New Profit Opportunities in Health and Nutrition to 2009: Changing Consumer Concerns and Market Influencers in Food and Drinks doc

Table of Contents New Profit Opportunities in Health and Nutrition to 2009 Changing consumer concerns and market influencers in food and drinks Identifying consumers’ health concerns

C O N S U M E R

NEW PROFIT OPPORTUNITIES IN

HEALTH AND NUTRITION TO 2009

Changing consumer concerns and market influencers in

food and drinks

By Helen Lewis

Helen Lewis

Helen has worked for Business Insights managing the Consumer Goods publishing

division for more than three years Helen has a strong background in journalism, market

research and analysis and a Journalism BA (Hons) from City University in London She

has written for numerous lifestyle and food and drinks websites including www.a-z.com

and www.crushguide.com and worked for MORI Helen is currently studying nutrition

and will be a fully qualified practising nutritionist in mid-2005

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Table of Contents

New Profit Opportunities in Health and Nutrition to 2009

Changing consumer concerns and market influencers in food

and drinks

Identifying consumers’ health concerns 10

Profitability hotspots and innovation opportunities 11

Conclusions and profit opportunities by market category 13

Identifying the main health-related issues influencing the food and drinks

Who/what is accountable for the rising levels of obesity? 26

What factors are causing obesity in children? 27 What factors are causing obesity in adults? 28 Obesity case study: Weight Watchers’ reinvention 28

Diabetic food and drinks 32

Dieting choices – far too many to choose from? 37

Low fat/low calorie diets remain the most popular for consumers 39

Promoting a long-standing breakfast product as a diet food 40

Glycaemic Index: the next big thing? 42

New Zealand strongly in favour of GI 45

The small issue of exercise… 48

Over the last six months, how often have you exercised, on average, per

The impact of food scares on consumers’ perceptions of the food and

Asia 54 Russia 55 Africa 56 Australia 56

Are consumers likely to accept GM foods into their daily diet over the next

Steady market growth expected for the healthy food and drinks market 61

How successful in terms of sales do you believe the next five years will be globally for the health food and drinks market? 61

Most profitable target audiences for health food and drinks 62

The most successful healthy food and drinks sectors to 2009 65

Future success potential of functional food and drink products 67 With all this activity, are consumers prepared to pay a premium price for

Senior consumers are ready and waiting for functional and healthy products

Low carb versus low calorie competition assessment 76

Introduction 81

Launching a successful new product is difficult enough, let alone launching a

Which healthy brands/private labels are consumers most interested in? 81

Cadbury’s easily beats the diet products in terms of consumption 82

South Africa: the first prebiotic brand in the UK 90 United States: low calorie ready meals 91

United States: soy burger to replace veggie burger 91

Products sold on their omega content 96

The food and drink industry’s reaction and future action 99

Sodium reductions already made in some processed food sectors 100

Vegetarian and meat-free products 104

The future potential for vegetarian/meat-free products in the next five years 104

Branded, high quality, healthy vegetarian products are the way forward 106

Innovative vegetarian/healthy product launches 106

Opportunities By Market Category 110

Sources of gluten that have to be avoided on a gluten-free diet 121 Manufacturers of gluten-free products 122 Glutano – manufacturing gluten-free products 122

List of Figures

Figure 1.1: Highly important consumer concerns with a view to the potential future impact on

Figure 2.3: What are the most popular diets according to the consumers? 40

Figure 2.4: Is the GI diet set to become the next big dieting trend? 43

Figure 2.6: Is exercise as important as dieting to consumers? How often do consumers exercise

Figure 2.7: What impact do you believe food scares such as BSE/CJD and bird flu have had on

consumers’ perceptions of the food and drinks industry? 50 Figure 2.8: Are consumers increasingly likely to accept GM foods into their daily diet over the

Figure 3.9: How successful in terms of sales do you believe the next five years will be globally for

Figure 3.10: Age groups expected to experience the most NPD activity over the next five years 63

Figure 3.11: What do you perceive to be the most profitable health food and drinks sectors over the

Figure 3.12: How do you perceive the future success of the following functional products over the

Figure 3.13: Consumers’ willingness to pay a premium for functional versus organic 69

Figure 3.14: Profitability hotspots in the healthy food and drinks arena at present 74

Figure 3.15: Profitability hotspots in the healthy food and drinks arena by 2009 76

Figure 4.16: Cadbury’s easily beats the diet product examples in terms of consumption 82

Figure 4.17: Have you purchased any of the following retailer’s private label products in the past

Figure 4.20: Future forecast: top 10 successful healthy food products to 2009 88

Figure 4.23: Vegetarian-friendly cereals with added health benefits, soya milkshakes and meat-free

List of Tables

Table 1.1: Rating the importance of the influence of 11 consumer concerns on the development

Table 2.2: Do you think the food and drinks industry should be held responsible for the rising

Table 2.3: How important do you consider the following factors in the controversial debate on

Table 2.4: How important do you consider the following factors in the controversial debate on

Table 2.5: Prevalence of diabetes in the seven major markets 31

Table 2.6: Which of the following diets have consumers tried in the past? 40

Table 2.7: What impact do you believe food scares such as BSE/CJD and bird flu have had on

consumers’ perception of the food and drinks industry? 51 Table 3.8: How successful in terms of sales do you believe the next five years will be globally for

