The big issue: discretionary foods
Despite the media focus on sugar, our biggest nutritional issue is eating too many discretionary foods. The last National Health Survey results showed Australians over 2 years of age are consuming 35% of their total kilojoules as discretionary foods (1). A good start in improving this is to be clear about which foods are discretionary. It’s obvious that an apple is a core food and apple cake is discretionary but for many foods the distinction is less clear.
The Australian Dietary Guidelines (ADG) gives the following definitions:
Core food – Nutritious foods from the 5 food groups that form the basis of a healthy diet
Discretionary food– Foods high in saturated fats, sugars, salt and/or alcohol that can be included occasionally in small amounts, but are not a necessary part of the diet.
The Guide to Healthy Eating provides more practical guidance but it is not comprehensive, leaving many questions in the face of supermarkets with tens of thousands of products.
Core foods can have sugar added
Core foods from the five food groups are grouped together because they provide similar amounts of the key nutrients of that food group. For example, the milk, yoghurt, cheese and alternatives group provide calcium and protein. In many cases, even though foods may be processed in some way and have some added sugar, salt or fat, they are still core foods because they are nutrient-rich. For example, breakfast cereals and milk. Added sugar in these foods makes them more palatable. In the case of milk for children, flavoured milk is more appealing and encourages intake (2). Considering a significant proportion of children consume inadequate calcium intakes (3), flavoured milk is definitely better than no milk at all. However, when added sugars become too high even nutrient rich foods can become discretionary, for example condensed milk.
Even if sugar is added to milk or yoghurt to flavour it, flavoured milk and yoghurt are considered core foods. And the same goes for most breakfast cereals.
When it comes to breakfast cereals, a survey of products available in the Australian market found the majority (63%) contain less than 20g of total sugars per 100g, or less than two teaspoons per 40g serve (4). For the purposes of the Australian Health Survey data reporting, the Australian Bureau of Statistics (ABS) defined highly sweetened breakfast cereals with the following levels of total sugars as discretionary, ie
In reality, these high-sugar cereals are atypical. The market survey found no discretionary cereals with fruit containing more than 35g/100g total sugars, and only 15 out of 171 (9%) discretionary ready-to-eat-cereals with more than 30g total sugars per 100g.
While discretionary foods and drinks are not necessary, they add variety and enjoyment. In the case of honey, jam and marmalade, they are not consumed on their own but can increase enjoyment when added to core foods such as porridge or wholegrain bread/ toast. A comprehensive database of discretionary foods can also be found in the Australian Health Survey Users’ Guide here.
How to spot discretionary foods in the supermarket
The Health Star Rating (HSR) now appears on thousands of products. Could it be a good yardstick for determining whether a food is core or discretionary? The NSW Department of Health (DoH) recently conducted research to investigate this question and found good alignment. When they assessed 11,500 products across 30 categories they found 82% had a HSR that aligned with the ADG definition of core vs discretionary using a cut-off of 3.5 stars. They also found the HSR was better at doing this than the old ‘traffic light’ system used in schools and hospitals.
79% of foods classified as core by the ADG scored 3.5 stars or more,
86% of products less than 3.5 stars were classified as discretionary by the DGA.
Healthier discretionary foods
The DoH research found fourteen percent of foods that scored 3.5 stars or above were classified as discretionary by the ADGs. These could be described as healthier choices within the discretionary food category. The HSR rating includes fruit, protein, fibre and vegetable, nut and legume content so discretionary foods with these nutrients and ingredients score better, even if they have sugar added. For example, the following discretionary food categories contained products with added sugars with HSRs ≥3.5:
Alcohol- at your discretion
While an apple is an obvious core food, apple cider is not widely appreciated as a discretionary food. Alcoholic drinks are classified as discretionary foods and have significant potential to do harm as well as provide excessive, empty kilojoules. The last dietary survey showed alcohol was the largest contributor to discretionary food intake and provided 4.8% of total energy (1). According to ABS data, alcohol intake in Australia has increased since 2001 (5).
1. Australian Bureau of Statistics. Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12 http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Discretionary%20foods~700
2. Fayet-Moore F. Effect of flavored milk vs plain milk on total milk intake and nutrient provision in children
Nutr Rev. 2016 Jan;74(1):1-17. http://www.ncbi.nlm.nih.gov/pubmed/26534904
3. Australian Health Survey: Usual Nutrient Intakes, 2011-12- calcium. Available at URL http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008~2011-12~Main%20Features~Calcium~401
4. Grains & Legumes Nutrition Council. GLNC FY17 Grains and Legumes Product Audit. Unpublished.
5. Yusuf F, Leeder SR. Making sense of alcohol consumption data in Australia. Med J Aust 2015;203(3):128-130 https://www.mja.com.au/journal/2015/203/3/making-sense-alcohol-consumption-data-australia