Chapter 3 – Dietary Guidelines for the Brazilian Population: A Tool for Addressing Syndemic Problems

Severina Carla Vieira Cunha Lima*, Adélia da Costa Pereira de Arruda Neta, Rosa Sá de Oliveira Neta, Camille Lanzarotti Nolasco, Clélia de Oliveira Lyra, David Franciole de Oliveira Silva, Cecilia Rocha

*Corresponding author: severina.lima@ufrn.br

1. Introduction

The Global Syndemic framework (Swinburn et al., 2019), linking the problems of obesity, malnutrition and climate change, highlights the unsustainability of current food systems. Brazil has presented, unfortunately, a prominent example of this syndemic manifestation. The country features among the largest food producers and exporters in the world, with practices that are harmful to human and environmental health. The agro-industrial model in Brazil has significantly contributed to climate change. Furthermore, food insecurity and unhealthy diets persist in a great part of Brazilian households. This situation results in malnutrition, obesity and other dietary risks for chronic non-communicable diseases (NCDs). Systemic actions are necessary to change this syndemic trajectory (FAO, 2018; WHO, 2022).

In this chapter, we present the implementation of the Brazilian Dietary Guidelines as an important tool in simultaneously addressing the problems of obesity, malnutrition, and climate change. Published in 2014, the Dietary Guidelines for the Brazilian Population (BDG, the “Guide”, or the “Brazilian Food Guide”) pioneered an innovative approach to dietary recommendations, achieving some well-deserved international prominence (Seed and Rocha, 2018; Terry, 2018; United Nations, 2015). The Guide encourages the consumption of fresh and minimally processed foods, purchased from local producers and traders, prioritizing those who sell organic and agroecology-based foods (Ministério da Saúde, 2014). The Brazilian Food Guide, by basing its standards and recommendations on the type of industrial food processing (Monteiro et al., 2010), can contribute to the regulation of food environments, through changes in food labelling, taxation of sugary drinks and other ultra-processed foods, and legislation governing which foods are served in institutional spaces, such as schools.

Section 2 describes the main features of the BDG, highlighting its recommendations for social and environmental sustainability. In section 3, we point out three areas in which the Guide has impacted legislation. Section 4 offers some final words in considering the importance of the Brazilian Food Guide as a tool for systemic changes.

2. The Brazilian Dietary Guidelines: A Systems Approach to Nutrition

The Brazilian Dietary Guidelines, launched in 2014 by the Ministry of Health, present an approach that understands nutrition as a complex system, not limited to nutrient intake alone, but also considers social, cultural, economic, and environmental factors. The Guide’s main objective is to promote adequate and healthy nutrition, recognizing the importance of the food system (production, distribution, and consumption), as well as the influence of eating habits and cultures (Ministério da Saúde, 2014).

In a pioneering approach, the BDG proposed a new classification of foods based on type of processing and presents the idea that recognizing a healthy diet does not require counting calories but rather understanding how foods are made or processed. In the Guide, foods are classified into four types:

Products in natura or minimally processed (such as fruits, vegetables, nuts, grains, milk, eggs, meats, tea, coffee, and water)

Products used as condiments in culinary preparations (oils, fats, sugar and salt)

Processed foods (such as canned or frozen vegetables and fruit, dried meat, canned fish, cheeses, and breads)

Ultra-processed foods (such as cookies, ice cream, sweets, breakfast cereals, cakes, cereal bars, instant soups, snacks, sodas, juices, frozen meals)

Based on this classification, the Brazilian Food Guide encourages the population to prioritize ‘natural’ and minimally processed foods, with an emphasis on predominantly plant-based options, while discouraging the consumption of ultra-processed foods (UPFs). Its stated “golden rule” is “always prefer natural or minimally processed foods and culinary preparations to ultra-processed foods” (Ministério da Saúde, 2014; Monteiro et al., 2018; Silva, Louzada, & Levy, 2022).

The systemic approach embraced in the BDG is embedded in the 5 principles guiding its development, as well as in the 10 steps recommended towards healthy eating (here summarized in Table 1).

