Australian Dietary Guidelines Incorporating the Australian Guide to Healthy Eating

Public Health Association of Australia’s Response to the Draft for Public Consultation

Wednesday 15th February 2012

Andrea Begley, MPH, APDFood and Nutrition Special Interest Group (FANSIG) National-Convenor

School of Public Health, Curtin Universitya.begley@curtin.edu.au

Presentation Outcomes

• Outline PHAA’s Position on Public Health Nutrition & Dietary Guidelines

• Assess the importance of the historical & current context of Dietary Guidelines

• Identify the Commendation on Australian Dietary Guidelines (Guidelines) incorporating the Australian Guide to Healthy Eating (AGHE)

• Assess potential for further improvements to the Guidelines

• Identify how Guidelines can best be supported

“The promotion and maintenance of nutrition-related health and wellbeing of populations through the organised efforts

and informed choices of society.”The Barcelona Declaration, 2006

World Public Health Nutrition Association http:/www.wphna.org/

1.1 Context-Public Health Nutrition

1.2 Context-New Nutrition Science

Beauman C, Cannon G, Elmadfa et al. The principles, definition and dimensions of the new nutrition science. Public Health Nutrition. 2005;8(6A):695-8.Cannon G, Leitzmann C. The new nutrition science project. Public Health Nutrition. 2005;8(6A):673-94.

• Expression of the principles of nutrition education mostly as foods

• Intended for use by individual members of the general public, and

• If not expressed entirely as foods, written in language that avoids, as far as possible, the technical terms of nutrition science.

1.3 Context - Food Based Guidelines (WHO)

Food and Agricultural Organization, World Heath Organisation. Preparation and use of Food-Based Dietary Guidelines. Report of a joint FAO/WHO consultation. Nicosia, Cyprus1996; Available from: http://www.fao.org/docrep/X0243E/x0243e00.htm.

Deliver the nutrient requirements for people of varying age/gender, activity levels and life-stages

Are culturally acceptable, socially equitable and environmentally sustainable

Reflect the current Australian food supply and food consumption patterns

Provide some flexibility in food choice and promote health and wellbeing

National Health and Medical Research Council. Review of Dietary Guidelines. Canberra 2010 [cited 2010 23rd May]; Available from: http://hnhmrc.gov.au/your_health/healthy/nutrition/review.htm.

2.1 Content- Goals

1. Continuing International Recognition of Australian Dietary Guidelines– Expert Working Committee

2. Appropriate Goals for this Revision

3. Comprehensive Evidence Based Process & Supporting Documents

2.1 Content - Commendations

4. Acknowledgement of the Social Determinants of Health

5. Consistency & Specificity of Guidelines

6. Contribution to Improving Population Food Literacy

7. Well-defined Presentation & Format

2.1 Content - Commendations

• Sugary sweetened drinks associated with increased weight gain

• Milk & fruit intake associated with reduced risk heart disease

• Non-starchy vegetables decreased risk some cancers

• Wholegrain cereals consumption associated with decreased risk of heart disease as well as excessive weight gain

• Breastfeeding association with long-term health benefits

2.2 Content – Strengthening Associations From Evidence Review

NHMRC, 2011, http://www.eatforhealth.gov.au/page/about-guidelines

1. Incorporate Environmental Sustainability

– Chapter in 2003 Dietary Guidelines ‘Food for Health’ Professional Publication

– Number of statements on environment in Guidelines

– Recommendations:A) Include evidence in final documentB) Review evidence to develop

environmental guideline

2.3 Content - Recommendations

• PHAA contends that it would be a missed opportunity to not integrate environmental considerations in the 2012 revision

• Dietary guidelines need to go further than just maintaining an ‘interest’ in healthy diets and the environment

A healthy diet is generally an ecological sustainable diet

(http://www.gezondheidsraad.nl/en/search/results/guidelines%20for%20healthy%20diet)

2.3 Content-Recommendations

• Netherlands Government (Win-Win Guidelines)

– a less animal-based and more plant-based diet, containing fewer meat and dairy products and more whole grain products, legumes, vegetables, fruit, and plant-derived meat substitutes

– the reduction of energy intake for those with an excessive body weight, in particular by eating fewer non-basic foods, such as sugary drinks, sweets, cakes and snacks

Health Council of the Netherlands. Guidelines for a healthy diet: the ecological perspective. 2011.

