Shortcomings of food-based dietary guidelines worldwide: a focus on sustainability and food processing issues

Since 1992, food-based dietary guidelines (FBDGs) have been developed worldwide to help consumers and society on a larger scale make informed food choices for their health. However, the global prevalence of chronic diseases continues to increase, raising questions about the effectiveness of FBDGs in addressing the broader determinants of health, and in promoting sustainable food systems. Therefore, this policy and practice review intends to identify and summarize the main shortcomings of the current FBDGs. The more detailed focus on sustainability and food processing issues showed that these two dimensions are still lacking or insufficiently considered in current FBDGs, hindering the formulation of robust recommendations for protecting global health. Based on this analysis, we propose several paradigms shifts to increase the relevance and coherence of future FBDGs: moving from food pyramids to technological pyramids; shifting from the currently excessive quantitative and food group-based recommendations toward more qualitative and holistic guidance; emphasizing the role of the food matrix rather than isolated nutrients; and integrating sustainability and regenerative agricultural practices more explicitly. The overarching challenge lies in designing FBDGs that adopt a systems-oriented, holistic approach-one that reflects the interconnectedness of human, environmental, and societal wellbeing, and that organizes and hierarchizes nutritional information from broad dietary patterns down to specific nutrients.