The Ministry of Health of Aotearoa New Zealand has recently announced an update to its national Eating and Activity Guidelines, including a number of meaningful changes that Doctors For Nutrition is encouraged to see.
The Ministry of Health of Aotearoa New Zealand has recently announced an update to its national Eating and Activity Guidelines . While the central ‘Eating and Activity Guidelines Statements’ for adults remain the same and were not reviewed, several meaningful changes have been made that are welcomed by health-promotion charity, Doctors For Nutrition.
1. Kiwis have a new ‘plate model’ with a focus on whole plant foods
The tools used to describe what a healthy eating pattern looks like have changed and the Ministry of Health has created a plant-centric image  that looks somewhat similar to Canada’s Food Guide.
This updated image makes it clear that if an adult chooses to eat red meat, chicken or fish, these components should be a small segment of overall food intake.
As the nutritional guidance developed in 2015 was not reviewed, the ‘milk and milk products’ segment remains. However in 2019 the NZ Ministry of Health recommended ‘reducing dairy’ within its ‘Sustainability in the Health Sector’ report , so chances are high that the ‘milk and milk products’ segment will be reconsidered in future.
When Canada’s Food Guide was updated in 2019, a strong emphasis was placed on plant-based eating patterns for health and environmental sustainability. Dairy no longer has a stand alone segment, instead becoming a minor part of the ‘protein foods’ segment, alongside a statement to ‘choose protein foods that come from plants more often’.
2. The guidance is “largely plant-based” and explicitly allows for “totally plant-based” eating patterns
While the flexible guidelines do allow for moderate amounts of animal-based foods (eggs, dairy, poultry, seafood) and small amounts of red meat, it’s now clear that fully plant-based eating patterns are covered by these guidelines too.
Official recommendations are made for plant-forward changes to the eating practices of New Zealand adults, including limiting processed and red meat and increasing consumption of vegetables, fruit, legumes, nuts and seeds.
Will Kiwis get on board with putting this advice into action? Research by Colmar Brunton shows over 1.5 million New Zealanders are already eating less meat and that interest in ‘flexitarianism’ is growing fast. 
Despite this progress, there is much work to do to implement equitable policies that ensure all individuals and households have reliable access to healthy, affordable and sustainable food.
Health professionals are making their voice heard on these key issues, including OraTaiao: New Zealand’s Health and Climate Council, an organisation representing over 700 health professionals, who have called for Government Ministers to establish a Tiriti-based food system that is equitable, improves health, and reduces climate pollution. At a regional level, health advocates in Nelson are urging their City Council to adopt C40 Good Food City policies to make it easier for everyone to access healthy, sustainable food.
3. For those that choose to include meat in their diets, the recommended standard serving size for cooked lean meat has decreased to 65g
The new serving size for lean meat applies to cuts including beef, lamb, pork and veal. Further guidance suggests adding legumes to meat dishes to help increase intake of plant foods.
Serving sizes for cooked or canned beans, lentils, chickpeas, or split peas are generous at 1 cup (150g) and the serving size for tofu is 170g.
4. The Guidelines include commentary on the “urgent need to promote diets that are healthy and have low environmental impacts”
For the first time, the eating guidance acknowledges that the current food system is having a negative impact on the environment and the importance of promoting eating patterns that factor in environmental sustainability. This includes considering greenhouse gas emissions, fresh water quality and scarcity, land use, soil health and food waste when recommending eating patterns.
“Globally, people are increasingly focusing on the way that food is produced and consumed, and the negative impacts the food system is having on the environment. There is an urgent need to promote diets that are healthy and have low environmental impacts.”
– 2020 Eating and Activity Guidelines for New Zealand Adults
Doctors For Nutrition is hopeful that the New Zealand Ministry of Health will follow up this acknowledgement by swiftly reviewing their ‘Eating and Activity Statements’ to more clearly recommend plant-based sustainable eating patterns with reduced meat and dairy.
The Ministry of Health acknowledges the government sector has more work to do to define what constitutes sustainable healthy diets in the New Zealand context. A recent study by researchers at Otago University found that a population shift towards healthy, low-waste plant-based diets could reduce diet-related climate emissions by up to 42%. 
The study authors call for immediate action on policies to support this transition, stating “our findings reinforce the message from the recent EAT-Lancet Commission that the global evidence base is sufficiently strong to justify urgent action among policymakers, and that further postponement poses a great risk to society”. 
5. Advice has been added for pregnant and breastfeeding women, including statement to “Encourage, support and promote breastfeeding”
It is clear that nutrition is critical during the phases of pregnancy, breastfeeding and infancy and Doctors For Nutrition are pleased to see updates provide guidance for mothers, including advice for vegetarians and vegans. Pregnant and breastfeeding women who follow vegetarian or vegan diets are encouraged to discuss nutrition with their team of health professionals.
The guidelines recommend exclusive breastfeeding until 6 months and continued breastfeeding until two years and beyond, listing a wide range of health benefits for both infant and mother.
“Breast milk is the ideal food for babies because it provides important nutrition plus antibodies, enzymes, hormones and growth factors that cannot be replicated in commercially produced infant formula.  Improving breastfeeding rates in Aotearoa/New Zealand will directly contribute to achieving equity for Māori”
– 2020 Eating and Activity Guidelines for New Zealand Adults.
