Potential Health Benefits of Citrus - ACS Publications - American

Chapter 19

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Trends in Consumer Attitudes toward Food and Health: From Food Biotechnology to Personalized Nutrition David B. Schmidt Executive Vice President, International Food Information Council, 1100 Connecticut Avenue, NW, Suite 430, Washington, DC 20036

Scientific knowledge of the health benefits of citrus and other food components is developing rapidly. For example, consumers cite oranges and orange juice more than any other food as the ones that come to mind in promoting health. Consumers obtain nutrition information from a variety of resources, including the media, food labels, and health professionals, which can contribute to confusion and frustration. In addition, information from the human genome is providing us with tremendous potential to improve the quality of human nutrition in the future. The term "nutrigenomics" has now been coined to describe a new concept in "personalized nutrition" where an individual's DNA profile will be used to better determine which foods or nutrients they should consume more or less of due to their increased risk for a particular disease or health condition. Using International Food Information Council's six years of consumer attitudinal research on functional foods and "personalized nutrition," as well as 2004 data updating consumer attitudes toward food biotechnology, this paper will provide readers the tools to effectively address the challenges and opportunities in communicating the health benefits of citrus and other food components to consumers.

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© 2006 American Chemical Society

Patil et al.; Potential Health Benefits of Citrus ACS Symposium Series; American Chemical Society: Washington, DC, 2006.


255 More than 2000 years ago, Hippocrates said, "Let food be thy medicine." This concept underlies the definition of "functional foods" used by the International Food Information Council (IFIC): any food or food component that may provide a health benefit beyond basic nutrition. Citrus products are already at the center of a number of consumer trends indicating increased interest in beneficial food components for health promotion. While citrus products have not been developed using biotechnology to date, consumer awareness and acceptance of foods produced through biotechnology remain stable despite major publicity on various unrelated animal diseases and food safety issues, according to a survey conducted in 2004 by Cogent Research (/) and commissioned by the International Food Information Council (IFIC). A majority of consumers would be likely to purchase foods modified through biotechnology to be protected from insect damage and require fewer pesticide applications (66%), or to have improved taste or freshness (54%), Additionally, consumers who have heard or read about biotechnology are significantly more likely to purchase biotech food products for these benefits. Full survey results and consumer information can be found on the IFIC Web site (http://ific.org). The survey was conducted January 2-11, 2004 by Cogent Research, Cambridge, MA, and consisted of approximately 1,000 telephone interviews among a nationally representative sample of adults 18 and older in the continental United States. IFIC is also keeping a finger on the pulse of consumer attitudes toward functional foods, such as citrus products, with its most recent quantitative survey, conducted in March 2002. Cogent Research of Cambridge, Massachusetts, conducted telephone surveys with 1,004 randomly selected U.S. adults. Those surveys provided data that build on the quantitative data collected in 1998 and 2000. Consumers find health professionals (47%) such as physicians and dietitians the most believable sources for food and nutrition information with the media at 23%. Family/friends/self were listed as most believable by 10%, the government at 9%, and only 1% listed food labels as the most believable source in an openended format. Past consumer research (2) has confirmed that consumers rely on a wide variety of information sources on food such as citrus and health and look for confirmation from each source before changing purchase behavior. In an analysis of news media coverage of food safety and nutrition known as Foodfor Thought V, commissioned by the IFIC Foundation May through July 2003, functional foods represented the leading source of benefits mentioned in print and broadcast reports. Continuing the trend since 1998, almost all consumers (94 percent) agree that certain foods have health benefits that go beyond basic nutrition and may reduce the risk of disease or other health concerns. Consumers express little familiarity with terms commonly used to describe this concept, including "functional foods" (62 percent like it, whereas 27 percent dislike it). Even less well liked is "nutraceuticals" (only 34 percent like it; 49 percent dislike it). Still, 85 percent of Americans are either "very interested" or "somewhat interested" in



