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2007/08 Should the National Heart Foundation have given its tick of approval to nine McDonald's meals? ? <BR>

2007/08 Should the National Heart Foundation have given its tick of approval to nine McDonald's meals?


What they said ...
'McDonald's does not have the Tick. Only nine specific meals at McDonald's have earned the Tick by meeting the Heart Foundation's strict nutrition standards and committing to the most rigorous independent auditing of food outlets anywhere in Australia '
The National Heart Foundation

'My fear is that this will just mislead people. The tick will just encourage more people to go to McDonald's because it's healthier now, but when they get there the evidence shows they don't necessarily make the healthy choice'
Dr Rosemary Stanton, an author and independent nutritionist

The issue at a glance
On February 5, 2007, nine of the meals offered by McDonald's were given the National Heart Foundation's Tick of approval. This is the first time McDonald's has received such an endorsement of any of its products from a recognised health authority.
The development has met with a mixed response. Some dieticians and medical authorities have expressed concern that the Foundation now appears to be approving the consumption of fast food and that this could send a dangerous message to consumers.
Those who think the National Heart Foundation has taken a positive step in becoming involved with McDonald's have stressed the importance of improving and then regulating the food offered for sale by Australia's fast food outlets.

Background
[Much of the following information can be found at the National Heart Foundation's Internet site.]
Cardiovascular disease (heart, stroke and blood vessel disease) is the leading cause of death and disability in Australia, claiming the lives of 50,294 people in 2002, or 38% of all deaths. Around 3.67 million Australians are affected by cardiovascular disease. 1.10 million Australians are disabled long-term by cardiovascular disease.
The Heart Foundation is concerned about the increasing rise in overweight and obesity, and considers work in this area a high priority. Overweight and obesity are recognised as serious health, social and economic problems. Excess weight is clearly linked with an increased risk of ill health and death from heart and
vascular diseases. People who are overweight or obese have a higher risk of ill health including coronary heart disease, stroke, congestive heart failure and Type 2 diabetes.

The Tick approval system
The 'Tick' is the Heart Foundation's guide to help people make healthier food choices quickly and easily. It also encourages food manufacturers and food outlets to develop or modify products and meals so that they meet the Heart Foundation's nutrition standards. In general, Tick approved foods and meals have met strict standards for saturated fat, trans fat, salt and where appropriate, kilojoules and fibre, and with meals the Foundation also monitors serve size.
Guidelines for Tick Approval are developed and reviewed by the Tick Criteria Working Group which has expertise in human nutrition and public health. This Working Group uses a range of information when setting criteria, such as Heart Foundation nutrition policies, Australian Dietary Guidelines, consumption data, nutrient functionality and market data of similar food products.

Internet information
On February 6, 2007, the ABC's World Today program announced that the National Heart Foundation had given its Tick of approval to nine McDonald's meals. The program included comments from spokespeople for the Foundation and McDonald's as well as a prominent nutritionist who approved of the Foundation's action.
The full transcript of the program can be found at http://www.abc.net.au/worldtoday/content/2007/s1841333.htm

The National Heart Foundation's Internet site can be found at http://www.heartfoundation.com.au/
The site contains information on the aims of the Foundation, its Tick program and its funding arrangements. It also has a section through which the Foundation's media releases can be accessed.

The National Heart Foundation's media release announcing that nine of McDonald's meals had earned a tick of approval from the Foundation can be found at http://www.heartfoundation.com.au/media/Tick_Media_Release_2007-02-05.pdf
The release was dated February 5, 2007.