Alongside the health benefits, the guidelines describe breastfeeding is also the most environmentally sustainable option for feeding a baby. 
Importantly, it’s also acknowledged that the responsibility for breastfeeding does not lie solely on the mother and that everyone has a role to play in supporting breastfeeding, from partners, family, whānau, friends and health professionals to workplaces, early learning services, health facilities and the wider community. More information on breastfeeding and supporting breastfeeding can be found here.
If you are seeking more information on plant-based pregnancies, retired paediatrican Dr Heleen Roex has some reassuring advice.
6. The updated Guidelines acknowledge the wider determinants that influence people’s food and physical activity choices, and ultimately their health.
Age, ethnicity and socioeconomic status shouldn’t be a barrier to healthy nutrition, which is a basic human right. Yet these factors unjustly have a significant influence on both diet and health outcomes. Data from the New Zealand Health Survey shows that while most children live in food secure households, almost one in five children (19%) in New Zealand lived in severely to moderately food-insecure households in 2015/16. 
The Eating and Activity Guidelines acknowledge that there are a range of factors that influence dietary choices and many of these are not under individual control.
“Many different factors contribute to people’s food and physical activity choices, and ultimately their health. These include social, cultural, economic, accessibility, practical and personal factors and it is important to acknowledge that many of them are not under people’s direct control. Differences in these underlying factors contribute significantly to the inequity in relation to diet, physical activity and health in New Zealand.”
– 2020 Eating and Activity Guidelines for New Zealand Adults.
The Guidelines also refer to pae ora, the Government’s vision for Māori health. Pae ora is a holistic view of health that sees the elements of mauri ora (healthy individuals), whānau ora (healthy families) and wai ora (healthy environments) as interconnected and mutually reinforcing.
To achieve food security for all whilst improving human health, health equity and environmental wellbeing, leaders must follow the lead of scientists in acknowledging food as an urgent priority. Doctors For Nutrition look forward to Government progress on policies and initiatives that foster pae ora and ensure that all whānau have reliable access to healthy, affordable sustainable kai.
While the main dietary recommendations were not reviewed and hence remain unchanged, Aotearoa New Zealand’s updated 2020 Eating and Activity Guidelines contain useful additions and may signal further positive changes to come.
There is more clarity that the guidelines describe an eating pattern that is ‘largely plant-based and the new ‘plate model’ helps to communicate this in visual form.
It’s pleasing to see that “totally plant-based” eating patterns are noted to fit within the flexible guidelines.
Serving size recommendations have been updated. For those that choose to eat meat, a standard serve of lean meat is just 65g.
Acknowledgement of the wider determinants of food choices gives hope that national policy action will follow to support everyone to have reliable, equitable access to a nutritious diet.
Endorsement of breastfeeding and its benefits, as well as the need for everyone to play a role in supporting breastfeeding, is a key new update.
Arguably the most significant addition is the inclusion of commentary on environmental sustainability and the “urgent need to promote diets that are healthy and have low environmental impacts”.
This progress and increased clarity is pleasing to see. But in the face of health, equity and environmental crises, revision of the more substantial Eating and Activity Guidelines Statements is urgently needed.
The Australian Government has recently announced that they will provide $2.5 million to the National Health and Medical Research Council to review the 2013 Australian Dietary Guidelines. During this review process, Doctors For Nutrition will call for health equity and environmental sustainability to be key factors in the updated guidance, and a strong emphasis on promoting whole food plant-based eating patterns
Ministry of Health. 2020. Eating and Activity Guidelines for New Zealand Adults: Updated 2020. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-new-zealand-adults-dec20.pdf
Ministry of Health. 2020. Choose a Balance of Healthy Food Every Day PDF. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/choose-balance-healthy-food-every-day-dec20.pdf
Ministry of Health. 2019. Sustainability and the Health Sector: A guide to getting started. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/sustainability-and-the-health-sector-30jul2019_1.pdf
Food Frontier and Life Health Foods, 2019. Hungry for plant-based: New Zealand consumer insights. Colmar Brunton. https://www.foodfrontier.org/wp-content/uploads/2019/10/Hungry-For-Plant-Based-New-Zealand-Consumer-Insights-Oct-2019.pdf.
Drew J, Cleghorn C, Macmillan A, Mizdrak A. Healthy and Climate-Friendly Eating Patterns in the New Zealand Context. Environ Health Perspect. 2020;128(1):17007. doi:10.1289/EHP5996
Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
Davidove M, Dorsey J. 2019. Breastfeeding: A Cornerstone of Healthy Sustainable Diets. Sustainability, 11(18), 4958. doi:10.3390/su11184958
Victora, Cesar G et al. 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, Volume 387, Issue 10017, 475 - 490. https://doi.org/10.1016/S0140-6736(15)01024-7
Ministry of Health. 2019. Household Food Insecurity Among Children: New Zealand Health Survey: Summary of findings. Wellington: Ministry of Health. https://www.health.govt.nz/publication/household-food-insecurity-among-children-new-zealand-health-survey
About the author
Hannah O'Malley is Doctors For Nutrition's Projects Lead. Alongside her role at DFN, she is a practising clinical pharmacist and certified Lifestyle Medicine Practitioner, who also holds the e-Cornell certificate in plant-based nutrition. Find her full bio here.