Table 1: Principles and Recommendations in the Brazilian Food Guide of 2014

Principles

Recommendations: Ten Steps to Healthy Diets

1. Healthy eating is more than just ingesting nutrients   2. Recommendations on healthy eating must take into account time and place   3. Healthy and adequate eating is derived from a food system that is socially and environmentally sustainable   4. Food guides must take into account diverse and varied sources of knowledge   5. Food guides contribute to a greater autonomy of individuals, families, and communities

1. Make food in natura or minimally processed the basis of your diet   2. Use oils, fats, sugar and salt in moderation   3. Limit consumption of ready-to-consume food and drink products   4. Eat regular meals, paying attention, and in appropriate environments   5. Eat in company whenever possible   6. Buy food at places that offer varieties of fresh foods. Avoid places that mainly sell products ready for consumption   7. Develop, practice and share skills in food preparation and cooking   8. Plan time to give meals and eating the space they deserve   9. When eating out, choose restaurants that serve freshly made meals. Avoid fast food chains   10. Be critical of the information, guidance and messages conveyed by commercial advertisement of food products

The systemic approach addressing syndemic problems is clearly spelled out in the third principle of the Brazilian Food Guide: healthy diets derive from socially and environmentally sustainable food systems.

2.1 Aspects of Social Sustainability

The Brazilian Food Guide incorporates lessons from sociology, anthropology, and popular knowledge. The Guide promotes not only healthy food choices but also values ​​and practices related to eating, such as regular mealtimes, valuing appropriate environments, and preferring food obtained through sustainable means. The document also highlights the importance of planning time for meal preparation, developing a critical attitude toward food information, and reclaiming culinary practices in the home. Guidelines include eating regularly, mindfully, in appropriate environments, and in the company of others. These guidelines aim to restore social norms that regulate eating practices as a strategy to undermine the consumption of UPFs (Monteiro et al., 2018).

The Guide emphasizes the importance of enjoying food, diversifying eating habits, and encouraging culinary practices to promote a healthy and adequate diet, prioritizing natural or minimally processed foods. It also recommends culinary practices to promote, in addition to physical health, cultural identity, social belonging, culinary autonomy (Oliveira & Castro, 2022), collectivity, pleasure, and well-being. Cuisine is recognized as a complex system that incorporates ideologies, symbols, norms, and beliefs, transcending the simple preparation of food. These elements permeate the history, tradition, technologies, methods, ingredients, and participants of cooking, influencing territorial, gender, and class identities, among others. Furthermore, encouraging the development and sharing of culinary skills not only promotes healthy eating but also strengthens community ties, preserves cultural traditions, and honours ancestral knowledge related to food (Ministério da Saúde, 2014; FAO, 2013).

As the consumption of UPFs, such as cookies, sausages, soft drinks, and ready-to-eat meals, has been increasing (Martins et al., 2013; Moubarac et al., 2015; Camargo & Bós, 2022), the BDG work against this trend, encouraging higher consumption of traditional foods such as rice, beans, and cassava. In the broader perspective of the 2014 Guide, special consideration is given to traditional Brazilian dietary patterns, such as the famous “beans and rice”. These patterns are seen as more than simple food combinations; they are intrinsically linked to psychosocial and cultural aspects that impact individual well-being.

2.2 Aspects of Environmental Sustainability

Food system practices, such as the use of intensive chemical agriculture, the expansion of agribusiness-based agriculture, the production and marketing of UPFs, and global deregulation in the commodity food chain, can negatively impact the health of populations (IPES-Food, 2017). These practices are also conducive to food environments, which limit food choices, often leading to overweight, obesity, and food insecurity (Bezerra et al., 2024; Oliveira Neta et al., 2023; Kowalsky et al., 2022). In current food systems, decisions about what, when, where, and how to produce often overlook health principles and are primarily driven by economic profits, which contribute to environmental degradation and climate change (Triches, 2020).

In Brazil, the food system is based on monocultures that provide raw materials for the production of UPFs and feed used in intensive livestock farming (Norde et al., 2023). The industrialized approach has made the food system a major source of greenhouse gas (GHG) emissions. Meat production, especially beef, is a significant contributor to these emissions, and 90% of Brazil’s food system emissions result from the expansion of agricultural areas over existing vegetation areas (SEEG, 2023). Balancing increased food production with environmental protection, social equality, and poverty reduction in both urban and rural areas is essential to mitigate and reduce the harmful effects of the country’s food production (Martinelli et al., 2010).

