Writing in the British Journal of Sports Medicine this week, obesity researcher Zoe Harcombe criticised the ‘Eatwell Guide’ – a 2016 rejig of the 2007 Eatwell plate – claiming it is not evidence based. Nor does the guidance account for the difference between food weight and calories, she writes.
Public health policy needs to focus on a return to eating “real” (in other words unprocessed) food, she argued.
Harcombe told FoodNavigator she would prefer not to have any plate or diagram indicating how people should eat, but would instead: “Rip up all the libraries full of public health documentation on food/nutrition etc and replace them all with three words: ‘Eat real food’.
She added: “The lifestyle argument would have us believe that humans managed to live for 3.5 million years without an obesity problem, let alone an epidemic, and then we suddenly woke up in the late 1970s/early 80s (when the guidelines were changed) and decided to become greedy and lazy. It makes no sense.”
However, a range of public health experts have contested Harcombe’s suggestions, including the British Nutrition Foundation (BNF).
BNF nutrition scientist Helena Gibson-Moore told this publication of the foundation’s disappointment with recent claims the guide is not evidence based.
“(…) Particularly as the refreshed model was produced directly in response to the SACN report which provided an in depth review of a vast amount of literature on carbohydrates and health (including starchy carbohydrates, fibre and free sugars),” she said.
Professor Tom Sanders of King’s College, London also aired his discontent, noting the Food Standards Agency and Public Health England commissioned several large randomised controlled trials (RCTs) underpinning the guidelines.
"This editorial is a piece of provocative journalism not backed by science," he said. "It attacks the revision of the Eatwell Guide by making a number of flimsy claims and insinuates a malign influence of the food industry. There is not a shred of evidence to support the central claim that current dietary guidelines are responsible for the current obesity epidemic. The obesity and subsequent diabetes epidemic has resulted from changes in human behaviour, notably a more sedentary lifestyle and changes in eating habits, which have nothing to do with the dietary guidelines."
In a related blog post, Harcombe countered that the main study Sanders references – Reidlinger/ Sanders et. al. – is not a study of the Eatwell Guide or Plate’s suggestions and was not large enough with only 160 people over 12 weeks.
Harcombe told this publication: “An RCT to prove the (Eatwell Guide) would need to be large enough to be issued to millions of people it should at least be tested on thousands; long enough (at least a year); generalisable (include both genders, all ages, healthy and unhealthy people etc) and it should test the plate.”
In her paper, she adds: “There has been no RCT of a diet based on the Eatwell Plate or Guide, let alone one large enough, long enough and with whole population generalisability."
Reformulation, not real food “fantasy”
Other critics of Harcombe’s editorial question society’s ability to return to “real food”.
Nutrition policy expert Professor Jack Winkler, of London Metropolitan University, told FoodNavigator he agrees with Harcombe’s notion that that education attempts such as the Eatwell plate are failing. Though he noted this is more due to the fact the public do not tend to head such advice, adding: “We’ve been wagging our finger at them for years and diet got worse not better.”
He labelled the idea of returning to unprocessed foods a “fantasy”.
Instead, both he and Gibson-Moore suggested reformulation of processed foods to improve nutrition is more likely to impact healthy eating.
Up to 85% of foods consumed in the UK at the moment are at least partly processed, Winkler estimated, adding various market research asking ordinary people what they value in food show nutrition tends to be low on the list.
“It’s price, taste, convenience, what the kids will eat, what husband will eat. Lots of things come ahead of nutrition or healthiness in most people’s values on food.”
Gibson-Moore added: “In today’s environment most people are looking for convenience and it’s unrealistic to advise everyone to eat a diet that eliminates all processed foods. Reformulation, for example reducing the level of salt and free sugars in foods, is more likely to have an impact on nutrient intakes of the population.
“There is (…) no evidence to show that a healthy, balanced diet can’t contain some processed food,”
Industry role?
In her blog post, Harcombe also took aim at the Public Health England working group set up to revise the guidelines for being “dominated” by representatives of the “fake food industry”.
Winkler noted that he understands Harcombe questioning bodies such as convenience store associations having involvement in setting dietary guidelines.
Yet since reformulation is the way forward, in his view, Winkler said food industry players such as manufacturers should at least be engaged in the conversation since they will be some of the prime users of guidance.
“Manufacturers of food (…) are important players in policy. It doesn’t mean they should determine it, they are afterall interest groups, but they are one of the prime users of the guide and we need to make sure they are engaged and that things are peaceable.”