Table 3.9: Age groups expected to experience the most NPD activity over the next five years 63

Table 3.10: What do you perceive to be the most successful health food and drinks sectors over the

Table 3.11: Future success potential of functional food and drink products 67

Table 3.12: Profitability hotspots in the healthy food and drinks arena at present 73

Table 3.13: Profitability hotspots in the healthy food and drinks arena by 2009 75

Table 3.14: Low carb versus low calorie competition assessment 77

Table 4.15: Have you purchased any products from the following companies/brands in the past 12

Table 4.16: Perceptions of healthy drink products to 2009 86

Table 4.17: Perceptions of healthy food products to 2009 87

Table 4.18: Lessons to be learned by the food and drinks industry from the growing skincare

Table 4.20: Food and drinks companies plans to reduce levels of salt in their products 103

Table 4.21: What is the future potential for vegetarian/meat-free products in the next five years?

Executive Summary

Executive Summary

Identifying consumers’ health concerns

Many food and drinks companies can work to offer another option to people who

are overweight or obese by clearer labelling, healthier ingredients and intelligent

marketing and promotions

An unhealthy diet as a child often results in a permanently unhealthy lifestyle

throughout adulthood with 44% of the industry respondents citing this as a very

important factor

The prevalence of diabetes is rising rapidly, up from 30 million globally in 1985 to a

forecast 300 million in 2005 This reflects growth of the ageing population, adoption

of unhealthy diets, obesity and sedentary lifestyles

Breakfast is highlighted as a crucial meal for diabetics and as a result, a number of

products such as jam and marmalades have been launched to cater for this market

Manufacturers and retailers have a responsibility to inform consumers about what

they are eating and drinking, this can be anything from how much sugar and fat the

product contains to the glycaemic index

Despite the high level of interest in new diet concepts such as Atkins, nearly 60% of

UK consumers surveyed had tried a low fat/low calorie diet

The Glycaemic Index diet (the GI diet) is expected to increase in popularity over the

next five years with a predicted growth of 18% in terms of ‘high profitability’

The varying degree of food scares however does mean that some situations remain

at the back of consumers’ minds more than others and nearly a quarter of

respondents stated that food scares do have a long-term negative impact

The industry appears to be quite uncertain as to the future of GM foods – the mixed

message is being translated to the consumers

Profitability hotspots and innovation opportunities

90% of industry executives believe functional food and drinks are likely to be highly

or fairly profitable over the next five years

One out of every 10 persons is now 60 years or above; by 2050, one out of five will

be 60 years or older; and by 2150, one out of three persons will be 60 years or older

Glico Dairy Products in Japan has introduced a new yoghurt that meets the demands

of consumers seeking both healthy and indulgent foods The company has

introduced a probiotic yogurt with bifidobacterium, made with whole blueberries (a

source of antioxidants), plus five fruit juices (lemon, apple, raspberry, grapefruit and

passion fruit), finished off with white rum

‘Low carb’ is the most profitable hotspot at present with 42% of industry executives

believing it to be ‘highly profitable’ and 37% citing it as ‘profitable’

While low carb is currently regarded as the number one profitability hotspot it is

extremely interesting to note that this trend is not expected to continue with such

high levels of success

Kids remain the focus in the food and drinks industry – even when it comes to

healthy food and drinks The ultimate new product for kids would be healthy, loved

by both parents and children and eaten as much as a chocolate bar or packet of

crisps

In Denmark, Kellogg’s cereals have been under fire, followed by a ban of 12 new

cereals and six energy bars The Danish Veterinary and Food Administration

(DVFA) rejected the products on the grounds that the levels of iron, calcium,

vitamin B6 and folic acid were too high

New product development

All major supermarkets now have their own healthy eating ranges offering

everything from ready meals to biscuits, however, Sainsbury’s is the outstanding

leader according to the UK consumers surveyed for this report

Of the selected healthy drink products, functional drinks in general are perceived as

being the most successful for the next five years, this is closely followed by energy

drinks which were viewed by 21% of respondents are ‘very successful’ and an

extremely significant 53% think it will be ‘successful’

Lessons can be learned from Asia Pacific, particularly Japan, which is the most

advanced market in terms of consumer usage and acceptance of functional food and

drinks For example, Japan’s Snow Brand Milk Products announced in September

2004 that it would shortly announce findings on research that it says will lead to

more functional foods that could provide the same powerful benefits as mother’s

milk

The personal care market has long recognised the profit potential of targeting senior

consumers; with an ageing population comes a natural desire to prevent the ageing

process, however, it is only recently that the food and drinks industry has started to

recognise this potential and begun to promote the anti-ageing properties of specific

products

Omega-3 fatty acids are a form of polyunsaturated fats, one of four basic types of fat

that the body derives from food All polyunsaturated fats, including the omega-3s,

