Are the British and Irish really the best fruit and vegetable eaters? I doubt it | Devi Sridhar

aat the dawn of the new year, headlines reported that Britain and Ireland were ranked as “the best in the world for eating fruit and vegetables”. And this seemed surprising to me, as a public health expert. On economic grounds alone, the British import 50% of the vegetables and 84% of the fruit – largely from Europe, Africa and America. These foods are relatively expensive in Britain, average costs £11.79 per 1,000 kcal, versus £5.82 for 1,000 kcal of processed foods. And this at a time of limited family incomes. Cucumbersfor example, between 2022 and 2023, prices increased by more than 50%.

And of course, Britain and Ireland simply aren’t known for having the healthiest diets. Scotland invented the deep-fried Mars bar. Could the British really eat more fruit and vegetables than our European neighbors such as Italy, Spain, France, Denmark and Greece? I had to investigate.

I traced the stories to a linked report which was produced by the OECD, entitled Health at a Glance 2023, which compares healthcare performance in OECD countries and certain emerging economies. And yes, Figure 4.10 shows that Britain and Ireland have the highest rates of what the OECD calls “the daily consumption of five or more portions of fruit and vegetables in 2019, or the nearest year”. However, it is worth emphasizing that this data comes from before Brexit was finalized. Brexit increased total food prices by 6% and in recent years shortages of fruit and vegetables have been described as the “new normal”. So this nutritional data should first be seen as a snapshot of the past: pre-Brexit, pre-Covid-19 and pre-cost of living.

Going even further: the quality of any research lies in its methodology. Ask a senior researcher which two parts of a study he or she read first, and its methodology, followed by financial support – in short, how did the authors find the answers and how was it paid for? The OECD study is based on a previous one European health interview survey (EHIS), where people in different countries self-reported their health. People were asked to answer variations on the question “How many servings of fruits and vegetables do you eat per day?”, and their answers provided the data.

The self-report method is the standard approach to nutritional surveys. But we know about it other studies that comparing what people say they eat versus objectively measuring the nutrients they consume is systemic misreporting. People may misunderstand the question, misunderstand the sometimes arcane rules for what counts as fruits and vegetables, misjudge how much they actually eat, or even outright lie. Simply put, what people say they eat is not necessarily what they eat.

Health surveys care so much about nutrition because unhealthy diet is a major risk factor for obesity and chronic disease: an estimated 25.9% of adults in England are obese, while in the United States a further 37.9% are overweight. Health Survey for England 2021. These numbers have increased over the past decade. Britain has that too much higher levels of obesity than Greece, Spain, Germany, France or Italy. In addition to the increase in obesity, there has also been an increase in associated conditions such as diabetes, heart disease, high blood pressure and cancer.

In addition, more than 800,000 patients were admitted to hospital with malnutrition and nutritional deficiencies in England and Wales in 2022. These were largely people with a high-calorie diet that still lacked essential nutrients (such as proteins, vitamins and minerals). ). Nutritional deficiencies in childhood are reflected in height: there is clear evidence that “the greater the hardship, the shorter the child”. Data shows that children in Britain are getting smaller compared to other countries it has been claimed that the average height of a five-year-old in Britain has likely declined due to rising child poverty and Conservative austerity policies.

So Britain has major public health problems related to (but not limited to) nutrition. I don’t think anyone will dispute that.

If you want a more reliable and valid measure of how healthy a country is, child height and overall well-being are probably the best. Before we got excited about Britain being a ‘world leader’ in yet another area, the headlines should have specifically read: ‘The people of Britain and Ireland say they are the best in the world at eating fruit and vegetables.’ As we know from public health research, just because someone says they ate something doesn’t mean they actually did.