On February 5, 2007, the National Heart Foundation released a second media statement outlining the impact the changes it had required would have on McDonald's menus.
This release can be found at http://www.heartfoundation.com.au/downloads/Tick_nut_bckgrndr_2007-02-05.pdf

The National Heart Foundation has also responded to eight commonly asked questions indicating concern about the Foundation's association with McDonald's. These nquestions and answers can be found at http://www.heartfoundation.com.au/index.cfm?page=1239&IsVal=0

On November 6, 2006, the National Heart Foundation announced that Qantas was the first food outlet to have its meals receive a tick of approval under the new 'meals eaten out' program. The media release detailing how Qantas acquired the Foundation's endorsement can be found at http://www.heartfoundation.com.au/downloads/Tick_MediaRelease_Qantas_2006-11-06_FINAL.pdf

SAI Global, the testing and compliance agency responsible for monitoring McDonald's adherence to the Heart Foundation's standards has explained what it will be testing for. This information can be found on SAI Global's Internet site at http://www.sai-global.com/Corporate/ThinkingBusiness/2006/10-12/Features/OuttoLunch.htm

On February 7, 2007, The Sydney Morning Herald published an analysis by it consumer affairs reporter, Kelly Burke, titled, 'Deal with fast food giant faces grilling'. The analysis focused on the reservations a number of nutritionists and the Australian Medical Association have about the National Heart Foundation having given its Tick of approval to nine McDonald's meals.
The analysis can be found at http://www.smh.com.au/news/national/deal-with-fast-food-giant-faces-grilling/2007/02/06/1170524096371.html

On January 31, 2007, The Sydney Morning Herald published a report titled, 'Fried and tested: four years on' detailing the lengthy delay between agreeing to remove trans fats from its foods and the company actually doing so. The article can be found at http://www.smh.com.au/news/world/fried-and-tested-four-years-on-mcdonalds-new-oil-makes-menu/2007/01/30/1169919338587.html

On February 7, 2007, the president of the Australian Medical Association, Dr Mukesh Haikerwal, released a media statement indicating the association's serious reservations about the National Heart Foundation having approved nine McDonald's meals. Dr Haikerwal suggested the Foundation had been 'hamburgled'. The full text of this release can be found at http://www.ama.com.au/web.nsf/doc/WEEN-6Y6UJS

Arguments against the tick of approval for some McDonald's meals
1. The tick of approval may encourage consumers to eat other, less healthy, McDonald's foods
It has been suggested that the National Heart Foundation's tick of approval may simply encourage more people into McDonald's restaurants and that once inside they will purchase the less healthy options rather than those that have received the endorsement.
Dr Rosemary Stanton, an author and independent nutritionist, has stated, 'My fear is that this will just mislead people. The tick will just encourage more people to go to McDonald's because it's healthier now, but when they get there the evidence shows they don't necessarily make the healthy choice.'
VicHealth chief executive Rob Moodie has raised similar doubts. Mr Moodie has stated, 'If there's any sense that they're going to simply sell more junk food on the basis of improving their marketability and reputation and using it as a smokescreen, then I would be very concerned.'
A similar view has been expressed by Professor Louise Baur, from The Children's Hospital at Westmead. Professor Baur has claimed that MacDonald's needed to concentrate more on marketing its healthy menu options to children, rather than the high-fat standards currently so popular.
The professor expressed concern that the fast food chain's healthier image might merely entice more people with good intentions but weak resolve.
'We know that when McDonald's started selling its [Lighter Choices] a while back, the sales of burgers and fries went up,' Professor Baur said. 'More people felt comfortable going there, but they weren't necessarily ordering the healthier alternatives once they got to the counter.'

2. The supposed tick of approval may make consumers less wary about the health risks associated with fast food
Concern has been expressed that some of the National Heart Foundation's ticks of approval are relative judgments and as such they may encourage consumers to accept harmful foods. It has been noted that a relative judgement says no more than 'Of foods of this type, this is the healthiest option.' Yet such qualified judgements are often seen as full endorsements and so lead people to be less concerned about the health consequences of eating products such as fast food.
The relative nature of the National Heart Foundation's tick of approval can be seen in its application to Four and Twenty's low fat pie.
The Heart Foundation's communications manager for the tick program, Monique Blunden, has agreed that the meat pie's 'nutrients of concern' include saturated fats, trans fats, salt and fibre and concedes that although the approved meat pie is less damaging than the alternatives, it is still not healthy.
Blunden has compared the situation with the emergence of HIV. '...health authorities were quite realistic in understanding they weren't going to stop people having sex, so they asked people to use a condom.
We know people will eat meat pies, and we'd much rather they ate a tuna salad, but we know that they're going to eat meat pies . . . What we say to people is that if you must eat a pie, the one with a tick is the healthier choice.'
Critics of this philosophy argue that it blurs distinctions for consumers. According to this argument, consumers are likely to see the tick as a recommendation telling them the ticked product is safe to consume. In the case of fast food, it is claimed, this would be a dangerous conclusion to draw.

