The Eatwell Guide is nutritionally deficient

On 1st July 2018, the BBC Radio 4 Food Programme did a programme on the ‘Eatwell’ Guide. This is the visual guide showing UK people what they should be eating (Ref 1).

The programme was positioned as: “Sheila Dillon questions whether the government's Eatwell Plate that's issued to the medical profession and used as public guidance for a balanced diet could actually be harming us. An increasing number of medics are abandoning the plate because they say it still promotes dangerously high levels of starchy carbohydrates and processed foods that contain high levels of the sugars that cause many of today's chronic diseases such as obesity, diabetes and heart disease.”

The programme featured a number of people well known to real foodies, including Dr David Unwin and Dr Aseem Malhotra. There were also excellent contributions from a gastroenterologist, a hospital chef and patients who had drastically improved their health consuming far less carbohydrate. The discussion centered around: Is the ‘Eatwell’ Plate an appropriate model for healthy eating? One contributor from Public Health England, Louis Levy, tried to defend the model. He should have been asked about what follows:

‘Eatwell’ Plate/Guide history (Ref 2)

Throughout this post, the plate/guide will be called ‘Eatwell’ in inverted commas, to illustrate that it is anything but. In my 2010 book, The Obesity Epidemic, I coined the phrase ‘the eatbadly plate’, to capture the essence of the diagram (Ref 3). At that time, the Eatbadly Plate had a can of cola on it for goodness sake!

The original diagram for healthy eating in the UK was called the “Balance of Good Health (BOGH)” (Ref 4). This was launched by the UK Department of Health in 1994. The ‘Eatwell’ Plate was launched in September 2007, by the UK Food Standards Agency (FSA). It is described in the British Nutrition Foundation video on YouTube as the “healthy eating model for the UK” – suitable for young or old, vegetarian or not and for any ethnic group (Ref 5).

When the FSA revised the plate in 2007, it summarised the differences between the two plates. The BOGH title was seen as “unfriendly” and “lacking in emotion” and so the title and some colours on the plate rim changed. Food groups were tweaked. For example “bread, other cereals and potatoes” became “bread, rice, potatoes, pasta (and other starchy foods)”. In other words, a marketing company made a lot of money making the plate more “friendly” and “emotional”, but, to all intents and purposes, what we know as the ‘Eatwell’ Plate has been around since 1994.

The ‘Eatwell’ Plate was relaunched as the ‘Eatwell’ Guide on 17 March 2016. The four obvious changes were: i) the name change; ii) the knife and fork disappeared iii) the images were drawn, not photographed; and iv) the segment names were tweaked again. The four main content changes were: i) the segments have been resized; ii) the purple segment (the one that used to famously have a red can of cola) now only has unsaturated oils and spreads; iii) junk foods have been removed from the ‘Eatwell’ Plate purple segment and placed to the side of the plate – giving them more prominence in my view (and why do we need any junk on the role model healthy eating guide?); and iv) there’s a new hydration message (which has no evidence base) (Ref 6).

From ‘Eatwell’ Plate to ‘Eatwell’ Guide

I did a number of posts on the relaunch of the plate to the guide, including a peer reviewed article in the BJSM exposing the fact that Public Health England appointed a panel of representatives from industry bodies to design the ‘role model healthy eating guide’ for the UK (Refs 7, 8). I also did a post highlighting the three main issues with the revised guide (this is on open view here) (Ref 9):

1) The ‘Eatwell’ Guide is not evidence based;

2) The ‘Eatwell’ Guide does not understand the difference between volume/weight and calorie intake;

3) The ‘Eatwell’ Guide is another missed opportunity to issue a three word healthy eating message "Eat real food!"

Point 2 is particularly interesting. The ‘Eatwell’ Plate and ‘Eatwell’ Guide both have recommended proportions of different food groups. The proportions are based on weight (grams of food). In my 2010 obesity book I calculated what this equated to in terms of food intake by proportion of calories. I did the same for the ‘Eatwell’ Guide. The junk intake on the ‘Eatwell’ Guide was only intended to be 3% of food intake by weight (it was 8% on the Eatwell’ Plate), but junk is so energy dense that the 3% ends up as 9% of energy intake. Conversely, fruit and vegetables are supposed to form 39% of the ‘Eatwell’ Guide (by weight). This ends up being just 8% of calorie intake. By far the major part of calorie intake is the starchy foods segment, which ends up forming between 62-68% of calorie intake (depending on whether or not junk is consumed).

The nutrition content of the ‘Eatwell’ Guide

When the ‘Eatwell’ Plate was relaunched as the ‘Eatwell’ Guide, I did a great deal of analysis on the nutritional content of the recommended intake. I intended to write a journal article and this may still happen, but other things took over and suddenly two years have passed. The radio programme at the weekend reminded me that this would be a good time to put a nail in the eatbadly coffin, so here is the analysis that I did at the time:

 

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