are increasingly recognised as important to human health

Not all anti-ageing products have to be ‘super-foods’ that are enhanced with new

ingredients and technology Fresh fruit and vegetables contain many of the

antioxidants, vitamins and minerals that are essential for a healthy balanced

(anti-ageing) diet

Conclusions and profit opportunities by market

category

Making health claims can be a legal minefield, with differing rules in different

countries, but highlighting that products contain specific ingredients will be helpful

to consumers who are already increasingly building the knowledge of which

ingredients are linked to which concerns and push your product to the front of their

shopping list

Dairy foods containing health-promoting bacteria are an important segment of the

functional foods market Wide ranges of health benefits have been attributed to

specific strains of lactic acid bacteria (e.g., Bifidobacterium, Lactobacillus) or foods

containing these probiotic cultures

Consumers are often more attracted to the idea of supplementing their diet naturally

than through nutraceuticals and chemically enhanced products/supplements

Making health claims when promoting alcohol is a controversial and often ill-advised

step for alcoholic drinks companies In the United States, wine labels promoting

health benefits of moderate wine drinking met strong opposition

39% of industry executives believe that gluten-free products will be very

successful/successful over the next five years compared to 32% for wheat-free

products

Gluten-free diets are not the same as wheat-free diets as consumers on a wheat-free

diet can safely include other cereals in their diet, only excluding wheat However,

anyone on a gluten-free diet must avoid all gluten in wheat, barley, rye and oats

Premium canned food may seem like an oxymoron to many people but there is

potential for this market to develop with careful consideration of ingredients,

flavourings and ‘added’ value such as added vitamins and minerals

Chapter 1

Introduction to the Report

Chapter 1 Introduction to the Report

Aim of the report

The aim of this report is to investigate the opinions of food and drinks executives with

regards to some of the major issues influencing the industry across the UK, Europe,

Asia and the United States This investigation will help food and drink industry

executives understand some of the many, complex reasons why consumers purchase

specific products and identifies future concerns and issues that are expected to influence

their purchasing and eating habits – being aware of the potential future consumer trends

and concerns will not only enhance NPD success but also assist in targeted, intelligent

marketing and advertising plans

Health is a ‘glocal’ concern - while many food and drinks issues and regulations remain

local, health continues to be a global worry Consumers want to live longer, healthier

and happier and often turn to food and drink products for the answers Consumers are

increasingly refer to nutrition instead of, or as well as, medicine in an attempt to prevent

and cure a range of illnesses and ailments from allergies and skin disorders to diabetes

Food and drinks manufacturers are strongly advised to take heed of this growing

consumer interest in nutrition and enhance this by promoting the product’s health

benefits where possible

Consumers are aware of the influence of what they eat and that it makes a big difference

to energy levels, mood and self-esteem However, the notion that food and drink is

positive rather than negative, fattening, unhealthy or expensive is still not fully

understood by consumers or the industry itself When we choose foods rich in protective

factors such as fruits and vegetables we are also doing something positive for our health

and wellbeing – this positive image can be portrayed through the ‘4 P’s’ of marketing to

encourage new customers and customer loyalty

Understanding consumers’ health concerns and the relationship between nutrition and

purchasing habits unlocks the door to new profit opportunities and growth strategies

Consumers are becoming increasingly self-aware and self-medicating More and more

people understand the effects of probiotics, the health benefits associated with a

meat-reduction diet and the role of antioxidants in ageing and skincare The industry needs to

not only keep up with consumers’ requirements and education but also help continue

this positive relationship with food and drinks through new product development,

marketing, promotions, distribution and sourcing This report will help industry

executives work with consumers more effectively and open new revenue streams to all

companies whether they are involved in the healthy eating and drinking arena or not

In order to produce this report, a number of industry opinion surveys were conducted

throughout 2004 to gain access to the highly influential opinions of your peers and

competitors

Overall, 4,000 senior industry executives were surveyed and more than 1,250

respondents contributed to the findings of this report Around 30% of respondents were

based in the UK, 30% in Europe, 30% from the United States and 10% from Asia

Pacific The respondents all hold senior level executive positions within the food and

drinks industry ranging from Managing Director to Marketing Manager and NPD

Directors

The ‘Consumer Concerns and Healthy Issues’ industry opinion survey attracted

responses from 255 senior food and drinks industry executives from around the

globe and was conducted in July 2004;

the ‘Future Innovations in Food and Drinks’ industry opinion survey attracted

responses from 323 industry executives and was conducted in June 2004;

the ‘Healthy and Diet Food and Drinks’ consumer survey attracted 159 responses

from consumers in the UK and was conducted in April 2004;

the ‘Health Issues: Low Carbohydrate Diets, Obesity’ industry opinion survey

attracted responses from 519 industry executives and was conducted in March 2004

This report aims to quantify the future potential profitability hotspots, new product

development options and marketing streams based on a firm understanding of the major

consumer health concerns influencing purchasing decisions and eating habits

Identifying the main health-related issues influencing the food and drinks

industry at present

There are clearly more health-related issues that consumers could be concerned about

than there is space for in one report, however, 11 major concerns have been identified

that have an effect on varying sectors of the population This report will address the

following with a strong focus on the first eight:

mental health – stress;

mental health – depression;

pre and antenatal care;

bone health;

eating disorders such as anorexia bulimia

The three most important consumer concerns with a view to the potential future impact

