A snapshot of food-based dietary guidelines implementation in selected countries

https://doi.org/10.1016/j.gfs.2021.100533Get rights and content

Highlights

  • Key informant interviews from 27 countries and literature review used.

  • Good examples of FBDG implementation exist, mainly from HI/MI countries.

  • Countries can align food-related policies using FBDGs.

  • Both FBGD development and implementation require a food systems approach.

  • A strategy/plan and budget allocation are crucial for implementation.

Abstract

Governments use food-based dietary guidelines (FBDGs) to outline what constitutes a healthy diet to guide their population. The potential of FBDGs to align national food-related policies and programmes is increasingly recognized but information on FBDG implementation is scarce. We conducted a key informant survey in 27 countries. Several types of implementation activities were identified within various sectors and settings, although there were few examples from low- and middle-income countries. Most countries had an official body responsible for implementation, but a strategy/plan for implementation and budget allocation were less common, and very few collected monitoring and evaluation data. We argue for a food systems approach that involves sectors beyond nutrition and health in the development and implementation of FBDGs, to facilitate the alignment of policies that aim to promote healthy eating.

Introduction

Food-based dietary guidelines (FBDGs) are a country's recommendations to their people on what constitutes a healthy diet. FBDGs include, among other tools, a set of science-based easily-understood messages for the general public, often accompanied by an image/graphic (FAO 2020). The FBDGs development process includes a situation analysis, which ensures that FBDGs respond to the country context. Recent papers have highlighted the need for this process to be more systematic and transparent in order to ensure that FBDGs are informed by the best available evidence and pertinent contextual factors, better manage conflicts of interest and improve stakeholder participation (Blake et al., 2018; Zeraatkar et al., 2019). Some countries include recommendations on meal options, eating modes/food practises, food safety, hygiene and physical activity in their FBDGs, while a few have incorporated environmental sustainability aspects into theirs (Gonzalez Fischer and Garnett, 2016). Recently, there has been renewed interest in the potential of FBDGs to address the multiple sustainability challenges associated with diets and food systems,1 through recommendations that better support both human and environmental wellbeing (Ahmed et al., 2019; Springmann et al., 2020; UNEP, 2019). FBDGs are among the strategies used in system-oriented approaches that look for solutions across sectors and at different scales for food systems transformation (Brouwer et al., 2020).

FAO maintains a repository that catalogues FBDG made available by countries (FAO et al., 2020). While national FBDGs are available from 94 countries, not many low and middle income countries have them. In 2020 only 2 out of 29 low income countries (LICs) and 14 out of 50 lower-middle-income countries (LMICs) had FBDGs available on the repository (FAO et al., 2020) compared with 34 out of 56 upper-middle-income countries (UMICs) and 44 out of 83 high-income-countries (HICs) according to the World Bank classification of countries (World Bank, 2020). Nonetheless, several recent global reports and/organizations have increasingly recognized the need for countries to develop FBDGs, and implement them to inform coherent actions across food systems, covering actors and institutions from production to consumption (FAO, 2016; Global Panel 2017; Wijesinha-Bettoni et al., 2017). For this reason, experts recommend that FBDGs go beyond their common use in food and nutrition education programmes to be used by sectors such as agriculture, health, food security and nutrition to guide their relevant policies and programmes in order to contribute to the achievement of sustainable healthy diets.

Despite this potential, many factors impede the effectiveness of FBDGs in improving diets and the health of the general population. Such factors include lack of political support, non-participation of stakeholders and conflict with market forces during FBDG development and implementation, and lack of published research on evaluation of their effectiveness (Brown et al., 2011; Mozaffarian et al., 2018; Palma and Jetter, 2012). Although a degree of consumer awareness and understanding of FBDGs is evident in the literature reviewed, it is important to note that awareness and knowledge do not automatically translate into action (Bechthold et al., 2017; Brown et al., 2011; Smitasiri and Uauy, 2007). In addition to knowledge, motivation, skills and opportunities for choosing the proper action are needed (Ölander and Thøgersen, 1995). Therefore, the concurrent development of people's capacities and the provision of a supportive environment are essential in this context (Brown et al., 2011; FAO, 2016; Kwasnicka et al., 2016).

