Building 'sustainability' into national healthy eating guidelines: review of international practice and practical implications for policy

Aims and objectives
This 18-month project commenced in April 2021. A mixed methods approach was utilised to
identify best practice and practical approaches to building sustainability in healthy eating
guidelines, along with the potential policy implication, based on the literature and the lived
experience, knowledge and expertise of a broad range of actors on the island of Ireland. To
achieve this, the project was carried out in five distinct but interconnected tasks:
1) A case study exploring the context, content and process evidenced in seven countries
who have integrated sustainability within their food-based dietary guidelines ;
2) A review of peer-reviewed literature (n= 54) to identify consumer behaviours and
attitudes towards sustainable diets;
3) An online survey of 2525 persons living on the island of Ireland to identify dietary
patterns, attitudes, knowledge and behaviours towards more sustainable diets;
4) An online survey (island of Ireland), policy action review and a workshop with a
multidisciplinary team of experts in Ireland (IE) to identify both common and
contested ground regarding which sustainable dietary guidelines could be included
along with the wider challenges and opportunities associated with promoting more
sustainable diets in Ireland and Northern Ireland (NI); and
5) Seven consumer focus groups to investigate potential issues with sustainable dietary
recommendations across the island of Ireland.

Key findings and recommendations
Case study
The case study enhances our current understanding of best practice to integrating
sustainability into national healthy eating food-based dietary guidelines (Task 1), which can
inform the development process of sustainable dietary guidance on the island of Ireland.
Case study results
Based on the case studies exploring the integration of sustainability into healthy eating
guidelines in seven countries, several similarities were noted:
• All countries based their guidelines on current eating patterns and health
challenges, have complementary policies in place, and assume a whole food rather
than a nutrient approach. The majority also facilitated public consultations and
workshops during and after the development of the initial draft and pre-tested for
understanding.
• Most of the guidelines speak to food waste reduction. All recommend choosing
local, seasonal or regionally produced foods, and all outline the relationship
between food and the environment, albeit to varying degrees.
• Several offer guidance specific to the environmental benefits of limiting
overconsumption; in most instances, this is specific to highly processed foods.
• Further certainty in dietary guidance, particularly pertaining to animal-based foods,
will be required for future food-based dietary guidance.
Several considerations pertaining to the various stages of development were also highlighted
for consideration:
• The process should be guided by experts representing the multiple dimensions of
sustainability, led by strong guiding principles and delivering a clear statement of
intent.
• Capturing citizens’ expectations and the challenges associated with past guidance
pre-development will be beneficial.
• Protective measures to limit potential conflicts of interest in the development
process will be essential.
In relation to the guidance itself, considerations were also noted in the context of the
guidelines explored and emerging literature:
• Highlighting a clear link between each guideline and its relationship with the
various dimensions of sustainability;
• Recognition of the influence of food environments (e.g., marketing) and advice on
how to navigate same;
• Specific guidance on seafood in terms of species to favour over others, and portion
size;
• Specific guidance for vegetarian and vegan diets;
• The promotion of breastfeeding as a cornerstone of sustainable diets.
To support sustainable dietary guidelines, further ‘multi-level, multi-actor and multi-sector’
complimentary actions will also be required. These include:
• Incorporating joint human and environmental health remits and objectives within
the working of key state bodies;
• Aligning national (agricultural production) efforts with proposed consumer efforts -
recognising the interdependence of production and consumption;
• Complimenting, by further actions and collaborations, dietary diversity, healthy
eating practices and sustainability;
• Developing guidelines along with introducing or updating national food policy.