Official name

Dietary guidelines for the Uruguayan population: for a healthy, shared and enjoyable diet (Spanish: Guía alimentaria para la población Uruguaya: para una alimentación saludable, compartida y placentera).

Publication year

Uruguay published their first set of dietary guidelines in 2005. They were thoroughly revised and updated in 2016. 

Stakeholder involvement

The revision and development of the 2016 dietary guidelines was led by the Nutrition Programmatic Area under the Ministry of Public Health, with the support of a multisectorial group with representatives from the ministries of Public Health, Social Development, Education and Culture, Livestock, Agriculture and Fisheries, Council of Initial and Primary Education, Administration of State Health Services, Municipality of Montevideo, Honorary Commission for the Fight Against Cancer and Honorary Commission on Cardiovascular Health and academia. The process was technically supported by FAO.

Products, resources and target audiences

Development process

The aim of the guidelines is to promote healthy eating habits and lifestyles through educational tools that favor the decision-making of the population and contribute to the re-evaluation of the food culture based on a sustainable food system, in order to achieve greater well-being of the population. 

The process followed consisted of:

• Planning phase: the methodology followed was based on the model developed by the Institute of Nutrition of Central America and Panama (INCAP) for Latin America and the Caribbean. It was carried out through a cyclical process that began with the planning phase and the formation of a multisectoral group which assessed various methodologies for updating dietary guidelines from Chile, Brazil and the United States. 
• Definition of objectives and guiding principles: The group first defined the target population and main objectives of the guidelines, as well as seven guiding principles that value the influence of cultural and social dimensions in food practices. These principles consider that it is not only nutrients, foods and combinations of foods and meals that generate impacts on people's health.
• Characterization of the target population and situation analysis: a working subgroup analyzed the food and nutrition situation of the country. Based on this diagnosis, the main nutrition and health problems to address were identified (overweight and obesity, cardiovascular diseases, diabetes, cancer, osteoporosis).
• Review of the available evidence and development of technical recommendations: based on the prioritized issues, another working subgroup carried out the review of the scientific evidence through an exhaustive literature review. Subsequently, the technical recommendations were developed using an analysis matrix informed by the prioritized issues and the evidence review conclusions. For each of the issues included in the matrix, the related critical nutrients were identified, including whether the problem is a consequence of a deficiency, excess, or interference with their absorption. The foods containing the critical nutrients were thus identified as "critical foods". The association between these problems and food consumption, production, availability and access to these foods was also made, considering practices, habits and beliefs and identifying the determinants that affect each of the problems. Based on this comprehensive analysis the technical recommendations were developed, focusing on those that respond to several of the problems identified.
• Preliminary message design and validation: Eleven preliminary messages were designed for the target population through a new analysis matrix that focused on the benefits of implementing the suggested changes. To evaluate the feasibility of implementing the recommendations at the target population level, the understanding of the messages, perceived benefits, facilitating elements and barriers to their implementation were analyzed. Aspects to improve regarding communication, information quality and how to enhance impact of the messages on the population were also identified. Qualitative and quantitative methods were used including an online survey and focus groups. The appraisals made by the participants provided insights on the potential impact of the messages and on which modifications were required to improve their understanding, implementation and appropriation by the population. For this reason, each message included in the Dietary Guide contains in its argument the explanation of the benefits, offering possible alternatives in daily life and concrete examples that motivate a process of adopting changes towards lifestyles that promote health.
• Icon design and validation: An interdisciplinary subgroup was formed to develop the food icon. Guidelines were drawn up for the design of two options, and an online study was carried out to evaluate the perception of the population of both of them. One option was adopted based on preference, which incorporated suggestions to enhance its interpretation by the population.
• Correction and adjustment of materials: After completing the validation stage of the messages and the icon, the corresponding adjustments were made. The guide was publicly released in December 2016. 

Implementation

The implementation activities are planned annually. The guidelines have been incorporated into the Strategy for the Prevention of overweight and obesity in childhood and adolescence 2020. The strategy defines 7 practices to be implemented in school settings: practice 1 establishes training educator in the messages and contents of the food and physical activity guides, and practice 2 proposes including such guides as reference axes to guide the contents of the curriculum. However, there is no official implementation plan.

More than 40 training and dissemination workshops have been held for multipliers throughout the country, in which more than 1,200 technicians participated, mainly from the areas of health, education and food. A set of communication and nutrition education materials was created to facilitate the dissemination of messages with the technical support of FAO and UNICEF. The set proposes activities to stimulate reflection and motivate people for behaviour change, and a manual with suggestions for the development of group activities. Each of the guide's messages is developed according to the following scheme: 

• What do we want the participants to achieve?
• Why it is important? What will motivate the participants to embrace the change?
• What barriers must participants overcome to embrace change?
• How to adopt the change? What skills do participants need to act and embrace change? 

For the general population, posters and brochures have been designed and disseminated. The messages have been disseminated on social networks and an awareness campaign was carried out in the media. 

Evaluation

There is currently no official monitoring and evaluation plan. 

Sustainability

Sustainability aspects were broadly considered through one of the guiding principles established as a transversal axis of the guidelines: Food in harmony with biodiversity and environmental sustainability.

Food guide

The Uruguayan food guide is a circle that displays the food groups to be consumed regularly as part of a healthy diet: vegetables and legumes; fruits; breads, flour, pasta, rice and potatoes; milk and cheese; meat, fish and eggs; seeds and oils; and sugars and sweets (in small quantities). The size of each food group segment reflects the proportion the group should contribute to the total daily diet. Water is in the center of the circle.

Surrounding the circle are messages promoting physical activity and enjoyment and sharing of food. There are also some additional icons for restricting the consumption of ultra-processed foods. 

Recommendations

The dietary guidelines are intended for the general population over two years of age. . 

Day to day keys to achieve a healthy, shared and enjoyable diet:

• Enjoy your food: eat slowly and, when possible, eat in company.
• Base your diet on natural foods, and avoid the regular consumption of ultra-processed products with excessive contents of fat, sugar and salt.
• Start your day with a good breakfast and don't skip meals. 
• Cooking traditional foods is good for you: discover the joy of cooking and make it a shared activity.
• Be critical with the information and publicity that you receive about diet.
• Build up to at least two and a half hours of physical activity per week and reduce the time that you spent sitting. 

Keys to achieve a healthy and enjoyable diet at your table:

• Prefer water to other beverages. Limit sodas, artificial juices and flavored waters.
• Incorporate vegetables and fruits in all your meals. This will help you to feel good and to maintain a healthy weight.
• Choose oil for cooking instead of other fats. Avoid buying products with an excessive quantities of fat and specially the ones with trans fat.
• Include fish at least once a week and reduce the consumption of processed meats, like cold cuts and cured meats.
• Reduce the salt and sugar added when cooking: small quantities are enough to bring out the flavors.