3. McDonald's is using the National Heart Foundation as a marketing ploy
Concern has been expressed that McDonald's may merely be attempting to polish its image as a marketing device. According to this view the changes it has made may be little more than window dressing designed to alley the fears of parents and others with concerns about the health risks associated with fast food.
The president of the Australian Medical Association, Mukesh Haikerwal, has suggested, 'These "less unhealthy" meals could very well be loss-leaders to get people through the door and expose them to the toys, chips and burgers that have contributed to the serious obesity and overweight problems in Australia, especially among kids.'
Critics have pointed to other apparently positive steps McDonald's has taken as essentially image manipulation. These supposed marketing ploys have included establishing 'McDonald's houses' for ill children and their families needing accommodation while the children undergo treatment and setting up a McDonald's outlet within the Royal Children's Hospital in Melbourne.
McDonald's has been criticised for market-driven cynicism in actions such as the above. The corporation's critics have noted in contrast how slow McDonald's has been in removing damaging trans fats from its products.
More than four years after promising to eliminate trans fat oil from its french fries, in January 2007 McDonald's finally decided to change its oil.
It announced in 2002 that it would replace the oil by February 2003 - but despite an international move against the unhealthy product, it did not implement the change. Over the some period other fast food outlets such as Wendy's, KFC and Taco Bell found alternatives.
The company's chief executive, Jim Skinner, is reported to have told an investor conference in New York toward the end of 2006, "It's just taking a little bit of time because as we move forward we don't want to jeopardise the iconic nature of the french fry, which as you know is so very important to our brand." Such statements have led critics of the company to suggest that its primary concerns are commercial, not the wellbeing of those who consume its products.

4. Giving a tick to McDonald's and other 'meals eaten out' outlets is likely to undermine the National Heart Foundation's system of approvals
In August of 2006 the National Heart Foundation extended its tick system to include 'meals eaten out'. Concern has been expressed that this move will reduce the validity of the Foundation's approval system. Despite the promise of regular checks to ensure that the meals produced continue to conform to the standards set, there are those who fear that the system is unmanageable and that there is unacceptable scope for food outlets to deviate from the agreed requirements.
The risk of food outlets not conforming to the National Heart Foundation's standards was acknowledged when the Foundation announced its 'meals eaten out' program in August 2006.
The Heart Foundation's communications manager for the tick program, Monique Blunden, stated, 'We are particularly concerned with nutrition standards, as you would well imagine, but because food when you're eating out is made by people, rather than machines, there's obviously a lot of variation that can take place with these meals... so the other real pinnacle for the criteria is obviously going to be around maintaining very strict quality standards... ensuring that this meal can be replicated to our very high standards and be the same every time.'
The level of supervision required to ensure that standards are adhered to would be expensive. At the moment it is intended that these cost be met by the outlet that has received the Heart Foundation's endorsement. It seems likely that the outlet will then pass that cost on to the consumer. A time may well come when either it is not feasible to supervise food production often enough to ensure compliance or when the cost of such supervision becomes too much for the food outlet or the consumer to bear. Either development would reduce the real worth of the Heart Foundation's endorsement.

