How can we create dietary guidelines that truly support health, sustainability, and inclusivity? Our latest blog explores the perspectives of healthcare professionals and the urgent need for stronger, evidence-based policies.
By Marta Buczkowska, Registered Dietitian and Tanya Haffner, Registered Dietitian and CEO and Founder MyNutriWeb
Food-based dietary guidelines (FBDG) such as the British Eatwell Guide1 are important public health and policy tools shaping the government recommendations for healthy balanced diets at a population level. They provide guidance to a wide range of stakeholders, including government and industry representatives, schools, policy-makers and healthcare professionals, such as nutritionists and dietitians.2
The Eatwell Guide, published in 2016, provides visual guidelines on the recommended proportions of different food groups that should be included in a healthy balanced diet. Eatwell Guide is also accompanied by pdf documents3-5 containing written advice on macro- and micronutrients intake and portion sizes for a balanced diet and recommendations for specific nutrient intake, including sugar, salt or saturated fat stratified by age and gender. These recommendations were specifically designed to improve overall nutrition and health outcomes by reducing the prevalence of non-communicable, diet-related diseases such as cardiovascular disease, type 2 diabetes, and obesity.6 They currently fail to consider the social, cultural or environmental dimensions of food.
FBDG should reflect the changing world
Year to year, we continue to observe more pronounced consequences of the changing climate; record-high temperatures, floods, draughts and fires, while global obesity rates continue to rise. 7 Current dietary patterns contribute to 25-30% of total greenhouse gas emissions, as well as significant proportion of bluewater and land use and pollution.8 They are also a primary cause of numerous non-communicable diseases and pre-mature deaths.9 It is clear something has to change.
In 2019 World Health Organization (WHO) and Food and Agriculture Organization (FAO) published Sustainable Healthy Diets Guiding Principles10 – guidelines outlining the importance of incorporating social, cultural and environmental sustainability in FBDG across the world. Both organisations strongly recommend that countries consider local traditions, affordability, accesibility, as well as health and environmental impact of food when updating their FBDG. Since then, several countries, including Canada11, Denmark12 or Belgium13 updated their FBDG based on these recommendations.
According to the EAT-Lancet Commission8, adopting sustainable, plant-rich diets prioritising whole foods and plant-based protein sources, such as beans, legumes, nuts or seeds over animal-based protein sources could lead to a ~20% reduction in global deaths every year and result in a significant decrease in greenhouse gases emissions, as well as water, land and energy use.
However, despite evolving scientific insights and global shifts in dietary priorities, British FBDG have remained unchanged since 2016, with only minimal consideration for social, cultural, and environmental factors. Even more concerning, a staggering 99.9% of the UK population does not adhere to the Eatwell Guide recommendations—meaning fewer than one in a thousand people follow the guidance designed to promote national health.
What do dietitians and nutritionists think?
Nutritionists, dietitians and other healthcare professionals (HCPs) play an important role in shaping and promoting messages included in the national dietary guidelines, yet little is known about their perceptions of the FBDG format and content. While numerous studies have examined the FBDG communication style14, consumers’ perceptions15 or awareness16,17 research on how HCPs view and engage with these guidelines remains limited.
Rapid literature review
Methodology
To better understand the HCPs’ opinions on FBDG, we conducted a rapid literature review aimed to answer the research question: what are the perceptions of healthcare staff on food-based dietary guidelines?
The literature search was conducted in December 2024 and the results were presented at the Nutrition Society’s 2025 Winter Conference. Initially, this review was supposed to solely explore the perceptions of HCPs on the British FBDG, however no sufficient publications meeting these criteria could be found, hence the strategy was updated to also include papers published outside of the UK. Electronic databases – Scopus and PsycINFO, and grey literature sources – Google and Google Scholar, were used to identify relevant literature.
