 It's an honor and a pleasure to be here, and I should forewarn you in my presentation. I have made several changes based on the science that was presented today. In fact, as a dietitian in the trenches, one of my concerns is how do we bridge the short gap between recommendations and consumption, and based on the work of Dr. Kellogg that we heard here today, perhaps yogurt retention enemas may be the solution to that. Of course, I'm just joking. My disclosure today is that I am indeed an advisor for Dannon. That's the only disclosure that I have for you as well. And as you should probably already know, I am the only non-academic here as amongst the panel, so I feel truly honored to be here. And in fact, my job as a registered dietitian nutritionist is to talk about some of the challenges that I have as a clinician in the field to take all of this wonderful information that we've heard about here today and translate that into something delicious on the plate. Out of curiosity, how many dietitians do we have out here today that are in attendance? So I feel your pain, and hopefully we'll have some great recommendations today of how to translate this information. This is going to be an interactive session, so at the end, we have left some time I would love to, especially from our international community, to hear maybe perhaps some of your secrets about how you help include more fermented dairy products such as yogurt in the diet. I would truly be interested. This is a survey that was done last year by the International Food Information Council, and they do a yearly survey called the Food and Health Survey. And they pulled several hundreds, in fact over a thousand consumers, and asked them a very simple question about how they feel about making some changes based on some of the science that's available out there. And the question to them was, to what extent do you agree or disagree with the following statement? Because nutrition information seems to be changing, it's hard to know what to believe. So obviously, as some of the questions that we're developing here in this conference, and what do we bring back to the consumer can truly be challenging. And what they found in this study, in fact, is that the majority of consumers felt like they were very perplexed. They did not know what really to take away from much of the media exposure to some of the science that's coming out here today. So again, my challenge is, again, being in the trenches and trying to translate some of this information, is to convince them, based on some very sound research, what is an appropriate diet, what is the bulk of the research suggesting that they should follow. Now again, why I'm here today is to present this unique perspective of being in the trenches. I will be sharing with you today some trend survey research, some focus studies, as well as my personal observations of being in a clinical situation in the trenches for over 27 years. And the middle picture is a little dated. That is me. My unique practice I have is called nutrition house call. So you said something required a little further explanation. That's it. It is named nutrition house call because what I found is that I used to see my patients in a hospital setting, a clinic setting, an academic setting. And what I often found is that the problems were not in the settings, but truly in their home. So I decided to do something very unique and actually visit them in their home. And I performed something called a shelvic exam. And I literally go through cabinets and identify those foods that may not be beneficial for their health. And of course, I identify those foods that we need to have more of in their shelves. So what I used to do is tag those foods with a red tag that had a very frowny face to it. And of course, those foods that were better for them had a nice smiley face. And the instinctive thing that my patients would want to do is take those foods and give them to the poor. And my response is, what did the poor ever do against you? Let's give them to a neighbor you don't like, which seemed like a much better advice at the time. So I found that exponentially better results with my patients when I started working in their environment and tying this into this conference is that as we know as researchers and looking at the type of association studies we're talking about here today, that it may be sometimes a leap of faith to translate that information to the home setting, especially when we have some other confounding variables of other people who maybe choose food for the patients that you're seeing, the interactions, the first personal tastes and preferences. So there are a lot of different variables that I want to talk about here today that are challenges for us as clinicians who are trying to get people to eat a better diet. The gentleman that's over to the left actually is my taxi driver. I do quite a bit of traveling. And in fact, I literally took that picture of him yesterday. His name is Joe. And Joe was kind enough to allow me to take a picture. And you'll see the reason why I'm done here this momentarily. Joe, actually unbeknownst to me, and he's been my taxi driver for about three or four years now, has slowly been surely losing weight. And in fact, he's down about 40 pounds. I wish I had the before picture. And