Healthy eating: what you know and what you believe

To keep the rising cost of healthcare from spiralling out of control in the years ahead, we should focus on prevention. Personalised food can improve both individual and collective health outcomes.

Long distance runner Emma’s body fat percentage is too low and she needs to raise it a little to run a marathon. Her personal online food coach advises her to have a mackerel sandwich today and two handfuls of walnuts tomorrow. Harry (low-skilled and unemployed) is overweight and needs to move more and eat less fatty foods. Apps on his smartphone encourage him to visit the gym (‘Your friend Peter just burned 674 calories!’) and provide a quick and easy recipe for oatmeal, alerting him to the special offer at his local supermarket. Secretary Eva wouldn’t mind losing a few pounds and her blood sugar is all over the place. When she lines up in the cafeteria, she gets a push message from the health & fitness app everyone at the company has on their phones. It says: ‘Your blood sugar was a little high this morning. A salad and some whole wheat bread is your best choice. It will give you the energy you need to make it through your afternoon meeting.’

Technological innovation

Three fictitious examples of personalised or tailored food. This is healthy food that has been fine-tuned to an individual’s age, gender, weight, allergies, health risks, current illnesses, and lifestyle -with the aid of technological innovations such as wearable fitness trackers that record heart rate, calorie intake, and cholesterol, etc.; apps for putting together a healthy meal with the right nutrient values; and scanners that help the user choose items with the right ingredients at the supermarket. Personalised food is the future, but we’re only seeing the very earliest stages of its development now. ‘Personalised food is vitally important, both to our personal health and to society as a whole,’ says Sebastiaan Schreijen, a Senior Analyst at RaboResearch Food and Agribusiness. ‘If we do nothing, our ageing population will vastly increase healthcare spending in the coming years. That spending is already at roughly 80 billion euros a year in the Netherlands. Only two percent of that is spent on prevention. We’ll have to commit to a lot more resources to that effort.’ A challenge facing not just the Netherlands, but the entire Western world.

Knowledge gap on healthy eating

What exactly is health? ‘The resilience required to prevent disease,’ says the definition provided by TNO. Their definition stresses prevention too. Healthy foods play an important part in the prevention of health problems. ‘The range of foods on offer in supermarkets today is diverse enough to make responsible choices,’ Schreijen emphasises. ‘But most Dutch people don’t invest time to educate themselves on healthy eating, though an estimated 5 percent of them are foodies who do.’ Schreijen, however, has spotted a shift in that trend: people are starting to care about healthier foods. Unfortunately, research done by Gfk in collaboration with Rabobank reveals that a third Dutch people feel they lack the knowledge to design their ideal diet. ‘There is a knowledge gap between believing you know what you eat and actually knowing what you eat,’ says Schreijen. ‘Scientists often struggle to communicate which foods are healthy and which are not. And people don’t always believe them. So they look for answers in the latest trends in the media. They might start eating organic foods, foods without gluten or e-numbers, or take to a vegetarian diet, though there is no scientific proof that doing so has health benefits. The big question is: How will we close that gap?’

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Measuring meals

At the very least, Schreijen believes, the food industry will have to introduce uniform and clearly legible labels with precise information. A whopping 72% of Dutch people consider the label to be their primary source of information and want those labels to be more transparent, the Gfk/Rabobank study reveals. The food industry will also have to invest more heavily in databases of nutrient information, provide apps and scanners to make it as convenient as possible to choose healthy foods. That should lead to the next step: measuring your food intake and tailoring your food. A related challenge is the development of ‘smart food’: enriched food intended for the chronically ill or to promote post-operative recovery. Schreijen: ‘As a bank, we want to make our clients in the food industry aware of all these new developments and offer practical support as they respond to those developments.’ As an example, one group of private label producers approached Rabobank to ask who could tell them more about the legislation surrounding salt reduction. The bank put those producers in touch with KTBA, a food labelling consulting firm. ‘We act as a bridge,’ said Schreijen, ‘and increase our shared pool of knowledge.’

A healthy economy as well

Rabobank is committed to the continued development of personalised food and smart food by financing the required innovations, by sharing knowledge (conducting our own research, making scientific research more accessible, and fostering public debate), and by using the bank’s global network and broad platform. This includes strategic partnerships with initiatives like ‘Diagnose Voeding & Gezondheid’ (food & health diagnosis). This collaboration between government, industry and knowledge institutes in the Netherlands strives to promote the vitality of the Dutch population, curb healthcare spending, and educate the Dutch about healthy eating. Another strategic partner is Be Bright, an incubator that coaches start-ups in healthy food. Large food manufacturers are often wary of the risk of developing innovations. Rabobank puts people from that sector in touch with the incubator and the start-ups. This cross-pollination has proven fruitful: the food manufacturers provide the starters access to their knowledge and infrastructure, which means they’re right on top of any innovations being developed. Ten to fifteen million in investments has already created some 150 jobs, keeping the local economy in robust health.