on food and drink development are obesity, heart disease and cancer Globally, the

increasing weight of the population is the ‘hot’ issue at present, fuelled by the media

interest, particularly in light of the rising numbers of obese children 77% of industry

executives believe obesity to be highly important in terms of the future development of

the food and drinks world

The order of importance is demonstrated in the following table, with obesity being

classified as the most important and influential compared to just 11% of respondents

regarding skincare as highly important

Table 1.1: Rating the importance of the influence of 11 consumer concerns

on the development of the food and drinks industry

Highly important Important Quite important Not important

9 Eating disorders –

10 Mental health – depression13% 33% 34% 19%

*Rated in order of ‘highly important’ scores

Source: Consumer concerns and healthy issues industry opinion survey, August 2004 Business Insights

Figure 1.1: Highly important consumer concerns with a view to the potential

future impact on food and drink development

Chapter 2

Identifying Consumers’ Health

Concerns

Chapter 2 Identifying Consumers’

Health Concerns

Summary

Many food and drinks companies can work to offer another option to people who

are overweight or obese by clearer labelling, healthier ingredients and intelligent

marketing and promotions

An unhealthy diet as a child often results in a permanently unhealthy lifestyle

throughout adulthood with 44% of the industry respondents citing this as a very

important factor

The prevalence of diabetes is rising rapidly, up from 30 million globally in 1985 to

a forecast 300 million in 2005 This reflects growth of the ageing population,

adoption of unhealthy diets, obesity and sedentary lifestyles

Breakfast is highlighted as a crucial meal for diabetics and as a result, a number of

products such as jams and marmalades have been launched and are now well

established to cater for this market

Manufacturers and retailers have a responsibility to inform consumers about what

they are eating and drinking, this can be anything from how much sugar and fat the

product contains to the glycaemic index

Despite the high level of interest in new diet concepts such as Atkins, nearly 60%

of UK consumers surveyed had tried a more traditional low fat/low calorie diet

The Glycaemic Index diet (the GI diet) is expected to increase in popularity over

the next five years with a predicted growth of 18% in terms of ‘high profitability’

The varying degree of food scares means that some situations remain at the back

of consumers’ minds more than others and nearly a quarter of respondents stated

that food scares do have a long-term negative impact

The industry appears to be quite uncertain as to the future of GM foods – this

mixed message is being translated to the consumers

Introduction

This chapter considers some of the primary consumer health concerns from a food and

drinks manufacturer, retailer and supplier perspective: obesity, diabetes, dieting (with a

focus on the glycaemic index diet), exercise – or rather the lack of exercise, food scares

and genetically modified food

Obesity

A definition

Overweight refers to increased body weight in relation to height, when compared to

some standard of acceptable or desirable weight Obesity is defined as an excessively

high amount of body fat or adipose tissue in relation to lean body mass

Generally, men who have more than 25% body fat and women with more than 35%

body fat are considered obese Fat distribution in these individuals usually takes two

forms: central abdominal or android obesity (apple shaped figures) and gluteofemoral or

gynoid obesity (pear shaped figures) ‘Apples’ (typical of men) can be distinguished

from ‘pears’ (typical of women) by calculating a waist-to-hip ratio (WHR) A WHR of

0.8 or lower is usually found in women and a WHR of 0.85 or higher is usually found in

men A waist circumference that exceeds 102 cm (40 inches) in men or 97 cm (38

inches) in women is sometimes considered to be android obesity, but this has little

significance, as it does not take into account an individual’s height or bone structure

Additionally, the distribution as well as amount of fat has other health implications:

central abdominal fat is the major contributor to insulin resistance and risk of diabetes,

hypertension and cardiovascular disease

The health consequences of obesity range from day-to-day non-fatal complaints such as

respiratory difficulties, skin problems and infertility to those promoting premature death

consumer concern with the quality of life being threatened due to social stigma,

difficulty in getting employment and an associated lack of confidence

The unhealthy facts

An estimated 61% of U.S adults are either overweight or obese The proportion of

children and adolescents in the United States who are overweight has more than

doubled since the early 1970s, with about 13% being seriously overweight;

the prevalence of obesity has increased by about 10% to 40% in the majority of

European countries over the last decadei;

in the UK alone, a quarter of men and one-fifth of women are considered to be

obese according to figures released by the Food Standards Agency and the

Department of Health;

in Germany, 17.2% of men and 19.3% of women are classified as obese, with 19%

of Finnish men and women also obese Interestingly, while 27.9% of Russian women

are obese, only 10.8% of men there areii;

countries with lower obesity rates include France (9.6% of men, 10.5% of women),

the Netherlands (8.4% of men, 8.3% women) and Italy (6.5% of men, 6.3% of

women);

short-term treatment of obesity with pharmaceutical drugs is seldom warranted

because obesity is a chronic condition that requires long-term treatment Only three

drugs are currently available: phentermine, a short-term therapy, and orlistat and

sibutramine, both suitable for long-term treatment This explains the current drive

towards ‘healthy eating’ and diet plans for people who are overweight and obese

and want to see quick results such as the Atkins Diet;

the current obesity healthcare market is worth just less than $800 million and has the