what he did tell me is that, Dave, we've been a captive audience together for the 20 minute commute from your home to the O'Hare Airport. And believe it or not, I've been following some of your advice. That's absolutely fantastic. So I commended him and he said, Dave, what are you going to be doing out in Boston? And I told him I was going to be honored to attend this first conference, global conference on yogurt. And he got a very sound look on his face and he said, you know, I've eaten yogurt every single day of my life for as long as I can remember, except for the past two years. And I said, oh, what's happened? He said, I eat yogurt and it's cause and effect. Minutes later, I seem to be running for the bathroom. So I know we've had some debate about lactose, but I'm hoping out of this conference that we can help dear old Joe here eat more yogurt, because we already know what a healthy food it is. And as you heard, I've also written a book called The Best Things You Can Eat. This book actually came as a response from one of my patients who was on high blood pressure medication, type of medication he had, was potassium. It's a potassium-wasting diuretic. And he was not very compliant with his medication called K-Dur, a potassium supplement. So he said, Dave, can you recommend the top foods that are highest potassium? So what I did is I wound up turning to the United States Department of Agricultural Database and their reference 24, and I looked at what were considered the top sources of potassium. Can anybody tell me, according to the USDA reference 24, what is the number one highest potassium food? How many of you say yogurt? Not according to the USDA. Potatoes, how many of you say potatoes? No. Banana? No. You ready? One? Yes, someone got it. But not just your average tomato that the average consumer would consume. It is one cup of tomato paste. So as a dietician, I'm thinking, that's kind of silly. I went to the last time that you consumed some tomato paste. It's been a long time. And I looked at the second food, and do you know what the second food is? Three quarter cups of frozen orange juice concentrate. Precisely. So what I found is a lot of my colleagues, other registered dieticians, had literally cut and pasted that information from the USDA, and were frustrated why they were not able to get consumers to consume more high potassium foods. When the answer was as clear as the nose on their face as we already know, dairy products is actually the number one source of potassium in the American diet. So what I thought I would do with this book is actually take commonly consumed versions of foods and also superimpose the my plate guidelines, which are based on the dietary guidelines, and actually come up with those particular foods that are healthy and beneficial. So not surprisingly, a lot of the usual suspects kept appearing in list after list after list of being some of the most nutrient dense. And in fact, I have to give a nod to Dr. Jurnowski and Dr. Felgoni for my first book called 101 Foods That Can Save Your Life, which actually was based on nutrient density. So I have to give a shout out there. So not surprisingly that we see spinach and beans and fatty fish such as salmon. And surprisingly, liver kept popping up in a lot of these different lists. But of course, one of my challenges as a dietitian, especially in America, who is very liver phobic, especially some of our electric officials who do not want us to be eating foie gras, I knew I would not be able to turn the tables and get people to eat more liver. But yogurt seemed to me to be a very plausible thing that we can get people to eat more of. But however, as you've probably already heard that we still have a challenge with that. Don't want to spend a lot of time, but what was interesting in looking at this might plate portion size. And so many of you, and especially the dietitians, may be already aware that the dairy serving for my plate is not the 5.6 to six ounce serving sizes that we see in common yogurt in the grocery stores, but actually a full eight ounce serving of that. So based on that, we see that yogurt is indeed, as we already know, very nutrient dense and actually took very prestigious places in the top seven. Now of course we also know it's extremely high in protein too. Now this is from the research from the IFFIC Food and Health Survey in 2012. And many consumers are looking for more protein dense foods. We see the category Greek yogurt has gone up somewhat with male consumers because we do know that they're searching for more protein. But as we see yogurt as far as a protein destination does not to be as significant as poultry and nuts and seeds and eggs and fish with consumers. Still they are looking at it, but not as aggressively as the other ones. So what's happened with yogurt consumption over time and especially globally? And again, as you probably already know, our yogurt consumption here in the United States actually seems to be fairly abysmal compared to the rest of the world. And in fact, I don't know if did I have a pointer? Can I borrow your pointer? Thank you. That does not work. Okay. Well, take my word for it. If you take a look at the United States, flanking it actually to the left and having higher consumption is actually Mexico and Canada. So