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Healthy Sustainable Diets: Updating the Eatwell Plate
Submission to Public Health England & the External Reference Group
Eating Better welcomes the invitation from Public Health England to submit our
views and evidence to PHE and the External Reference Group advising on the
review of the Eatwell Plate.
Eating Better urges Public Health England and the Department of Health to use the
opportunity of reviewing the Eatwell Plate and associated communication
messages in response to the SACN review of Carbohydrates and Health to include
within its scope an update of the Eatwell Plate in line with scientific evidence on
sustainable diets.
The evidence of win-wins for health and the environment achievable via
sustainable eating patterns is well established. UK guidelines do not yet reflect this
evidence as they were introduced over twenty years ago and have not been
updated since. It is therefore important that the Eatwell Plate and its associated
communications take account of this evidence.
Integrating sustainability within Eatwell provides an opportunity for Public Health
England to demonstrate its leadership in promoting system-wide change to tackle
obesity and to support the principles of joined up policy across government. It will
also motivate and enable a wider range of stakeholders to support PHE in the
achievement of its diet and obesity objectives.
It will also enable PHE and the UK to join other countries that are already
demonstrating leadership in this area. Official bodies in other countries including
the Netherlands, Sweden, Nordic Countries, France and Germany have produced
their own nutrition guidelines incorporating sustainability advice for their citizens
and stakeholders. Most recently the US Dietary Guidelines Advisory Committee in
its Scientific Report1 is recommending the inclusion of environmental criteria
within the 2015 US dietary guidelines.
We urge Public Health England to build on the body of work including the Livewell
Plate and the peer reviewed DEFRA-coordinated work to define principles for
healthy sustainable eating to implement sustainability within the Eatwell Plate.
Eating Better
Eating Better2 is a broad alliance currently supported by forty-five national
organisations and partner networks bringing together public health, environment,
animal welfare, resource use, international development, research and responsible
food interests and expertise. Eating Better also benefits from the academic advice
of the Food Climate Research Network and the British Heart Foundation Centre on
Population Approaches for Non-Communicable Disease Prevention both at the
University of Oxford.
Eating Better is calling on governments, businesses and all those who can make a
difference to help people move towards healthy and sustainable eating patterns
based on plant-based eating with less and better meat as a healthier, fairer, greener
way to eat for people and the planet.
Healthy Sustainable Diets: Updating the Eatwell Plate
Eating Better’s Policy Briefing3, developed in consultation with our supporting
organisations and partner networks, calls on UK governments to develop policies
and practices to support a transition to healthy and sustainable eating patterns.
An essential first step towards this goal, is the updating of official guidance –
including the Eatwell Plate - to provide audiences and stakeholders, including
businesses, professionals, educators and the public, with integrated advice on
healthy sustainable eating patterns.
We recognise that cross-government working is vital and one department or
agency alone cannot meet this objective.
DEFRA has already recognised the importance of sustainable food consumption in
its Green Food Project and convened stakeholders in 2013, including the
Department of Health, to define principles for healthy sustainable eating.4 The
principles include advice to:
Eat a varied balanced diet to maintain a healthy body weight.
Eat more plant based foods, including at least five portions of fruit and
vegetables per day.
Value your food. Ask about where it comes from and how it is produced. Don’t
waste it.
Moderate your meat consumption and enjoy more peas, beans, nuts and other
sources of protein.
Choose fish sourced from sustainable stocks. Seasonality and capture methods
are important here too.
Include milk and dairy products in your diet or seek out plant based
alternatives, including those that are fortified with additional vitamins and
4 Sustainable Food Consumption Report, Follow-Up to the Green Food Project July 2013
Drink tap water.
Eat fewer foods high in fat, sugar and salt.
DEFRA has supported the peer review of this work (now completed) and its
forthcoming publication by the Global Food Security Programme. We urge Public
Health England to build on this work and implement the guidance within the
Eatwell Plate.
