Do doctors need to exercise caution when recommending products with the Heart Foundation Tick?

YES The National Heart Foundation of Australia plays a valuable role in bringing heart disease to public attention. However, shortcomings of their Heart Foundation Tick program1 demand caution.

Media releases proclaim that the Tick has been “awarded to” or “earned by” particular foods. These must meet the Heart Foundation’s nutritional criteria, but companies then pay to use the Tick. For food companies, whose purpose is to make a profit, the Tick is a marketing exercise. By tweaking products (where necessary) and paying for the Tick, companies gain credibility by linking their brand to the positive emotions attached to the Heart Foundation. The extra cost is passed on to the shopper.

The cost of food is a particular concern for people on low incomes, who have a higher incidence of diet-related health problems.2 Processed foods that bear the Tick almost invariably have a higher price, while cheaper products in many food categories may have a nutritional profile at least as good as those with the Tick — sometimes better. Rolled oats with the Tick are 4.5 times the price of house-brand oats. How can this be justified? A similarly expensive Tick approved product dilutes rolled oats with 20% wheat starch, adding inulin for extra fibre. Why?

The Heart Foundation’s criteria for “earning” the Tick are a cause for concern, especially the variation in its criteria for different product types. To earn the Tick, tomato sauce must have no added salt, but a similar restriction does not apply to salad dressings. Some salad dressings with the Tick contain more than 600 mg sodium per 100 mL. A much healthier option is homemade dressing, such as olive oil with lemon juice or vinegar — quick and easy to make, with virtually no sodium. In food categories such as pies, frozen pizza, fast foods, sweet biscuits, rolled fruit confectionery and frozen meals, products with the Tick may represent a slight improvement on similar products, but these food types do not deserve any stamp of credibility. The appropriate message for an overweight population is to avoid such products. Fresh fruit is a better option than a sweet biscuit or sticky fruit bar bearing the Tick.

A recent editorial in the Canadian Medical Association Journal notes that partnerships between the food industry and health organisations can risk jeopardising public health goals, leading to health organisations becoming “inadvertent pitchmen for the food industry”. The authors conclude that “corporate dollars always introduce perceived or real biases that may taint or distort evidence-based lifestyle recommendations and health messages”.8 This is a particular problem when fast foods are awarded the Tick. The healthier option lures extra customers, but the bottom line is an increase in sales of regular burgers and fries.

Most Australians need to eat less of almost everything except fruit and vegetables, and the new dietary guidelines for Americans have taken such recommendations on board.9 It is not a message that pleases the processed or fast food industries, but that is their problem — it is not the role of health organisations such as the Heart Foundation to keep these companies profitable.

Doctors should, therefore, exercise caution when recommending products that bear the Heart Foundation Tick. The important message for Australians is that we need to change our attitude to food — from quantity to quality, and from highly processed foods to home-cooked fresh produce. The Tick is simply a distraction.