we can't even say that it's a North American phenomenon. Those that are in Mexico and Canada are actually consuming more. So, but what we do see is when we're comparing it to our neighbors in Europe, they're consuming quite a bit more, about one cup daily compared to ours, which is less than one cup a week. So we have a long way to go. The category of yogurt consumption actually here in the United States has been fairly robust within the past 10 years, but what we've seen is actually a dip in yogurt consumption in the category within this past year. The per capita consumption in the U.S. also compared to other dairy products we see and has taken the dip. Fluid milk consumption, for example, we've known has been on the decline. So we've seen from last year that there's been a dip and then there's also been a dip in yogurt as well. Cheese, as we heard of potentially some of the health benefits of that has remained fairly stable. So that's a good thing. Household trends that we see is that 83.7% of households do consume yogurt on an annual basis that results to about 14 trips to the grocery store to purchase yogurt overall, and that equates to about 2.5 pounds of yogurt consumed per trip. But to me, the troubling thing is that we have about 11% of these consumers that are only consuming yogurt very sporadically and minimally once per year. And there may be some reasons why that's happening. Why isn't yogurt consumption as robust here in the United States is what we might see around the world. And through some of these trend and focus group surveys, what we're finding is that consumers are saying that yogurt is not top of mind. It's not one of the first things that they think of when they're thinking of a snack for something for breakfast and certainly even after the afternoon meal, that is a little bit more of a concern to getting in yogurt. We definitely have seen that there may be an effect of some of the economic downturn here in the United States affecting purchasing, especially for that price per value. Most of those that are surveyed do agree that yogurt is a nutritious and healthy food, but when they start making some decisions with their dollars, yogurt may not be again front of mind. And then also a smaller percentage simply just don't like the taste. Now out of curiosity, how many of you here absolutely love yogurt? Okay, I know we're preaching to the choir as the saying goes. How many of you think yogurt's okay, but I only consume it a couple of times a week? You can be honest, we're amongst friends here. All right, how many of you would not eat yogurt if you're life dependent on it? All right, so I'm glad we're talking to the group here too. But I do want to address kind of those three different distinct categories, because believe it or not, outside of this conference, there are some people out there who actually don't like yogurt. So hopefully we'll come up with some innovations to make that change. And there is a spectrum of consumers, as we just talked about. We have obviously a group here who's very passionate about yogurt and will eat it every single day. And then again, there are those what are considered to be the yogurt rejecters. And what's interesting is when we start looking at trends and we look at the consumer, many of them actually, as I mentioned, think of yogurt as being a healthy food and they like to associate that themselves. But what I also found interesting as a trend is that most Americans kind of are starting to refer to themselves as healthy, even though we have higher chronic disease, questionable life expectancy compared to our parents, but certainly we've got more chronic disease that we're dealing with here too. So it's an interesting perception and I will actually come back and talk about male perception of health as well, which I think is a unique thing that I like to target. I actually focus specifically in male health challenges. We do know that when people think about yogurt, they think about it as being more aspirational. They think about it being healthy, that you're strong, you're active. There's a lot of positive words that are associated with yogurt, but as we already know, just having a health benefit or a nutrition benefit is not always necessary enough for the consumer to make dietary changes in their life. So those that tend to be passionate about yogurt consumption is something that you probably already knew is that they tend to be typically female, a little higher socioeconomic status, they tend to be white, non-whites tend to have lower consumption. Children we know have a little higher consumption as well. I have three daughters that are teenagers and I can tell you that their yogurt consumption has been fantastic, but when they get to the teenage years, I think it's a little bit more challenging for them. And so I have the vested interest in helping them to keep that good habit healthy, more likely to exercise, and then of course not surprising that we're always in the pursuit of weight management here. So we've heard some information today that yogurt may play a role in that. Heavy users are really broken up into four distinct quadrants as far as their association with yogurt and what kind of they believe in. Health and nutrition is a very important aspect of the health benefit. They are looking