potential to expand to around $1.6 billion by 2010 Expansion will primarily be

driven by the reimbursement and wider availability of anti-obesity therapies, based

on the growing realisation that treatment leads to a reduction in expensive

co-morbidities and mortality;

an example of a drug used to combat obesity is Abbott’s Reductil, which began to

experience problems in 2002 when regulatory authorities and consumer groups

voiced concerns over the product’s safety However, sales continued to grow,

reaching $272 million in 2002;

several investigational approaches to weight loss are being examined in clinical trials,

ranging from the creation of new appetite suppressants to agents that act as fat

blockers and drugs that hasten burning of stored body fat A considerable amount of

research is being expended on 3-agonists, which expedite energy burning without

additional physical exertion;

many food and drinks companies can offer another option to people who are

overweight or obese by clearer labelling, healthier ingredients and intelligent

marketing and promotions

Nutritional influence

Excessive dietary fat intake has been implicated in the root cause of obesity for decades

However, this only represents one factor in the complex nature of the condition

Weight-for-weight, fat provides more energy than carbohydrate or protein It may

contribute to obesity independently of its role in energy balance, it can influence food

intake, energy metabolism and substrate oxidation, and it has a weak satiety effect

A nutritional study compared fat intake of normal weight, moderately obese and

consumed significantly more fat and cholesterol and less carbohydrate than normal

weight subjectsiii Obese participants also had higher intakes of saturated, monosaturated

and polyunsaturated fat compared with normal weight subjects A positive association

was also found between dietary fat and obesity after adjusting for age, total energy

intake, physical activity level and smoking status

Who/what is accountable for the rising levels of

obesity?

The obesity debate is raging around the world and a whole host of factors have been

held to blame for the increase including parents, schools, the government, food and

drinks companies and the media

Industry executives were asked whether they thought the food and drinks industry

should be held responsible for the rising levels of obesity in children Just 6% agreed the

industry was wholly responsible, while the majority (59%) accepted responsibility in

some respects

Table 2.2: Do you think the food and drinks industry should be held

responsible for the rising levels of obesity in children?

Source: Obesity, Low-Carb Diets and the Atkins Revolution Industry Opinion Survey, April 2004

Business Insights

According to Janine Wilson, an independent nutritionist based in the UK: “The rising

levels of obesity are due to a combination of factors but food and drinks companies need

iii

Alfieri et al., 1997

to act more responsibly and governments should come down harder on manufacturers to

play their part Targeting children with unhealthy foods lacking in any nutrients in school

vending machines is an example of irresponsible behaviour.” Ms Wilson added: “Crisps

manufacturers offering sports equipment is an oxymoron”

The UK’s Food Standards Agency (supported by The Health Education Trust and The

Dairy Council) launched a guide for schools in October 2004 on how to set up healthy

vending machines and make a profit in secondary schools by selling healthier drinks such

as milk, pure fruit juice and water The report outlines eight main points for schools to

remember when setting up a vending machine such as: ‘Encourage pupils to devise a

marketing or promotional campaign for the new machines as part of their studies’

Adults versus children

What factors are causing obesity in children?

In order to get a clearer picture regarding the potentially influential subjects contributing

to child obesity, the respondents were asked to grade factors such as ‘large portion

sizes’ and ‘increased snacking’ The unique, overwhelmingly important factor was lack

of exercise, with 85% of respondents citing it as ‘very important’

Table 2.3: How important do you consider the following factors in the

controversial debate on rising levels of obesity in children?

Very important Important Average importance Low importance

Nutritionally poor school

Decline in the traditional

High fat and/or carbohydrate

Poor labelling on food and

Source: Consumer concerns and healthy issues industry opinion survey, August 2004 Business Insights

What factors are causing obesity in adults?

Research indicates that adult males are more likely to be overweight than adult females,

but the situation is reversed when it comes to obesity An unhealthy diet as a child often

results in a permanently unhealthy lifestyle throughout adulthood with 44% of the

industry respondents citing this as a very important factor For both children (85%) and

adults (79%), a lack of exercise is regarded as the most significant factor in the rising

levels of obesity Interestingly, portion sizes are viewed as more of a contributory factor

to obesity in adults than in children

Table 2.4: How important do you consider the following factors in the

controversial debate on rising levels of obesity in adults?

Very important Important Average importance Low importance

Unhealthy eating habits as a

Decline in the traditional

High fat and/or carbohydrate

Poor labelling on food and

Source: Consumer concerns and healthy issues industry opinion survey, August 2004 Business Insights

Obesity case study: Weight Watchers’ reinvention

Weight Watchers is an established brand, diet and product in 30 countries, however, it

has experienced difficulties recently as a result of the rise in competitor diets In the

second quarter of 2004, Weight Watchers International, Inc announced that its

consolidated net revenues had increased by 2.3% to $264.9 million, compared to $258.9

million in the prior year period Net income was $52.9 million, a decrease of 1.7% from