256 learning more about functional foods. (3) This level of interest has been consistently strong since 1998. As in 1998 and 2000, a majority of consumers believe they have a "great amount" of control over their own health (68 percent). They overwhelmingly believe that food and nutrition play "a great role" in maintaining or improving overall health (71 percent), and the proportion is even greater than the proportion of individuals who believe that exercise (63 percent) or family health history (41 percent) is a key determinant of health. Although more than half (54 percent) of the respondents are reducing the amounts of certain foods or food components in their diets, 35 percent (compared to 36 percent in 2000 and 28 percent in 1998) (5) are adding foods or beverages for their health benefits, particularly vegetables,fruitsincluding citrus, and water. Citrus is at the top of the top 10 foods that consumers identify as having a health benefit beyond basic nutrition, [oranges or orange juice (9 percent), broccoli (9 percent), fish or fish oil (9 percent), green leafy vegetables (9 percent), carrots (8 percent), garlic (7 percent), fiber (6 percent), milk (6 percent), oats/oat bran/oatmeal (6 percent), and tomatoes (6 percent)] The foods in the top five have remained constant since 1998 and are consistently associated with America's top health concerns: cardiovascular disease and its factors, including heart disease/heart attack, high blood pressure, stroke, and high cholesterol, which remain the top collective concern of Americans (41 percent). Cancer continues to concern almost a third (30 percent) of consumers. Other health concerns that consumers mention include weight (17 percent), diabetes (17 percent), and nutrition/diet (12 percent). Overall, 44 percent of consumers associate foods or food components with a reduced risk of cancer, often naming fruits and vegetables. A slightly larger number of consumers (53 percent) associate foods with heart health, including fish or fish oil, garlic, and fiber.] Almost two-thirds (63 percent) of Americans say they are eating at least one food to receive a functional health benefit. Although these results are not significantly different from those from the survey conducted in 2000 (59 percent), they do represent a significant increase from the results obtained in the survey (5) conducted in 1998 (53 percent). When asked about specific associations between food and health, awareness of the connection between calcium and osteoporosis remains high, as was the case in 2000 (79 percent). The increasing popularity of orange juice fortified with calcium may contribute to this high awareness. Fewer Americans are aware of the association between antioxidants and cancer (54 percent), and fewer still know about the heart health benefits of soy protein (35 percent). Those who had heard of these associations were asked how much they had heard: 64 percent had heard "a lot" about the calcium-osteoporosis relationship, whereas only 34 percent had heard "a lot" about antioxidants cancer relationship and 23 percent had heard "a lot" about soy protein-heart disease relationship. Therefore, in addition to fewer consumers actually hearing about the last two relationships, those consumers are also hearing only "a little" about them.



257 The relatively recent determinations of relationships between soy protein and heart disease and between antioxidants and cancer may help to explain why belief in the efficacies of these relationships is lower than that for the efficacy of the calcium-osteoporosis relationship. Compared to the results for 2000, fewer consumers (59 percent) believe in the efficacy of the soy protein/heart disease relationship. Slightly more believe in the efficacy of the antioxidant-cancer relationship (66 percent). It's a different story for calcium-osteoporosis relationship, with 91 percent of consumers believing in the efficacy of the relationship. The differences in the levels of belief in the effectiveness of these relationships lie first in the length of exposure to the information—the health benefits of calcium have been discussed in detail for many years, and calcium-fortified orange juice is now widely available. Also, a wide range of communicators from health professionals to journalists to government officials have extolled the health benefits of calcium against osteoporosis. In addition, Americans are less familiar with food sources of soy protein and antioxidants, and some consumers who did not like the taste of early soy products are unaware of new ones. Additionally, lower levels of belief in the efficacy of an association may be related to hearing relatively less about the association. For functional foods to deliver their potential public health benefits, consumers need a clear understanding of and a strong level of confidence in the scientific criteria that are used to document health effects and claims. When communicating about functional foods, it is important to translate quality science into understandable and usable messages that meet consumer needs. The following are specific communication strategies: (1) Cite the need for credible, scientific criteria as the basis for messages about functional foods and the development of new food products. (2) Accentuate the "good news" about food. (3) Place new research findings into context with the overall body of scientific evidence. (4) Discuss the benefits of particular components within the context of familiar foods and overall eating patterns. (5) Do not overstate potential benefits, and ensure that any claims made on- or off-label are based on reasonable and responsible information. A paradigm shift has occurred over time where the old model of research focusing on disease being treated by physicians has been updated and sometimes replaced by a focus on wellness where the media and other health professionals become additional sources for consumers who often make their own health decisions. It is no surprise then that consumers are very receptive to the idea of personalized nutrition or "nutrigenomics." Cogent Research conducted in December 2002 (2) a total of six focus groups with consumers in three markets, including Los Angeles, CA, Dallas, TX and Washington D.C. All participants were required to meet specific screening criteria developed by Cogent Research and IFIC. These criteria provided us with a mix of general consumers who agree that foods can provide health benefits that go beyond general nutrition. They clearly see the benefits to their overall