2.3 Content - Recommendations

• UK Sustainable Development Commission

– Changes likely to have the most significant and immediate impact on making our diets more sustainable, in which health, environmental, economic and social impacts are more likely to complement each other:• Reducing consumption of meat and dairy products• Reducing consumption of food and drink of low

nutritional value (i.e. fatty and sugary foods)• Reducing food waste

Sustainable Development Commission. Setting the Table: Advice to Government on priority elements of sustainable diets. London: Sustainable Development Commission; 2009 [cited 2012 15th January]; Available from: Retrieved from http://www.sd-commission.org.uk/publications/downloads/Setting_the_Table.pdf.

2.3 Content - Recommendations

2. Greater Emphasis on Social Equity & Food Costs– Low cost foods to achieve a healthy diet in practical

considerations & AGHE

3. Comprehensive Implementation & Dissemination– Practical Considerations for ALL stages of lifecycle and

vulnerable groups – Clear simple communications for the population and

individual lifecycle stages

4. Reword & Reorder Guidelines and provide additional detail in AGHE

2.3 Content - Recommendations

Content Recommendations

2.4 Content -Guidelines

• Guideline 1: Enjoy a wide variety of nutritious foods from these five food groups every day to maximise health and environmental sustainability:

– Plenty of vegetables, legumes/beans including different types and colours

– Plenty of fruit– Plenty of grains (cereals) foods, mostly wholegrain such as bread,

cereals, rice, pasta, noodles, polenta, couscous, oats and barley– Some lean meat and poultry, fish, eggs, nuts and seeds and

legumes/beans– Some milk, yoghurt, cheese and/or their alternatives, mostly

reduced fat (reduced fat milks are not suitable for children under the age of 2 years)

– And drink plenty of water, mainly tap water

PHAA’s Recommendations

2.4 Content -Guidelines

• Guideline 2: Avoid the intake of foods and drinks high in total energy, fat, salt and added sugars, particularly from highly processed foods and drinks

– Limit intake of foods and drinks containing high total fat, saturated fat and trans fats (Low-fat diets are not suitable for infants)• Include small amounts of foods that contain unsaturated fats

– Limit intake of foods and drinks containing added salt– Limit intake of foods and drinks containing added sugars. In

particular, limit sugar sweetened drinks– If you choose to drink alcohol limit intake

PHAA’s Recommendations

2.4 Content -Guidelines

• Guideline 3: Choose amounts of nutritious foods and drinks to meet your energy needs to achieve and maintain a healthy body weight

– Children should meet energy needs for healthy growth and development

– Older people need to maintain muscle strength in conjunction with healthy weight

– Be physically active every day

PHAA’s Recommendations

Guideline 3 Choose amounts of nutritious foods and drinks to meet your energy needs to achieve and maintain a healthy body weight

Guideline 1 Enjoy a wide variety of nutritious foods from these five food groups every day to maximise health and environmental sustainability

Guideline 2 Avoid the intake of foods and drinks high in total energy, fat, salt and added sugars, particularly from highly processed foods and drinks

Guideline 4 Encourage and support breastfeeding

Guideline 5 Care for your food; prepare and store it safely

PHAA’s Recommendations

“Trying to revise the guidelines and update the pyramid without

consumer testing is a little like trying to reach the North Pole

without a compass”

2.4 Content –AGHE

Edge MS, 2004, Promoting healthful diets from a public perspective, JADA, vol.104,no.5,pp.827-31

• National Food Policy– Applying Dietary

Guidelines to Stakeholders

– Develop large & effective workforce

– National Food and Nutrition Monitoring and Surveillance System

3. Supporting the Dietary Guidelines

World Health Organisation. A Framework to Monitor and Evaluate Implementation; WHO Global Strategy on Diet, Physical Activity and Health. Geneva: World Health Organisation; 2008 [cited 2009 9th September]; Available from: http://www.who.int/dietphysicalactivity/DPASindicators/en/index.html.

WHO Framework 2008

• Dietary Guidelines Working Committee to inform 2012 Guidelines

• Professor Colin Binns, John Curtin Distinguished Professor, Curtin University for his life-long commitment to Dietary Guidelines and Infant Feeding Guidelines for Health Workers for Australia

Acknowledgments

Comments & Questions