$53.8 million in the second quarter of 2003

In an attempt to regain its position as a leading diet and brand, Weight Watchers

introduced a new programme in the United States and Canada in August 2004 called

TurnAround The aim of the programme is to work with consumers’ changing dietary

requirements, providing them with another option to the more regimented, points-led

diet The coaching and person-to-person elements of the original Weight Watchers

system remain

There are two food plans on the TurnAround programme called the FlexPlan and the

Core Plan The Flex Plan maintains the points system, which allows consumers to eat

what they want according to the number of points they can consume in one day The

Core Plan places more emphasis on the types of food being eaten with a core list of

wholesome, nutritious foods There is no tracking or counting involved in this plan

One of the major hurdles for dieters is portion size and the Core Plan takes this into

account by encouraging people to eat low-energy density foods that are low in calories

and discouraging those foods linked with overeating This is in direct competition with

the Atkins Diet, which allows consumers to eat certain food products in less restricted

portion sizes until they feel full

In order to ensure the new diet would be effective, tests were carried out with more than

10,000 people According to Karen Miller-Kovach, Chief Scientific Officer at Weight

Watchers International: “Interestingly, we did not find that one demographic group

prefers the Core Plan while another prefers the Flex Plan Instead, the determining factor

was based on a very personal sense of what constitutes 'freedom.' Some people felt the

Flex Plan provided them more freedom because it offered the entire range of foods,

while others felt that the Core Plan was more freeing because it focused on wholesome

foods without counting”

The programme targets the majority of consumers who are looking for flexibility in their

weight loss rather than sticking to one regimented diet People can switch between the

plans depending on their circumstances, if they get bored or if their weight loss slows

down

Diabetes

A definition

Diabetes mellitus is a chronic metabolic disorder characterised by high levels of blood

glucose It results from failure of the body to produce insulin and/or an inability of the

body to respond adequately to insulin secreted Insulin is a hormone that is produced in

the pancreas and that enables the glucose released during digestion to enter the body’s

cells as a source of energy A consequence of diabetes is a build-up of glucose in the

blood, which passes out of the body as urine, thereby depriving the body of its main

source of fuel High blood glucose – hyperglycaemia – is the main problem arising from

diabetes and can lead to the development of serious complications and premature death

if left unchecked or poorly controlled

There are three main categories of diabetes, two of which can be controlled to varying

degrees by nutrition:

Type 1 diabetes is usually first diagnosed in children, teenagers, or young adults In this

form of diabetes, the beta cells of the pancreas no longer make insulin because the

body's immune system has attacked and destroyed them Treatment typically offered for

type 1 diabetes includes taking insulin shots or using an insulin pump, healthy eating,

exercising regularly, taking aspirin daily, and controlling blood pressure and cholesterol

Type 2 diabetes is the most common form of diabetes People can develop type 2

diabetes at any age In type 2 diabetes, the pancreas does not make enough insulin, and

the fat, muscle, or liver cells do not use it properly Being overweight can increase the

chances of developing type 2 diabetes Treatment typically recommended includes using

diabetes medicines, making wise food choices, healthy eating, taking aspirin daily, and

controlling blood pressure and cholesterol

Gestational diabetes - some women develop gestational diabetes during the late stages

of pregnancy Although this form of diabetes usually goes away after the baby is born, a

woman who has had it is more likely to develop type 2 diabetes later in life Gestational

diabetes is caused by the hormones of pregnancy or a shortage of insulin

The unhealthy facts

Cardiovascular disease is the leading cause of death in type I and type II diabetics,

accounting for 52% and 46% of all mortality, respectively;

the prevalence of diabetes is rising rapidly, up from 30 million globally in 1985 to a

forecast 300 million in 2005 This reflects growth of the ageing population, adoption

of unhealthy diets, obesity and sedentary lifestyles

Table 2.5: Prevalence of diabetes in the seven major markets

Country Type I Type II Total diabetic pop n CAGR 2002-10 (%)

Diabetic food and drinks

Diabetics are advised to follow a balanced healthy diet, as recommended for the rest of

the population — low in fat, sugar and salt, with plenty of fruit and vegetables and

meals based on starchy foods, such as bread, potatoes, cereals, pasta and rice

Healthy meal recommendations

Breakfast iv

All breakfast cereals are fine especially high fibre cereals;

low fat monounsaturated/polyunsaturated margarine or spreads;

semi-skimmed/skimmed milk;

unsweetened fruit juice, fresh, dried or canned fruit in a juice;

breads or toast;

intense sweeteners e.g Canderel, Hermesetas or Sweetex are available in tablet or

granulated form if required;

grilled rather than fried cooked breakfasts, ideally should include starchy

carbohydrates such as bread or hash browns

Lunch and dinner

Lunch should not be missed to ensure a balanced food intake throughout the whole

day;

iv

Diabetes UK

should be based on starchy foods and include plenty of vegetables and fruits Fried

and pastry dishes should be limited Ensure ready-prepared meals are balanced, by

serving them with starchy foods and extra vegetables or salads;

it is recommended that meals end with fruit-based desserts

Diabetic-friendly products

A range of diabetic products is available on retailer and pharmacy shelves across many

categories; most of these are marketed as sugar-free and ‘diabetic-friendly’ These

products were extremely popular in the 1960s when doctors regularly recommended

incorporating them into a healthy diet to help control diabetes Recent criticism has been

directed towards the manufacturers of products aimed at diabetics The products are

typically positioned as premium products and subsequently priced higher than the

standard version They are also often marketed as ‘healthy’ thanks to the low sugar

content; however, this is not always the case Often, the sugar substitute used in the

products can be as fattening as sugar itself There are also issues with the salt levels in

some products

The European Commission is at present assessing how foods aimed specifically at

people with diabetes can be controlled

In 1984, UK legislation was introduced to give criteria for the composition of ‘diabetic’

foods Products labelled ‘diabetic’ were no longer permitted to contain more fat and

energy than comparable foods And any product that did not offer a 50% reduction in

energy content had to carry a warning saying ‘not suitable for the overweight’

