by Paul A. Holmes
Everyone has heard the frightening statistics. The eating and drinking habits of Americans have been implicated in six of the ten leading causes of death in this country, including heart disease, cancer, stroke, diabetes, atherosclerosis and chronic liver disease and cirrhosis, as well as in several nonfatal but potentially debilitating disorders such as osteoporosis.   
The U.S. Surgeon General's report on nutrition and health suggests that coronary heart disease claims more than half a million lives each year. Another half million die from cancer, including an estimated one-third whose cancers are believed to have been caused by improper diet. About 35 million Americans have serious health problems related to being overweight.
"Nutrition and health professionals have routinely peppered the American public with startling statistics just like these," says Judi Adams, executive director of the Wheat Foods Council. "We knew that Americans cherished their health and longevity more than anything else, and that a few statis­tics with shock value would motivate change. But throw these facts around today and there's little, if any response.
"Study after study has shown what we should cut out, avoid or stay away from to live healthier. Reams of information, advice and seemingly contradictory research have left Americans without a clear understanding of what or how to change. We are equipped with more research-backed nutrition information than society has ever known, yet Americans are so confused and cynical that even the most basic advice falls on deaf ears."
The Wheat Council is at the forefront of such issues because bread, despite its low-fat content and usefulness in satisfying hunger, is characterized as fattening ­ by 50% of American  adults. AGallup poll commissioned by the Council recently found that 93 % of Americans eat less than the recommended six servings per day of bread and grains, but 74% think they are eating the right amount.
Recent surveys indicate that ignorance is considerably more widespread. Most consumers have little or no idea how much fat or sodium they should eat; only half the population knows how many calories per day the average adult ought to consume.
"The public's understanding of nutri­tion matters remains relatively superfi­cial," says Dr. David Kessler, commis­sioner of the Food & Drug Administration. Americans, he says, are "nutrition ignorant." The FDA's major effort to remedy this situation has been the creation of a nutrition pyramid, designed to provide consumers with a simple graphic explanation of nutritional advice.
Nancy Glick, who heads the food and nutrition practice at Hill & Knowlton's Washington office, agrees. She says that the nutrition education efforts which began in this country a decade ago have resulted in far greater knowledge of nutrition issues, but warns that a wide gap exists between what consumers know and how they behave.
"People know all the terms, but they don't necessarily know what they mean," Glick says. "There's a gap between hear­ing terms like cholesterol and under­standing them, and an even wider gap between understanding them and putting them into some kind of practice."
More alarmingly, that gap appears to be widening, as information overload sets in and consumers tire of apparently mutually contradictory messages.
The American Dietetic Association recently conducted research indicating that a third of Americans no longer want to be bothered with nutrition. Another third figure they could do better but don't want to make changes. The rest believe they are already doing all they need to do. What the ADA could not find were people who wanted help in changing their lifestyles.
Marian Burros, who writes the Eating Well column for The New York Times, also divides consumers into three categories: "The blissfully ignorant, who never pay a nickel's worth of attention to the nutritional trigger words as they come and go—calcium, fiber, choles­terol, fat; the `nutritionally correct' who have a thorough grasp of the principles of healthful eating and think brownies don't taste as good as sprouts; and [those] who wish we were like the people in group one and despise the people in group two.
"Most of the rest of us would like to do the right thing, but are totally befuddled by the mixed messages we receive from magazines, radio, television, the Federal government, advertising and, of course, our friends. We don't know whom to believe, so we fashion a personal version of healthful eating, cherry-picking advice we can live with, irrespective of its mer­its, and discarding the rest."
There is little doubt that much of the nutritional advice consumers have been receiving over the past few years has been confusing. Having been told to cut back on saturated fats and lower cholesterol, many Americans switched from butter to margarine, looked for "made with pure vegetable shortening" on packages and sought fast foods that were not fried in beef fat. Reports that walnuts and olive oil may promote cardiovascular health, many increased their consumption of these products.
Then came the news that margarine may not be so good for the heart after all, that at least some of the saturated fat in red meat does not raise cholesterol, and that overdoing the nuts and the olive oil may put on pounds that lead to an increase in cholesterol.
Food marketers are both villains and victims in this scenario. Villains because their use of health claims in labeling has often been misleading if not downright duplicitous; victims because as confusion and conflicting advice fatigue sets in, communicating any kind of nutritional message becomes almost impossible.
One of the most egregiously mislead­ing food labeling ploys has been the mar­keting of foods as "80% fat free." While such claims may theoretically be true, they are meaningless because the per­centage refers to the weight of the prod­uct, and the weight of the product may be 70 or 80% water. Bologna is 54% water; pasta al dente is 64% water; even ice-cream, which most people would acknowledge to be high-fat foods, con­tain so much water that they could advertise their products as being 80% fat free. "Science has outpaced its ability to explain itself," says Barbara Campbell, head of the food and nutrition practice at Ketchum Public Relations in New York. "The ability to communicate the tremen­dous advances science has been making is being hampered by the background of scientists and the environment they work in. They are not marketers. They are not communicators."