The keywords strategy was designed to best answer the research questions and was refined based on the initial searches. A full list of keywords can be found below:
• Perception*: opinion*, thought*, like*, dislike*, perspective*
• Healthcare staff*: doctor*, nurs*, dietitian*, health worker*, HCP*, AHP*, allied healthcare professional*, healthcare professional*, nutritionist*, hospital worker*, healthcare
• Food-based dietary guidelines: nutritional guideline*, Eatwell*, FBDG*, nutrition guideline*
The review included publications exploring the HCPs’ opinions on FBDG, published in English in 2016 and onwards. Publications exploring consumer perceptions of FBDG were excluded.
Nine publications were included in the review – two research articles 18,19, one conference proceeding20, three reports21-23, one position statement24 and two newspaper articles.25,26 Two positions were identified through the electronic database search, three through reference screening and four through grey literature scoping search. Five of the publications were published in the UK, two in Canada and two in the United States of America (USA).
A short characteristic of each publication can be found below:
| Title & Publication year | Authors | Country | Publication type | Key findings |
| Registered dietitians’ perceptions and use of the plant-based recommendations in the 2019 Canada’s Food Guide18 (2021) | Asher, Doucet & Luke
|
Canada | Research article, cross-sectional online survey (n=411)
|
Including more plant-based products in FBDG encourages dietitians to recommend them to patients more often.
FBDG should not overlook the needs of elderly and children. |
| A survey to understand whether an evolution of the Eatwell Guide and use of icons would support protein diversification, particularly more plant-based and fungi-based (non-animal) proteins19(2024) | Durrant et al.
|
UK | Research article, online survey (n=865) | The Eatwell Guide protein group should be updated to include more diversified protein sources – namely novel and plant-based protein foods.
Eatwell Guide messaging should be clearer for patients. |
| Dietitians’ attitudes towards meat-alternatives in food-based dietary guidelines: findings from a survey20 (2022) | Roper et al.
|
UK | Conference proceeding, online survey (n=188)
|
The majority of the UK dietitians agree that the Eatwell Guide should be updated to better reflect sustainable dietary patterns. |
| Eating for net zero – how diet shift can enable a nature positive net-zero transition in the UK21 (2023)
|
Halevy, S., & Trewern, J. (WWF-UK)
|
UK | Report | Governments can enhance dietary guidelines to support health, climate, and nature by providing implementation guidance, refining public recommendations on high-impact foods like meat and dairy, and integrating environmental indicators. |
| Birmingham Eating Guidance Exploration Report22 (2024) | Food System Team, Public Health Division, Birmingham City Council | UK | Report,
focus groups and structured interviews
|
Clearer, culturally inclusive dietary resources are needed to improve FBDG accessibility.
|
| Adherence to the Eatwell Guide and population and planetary health: A Rank Prize Forum report23 | Shannon et al. | UK | Report | Better understanding of the HCPs views on FBDG is essential. |
| Dietitians of Canada applauds new Food Guide, calling it relevant, modern and evidence based24 (2019) | Dietitians of Canada | Canada | Position statement | Dietitians of Canada strongly support the inclusion of social, cultural and environmental dimensions in the Canadian FBDG. |
| Nutrition experts criticize new federal dietary guidelines25 (2016) | Scudellari, M. | USA | Newspaper article | Nutrition experts were concerned about food industry lobbying in the process of developing national FBDG. |
| What nutrition experts think is missing from the new Dietary Guidelines26 (2016) | Warshaw, H. | USA | Newspaper article | Concerns about overlooking the environmental sustainability aspect in designing FBDG & not including the recommendation to reduce red meat intake. |
Key findings
Two main themes were identified across all nine publications included in this review – namely alternative protein sources and improved communication.
Alternative protein sources
In the study conducted by Roper et al.20, 72.3% of dietitians agreed the Eatwell Guide should be updated to better reflect sustainable dietary patterns and include more
alternative protein sources. Similarly, in the study by Durrant and colleagues19, 92% of dietitians believed that the Eatwell Guide protein group needs to include more plant-based foods (PBF). A Canadian study18 looking into dietitians’ perceptions on the new Canadian FBDG found that 58.7% of dietitians encouraged patients to choose plant-based protein more often under the new guide.