On March 1, 1995, the rules on the composition of ‘diabetic’ foods were removed

because by that time healthy eating advice for people with diabetes was the same as for

other people

The Food Standards Agency advises manufacturers that the use of ‘diabetic’ claims is

not necessary The use of nutrition claims such as ‘sugar free’ is currently being

discussed at European Union (EU) level

Consumers are expected to increasingly demand products to directly fit their dietary

requirements, however, with a growing awareness of health issues, consumers require

more information in terms of nutrition labelling and ingredients information As some

companies have already experienced, consumers are not content simply with a reduction

in sugar levels if they are diabetic

There is no single food that experts recommend be excluded from the diet of diabetics

and the total avoidance of sugar is no longer considered necessary Diabetic foods are

typically a range of confectionery items such as cakes, biscuits, chocolates and jams that

are sweetened with nutritive sweetening agents such as sorbitol and fructose instead of

ordinary sucrose It is now accepted that ordinary cakes and biscuits can be consumed

as part of a balanced diet without being detrimental to diabetes control

Product opportunities

Breakfast is highlighted as a crucial meal for diabetics and as a result, a number of

products such as jam and marmalades have been launched to cater for this market

However, further opportunities remain for manufacturers, which produce breakfast

products for anyone following a healthy and balanced diet A study, which was

presented at the American Heart Association's 43rd Annual Conference in 2003 on

Cardiovascular Disease Epidemiology and Prevention, surveyed 2,681 young adults

over a period of eight years “In comparison to those who reported eating breakfast

twice per week or less often, those reporting eating breakfast every day had 35% to

50% lower rates of developing obesity and insulin resistance syndrome,” according to

researcher Dr Mark A Pereira

Diabetes UK offers specific recommendations when it comes to diabetics choosing

breakfast products:

Cereals based on oats are recommended to keep blood glucose under control, but

portion sizes must be monitored;

full-fat milk is not advised to serve with the cereal;

diabetics are advised to check the salt levels on the nutrition labels as some breakfast

items can contain high levels;

fruit is recommended to bulk up or increase the appeal of breakfast products

Ingredients

Tagatose

Many ingredients have been patented for use in diabetic products Kellogg’s in the

United States received a U.S patent for the use of tagatose in products such as

ready-to-eat cereals Its use in products aimed at diabetics is based on its main benefit that it

does not lead to a rise in glycaemic index It is also said to have a prebiotic effect A

spokesperson for Spherix (the company that manufactures tagatose) did note that the

patent award does not mean Kellogg will actually ever incorporate tagatose into any of

its products

Arla Foods began commercial production of tagatose in 2003 in partnership with the

German sugar producer, Nordzucker, having formed a 50/50 joint venture called

Sweetgredients

In April 2004, Spherix announced that Food Standards Australia New Zealand

(FSANZ) approved the firm's tagatose sweetener for use in foods Tagatose is expected

to be used in breakfast cereals, carbonated diet soft drinks, non-carbonated diet soft

drinks, low-fat and fat-free ice cream, low-fat frozen dairy desserts, diet/health bars, diet

soft confectionery, hard confectionery, icings/frostings, and special purpose foods/meal

replacements

Chromium

Chromium is an essential mineral that is made by the body and must also be obtained

from food and drinks Research shows that chromium enhances the effects of insulin to

help glucose move from the bloodstream to the cells, rather than stimulating the body to

make more insulin Chromium is useful in alleviating insulin resistance and is said to

benefit individuals with diabetes, who are trying to control their blood sugar Recent

studies support the claim that chromium picolinate lowers total cholesterol, triglycerides

and LDL cholesterol levels while raising HDL levels There are numerous studies

indicating that for people interested in weight management, which is often associated

with diabetes, chromium can reduce fat mass, increase lean body mass and lower body

weight

Natural sources of chromium include brewer’s yeast, beef, liver, whole wheat, rye, fresh

chillies, oysters, potatoes, wheat germ, green peppers, eggs, chicken, apples, butter,

bananas and butter There is no recommended daily allowance of chromium although

nutritionists and dieticians recommend approximately 100-200 mcg daily

Chromium picolinate, sold under the Chromax® brand is marketed as a dietary

nutritional supplement in capsules and tablets Nutrition 21 Inc., Purchase, New York,

has undergone a self-affirmed generally recognised as safe (GRAS) process, allowing

the mineral to be used as an ingredient in foods such as beverages and nutrition bars

Chromax was showcased at the American Diabetes Association 64th Scientific Session