5. The National Heart Foundation may have damaged its own credibility
Concern has been expressed that in giving its official tick to nine McDonald's menu options the National Heart Foundation may have seriously undermined the credibility of its endorsements in the minds of both consumers and those manufacturers who have previously sought the Foundation's approval.
In a comment published in The Australian on February 8, 2007, Simon Canning argued, 'The announcement that nine meals have been awarded the heart tick will be welcomed by some. But the question is, can the tick stretch to accommodate the fast-food giant?
In many people's minds fast food is synonymous with fat and there is a real danger ... that the McDonald's alliance could undermine the value of the heart tick.
There are plenty of companies out there that, having paid their Heart Foundation licensing fees and reaped the benefits of the organisation's marketing power, will now be asking whether the McDonald's deal is in the interests of Heart Foundation's own health. If McNuggets are now officially a healthy food option, what hope is there?'
In addition concern has been expressed that like all recipients of the National Heart Foundation's tick, McDonald's will be paying the cost of checking to ensure that it is continuing to comply with the Foundation's standards. It has been suggested that this arrangement leaves room for doubt in the public mind about the integrity of the Foundation's judgments. It could appear that McDonald's is paying the Foundation $330,000 a year to purchase its approval tick.
This point was made in an editorial published in The Age on February 7, 2007. The editorial stated, 'McDonald's, in order to earn and maintain its tick, is paying the NHF $330,000 a year, which it says is not for profit but to cover the costs of weekly testing of the ticked meals. In other words, the company reimburses the foundation in order to acquire and retain the foundation's approval. It is neither the most efficient nor the most desirable system, as it always leaves room for doubt on matters of purpose or integrity.'

Arguments in favour of the tick of approval for some McDonald's meals
1. The National Heart Foundation applies rigorous standards to those products that are awarded its tick
On its Internet site the National Heart Foundation has explained the four step process it applies to any food outlet some of whose products have received its Tick of approval.
The first step requires that the food outlet uses 'Fresh ingredients, cooked right'. It is required to 'Modify key ingredients and cooking methods to reduce saturated and trans fat, salt, serve size and increase vegetables so meal meets Heart Foundation nutrition standards.'
The second step requires 'Regular audits to prove outlets follow the approved recipe'. The food outlet also 'Must have Hazards Analysis Critical Control Points (HACCP)-based food safety program and quality systems to even apply for the Tick. Then face the most rigorous independent random testing of meals and procedures anywhere in Australia.'
The third step requires that the food outlet 'Serve it up right with truthful nutrition information'.
This means the approved meal must be served 'As a meal, not a snack - [with] no substitutions or upsizing.' It also means that the outlet must supply 'Accurate nutrition information for customers and no misleading health claims. Heart
Foundation checks all their ads, brochures, signage and more.'
And finally the Heart Foundation retains the right to remove its Tick of approval from an product or outlet if it does not meet the strict standards applied. As the Foundation states on its Internet site 'Get it all right or lose the Tick. Sign the 12 month contract to ensure they're committed. Break it - and they're out.'
The Heart Foundation has employed the independent tester is SAI Global, Australia's leading auditor. SAI Global helped the Heart Foundation build the most rigorous auditing process of food outlets in Australia and now conduct unannounced audits of meals and procedures in food outlets with the Tick. The nutrition analysis of meals is completed by AgriQuality Australia.

