While the emphasis on physical activity included in the recently published Australian Dietary Guidelines has been welcomed by food industry advocates, the inclusion of a recommendation to limit foods containing added sugars was less enthusiastically received. Ben Cooper reports.

One of the defining features of the revised Australian Dietary Guidelines, published by the National Health and Medical Research Council (NHMRC) last week, is that they are not purely dietary. Much to the approval of the food industry, a strong emphasis has been placed on the importance of physical activity.

This is the first revision of the guidelines, a joint initiative between the NHMRC and the Department of Health and Ageing, since 2003. Finalised after two consultations last year, the guidelines are now grouped into five overall recommendations and the first of these is: “To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.”

Dr Geoffrey Annison, deputy chief executive of the Australian Food and Grocery Council (AFGC), says the AFGC is “extremely supportive” of the emphasis placed on physical activity which “makes a lot of sense”.

He continues:  “You can maintain healthy weight by reducing energy in or increasing energy out and there’s a role for both”. However, he also points to the added benefits of physical activity relating to hyper-tension, bone health and a number of other conditions.

Coincidentally, the AFGC, which represents Australia’s A$110bn food and grocery sector, has recently launched its own multi-partner healthy living initiative called the Healthier Australia Commitment (HAC), which also emphasises the combination of a balanced diet and active lifestyle. Annison says the HAC is “very much in harmony” with the new guidelines. 

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It was a coincidence that the HAC was launched more less at the same time as the Australian Dietary Guidelines were published, Annison adds, but a fortuitous one given that the “message behind the Dietary Guidelines and the Healthier Australia Commitment reinforce each other”. 

In the obesity debate across many countries it is common for the food industry to emphasise physical activity over the identification of problematic foods, so it is no surprise to see the AFGC take exactly that line. 

“I think it’s generally accepted that all foods can be incorporated into a healthy diet in the same way that they can be incorporated into an unhealthy diet,” Annison says. “We are not subscribers to the view that there are bad food and good foods, just bad diets and good diets.”

However, campaigners such as Jane Martin, executive manager of the Obesity Policy Coalition (OPC), are sceptical of this stance. “It is in the interest of industry to focus on physical activity and to downplay the role of poor diet and overconsumption of processed foods,” she tells just-food. 

Martin points out that the majority of the information in the guidelines pertains to diet and the ‘calories in’ side of the dietary health equation. “These are guidelines about diet, not physical activity, and I thought that the vast majority of the information in the guidelines was related to this.”

This is certainly true. While the opening guideline emphasises the importance of physical activity, the second and third, which are by far the most extensive and detailed of the five guidelines, focus on what people should and should not be eating.

They recommend that people should “enjoy a wide variety of nutritious foods” from five food groups every day, namely vegetables, legumes and beans; fruit; grains (mostly wholegrain or high-fibre; lean meats, poultry, fish, eggs, tofu, nuts and seeds; milk, yoghurt, cheese or their alternatives; and drink plenty of water. 

The fourth and fifth recommendations pertain to breastfeeding and food safety, preparation and storage but it is the third guideline, which advises Australians to “limit intake of foods containing saturated fat, added salt, added sugars and alcohol”, which has caused the most debate.

The food industry is unhappy at the inclusion of added sugars in this list. Dr Annison suggests that while there are proven links between the consumption of substances such as saturated fat, sodium and alcohol and negative health impacts, the same links have not been proven specifically for added sugar.

“When it comes to added sugars there is no plausible biological mechanism as to why added sugars need to be singled out from any other sugar or indeed any other carbohydrate, so the level of evidence behind it is simply not as great,” he says.

Sugar, Annison believes, should therefore be treated like any other carbohydrate. “Sugar is simply another carbohydrate. It definitely has an energy content and people should definitely be careful about the amount that they eat but there’s no unique attribute about sugar or added sugar, there’s no unique chemical attribute, there’s no unique biological activity which of itself makes it potentially more obesogenic than any other energy-containing component in the diet and this is where it’s misleading in that sense.

“However, campaigners support the inclusion of food containing added sugars in the list of foods to limit.

“All previous Australian Dietary Guidelines have recommended restricting added sugars,” says Martin. “However the literature review for these guidelines found strengthened evidence on the relationship between consuming sugar sweetened beverages and increased risk of weight gain in adults and children.”

Annison, however, suggests that the correlation between the consumption of carbonated soft drinks and obesity is “tenuous at best”.

Martin  continues: “The evidence around sugar sweetened beverages and the link with overweight and obesity in adults and children is very robust and this is reflected in the level of evidence assigned to this statement in the guidelines, which are based on the scientific literature.”

While Annison believes there is “a good chance” that the next review of the guidelines might see the removal of added sugars from the list on the basis of ongoing research, Martin certainly does not. “Evidence is likely to continue to build in support of this recommendation,” she says.

What all stakeholders agree upon, however, is that ten years was a long time to wait for a review of the guidelines. “I think it’s probably appropriate to look at the Dietary Guidelines a bit more often than once every ten years,” says Annison. “Every ten years is probably a bit too long.”  

“The process took a long time,” Martin adds. In the US, the comparable Dietary Guidelines for Americans are reviewed every five years.