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health, specifically, being able to potentially avoid the diseases and other health problems to which they are genetically predisposed. Participants liked being able to have some control over their destiny. One woman felt that people would "make more wise choices about your life if you know these things in advance." Another woman stated that she "could avoid certain foods that could be triggers." Although participants see the benefits of such an advance in the arena of food and health, they had a few concerns: Privacy: Many participants were concerned with the confidentiality of the results of the DNA profile. They were afraid that insurance companies would look at the results and refuse to cover them if the results show they were likely to have a health problem that is expensive to treat. One group also discussed the possibility of discrimination, in general, based on one's genetics. Expense: The cost of such DNA profiling was a concern for many participants. They would like the cost of the test and subsequent recommendations to be covered by insurance and/or available to everyone regardless of economic status. Depression: Some participants expressed that the knowledge of what diseases or other health problems they are likely to get later in life would be depressing. Many stated that they would like to know, but not until they are older because they feel the knowledge "could hinder your life." Unnecessary worry: A few participants mentioned that the results could be wrong and you could spend your life worrying unnecessarily and trying to avoid a certain disease or health problem that you are not actually predisposed to. Limitations: A few participants mentioned that focusing on modifying one's diet ignores the other factors that influence one's health such as lifestyle and environment. The terms "Personalized Nutrition" and "Individualized Nutrition" were both rated extremely positively by participants. While 22 of the 48 participants preferred Personalized Nutrition, 18 of the 48 preferred Individualized Nutrition. However, many participants found it difficult to choose one over the other. Those who had a strong preference for one over the other had the same rationale regardless of which one they liked best - (personalized/individualized) speaks to them more as an individual or as a person. In the end, it comes down to word preference. "Nutrigenomics" and "Nutritional Genomics" received generally negative ratings. Participants mentioned both terms were difficult to understand. Nutrigenomics, in addition, was "scary" to some participants. They also mentioned the term sounds "mathematical and "like a disease." Each term was chosen as "best" by only one participant. When asked if they see a connection between functional foods and personalized nutrition, participants were hesitant to respond. In most groups, one consumer would note that a personalized nutrition plan might include eating



259 functional foods. However, it did not appear as if the connection was immediately evident to most. The best advice for helping consumers to reap the health benefits of foods is to eat moderate portions of foods from the various groups in the Food Guide Pyramid, as well as increase the variety of foods consumed from each of these groups. Citrus products are uniquely positioned to benefit from increasing focus on food and health, as they are both an important natural source of functional components as well as convenient and popular vehicles for additional fortified components. After all, "variety is the spice of life!" These consumer insights provide an opportunity for increasing awareness and education on the potential health benefits of citrus. It is important to understand that consumers don't rely on just one source of information on food and health, so an effort that targets multiple sources of information that complement each other would be most effective.

References 1. Support for Food Biotechnology Stable Despite News on Unrelated Food Safety Issues, URL http://www.ific.org/research/biotechres03.cfm; Cogent Research and commissioned by the International Food Information Council (IFIC) January 2-11 2004 2. Functional Foods: Attitudinal Research (2002), URL http://www.ific.org/research/funcfoodsres02.cfm: Cogent Research and commissioned by the International Food Information Council (IFIC) March 2002 3. Functional Foods. Attitudinal Research (2000),URL http://www.ific.org/research/funcfoodsresOO.cfm: Cogent Research and commissioned by the International Food Information Council (IFIC) May/June 2000


Potential Health Benefits of Citrus - ACS Publications - American

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