2. McDonald's has had to make significant changes to have nine of its products awarded the National Heart Foundation tick of approval
McDonald's Australia worked with the Heart Foundation for12 months, modifying its recipes to reduce the levels of salt, saturated fat and kilojoules, virtually eliminate trans fat use and add more vegetables to each approved meal.
The salt content in McDonald's deli-style bread rolls was cut by more than 40 per cent.
The result of these modifications was that nine meal combinations eventually met the Foundation's demands which were that there be less than 2 per cent saturated fat, virtually no trans fat, and a minimum 75-gram serve of vegetables in every meal. Further, each meal must not provide more than a third of an adult's daily energy needs.
Monique Blunden, the communications manager for the Foundation's tick program, said the ingredient changes made to the new McDonald's menu, which will come into effect by the end of February, meant that even the standard Big Mac, fries and soft drink would be marginally more healthy than the original.
Real health benefits would result if people substitute their typical fast food order with, for example, the tick-approved meal of lean beef burger, garden salad and orange juice. This would result in a 70 per cent reduction in saturated fat, a third less salt and half the kilojoules.
The Foundation has claimed that if just 10 per cent of customers make such a swap, collectively they will remove 294 tonnes of saturated fat from their diet each year.
The Heart Foundation has been careful to stress that its tick of approval has been given to nine McDonald's meals and to these meals only. Thus the tick of approval does not apply to everything McDonald's sells and is not an endorsement of fast food generally.
On its Internet site the Foundation has stated, 'McDonald's does not have the Tick. Only nine specific meals at McDonald's have earned the Tick by meeting the Heart Foundation's strict nutrition standards and committing to the most rigorous independent auditing of food outlets anywhere in Australia.'

3. It is important to improve the products offered for sale through fast food outlets
Nearly one in three Australians eats out every day, adding up to 3.8 billion meals eaten out each year. In response to this situation the National Heart Foundation decided in August 2006 to launch a program which would enable it to influence the quality of food offered in restaurants and fast food outlets.
Supporters of the National Heart Foundation's 'meals eaten out' endorsement program have argued that it is important that the Foundation try to improve the ready-cooked food offered for sale to the Australian consumer.
David Lloyd, the chief operating officer at the Baker Heart Research Institute, has stated, 'The decision to venture into the lion's den to try to improve the food Macca's serves up was ...gutsy. By deciding on this course, the Foundation gave itself a chance to make a real difference. The claim can now be made that at least nine combination meals served up at these restaurants are, if not good for you, then at least less bad for you than they otherwise might have been.
This is only incremental progress, but it's progress nonetheless. Cardiovascular disease is the leading cause of death and disability around the world. In Australia, someone dies of cardiovascular disease every 10 minutes, representing more than 40 per cent of all deaths. It's the greatest health burden we face and much of it is brought on by the rubbish we eat. The Foundation's view has been that it cannot responsibly see what McDonald's is serving up and NOT try to influence it - a very principled position for the organisation to have taken.'

4. McDonald's performance will be regularly monitored
To maintain the Tick's credibility and to ensure a genuine effect on consumer health, Tick approved meals must consistently meet appropriate nutrition standards. As far as the retail market is concerned, compliance audits can be conducted by simply selecting random samples from supermarket shelves.
However, to achieve impartiality in food service auditing, random samples need to be taken while the meals are being served, usually at the busiest times of the day.
McDonald's will allow twice-weekly independent audits at randomly selected outlets.
All 747 Tick-licensed commercial outlets will be subject to regular, unannounced compliance audits from SAI Global. (SAI Global is an applied information services company that helps organizations manage risk and achieve compliance to particular standards. It will conduct surveys, process checks and audits and prepare reports.) Some features of the 'meals eaten out' audits include:
Sampling randomly-selected Tick meals for laboratory testing against established nutrition criteria.
Testing staff knowledge, training and technique.
Examination of quality and safety control systems and record keeping.
Any outlet that does not meet these rigorous tests is failing to uphold the Tick standard and runs the risk of being suspended from the Program.
Staff will be trained to ensure meals are consistently prepared to the Tick's nutrition standards.
On its Internet site the National Heart Foundation has stated, 'The Heart Foundation ensures Tick approved meals at any outlet are genuinely healthier meals because we test outlets as they create meals, cook them, serve them and advertise them. On average, McDonald's faces twice weekly random audits by an independent auditor who will test Tick approved meals and procedures in a McDonald's restaurant somewhere around Australia. This is the most rigorous independent auditing of food outlets anywhere in Australia.'