Adding to the above difficulties, the concept of FBDGs “implementation” has been ambiguously interpreted in published papers. A number of terms encountered in the literature, such as implementation, dissemination, socialization of messages, creation of community consciousness, promotion and communication, were sometimes used interchangeably in the same text, or taken to mean different things by different authors (EUFIC 2009; Keller and Lang, 2008; Usfar and Fahmida, 2011). The European Food Information Council (EUFIC), for example, refers to “communicative efforts” to “inform the public on the FBDG messages” when referring to “Implementing FBDGs” (EUFIC, 2009). Many published papers use the term “implementation” to refer to simple dissemination activities. By contrast, the EURODIET report has suggested that FBDGs should be implemented both as a communication tool and as a ‘springboard to planning, implementing, and evaluating public health nutrition strategies’ (Sjöström and Stockley, 2001), giving a much broader meaning to the term “implementation”.

For this study we defined “dissemination” as referring to activities that aim to inform the public about the FBDG messages using different channels (e.g. videos, songs, websites, social media etc. and print materials (e.g. leaflets, posters etc.). “Implementation” was defined as referring to comprehensive strategies and actions that embed FBDGs in national policies and programmes, and apply and activate them in different sectors (e.g. health, agriculture, education etc.) and settings (e.g. schools, communities, workplaces).

In order for FBDGs to be effective in influencing food practices in the long term, a pre-requisite is that they are well implemented (EFSA, 2010). At present, very little documentation, mainly limited to HICs, is available on how countries actually implement FBDGs. Similarly, details of monitoring and evaluation (M&E) of implementation, as well as guidance on implementation are scarce (Bechthold et al., 2017; Brown et al., 2011; Bush, 2003; Keller and Lang, 2008; Smitasiri and Uauy, 2007; WHO, 2013). Given the increased interest and demand for FBDGs, documenting the processes/strategies used for FBDGs implementation is critically important. We conducted this study to help fill some of the existing knowledge gaps regarding FBDGs implementation by conducting a survey of key informants together with a review of literature.

Section snippets

Desk review of literature

A desk review of the available literature was conducted in two steps as part of the study. At the planning stage, the literature was consulted to help frame the survey, design the questionnaire and get an idea of sectors/settings where FBDGS were being implemented. Key scientific databases such as Web of Science, Pubmed and Scopus were searched together with grey literature to identify policies and programmes guided by FBDGs. Articles were selected based on their abstracts, mainly limited to

Results

Responses were received from 27 countries out of the 36 countries contacted (75% response rate for countries). The responding countries corresponded to one LIC, three LMICs, 10 UMICs and 13 HICs. Of the 41 individual respondents, 26 were employed by the national authority responsible for FBDG development, generally the Ministry of Health (MoH). Others worked for the Ministry of Agriculture (MoA), Ministry of Education (MoE), Ministry of Food and Environment, Ministry of Agriculture and

Discussion

The current study identified several examples of FBDGs implementation spanning various sectors and settings. The majority of activities were led by health and education sectors, in line with findings from the previous FAO study in Latin America and the Caribbean (FAO, 2014). This could be explained by the fact that in many countries the FBGDs development process has traditionally been carried out by health and nutrition experts, who go on to use the FBDGs in their work. The involvement and

Conclusion

This study provides a snapshot of FBDG implementation in the surveyed countries, which shows that FBDGs are generally not utilized to their full potential. For FBDGs to be used more effectively, sectors other than nutrition and health need to see their value and be involved in their development and implementation. The FBDGs development process should lean on a wider base of inputs that come from the different sectors that have an impact on diets and healthy eating. Therefore, having a food

Funding

This work was carried out under the regular programme of work of the Food and Agriculture Organization.

