Redefining healthy diets?
This subsection addresses the following four elements:
The current health crisis and the problem with nutritional advice
Many countries worldwide face significant challenges in achieving optimal health among their populations. Only about one on ten adults in the US is in a state of optimal cardiometabolic health while the majority of Americans are either overweight or obese. Similar health issues are observed in other Western countries, where a high percentage of older adults are abdominally obese, and many are at high cardiometabolic risk. Public health nutrition strategies, including dietary guidelines, have been criticized for being ineffective and lacking evidence and rigor. Nutritional epidemiology of chronic disease (NECD) has been accused of producing implausible conclusions and overstating evidence. Some argue that the current dietary guidelines should be ignored altogether due to insufficient evidence. Additionally, 'preventive' public health nutrition has been described as arrogant, aggressive, presumptuous, and overbearing in its approach.
Too zealous adherence is not necessarily harmless
Excessive adherence to (or overinterpretation of) certain nutritional guidelines may have unintended consequences, especially for vulnerable groups. It can lead to overly restrictive diets, particularly when combined with food allergies that require additional exclusionary measures. Given the persisting call for more 'plant-based' eating, disproportionate reliance on 'protein alternatives' may result in higher consumption of processing contaminants and anti-nutritional compounds, as well as a higher proportion of ultra-processed foods. In excess, some improperly prepared or treated plant-based foods could lead to higher intakes of harmful substances like cariogenic sugars, fructose, mycotoxins, heavy metals, pesticide residues, plant-derived toxins, phytoestrogens, allergens, oxidation products, and acrylamide. Additionally, diets that are very low in fat and high in fibre may cause increased flatulence and bowel discomfort. The health impact of plant-based diets largely depends on the specific food items chosen, and individual health status should also be considered.
Nutritionism as an alibi for ultra-processing
Nutrient profiling systems designed to assess the healthiness of foods, and used for Front-of-Pack labelling and nutritional advice, may not only exaggerate the risks of animal source foods but also underestimate the risks of ultra-processed foods (UPFs). Food corporations exploit such models to reformulate products superficially without addressing the true health impacts of UPFs. UPFs have become prevalent, with negative impacts on health and the environment. UPFs are typically made from cheap, extracted, and refined ingredients, lacking in whole and fresh components. They often contain additives and are designed to be hyper-palatable, leading to quasi-addictive behaviours and mindless eating. UPFs are aggressively marketed, and corporations use greenwashing and nutri-washing tactics to create demand within global supply chains. As such, they replace traditional meals and contribute to the atomization of society. UPFs disproportionately affect lower socioeconomic groups, exacerbating nutritional imbalances.
Ways forward?
Future health policies should move beyond a narrow focus on nutrients or even foods, and consider dietary patterns as well as the broader social, commercial, and ecological determinants of health. Instead of monolithic top-down approaches, a reappraisal of culinary legacies could offer more constructive options that accommodate personal and cultural preferences. Foods associated with the recent 'Western diet,' particularly ultra-processed foods (UPFs), should be approached with caution. UPFs may serve as a primary target for preventing non-communicable diseases, including colorectal cancer. Their harmful effects may be attributed more to the act of ultra-processing itself rather than the nutritional content. Adequate essential nutrition, including sufficient protein and micronutrients, should also be a focal point of public health policies to address deficiencies that persist globally.