Should we have food-based dietary guidelines?
At the end of June I attended a seminar hosted by the University of Edinburgh and Obesity Action Scotland ‘Towards a transformation in nutrition policy: Lessons from Brazil’. There were fantastic presentations from Inês Rugani, Associate Professor at the Nutrition Institute, State University of Rio de Janerio and Fabio Gomes, Advisor on Nutrition and Physical Activity, Pan-American Health Organisation/WHO.
Inês explained that in 2014, the Brazilian government introduced new dietary guidelines that extended beyond the traditional confines of nutrition policy. The guidelines are remarkable as they take a broad and comprehensive view by considering nutrients, foods, combinations of foods and meals as well as dietary patterns and the social and cultural dimensions of eating. Of note is that the guidelines are driven by both evidence and values.
The overall ‘Golden Rule’ of the guidelines is
“Always prefer natural or minimally processed foods
and freshly made dishes and meals
to ultra-processed foods”
The 10 main recommendations of the guidelines are:
Prepare meals from staple and fresh foods.
Use oils, fats, sugar and salt in moderation.
Limit consumption of ready-to-consume food and drink products.
Eat regular meals, paying attention, and in appropriate environments.
Eat in company whenever possible.
Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption
Develop, practice, share and enjoy your skills in food preparation and cooking.
Plan your time to give meals and eating proper time and space.
When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
Be critical of the commercial advertisement of food products.
The above recommendations are fairly easy messages for the general public to remember with the first 5 linked to the choice of food and the last 5 linked to overcoming potential obstacles to following the recommendations. Ensuring the guidelines were realistic and feasible was of great importance. There is also a degree of flexibility in the recommendations. For example, instructions on amounts of food (e.g. 5 portions of fruit and veg a day) are not used, and instead, terms such as ‘prefer’ and ‘most of the time’ are used.
In the UK in 2007, the Food Standards Agency launched the ‘Eatwell Plate’, which was replaced in March 2016 with the ‘Eatwell Guide’. The Eatwell Guide shows the different types of foods and drinks we should consume, and in what proportions, to have a healthy, balanced diet. It doesn’t however consider cultural, social and environmental factors relevant to food choice and dietary consumption.
In Scotland, overweight and obesity rates have not changed significantly since 2008 with two in every three people overweight or obese - a prevalence that is unacceptably high (Obesity Action Scotland).
It’s too soon to determine if Brazil’s food-based dietary guidelines are having a positive impact on the prevalence of obesity and the health of the Brazilian population. However, is it time for food-based dietary guidelines in Scotland? As highlighted in the recent Food Standards Scotland report “The Scottish Diet: It needs to change”, a change is indeed, clearly needed. Adopting a holistic and realistic approach to dietary guidelines could result in positive changes to our current food culture and diet, and food-based dietary guidelines may well prove to be more effective than the Eatwell Guide in improving the population’s diet and health. People eat food, not nutrients after all!
Public Health England (2016) The Eatwell Guide https://www.gov.uk/government/publications/the-eatwell-guide
Obesity Action Scotland (2016) Scotland can’t stomach it any longer http://obesityactionscotland.org/scotland-s-weight
Food Standards Scotland (2015) report “The Scottish Diet: It needs to change. http://www.foodstandards.gov.scot/sites/default/files/Situation%20Report%20-%20COMPLETE%20AND%20FINAL.pdf