About this paper
Launched jointly by the National Obesity Forum and the Public Health Collaboration on 23 May 2016, this report is arguably the most publicly visible document PHC has co-authored. It framed an explicit confrontation with Public Health England's newly released Eatwell Guide and with NICE's 2006-era low-fat weight-loss guidance, arguing that both rest on flawed mid-20th-century epidemiology rather than RCT evidence.
The introduction is unusually direct. It notes that humans evolved over 250,000 years as a long-lived, healthy species, yet 'in only 30 years, things have gone catastrophically wrong', with unchecked epidemics of obesity and T2D. It locates the turning point in the dietary-fat-reduction guidelines issued in the US in 1977 and the UK in 1983, which, the authors argue, ushered in increased consumption of refined carbohydrates and vegetable oils with no supporting RCT evidence.
The report is organised around 10 numbered recommendations: eating fat does not make you fat; saturated fat does not cause heart disease, and full-fat dairy is likely protective; avoid processed foods labelled 'low fat', 'lite', 'low cholesterol' or 'proven to lower cholesterol'; limit starchy and refined carbohydrates to prevent and reverse T2D; optimum sugar consumption for health is zero; industrial vegetable oils should be avoided; stop counting calories — obesity is a disease of energy partitioning, not total energy intake; you cannot outrun a bad diet; snacking will make you fat; and evidence-based nutrition should be incorporated into the training of all healthcare professionals.
Each recommendation is buttressed with RCT, meta-analysis and cohort evidence. The authors lean heavily on the Harvard-led analysis of 53 RCTs and 68,128 participants, the Women's Health Initiative results, and the 76-study saturated-fat systematic review covering more than 600,000 participants — concluding that saturated fat is not linked to CVD mortality, CHD, stroke or T2D — to argue that current advice is not merely outdated but actively harmful.
The policy recommendations are sharp. Sugar should be 'relegated to the status of condiment', labelled in teaspoons. Calorie counting should be abandoned as a primary weight-loss strategy, citing UK data showing a 1-in-167 chance of achieving normal weight via conventional calorie-restriction methods. Snacking — which the authors note has doubled eating occasions per day since the 1970s — should be discouraged, with the return of meal-spaced eating and overnight fasting windows. Low-carb, higher-fat, ad-libitum real-food eating should be added to NHS and NICE guidance.
The report drew significant public controversy from PHE, the BDA, the Royal Society for Public Health and parts of academia, and has since been one of the most-cited British nutrition-policy interventions of the decade. For PHC's purposes, it functions as the high-profile companion to the same-month Healthy Eating Guidelines report — a joint, clinician-signed statement of the 'Real Food' position that PHC's later RCT tables, T2D summary and Ambassadors Programme all operationalise.