A Guideline is Just a Guideline
“Values are as important as evidence. Do we need a randomised control trial to tell us that eating food together is a good idea?”
A striking statement that stimulated reflection from the audience at a recent event we were delighted to co-host with the University of Edinburgh.
The event saw two representatives from Brazil, who were instrumental in the creation of the recently published Brazilian dietary guidelines, speak about the journey from concept to published dietary guidelines. A process filled with challenges, not least opposition from industry, but also from fellow nutritionists who were initially reluctant to see change.
The distinct and ground breaking aspect of the Brazilian work has been the move away from nutrient based guidelines to ones based on real meals. They used the ‘NOVA system’ which classifies foods according to the extent of processing involved.
The Brazilian guidelines contain 10 recommendations and a golden rule:
- Make unprocessed or minimally processed foods the basis of your diet
- Use processed culinary ingredients in small amounts for seasoning and cooking foods and to create culinary preparations
- Limit consumption of processed foods
- Avoid ultra-processed products
- Eat regularly and carefully in appropriate environments and, whenever possible, in company
- Shop in places that offer a variety of natural or minimally processed foods
- Develop, exercise and share cooking skills
- Plan your time to make food and eating important in your life
- Out of home, prefer places that serve freshly made meals
- Be wary of food advertising and marketing
The Golden Rule
Always prefer natural or minimally processed foods and freshly made dishes and meals to ultra-processed products
It is impossible to give full justice to the content of the talks so let’s reflect upon a few key issues that came out of the presentations and discussions on the day.
Science and Art
The Brazilian work has been a blend of science and art. Unfortunately, industry takes the science and undermines it with a different sort of art; the art of marketing, advertising and selling a lifestyle. Mastered and well informed art of objecting to policies and lobbying hard without damaging brands or reputation.
Balance of Power
There was strong industry lobbying in the face of the Brazilian guidelines right up to the last moment. It is testament to the commitment of the government and the politicians that the final launch went ahead. We are seeing other brave and bold policies emerging internationally. Chile, for example, has introduced strong laws around the marketing of food to children.
Can we demonstrate the same balance of power here in Scotland and UK? Does the Prime Minister’s office leading a Childhood Obesity Strategy mean leadership or does it just give industry more options to play the economic card? Would a ‘health–first’ approach to this be stronger?
The speakers’ view was that a nutrient based approach allows people to lose overall perspective on healthy meals and eating, and favours ultra-processed food. Watching a growing intake of processed foods in the country, they were keen to stop that before it became a substantial part of the Brazilian diet. In Scotland, processed foods already make up a significant part of the diet and have done for a number of decades. How easy would it be for Scotland to classify foods by the degree of processing? More importantly, how easy would it be for Scotland to choose natural minimally-processed foods over heavily processed ones and take pride in our natural food culture?
Food Standards Scotland also attended the event and spoke about producing dietary guidelines for Scotland. New guidelines are to include consideration of the social context, environmental issues, mindfulness, skills and ability. We welcome this broad approach to the issue and hope that there will be space to reflect on the Brazilian approach and how it could inform our thinking in Scotland.
Are we brave enough about our values? The Brazilian speakers mentioned values a lot and how they wove them into the guidelines; values around eating together and finding time for cooking. “Why is it okay to watch TV for 3 hours but not to find time to cook?” asked one of the speakers.
I was also lucky enough to visit the House of Food in Copenhagen recently. I heard wonderful stories about how they were shifting the population’s view of food in schools and hospitals by not only improving the food but by creating a values system. The school dinner ladies were skilled and valued, the source of the food was known, understood and valued, and the children valued their school dinner because they had a part in preparing it. During my visit I asked (in the traditional UK way) could they supply me with the evidence/evaluation showing this was working so that I could share it. There was no evidence, no evaluation – they just knew it was working and that it was a good idea. Strong political leadership on the issue was driving and supporting the work.
A Guideline is Just a Guideline
We need to remember that a guideline is just a guideline. The key is how it can be turned into policy and how easily it can be adopted by society. Could policy in Scotland reflect and influence our values? Do we appreciate enough, our natural Scottish food culture and the enjoyment of eating together?
Lorraine Tulloch, Obesity Action Scotland Programme Lead