The Livewell Plate provides further evidence that it is possible to include
sustainability within dietary guidance5. This project from WWF-UK and Aberdeen
University sought to define a sustainable (lower GHG) diet that is nutritionally
adequate and acceptable. By adapting the Eatwell Plate to include reductions in
greenhouse gas emission, Livewell offers dietary recommendations that would
meet current nutritional guidance and cut GHG emissions from the UK supply chain
inline with UK emission reduction targets. Livewell proposes reductions in GHG
intensive foods (meat & dairy) without eliminating these and an increase in plantbased foods including vegetables and fruits. The Livewell diets have now been
developed for Sweden, Spain and France.
Official bodies in other countries including the Netherlands6, Sweden7, Nordic
Countries8, France9 and Germany10 have produced their own nutrition guidelines
incorporating sustainability advice for their citizens and stakeholders. The Italian
Barilla Center’s ‘Double Pyramid’11, provides guidance on how to achieve diets that
combine both health and environmental benefits.
Most recently the US Dietary Guidelines Advisory Committee in its Scientific
Report12 is recommending the inclusion of environmental criteria within US dietary
Healthy eating guidelines have many functions including supporting the
development, implementation and evaluation of local and national food policy and
supporting professions and the public in relation to health improvement and
education. Updating the Eatwell Plate for sustainability would also support PHE’s
own prioritisation of sustainable food procurement at the local level.
8 Norden (2014).Nordic Nutrition Recommendations 2012, Nordic Council of Ministers, Copenhagen
We note that as part of its priority on obesity, PHE has committed to ‘support local
authorities to deliver whole system approaches to tackle obesity, including through
supporting healthier and more sustainable food procurement”.13 Failing to include
sustainability recommendations within the Eatwell Plate would be a missed
opportunity to reinforce this important message to local authorities and the wider
audience of stakeholders who use the Eatwell guidelines.
The evidence for healthy sustainable diets
The way we feed ourselves is unhealthy and unsustainable14. It contributes to some
20-30% of anthropogenic greenhouse gas (GHG) emissions, is the leading cause of
deforestation, land use change and biodiversity loss; accounts for 70% of all human
water use and is a major source of water pollution.15
Strong evidence now exists of the need to shift diets towards healthy and
sustainable eating patterns and there is growing agreement on the principles that
underpin such healthy sustainable diets. This includes a shift to more plant-based
eating with reduced levels of meat-eating among high consuming countries like the
UK to help address climate change, promote public health and help feed the world
more fairly and humanely.16
A growing body of interdisciplinary evidence demonstrates that applying
environmental and sustainability factors to dietary guidelines can be accomplished
because of the compatibility and degree of overlap between favourable health and
environmental outcomes.17 It is possible to devise diets that generate lower
environmental impacts than the consumption average and that are broadly in line
with current nutritional guidelines.18
An authoritative review of the evidence for sustainable diets has recently been
published in the 2015 Dietary Guidelines Advisory Committee’s Scientific Report.19
This concludes:
‘Consistent evidence indicates that, in general, a dietary pattern that is higher in
plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds,
14 The Government Office for Science, The Future of Food and Farming: Challenges and Choices for
Global Sustainability, 2011,
15 T Garnett, What Is a Sustainable Healthy Diet? Food Climate Research Network, 2014,
16 See for example
UN Food and Agriculture Organization (FAO), Sustainable Diets and Biodiversity - Directions and
Solutions for Policy, Research and Action, 2014,
17 Scientific Report of the 2015 Dietary Guidance Advisory Committee: Advisory Report to the
Secretary of Health and Human Services and the Secretary of Agriculture, February 2015
18 T Garnett, What Is a Sustainable Healthy Diet? Food Climate Research Network, 2014,
and lower in animal-based foods is more health promoting and is associated with
lesser environmental impact (GHG emissions and energy, land, and water use) than is
the current average U.S. diet.’
The evidence the Committee drew on includes UK research.
