From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines.

OBJECTIVE: The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. DESIGN: A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. SETTING: National FBDG from all world regions. PARTICIPANTS: None. RESULTS: Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. CONCLUSION: Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.

What are the benefits and risks of nutrition policy actions to reduce added sugar consumption? An Australian case study.

OBJECTIVE: This study aimed to critically analyse Australia's current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders mean they have disparate views regarding which policy actions are preferable to reduce added sugar consumption. DESIGN: Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system). SETTING: Australia. PARTICIPANTS: Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia. RESULTS: All proposed and existing policy actions targeted the food environment/behaviour change; most were assessed as first-order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policies. CONCLUSIONS: Most of Australia's policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient specific, first-order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second- or third-order changes. Pursuing only first-order policy actions could lead to 'regrettable' substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.

Positioning food standards programmes to protect public health: current performance, future opportunities and necessary reforms.

OBJECTIVE: To assess current performance and identify opportunities and reforms necessary for positioning a food standards programme to help protect public health against dietary risk factors. DESIGN: A case study design in which a food standards programme's public health protection performance was analysed against an adapted Donabedian model for assessing health-care quality. The criteria were the food standards programme's structure (governance arrangements and membership of its decision-making committees), process (decision-making tools, public engagement and transparency) and food standards outcomes, which provided the information base on which performance quality was inferred. SETTING: The Australia and New Zealand food standards programme.ParticipantsThe structure, process and outcomes of the Programme. RESULTS: The Programme's structure and processes produce food standards outcomes that perform well in protecting public health from risks associated with nutrient intake excess or inadequacy. The Programme performs less well in protecting public health from the proliferation and marketing of 'discretionary' foods that can exacerbate dietary risks. Opportunities to set food standards to help protect public health against dietary risks are identified. CONCLUSIONS: The structures and decision-making processes used in food standards programmes need to be reformed so they are fit for purpose for helping combat dietary risks caused by dietary excess and imbalances. Priorities include reforming the risk analysis framework, including the nutrient profiling scoring criterion, by extending their nutrition science orientation from a nutrient (reductionist) paradigm to be more inclusive of a food/diet (holistic) paradigm.

Integrating Environmental Sustainability Considerations into Food and Nutrition Policies: Insights from Australia's National Food Plan.

The environmental sustainability (ES) of food systems is a critical challenge for policy makers. This is a highly contested policy area with differing views among stakeholders. The aim of the study was to develop a better understanding of how ES considerations are addressed in Australian food and nutrition policies and the way that consultation processes affect final policy outcomes. A mixed-methods study design combined a detailed chronology of key policy developments (2009-2015), a content analysis of written submissions obtained during the NFP's consultation period (2011-2013) and a frame analysis of the sustainability perspectives - efficiency, demand restraint, and system transformation - in the NFP's Issues, Green, and White Papers. There were 555 written submissions responding to two consultation papers. Stakeholders represented all sectors of Australia's food system including government, non-government organizations, the food supply chain, research and academic institutions, and members of the general public. Around 74% of submissions referred to ES considerations and ~65% supported their inclusion into the final policy. Efficiency frames were most dominant; emphasizing a production-oriented approach that regards the environment as a natural resource base for food production but overlooks consumption and equity concerns. Despite strong support for the inclusion of ES considerations in the NFP, the influence of Australia's socio-political context, powerful, industry-dominated stakeholders, and a reliance on traditional production-oriented perspectives delivered a business-as-usual approach to food policy making. It has since been replaced by an agricultural strategy that provides only cursory attention to ES. Our findings indicate that Australia's political environment is not sufficiently mature for ES considerations to be integrated into food and nutrition policies. We propose reforms to the current consultation process in Australia to better support this integration by promoting greater transparency and participation in the development of food and nutrition policy making.