“Complementary and Alternative Therapies for Diabetes” Dr Anderson, a leading U.S

Department of Agriculture nutrition research scientist, provided evidence showing that

chromium supplementation may lead to improvements in glucose and insulin metabolism

in people with glucose intolerance, depression and gestational and type 2 diabetes In

association with the improvements in insulin function, supplemental chromium also

improves blood lipids and decreases the risk factors associated with cardiovascular

diseases Dr Anderson's data showed that stresses on the body, including high sugar

diets, strenuous exercise, pregnancy, lactation, infection, physical trauma and

glucocorticoid treatment increase chromium losses

There are a number of other food products that are believed to assist with diabetes:

Fibres such as bran – studies of people who consume a high fibre diet (50g or

more per day) indicate that these individuals have a decreased risk for many

diseases, including diabetes;

ginseng – treatment with an extract of ginseng has been found by scientists at the

University of Chicago to normalise blood sugar levels and boost the way insulin

works The extract was injected once a day into mice with a gene defect that causes

weight gain and Type 2 diabetes The scientists found blood-glucose levels fell from

222 mg/dl (quite high for a mouse) to 137 mg/dl (normal) within 12 days Diabetic

mice, which were also obese, lost more than 10% of their body weight in 12 days

Untreated mice gained 5% of their weight in 12 days The treated mice ate 15% less

and were 35% more active than untreated mice Treated diabetic mice had 30%

lower cholesterol levels than untreated diabetic mice;

antioxidants – lipid oxidation increases in diabetics and is thought to be partially

responsible for kidney damage A number of published clinical studies find vitamin E

supplementation to be of potential benefit, as well as other antioxidants such as

a-lipoic acid

Dieting choices – far too many to choose from?

Consumers are inundated with mixed messages and lifestyle and diet options; from the

most promoted and long-standing diets such as the healthy balanced diet to the extreme

and bizarre fad diets - the watercress soup diet Manufacturers and retailers have a

responsibility to inform consumers about what they are eating and drinking, this can be

anything from how much sugar and fat the product contains to the glycaemic index The

pressure on food and drinks companies to provide further nutritional information is

increasing but like the consumers, it is difficult to keep up with the latest dietary trend or

fad Consumer concerns are limitless, however, it is possible to identify the most

pressing concerns and popular diets and work with these

According to nutritionist Amanda Reuter: “No diet is worth embarking on if you cannot

keep it up for the rest of your life Short-term diets are the extreme and will result in

yo-yo dieting, which in the long run will restrict weight loss” However, many consumers

who seek a quick fix ignore this message

While it should be noted that many people do not like to admit to being on a diet, 36%

of consumers surveyed had not followed a diet in the previous 12 months At the time,

31% of respondents considered themselves to be following a healthy eating planv

The typical length of a diet

The majority of respondents had started a diet less than a week ago, which would

indicate that many people do not last long on specific diets or they do not regard dieting

as a long-term necessity However, the next most popular response was ‘more than

three months’

v ‘Healthy and Diet Food and Drinks’ consumer survey attracted 159 responses from consumers in the

UK and was conducted in April 2004

Figure 2.2: How long is the typical diet?

Less than a week About two weeks About three weeks

About four weeks More than a month More than two months

More than three months

Source: Obesity, Low-Carb and Atkins Revolution Industry Opinion Survey April 2004

Low fat/low calorie diets remain the most popular for consumers

Despite the high level of interest in new diet concepts such as Atkins, nearly 60% of UK

consumers surveyed had tried a low fat/low calorie diet Other branded

low-carbohydrate diets did not fare so well, with only two and four consumers trying the

Zone or South Beach diets respectively, although low-carbohydrate diets in general

were popular – a combined 57% of consumers had tried one in some form Only 19% of

the sample had attempted to diet on the Slim-Fast plan, and only 7% had used diet pills

Interestingly, the Kellogg’s diet, which was heavily marketed through the Kellogg’s

breakfast cereals television adverts and magazines, attracted nearly 12% of consumers

(see page 40 for further detail) This is an example of a successful marketing and

re-positioning idea to target health-conscious consumers 41% of respondents said they

had tried other, unnamed diet plans, which included:

Scarsdale diet;

Slimming World;

Weight Watchers;

Cabbage Soup diet;

personal healthy eating diet;

“eat less, exercise more”;

Figure 2.3: What are the most popular diets according to the consumers?

The

Sout

Beac

h diet

Any

othe

r low-car

Oth (ple

ase

specify)

Source: Healthy and Diet Food and Drinks CONSUMER Survey, May 2004 Business Insights

Table 2.6: Which of the following diets have consumers tried in the past?

Diet Percentage of consumers

Any other low-carbohydrate diet 15%

The Kellogg's cereal diet 12%

Low fat/low calorie diet 59%

Other (please specify) 41%

Source: Healthy and Diet Food and Drinks CONSUMER Survey, May 2004 Business Insights

Promoting a long-standing breakfast product as a diet food

Cereals moved away from solely being a breakfast product a long time ago, with many

people opting for a bowl of cereal as a snack between meals However, Kellogg's has

re-positioned cereals even further to what the company terms a ‘shape management food’