UK research considered by the Advisory Committee include Scarborough et al.20
This demonstrates that a diet with 50 percent reduced total meat and dairy
replaced by fruit, vegetables, and cereals contributed the most to estimated
reduced risk of total mortality and also had the largest potential positive
environmental impact. This diet scenario increased fruit and vegetable
consumption by 63 percent and decreased saturated fat and salt consumption;
micronutrient intake was generally similar with the exception of a drop in vitamin
Also quoted is Macdiarmid et al.21 This research which supported the development
of the Livewell Plate, demonstrates that a sustainable diet that meets dietary
requirements and has lower GHG can be achieved without eliminating meat or
dairy products completely, or increasing the cost to the consumer.
Meat consumption
A reduction in the consumption of meat has been demonstrating as likely to have
the most significant and immediate impact on making diets more sustainable.22 UK
per capita meat consumption is average for the EU it is high in global terms –
approximately twice the world average.23
High levels of meat consumption - particularly of red and processed meat - are
detrimental to public health. UK Department of Health advice24 is to consume no
more than 70g/day of red and processed meat. Other scientific bodies go further in
their advice. The World Cancer Research Fund (WCRF), which carries out a major
global study of cancer and diet every ten years, recommends that we should eat
mostly foods of plant origin and limit intake of red meat and avoid processed
Current average intakes of red meat for men exceed government health
recommendations, with young men (16-24) being the highest consumers of red
meat. Four in 10 men and one in 10 women eat more than 90g of red and processed
Scarborough P, Allender S, Clarke D, Wickramasinghe K, Rayner M. Modelling the 2028 health
impact of environmentally sustainable dietary scenarios in the UK. Eur J Clin 2029 Nutr.
2012;66(6):710-5. PMID: 22491494. 2030
21 Macdiarmid JI, Kyle J, Horgan GW, Loe J, Fyfe C, Johnstone A, et al. Sustainable diets 2006 for the
future: Can we contribute to reducing greenhouse gas emissions by eating a 2007 healthy diet? Am J
Clin Nutr. 2012;96(3):632-9. PMID: 22854399. 2008
22 Garnett, T. (2013). Food sustainability: Problems, perspectives and solutions. Proceedings of the
Nutrition Society, 72(1), 29-39.
25 World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical
Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007
meat a day26. In 2012 it was calculated that six out of ten men and one in four
women consume more red and processed meat than government health guidelines
Reducing meat consumption in high meat consuming countries, such as the UK, will
help reduce heart disease, obesity and cancer.28 It has been calculated that eating
meat no more than three times a week would prevent 45,000 early deaths a year in
the UK and save the NHS 1.2bn a year. 29
Eating meat that is more extensively farmed may also have health benefits. Pasturereared beef has been found to contain less fat and has a higher proportion of
omega-3 fatty acids compared with intensively reared beef.30 There are therefore
health grounds, as well as environmental and animal welfare reasons, when
consuming meat, dairy products and eggs to choose the highest possible welfare
options. A ‘less and better’ approach to consumption of these products means that
such choices need not cost more.
This submission demonstrates the substantive body of evidence that now exists on
the co-benefits for public health and the environment of a transition to healthy and
sustainable eating patterns in the UK. It also highlights practical ways in which it is
possible to update the Eatwell Plate to integrate sustainability.
We urge Public Health England to progress the work already undertaken in the UK,
including work led by DEFRA and to update the Eatwell Plate and associated
messaging in line with scientific evidence on sustainable diets.
Eating Better, April 2015
Contact: Sue Dibb, Coordinator, Eating Better
Email: [email protected]
Red meat and the risk of bowel cancer, NHS Choices
S. Westland and H. Crawley, Healthy and Sustainable Diets in the Early Years, First Steps Nutrition
Trust, 2012,
28 McMichael A J, et al, 2007, The Lancet 370:1253-1263
30 Compassion in World Farming (2012) Nutritional benefits of high welfare animal