Improved communication
Patient-centered communication
Healthcare professionals frequently cited the lack of clarity as a significant concern associated with the Eatwell Guide. It was especially prominent in the context of PBF. In the study by Durrant et al.19 focused on the protein diversification, only 12% of dietitians believed patients can easily identify PBF in the current Eatwell Guide. Dietitians suggested to include clearer recommendations for PBF20 to improve communication and 68% of them believed adding visual representation of PBF would be helpful for patients19. On the contrary, in Canada, some dietitians expressed concerns that more plant-based FBDG may overlook vulnerable populations, such as elderly or children.18 Some concerns were also expressed regarding the communication around other food groups. HCPs included in the Birmingham Eating Guidance Exploration Report22 highlighted patient confusion around some of the Eatwell Guide recommendations – namely portion sizes and meeting the 5-a-day target, and voiced concerns around the cultural foods not being included in the Guide.
Clearer and and more inclusive communication
The Birmingham Eating Guidance Exploration Report22 also suggested that FBDG should be more interactive – i.e. available in the form of social media posts or videos, and include real meal examples. Havely & Trewern21 in their report suggest that to improve adherence, FBDG should be available in the form of sector-specific guides for food businesses, local authorities and public health practitioners. It also suggests that FBDG should provide clearer guidelines on the consumption of foods with high environmental impact, such as red meat and dairy. A similar issue was raised in two newspaper articles published in the USA. 25,26 They described the HCPs’ disappointment about poor communication around the development of new FBDG. Dietitians and nutrition experts were especially alarmed about the lack of recommendations to reduce red meat intake and reported concerns about meat industry lobbying.
Discussion and key takeaways
As reflected in the above findings, HCPs – mainly in the UK and the USA, identified confusion and accessibility issues and missed opportunities to promote sustainability as the main concerns around the FBDG. One of the key areas for improvement suggested by healthcare workers included improving the diversity, visibility and communication of PBF in the dietary guidelines. HCPs agreed the British Eatwell Guide should:
• Consist of clearer messaging around the consumption of foods with high environmental impact,
• Include more plant-based protein sources,
• Present clearer recommendations for PBF consumption, without overlooking vulnerable populations.
Another area for improvement highlighted by HCPs was better communication with patients, public, government and business representatives, as well as other stakeholders. Key suggestions included:
• Improved visual representation of foods (i.e. pictograms),
• Introducing more interactive communication channels – such as social media posts or industry-tailored guides,
• Adding more cultural nuance – i.e. including cultural foods,
• Including real meal examples.
In Canada, where FBDG were already updated to better reflect environmental, social and cultural needs, dietitians reported strong support for the new FBDG. They highlighted that the revised guidelines empowered them to more frequently recommend plant-based protein sources to patients.
Limitations
A significant proportion of the publications in this review consists of grey literature, which was not conducted under strict methodological guidelines. Additionally, most studies focused specifically on healthcare professionals’ perceptions of plant-based and novel protein sources, rather than their broader views on FBDG.
What does the future look like?
Findings from this review suggest that healthcare workers generally support evidence-based, plant-forward dietary guidelines but see significant room for improvement in terms of sustainability, inclusivity, clarity, and practical implementation. The research is clear – in order to improve physical, mental and planetary health, our dietary habits need to change. This urgency is echoed by the WHO & FAO’s Sustainable Healthy Diets Guiding Principles10 and the global shift toward more sustainability-focused FBDG. Governments have a powerful role in shaping public behavior and must take decisive action to improve dietary guidelines. Public support is strong—a 2024 study including 130,000 participants found that 89% demand stronger political action against climate change. 27
Healthcare workers are vital stakeholders in designing effective FBDG, and their perspectives should be integrated from conception to implementation. Yet, this review reveals a significant gap in understanding their views. High-quality research involving a diverse range of HCPs is urgently needed to ensure British FBDG align with social, cultural, and environmental needs—creating truly inclusive and impactful dietary guidelines.
