave Letele supports the need for research, but says he doesn’t need it to tell him what he sees on the ground – that unhealthy food is having an impact.
“It’ll be great to have that research. It’s a huge cost, but it would [bring] a huge saving – as long as they do the right thing with it.
“But it’d be a lot cheaper to just come and walk around here. Have a look around, talk to people, talk to the groups that are doing the work, and you’ll get a pretty good picture. For a lot less money.”
Middle ground
Reviving a nutrition survey would not mean starting from scratch, the reseachers say. The tools and methods have already been developed, as part of the Nutrition Survey and Development project led by Ni Mhurchu and completed two years ago.
She says the briefing paper was partly intended to remind policy makers that the ministry has made a considerable investment in this area already. “That’s a million dollars of public funding that has not been leveraged now.”
And there are new methods such as digital tools to make data collection more efficient, along with updated questionnaires.
Ni Mhurchu suggests looking at overseas models to come up with a survey that’s easier and more cost effective. “I think we’re a little bit fixated in New Zealand on doing that very big traditional, old-style nutrition survey. Other countries are starting to do them differently, like having rolling surveys with smaller numbers of people.”
The Australian government has just completed another National Nutrition Survey, and both the UK and US have continuous rolling national surveys.
There’s also the possibility of funding coming from other sources, such as industry – something Ni Mhurchu is cautiously open to. She says it would be better for the food industry not to fund a nutrition survey.
“But we don’t live in a perfect world. If I put a very pragmatic hat on, I think our best chance of getting a nutrition survey funded in the current environment in New Zealand may be through a consortium of funders. And there could well be a place for the industry to contribute funding.”
But she says some very clear ground rules would need to be established.
To that end, Mann and his fellow public health experts and representatives from industry, NGOs and the Ministry of Health will soon meet to discuss how a survey could be done under a different funding model. It’s too important, they say, to ignore.
Snacks on demand
Information is sparse but several clues suggest our diets fall short of the optimum.
In the vacuum of information caused by not having National Nutrition Survey data, health researchers and food companies are left with a patchwork of information about what and how Kiwis are eating.
“The only up-to-date data we have is from individual studies,” says the Food and Grocery Council’s Raewyn Bleakley, “but these have their limitations as they are not nationally representative. We can also look at sales data, but again, it’s not a complete dataset or an accurate measure of individuals’ consumption. And it lacks the detail about how something is consumed.
“For example, we may know people eat potatoes or quinoa, but not who’s eating it, or how it is prepared.”
Glimpses of our diets are provided by the Ministry of Health’s New Zealand Health Survey – though this is broad strokes only and doesn’t cover all foods. Then there’s the Growing Up in New Zealand study, which covers one cohort over their lifetimes. It’s useful up to a point, says Clare Wall, head of the University of Auckland’s school of medical sciences.
“It’s okay for looking at food groups and looking at adherence to the food groups, but it’s no good for looking at nutritional status or nutrient intake.”
Wall notes ad hoc projects are going on all the time, including student research “that might be quite useful. But they’re not robust enough to be an evidence base to inform a [healthy eating] guideline.”
Useful snapshots come from industry-led research, too. They include:
■ Snacking instead of meals is popular. According to its 2024 State of Snacking report, food giant Mondelēz International found more than a quarter of New Zealanders (27%) said they preferred to skip breakfast in favour of a snack, rising to 40% of Gen Z (aged18-26). Almost half of this age group also preferred a late-night snack to having an evening meal.
■ Our takeaway behaviour has changed as food deliveries became popular. Uber Eats says it has fulfilled 70 million food orders in 10 years of operation in New Zealand. The food delivery app now operates in 29 centres. In 2019, a Christchurch kebab shop’s “meat on chips” topped the rankings of the most-ordered late-night dish.
■ We’re not eating enough veges. According to the 2023/24 New Zealand Health Survey, just one in 11 adults (9.1%) ate the recommended daily amount of vegetables (5-6 servings, depending on age and gender). We’re doing better on fruit: just under half of us manage two serves of fruit a day.
■ We may have reached “peak meat”. Meat consumption may be on the way down, according to a 2021 report by AgResearch and Lincoln University. The study found that, on average, each New Zealander ate 75.2kg of meat (including chicken) in 2019, down from 86.7kg in 2000. We were eating less beef and lamb in favour of more chicken and pork.