for higher calcium protein, some of the add-on benefits of the friendly bacteria, the probiotic benefits, good nutrition, healthy snacks, certainly the diet and weight loss. It's a very big industry here. And of course people like the idea that they can find non-fat calorie controlled yogurt. Of course, whether that's debatable overall health scheme, of whether that's truly better or not, but certainly a lot of them are also focused on lower sugar intake. Big swing to looking at this farm to table as we just talked about less processed foods. Most heavy user consumers don't think of yogurt as a processed food. They think it is of being very simple ingredients and a very simple transition from farm to table. And then of course the biggest thing here is taste. The creamy, the thickness, the refreshing taste of yogurt is something that they particularly enjoy and have fondness for. Now in 2011, IFIC also did a study and looked at the add-on benefits of fortification. So one of the other things that we see with consumers is they like the idea that yogurt can be a vehicle for other nutrients. So whether we're bringing along additional fiber, additional friendly bacterial strains, that seems to be extremely valuable to a consumer who is very health-minded. Now as we go down the continuum to those that are not consuming it as much, we see again income maybe a role here. We do know ethnicity. Non-whites tend to purchase less yogurt than those that are white. Singles, the light buyer again being a younger female, but not children, but not someone who's a middle age. Those areas in particular might be the area that we wanna concentrate on targeting to increase yogurt consumption. What are some of the reasons that some of the consumers are giving for them having very low consumption of yogurt? Life changes, that they feel that they're busy, they're on the go. Yogurt is a refrigerated product. That might be a concern for them or a problem. I remember talking to Joe, my taxi driver, and I said, well gee, why don't you go ahead and find a yogurt that does not have any lactose in it and you can keep a little cooler, and he just told me like I was from outer space, that's way too much work, I don't wanna do that. So we may have to again innovate and think about some of the creative ways of doing that. A lot of the parents that I see will buy a bunch of yogurt, and I usually observe two things in their home. I either see a bunch of yogurt that's already expired because I haven't consumed it within that expiration, or they bought a lot of yogurt and it's already been consumed by their kids. They never had an opportunity to get to it. So that's one of the challenges. And then also we see competition within that snack space as well. Is that yogurt, obviously we already know is a great portion controlled snack, but there's a lot of other competition out there that actually either has or a foe or a halo effect, a health effect of being beneficial. So granola bars, an example, it's easy to peel it apart, eat it, and then you don't have to worry about refrigeration or washing a spoon afterwards. So the yogurt rejector, those that tend to eat less yogurt, not surprisingly, tend to be here at least in the United States, more males, more my age, likely no children at home. Again, non-whites tend to be yogurt rejectors, lower socioeconomic status, also not as committed to physical activity. Again, so a lot of these positive health associations that are associated with eating yogurt, perhaps overweight, but not trying to lose weight, which I thought was an interesting category. They may have lactose intolerance or digestive challenges. Taste and price is also an issue for them. Now interestingly enough about men being overweight, though not thinking that they need to lose weight, I wanna kinda address this. There was what was called a modern man index survey that was conducted last year of over 1,000 men. And men's perception of what they do here in the United States compared to what they actually are doing may be a little bit different and those women who are in the audience can certainly give me feedback. More men last year thought that they were doing more household chores, they were cooking more, they were taking care of the children and doing more shopping. So ladies who live here in the States maybe would say that's true of the men. Not a lot of hands on that, okay. What men also agreed that they were not doing as much of is being physically active, getting enough sleep, and then also taking more time for themselves. So those are some of the unique challenges. Also men my age don't go and see a doctor to get advice or even have their health checked as much as women do. So again, here we see the strong yogurt buyer being a little bit more proactive about their health. Here certainly I think in the United States we defer our health to our women in our lives. And when it comes to weight, not surprisingly, more men than women who are overweight don't think they're overweight. They are most likely to underestimate their weight compared to women. That was the University of Illinois study last year. So those are some of the challenges. Even for those men who say gee I do have a problem and I have to get some of the weight off, they tend to go to extremes to try to reverse that