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Analysis Science and Politics of Nutrition

Role of government policy in nutrition—barriers to and opportunities for healthier eating

BMJ 2018; 361 doi: (Published 13 June 2018) Cite this as: BMJ 2018;361:k2426

Food for thought

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  1. Dariush Mozaffarian, dean1,
  2. Sonia Y Angell, deputy commissioner2,
  3. Tim Lang, professor3,
  4. Juan A Rivera, director4
  1. 1Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA
  2. 2New York City Department of Health and Mental Hygiene, New York City NY, USA
  3. 3School of Arts and Social Sciences, City University of London, UK
  4. 4Instituto Nacional de Salud Pública, Mexico City, Mexico
  1. Correspondence to: D Mozaffarian dariush.mozaffarian{at}

Dariush Mozaffarian and colleagues review strategies governments can use to improve nutrition and health

For most of human history including much of the 20th century, insufficient food was the greatest nutritional challenge. To tackle this, government sought to stimulate the production and distribution of as much inexpensive food as possible, in particular starchy (high carbohydrate) staple commodities and their shelf stable processed products. At the time, a global pandemic of obesity and chronic diseases from the widespread availability of inexpensive, unhealthy food was inconceivable.

The relatively recent rise of diet related chronic diseases including obesity, type 2 diabetes, cardiovascular diseases, and several cancers is at least partly a byproduct of these historical approaches and the responses of industry and consumers. A separate article in this series reviews the trends in nutrition science over this period,1 which have slowly shifted focus from undernutrition defined by calories and micronutrient deficiency to food based diet patterns and overall health effects of the food supply.

Even with the unprecedented rise in diet related chronic diseases, government policies have continued to emphasise agricultural production of staple commodities and support for the food industry motivated by conventional perspectives on food security, economics, and trade. While undernutrition has improved with government supported systems changes such as agricultural development and fortification programmes,1 government has tended to use educational policy measures directed at individuals in response to the rise in chronic diseases. Such measures aim to influence diet quality by emphasising personal responsibility and choice through dietary guidelines, food labels, menu labelling, and clinical counselling.

Growing evidence makes clear that multiple, complex factors beyond personal decisions strongly influence dietary choices and patterns (fig 1).234567 Even at the individual level, dietary habits are determined by personal preference and also age, gender, …

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