5. The money McDonald's has paid the National Heart Foundation is to meet the costs of monitoring its approved products
There have been criticisms that the National Heart Foundation has compromised its integrity by having McDonald's pay $330,000 annually toward the cost of monitoring whether all its outlets are adhering to the Foundation's standards in preparing the nine meals that have been given a Tick.
On its Internet site the Foundation explains 'Once a company has met all the Heart Foundation's strict standards to earn the Tick, it is charged a licence fee. Testing recipes and ingredients and having inspectors at food outlets ensuring everything continues to meet these standards is a direct cost to the Heart Foundation which we then pass on to McDonald's. This is the most rigorous independent auditing of food outlets anywhere in Australia.'
The National Heart Foundation is a non-profit organisation. It is not structured in a way which would allow it to gather moneys from companies some of whose products it has approved and then pass that money on to directors or others.
The National Heart Foundation has continued to stress that rather than the money it has received from companies like McDonald's placing it in a sound financial situation it still relies exclusively on public donations to do its important work.
On its Internet site the Foundation states, 'Donations are the only way the Heart Foundation has been able to fund vital life-saving research into cardiovascular disease. Fees from the Tick Program only cover the cost of running the Tick; there is nowhere near enough to fund vital Heart Foundation research and health programs. Similarly, not one cent of donor funds are used to run the Tick Program so donations to the Heart Foundation are as valued as ever.'
The National Heart Foundation has claimed, 'As a non-profit, non-government organization, the Heart Foundation uses these fees to run the Tick Program. They are the sole source of income for the Tick. Fees contribute towards: educating consumers and health professionals about the Tick and its role in good nutrition and randomly testing Tick foods or meals to ensure they continue to meet Tick's tough standards
Supporting national nutrition research and education.'

Further implications
It is too early to determine what effect the National Heart Foundation's Tick of approval for nine McDonald's meals will have on the nutritional status of those millions of Australians who regularly consume meals beneath McDonald's arches.
There is clearly the potential for the Heart Foundation's intervention to improve not only what McDonald's offers but what its customers consume. As part of its arrangement with the Foundation McDonald's has had to reduce the sugar and salt in its buns and condiments and has also significantly reduced its use of damaging trans fats. These changes will benefit all who eat at McDonald's, irrespective of whether they eat the nine approved meals or not.
The big advantages, however, will come to those who eat one of the specifically endorsed meals. These people have the opportunity to reduce the amount of fat and the number of calories they consume while ingesting a McDonald's meal by quite marked percentages.
The question remains, however, what will the balance be. Will the Foundation's endorsement simply encourage more people to eat at McDonald's by allaying their fears about the unhealthy nature of its food? Or will it cause many established McDonald's diners to alter their choices and eat Macca's options that are far better for them?
At the moment it is not possible to say where the balance will fall. It will take some time before it becomes clear whether the National Heart Foundation's intervention has struck a valuable blow against poor quality fast food or whether it has merely promoted the consumption of burgers, fries and coke.

Newspaper items used in the compilation of this issue outline
Herald-Sun, January 3, page 21, comment (ref to McDonald's restaurants and hospitals, incl Royal Children's) by Flip Shelton, `Keep Maccas out'.
Herald-Sun, January 4, page 21, comment by Trevor Marmalade, `You can make mine Maccas'.
Herald-Sun, February 7, page 20, editorial, `Food worry'.
Herald-Sun, February 6, page 9, news item by Grant McArthur, `Healthy tick for Maccas meals'.
The Age, February 7, page 19, analysis by Carol Nader, `Is a heart foundation tick worth more to the company or the consumer?'
The Age, February 7, page 20 editorial, `Does this health-approval rating tick all the right boxes?'.
The Age, February 6, page 3, news item (with boxed information on McDonald's foods) by Carol Nader, `Just a tick, Maccas has taken health to heart'.
The Age, February 12, page 6, news item by Jill Stark, `Child obesity rate is "likely to double"'.
The Age, February 9, page 17, comment by Paul Harrison, `A tick goes far in consumers' minds'.
The Age, February 9, page 17, comment by David Lloyd, `Don't demonise the fast-food deal'.
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