weight. So they don't necessarily look for portion controlled those foods that may provide a satiety effect, all those things that we would think logically. But when you are faced with having a weight problem and you wanna do something about it, usually men will go to extremes such as skipping meals. So again, that's another challenges that we have out in the trenches. So my suggestion is maybe at this time, especially for men that we start thinking about innovation. And I thought I was being really clever here today in preparing for this and coming up with the term brogurt, but apparently someone has already come up with that. But I do have some recommendations for the Dan and folks here. Perhaps you can come up with an entire line called Manon. I don't know, might not be a bad idea. Take your Danimals and make it Manimals. Maybe instead of the Oikos, we can come up with Boykos. There's a lot of different things. And of course, we won't leave other brands out. Maybe Bro Play and maybe even Bro Bonnie. So anyhow, these are some suggestions that maybe we could do to reach out. And of course, I don't know about bacon flavored brogurt, but that might be more appealing to men. I don't know, but again, we may have to think about some unique innovations to go ahead and capture guys. Now, the other thing that seems to be universal, whether it's men or women, is certainly concerns about taste and price. And again, this is an epic study that was conducted last year. Of those survey, they ranked price and taste, I should say reverse that, taste and price more concerning than healthfulness, convenience, and sustainability. So I think this isn't a really important thing. As obviously I know that we're here talking about the health benefits and nutrition benefits, but when it gets down to it, when I go visit a patient in the home, it always boils down to it's gotta be enjoyable. It's gotta be a health habit that I can sustain life long, and unless it tastes good, that's not going to happen. Price concerns, obviously, not surprisingly, those with low household income, especially when we look at the protein component, because we know that protein can be the driver of price. So those that don't see a value of having a higher price for that protein, quite often will elect not to purchase that. Younger consumers as well, who might be a little bit more value conscious, and not as much disposable income are concerned about price. Non-white, Hispanics, again, also most likely to feed a protein that does not as costly to their family. And also obese individuals, interestingly enough, are gonna be more apt to go ahead and be concerned about the price for protein as well. Now, maybe not surprisingly, we see that older individuals that all kind of turns around a little bit. If you can see to the right here, and I apologize for not having a pointer, what the issue is for them is really it is taste, not price. It is actually taste and healthfulness that's more of a concern compared to some of the younger constituents. So what is next? And again, this is posing the question to all of you that are coming here today. What is it that we can do to help drive up the category of yogurt consumption? So when we think about innovation, lactose-free, again, we've talked about some of the issues here with lactose, taste and mouthfeel, there's some things that can be done to maybe lure in those that are not typical traditional yogurt consumers to really make a difference with them. The portion container, again, I know that we've kind of gone to the smaller container, but for men in particular, a lot of them will actually say that they don't feel satisfied on them, that size container, they may actually need something larger. Perhaps maybe even shelf-stable. Now, of course, I can't think of, I think we were talking about hot yogurt here earlier. I can't think of ever consuming my yogurt at room temperature. I think I've got to have it nice and cold, but it's something to think about for a portability standpoint to make it easier for the consumer. Certainly price, what can we do as health educators to do a better job of translating science to motivate consumers to consume such a healthy food? Is there a public policy, having more yogurt in schools, medical institutions and so forth, and, of course, last but not least, what can we do together to help my friend Joe? Thank you very much, and I'll take any questions. Thank you very much, David. Time for one question. Well, more of a comment than a question. Not to advertise Bulgaria, but that's where a good chunk of good yogurt comes from and almost half of the recipes, if not more than that, in the Bulgarian cuisine are yogurt-based. So maybe that could be an interesting recipe market to be advertised and tried out, and it's pretty tasty. Yeah, I think that's a great comment, and that's certainly an opportunity to kind of bridge that gap. A lot of the patients that I talk to are unaware that you can swap out sour cream very easily for a plain yogurt. So I think there is a cultural difference that we don't have yogurt as part of many recipes, and hopefully maybe that's something we can do in partner with chefs that are creating recipes. Excellent, thank you. Okay? Thank you very much. Thank you very much. Thank you very much. Thank you very much.