Campbell points to some of the top of mind issues in food marketing, such as the bovine growth hormone, a bio-engi­neered treatment that causes cows to yield more milk. The fact that most con­sumers are not scientifically literate sug­gests that BGH has to be communicated in non-scientific terms.
"There are values issues," she says. "There are religious issues. There are emotional issues. You are dealing with milk, which is a real mom-and-apple-pie kind of product. You have to address these issues on their own terms, not in scientific terms. But people who spend the majority of their lives in a laboratory, isolated from people who do not share their thrill at this new discovery, do not think in those terms."
Campbell has a grudging admiration for certain consumer activist groups, who seem to have instinctively grasped this point much more quickly than many cor­porate marketers. The communications efforts of activists who oppose new scien­tific developments like BGH, or who advocate stricter regulation of health claims, tend to be pitched at an emotion­al level, and thus are far more effective in reaching most consumers.
There is a tendency, Campbell says, for marketers to assume that purchasing decisions are driven by rational factors: price, quality, availability. The truth is that emotional factors, often ignored by quantitative, MBA-educated managers in modern corporations, are sometimes even more important.
"We are not talking enough about the benefits, about the advantages, about the pluses new products and new develop­ments can bring to people's lives," she says.
Again she points to the bovine growth hormone issue. Little has been done to communicate the benefits of the BGH to the consumer, to the point that many consumers are beginning to question whether it has any. Discussion has instead focused on the benefits to the producers, and to the biotech industry, none of which is relevant to the people who buy the product.
Another problem, Campbell says, is that science is evolutionary. When a question is answered, it generally raises more questions. Thus when scientists find that a particular ingredient has a harmful effect, that finding is rarely definitive. Further research may show that it has an off-setting beneficial effect, or that the food substituted for it in the diet has a different harmful effect, or that a slight change in the way the food is prepared can mitigate any harmful effect.
"There are times in the stages of scien­tific discovery when perhaps certain things should not be communicated," says Campbell. "There are times when we should hold off, because we do not have the complete picture."
An associated issue is the faddishness of nutrition communication, what Hill & Knowlton's Nancy Glick calls the "scare of the week" approach. In part this is a problem with the media. While it is clear that many of the nutrition messages that dietitians have been communicating over the past decade need repetition, the media regards these messages as "old news" and is more interested in new find­ings, particularly those with a fear factor built in, no matter how inconclusive the research may be.
Meanwhile, the results of ineffective nutrition communication are becoming clear, as many of the foods Americans cut from their diets over the last decade make a comeback. Retail sales of beef in the last quarter of 1993 jumped seven per cent, and traffic at casual steak houses surged 19% last year, according to the Beef Industry Council of America. The National Dairy Board reports that sales of premium ice creams were up eight per cent last year, while butter sales have rebounded to the levels of 30 years ago.
This creates problems for food mar­keters in two respects. For those who wish to make health claims, it means that those health claims are increasingly less credible. For those who have products that have been called into question by research, it creates a problem because of the increasing tendency of consumers to divide foods into "good" and "bad" and to avoid the bad altogether.
"There's a simplistic perception that McDonald's is bad," says Nancy Glick. "While carrot sticks, for example, are good. But there's no reason why people should not eat McDonald's every now and again as part of a healthy diet, while if you ate nothing but carrot sticks you would not be healthy for long."
To try to correct some of the more common myths and provide advice to those who want it, the National Center for Nutrition and Dietetics has a toll-free hotline, financed with a grant from Kraft General Foods. Kraft also underwrote the American Dietetic Association's recent nutrition-knowledge survey.
And new approaches are being tried. "Americans resent being scolded about their dietary decisions," says the Wheat Council's Judi Adams. "In the age of empowerment, Americans will resist whatever the `diet cop' says. It will take years of rethinking the way we present nutrition information to avoid the shop­worn `shame on you' technique and replace it with helpful information that contemporary consumers want to use."
Nutrition information must be pre­sented in ways that help consumers remember and act upon it, Adams says, and change must be made enjoyable.
Nancy Glick is currently working for the California Olive Commission, which has some perception problems of its own. Research conducted before the public relations program began indicated that some consumers believed there were 200 calories in an olive. In fact, there are four. What H&K did was create a pro­gram that linked olives to all the positive publicity olive oil has been receiving recently.
"In a climate where people can only absorb; so much information, the impor­tant thing is to put your message in some kind of context," says Glick. "You have to package the information in a way that means something to the consumer."
Ketchum's Barbara Campbell believes the best long-term solution, however, is a closer working relationship between mar­keting and communications professionals and scientific and research and develop­ment experts.
"There is so much we can do to help them market the science more effectively, and a great deal they can do to help us put new developments in con­text," she says.