Contributions

RW-B and AK were involved in all stages of the study, including the analysis and drafting of the manuscript. RW-B and AK prepared the manuscript with inputs from YH and FH. AK prepared the survey in electronic format, collated the responses, and followed up where further clarifications were needed. AK and RW-B analysed the data. All other authors made important contributions to the conceptualization and design of the study, helped to identify key informants, reviewed the survey questionnaire

Disclaimer

The views expressed in this information product are those of the authors and do not necessarily reflect the views or policies of FAO.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We are very grateful to all those who participated in the key informant survey, and in some cases, continued to communicate with us to provide further details and clarifications. We thank the two anonymous reviewers and the editor for their comments, which helped to improve the article.

References (51)

  • A. Bechthold et al.

    Perspective: food-based dietary guidelines in europe—scientific concepts, current status, and perspectives. Adv nutr

    2018 Sep

    (2018)
  • I.D. Brouwer et al.

    2020. Food systems everywhere: improving relevance in practice

    Glob. Food Sec.

    (September 2020)
  • S. Ahmed et al.

    Advancing an integrative framework to evaluate sustainability in national dietary guidelines

    Front. Sustain. Food Syst

    (2019)
  • J. Albert

    Global patterns and country experiences with the formulation and implementation of food-based dietary guidelines. Ann nutr metab

    2007

    (2007)
  • World Bank

    Country classification

  • A. Bechthold et al.

    Consumers' awareness of food-based dietary guidelines in Germany. Results of a representative survey

    Ernahrungs Umsch.

    (2017)
  • P. Blake et al.

    An analysis of methods used to synthesize evidence and grade recommendations in food-based dietary guidelines

    Nutr. Rev.

    (2018)
  • K.A. Brown et al.

    A review of consumer awareness, understanding and use of food-based dietary guidelines. Br.. J. Nutr, vol

    106, no

    (2011)
  • M. Bush et al.

    Setting dietary guidance: the Canadian experience

    J. Am. Diet Assoc.

    (2003)
  • K.B. DeSalvo

    Public health 3.0: applying the 2015-2020 dietary guidelines for Americans

    Publ. Health Rep.

    (2016)
  • Efsa

    2010. Scientific opinion on establishing food-based dietary guidelines. EFSA Panel on dietetic products, nutrition, and allergies (NDA. European food safety authority (EFSA)

    Parma, Italy. EFSA Journal

    (2010)
  • EUFIC

    Food-based dietary guidelines in europe

    European Food Information Council

    (2009)
  • EUFIC and FAO

    Food-based dietary guidelines. Summary report of a workshop held on 18–20 May 2009

  • FAO

    Influencing food environments for healthy diets

  • FAO

    Sustainable food systems: concept and framework

  • FAO

    Food-based dietary guidelines repository

  • FAO
  • FAO

    El estado de las alimentarias basadas en alimentos en América Latina y el Caribe. FAO

  • FAO and ILSI Europe

    National food based dietary guidelines: experiences, implications and future directions

  • FAO et al.
  • FAO/WHO

    Preparation and use of food-based dietary guidelines. Report of a joint FAO/WHO consultation. FAO/WHO

    World Health Organ Tech Rep Ser

    (1998)
  • A.R. Gagliardi et al.

    2015. Developing a checklist for guideline implementation planning: review and synthesis ofguideline development and implementation advice

    Implement. Sci.

    (2015)
  • C. Gonzalez Fischer et al.

    Plates, pyramids, planets

  • C. Hawkes et al.

    Fanzo. J., 42 policies and actions to orient food systems towards healthier diets for all. Centre for Food Policy Research Brief

  • HLPE

    Nutrition and food systems

  • Cited by (16)

    • How supportive is the global food supply of food-based dietary guidelines? A descriptive time series analysis of food supply alignment from 1961 to 2013

      2021, SSM - Population Health
      Citation Excerpt :

      A recent survey suggests that there is substantial variation in how countries ‘implement’ FBDGs by aligning fod policies and programmes with them (Wijesinha-Bettoni et al., 2021). A number of approaches exist, including providing educational materials for school; using FBDGs to develop regulations around public procurement in institutions such as schools and hospitals; and supporting farmers and food producers to grow foods recommended by FBDGs (Wijesinha-Bettoni et al., 2021). Additional research could evaluate the effectiveness of these different approaches to implementing FBDGs in improving food supply alignment, in order to inform policy decisions.

    View all citing articles on Scopus
    View full text