"Personalised food improves health and society"

- Sebastiaan Schreijen, Senior Analist at RaboResearch Food and Agribusiness

Bringing people together

One of the projects Be Bright invests in is Diverzio, which brings together local producers of fresh foods (like farmers) and local healthcare facilities to encourage the people in their care to eat more healthily. Rabobank has contacts in both agribusiness and healthcare and provides not just financing, but access to the bank’s platform to bring the parties together and roll the project out through other local banks. Another collaboration is Shift Invest, which has Rabobank working with partners like health insurer Menzis, the World Wildlife Fund, TU Delft, Wageningen University, Topfonds Gelderland and the Netherlands Enterprise Agency. Investment targets scale-ups such as Nitriles’, a company that develops ingredients – mostly from bell peppers and onions – that support the immune system and can be used in medical nutrition, dietary supplements, and animal feeds.

Updating the business model

Occasionally, Rabobank will put people in the food sector in touch with an organisation like TNO. That research institute created the Personalised Nutrition & Health public-private partnership to develop knowledge with frontrunners in the food & agri sector. The research is conducted from the consumer’s perspective, the better to catalogue the various target demographics for personalised food. Emma, Harry, and Eva are examples of this. Schreijen: ‘Recently, one of our clients mentioned they wanted to update their business model. We told them to talk to TNO.’

Link to DNA profile

One of the partners in the TNO programme is VitalinQ, a company that uses individual profiles to provide nutritional advice online through a Personal Health Assistant. Tailored food, essentially. Schreijen outlines a few more examples of innovative applications in this area. Daily Fresh, for instance, provides tailored nutritional solutions for care, cure, and hospitality. ‘If you pick custard for dessert, you’ll also get a smaller cut of meat,’ Schreijen smilingly explains, ‘Since the custard has lots of protein in, too.’ Other examples of food innovation: Carezzo meal services, which enriches food with protein, and Huuskes, which provides meals to healthcare facilities and infuses additional protein, calcium, and vitamin D. The next step will be to link personalised nutritional advice to a DNA profile. Consumers can have such a profile drawn up by Habit, an American company who will include a personal coach and a boxed meal if desired. But more convenient and less extreme options than DNA profiling are available to encourage people to eat better, Schreijen believes: ‘You can use apps and different shop layouts to stimulate healthy choices. In the years ahead, food distribution will target ever more specific consumer groups. Supermarkets will face competition from new channels: not just from new online providers, but perhaps even from pharmacists, health insurers, or patient organisations.’

Taking the lead

Are these developments moving fast enough to keep pace with the ageing population and mitigate expected spikes in healthcare costs? There’s reason to hope, says Schreijen. After all, a still-shrinking workforce will be expected to foot the bill. Karen Freier at Maastricht University recently calculated that if the people who eat poorly now switched to healthy foods, it would save some 1.8 billion euros in healthcare spending. That improves the health not just of individuals, but of society. ‘How do you persuade those people to eat healthier foods?’ Schreijen wonders. It will have to be a joint effort, one on which Rabobank could take the lead. Family doctors, schools, employers, health insurers: all can play a part in spreading the word about what healthy foods are and offer practical support in making healthy choices. Schreijen: ‘These days, health insurers hand out step counters to their customers. That’s a start. As an employer, Rabobank has the Seven Day Challenge: to live each of seven days just a little bit healthier than the one before by eating better and moving more.’

Strength training for the elderly

Schreijen strongly believes that movement is essential to a healthy lifestyle. ‘Eating better but not moving doesn’t work. The rise in obesity is not all down to eating too much of the wrong foods. Inactivity is also a major culprit.’ Rabobank has a role to play there, as well. Right now, Rabobank is collaborating with FrieslandCampina, Wageningen University, and Workgroup Noordwest-Veluwe to study whether the combination of strength training and a high-protein diet will increase strength and muscle mass in the elderly. Rabobank is handling the funding and constantly has its finger on the pulse. The seniors taking part in the study may even have smartphones, on which they receive messages such as: ‘Your friend Muriel just burned 374 calories in strength training!’ or ‘It’s time for your protein shake to build up your muscle mass.’ The future is about tailored food and exercise.

How (un)healthy are the Dutch?

There are currently 4.5 million people in the Netherlands who suffer from one or more chronic illness and 800,000 people are operated on. There’s an overlap there, but roughly a quarter of the Dutch population makes regular use of healthcare. That demand is expected to spike as the population ages. Among people over 65, eight out of ten have at least one chronic illness. Three million Dutch people are over 65 right now and that number will go up. The expectation is that by 2025, almost ten percent of the population will be over 75.

Better shopping list

The desire to eat healthy is on the rise. Gfk research conducted in cooperation with Rabobank revealed that, nowadays, 95% of Dutch people claim to consider the health effects of the food they buy, 55% have started actually eating healthier, and 86% of those are deliberately buying less “unhealthy” food. It also revealed that around half of all Dutch people is prepared to pay more for healthy food that can prevent health problems. It’s worth mentioning that the research shows healthier food need not be more expensive. Putting fewer unhealthy things in your shopping cart saves money, in fact. Fizzy drinks, for instance, are a lot more expensive than tap water.