The Brazilian Food Guide highlights the importance of nutrition recommendations, which consider the impact of food production and distribution methods on social justice and environmental integrity. It advocates for agroecology and the empowerment of small farmers and rural communities, strengthening their resilience and adaptation capacity (Fernandes, 2009). In this aspect, the Guide is in tune with the UN Food and Agriculture Organization (FAO) in recommending “sustainable diets” as those with “low environmental impact that contribute to Food and Nutrition Security (FNS) and healthy lives for present and future generations”. It should be emphasized that a sustainable and environmentally sound diet must be affordable (Trijsburg et al., 2021), and the implementation of government policies that address food and social protection is crucial to achieving food sovereignty (Ministério da Saúde, 2013; Rodrigues, Kauchakje, & de Oliveira, 2023). The key to ending hunger and protecting the planet lies in transforming current food systems into a model that addresses all these issues (von Braun, Afsana, Fresco, & Hassan, 2021).

Agroecology has multiple meanings for farmers, communities, and indigenous groups (Niederle, de Almeida, & Vezzani, 2013). Unlike conventional farming systems, which often focus on monocultures and mass production of staple foods for ultra-processed products, agroecology encourages crop diversity and farming practices that enhance the nutritional quality and variety of food, thereby reducing reliance on ultra-processed foods linked to obesity and other chronic diseases (Altieri & Nicholls, 2020). By implementing practices such as establishing and maintaining agroforests, protecting vegetation cover, using green manure, avoiding pesticides, and respecting local fauna and natural resources, agroecology also helps to lower greenhouse gases through carbon sequestration and decreased emissions contributing to the mitigation of climate change and boosting the resilience of agricultural systems against extreme weather events (Nepstad, Stickler, Soares-Filho, & Merry, 2008). Furthermore, it aims to improve access to fresh and nutritious food for communities facing adverse conditions (Nolasco, Lahsen, & Ometto, 2016; Cozer, Triches, & Perondi, 2023), especially in rural and marginalized areas where food insecurity is more common.

Beyond nutritional recommendations, the Brazilian Guide suggests the need for efforts to strengthen the resilience of the entire food system. It encourages: (1) adoption of agroecological practices, especially by family farmers (Altieri & Nicholls, 2020); (2) implementation of public policies supporting family farming (Grisa & Schneider, 2014); (3) organization of social movements like the Landless Workers’ Movement (MST), which have been vital in advancing agrarian reform and agroecology, empowering family farmers to adopt sustainable practices and resist pressure from industrial agriculture (Fernandes, 2009); (4) growing scientific evidence that agroecological systems can boost productivity, improve climate resilience, and increase biodiversity (Tittonell, 2014); (5) expansion of education and training initiatives in agroecology (Petersen, 2013); (6) strengthening of market initiatives such as agroecological fairs and community-supported agriculture (CSA), which facilitate direct producer-to-consumer sales, fostering sustainable production and food security within the concept of “real food”.

3. Impact of the Brazilian Dietary Guidelines on Policies: Some Examples

The BDG serve as a technical reference tool for professionals and policymakers across various sectors, such as health, education, agriculture, and sustainability (Monteiro et al., 2018). However, it does not constitute a public policy in itself. Its effectiveness depends on the existence of intersectoral governance mechanisms that enable its incorporation into institutional agendas (Maluf & Reis, 2021). Brazil’s experience with food and nutrition security policy demonstrates that structures such as the Inter-ministerial Chamber of Food and Nutrition Security (CAISAN) and the National Council for Food and Nutrition Security (CONSEA) are essential for articulating actions between government and civil society, providing legitimacy and effectiveness to public initiatives (Pinheiro et al., 2021). Moreover, civil society engagement is crucial not only to legitimize the Guidelines but also to advocate for their implementation and monitor governmental actions (Carvalho & Oliveira, 2020).

Three policy areas in which one can see the impact of the Food Guide are in the School Food Programme, food labelling, and taxation of ultra-processed foods.

3.1 Restricting UPFs in School Meals

Brazil’s National School Food Programme (PNAE) is one of the largest in the world, serving over 40 million students enrolled in all stages of public schooling, from daycare centres to the end of high school (FNDE, 2025; Rocha et al, 2026). Schools play an important role in shaping children’s eating habits (Drouka et al., 2023). In recent years, Brazilian legislation has advanced in defining restrictions on the use of ultra-processed foods (UPFs) in school meals, a measure considered important for promoting the full growth and development potential of children and adolescents (Parizotto et al., 2021). This is particularly important considering the growing scientific evidence linking UPFs consumption to problems such as obesity and metabolic diseases, due to the high amount of sugars, fats, sodium, and additives in these products (Mendoza-Herrera et al., 2024; Lane et al., 2024).

A significant milestone in implementing the Guidelines was a legislative resolution to limit the purchase of UPFs to a maximum of 20% of the total funds allocated to school meals under PNAE (Anvisa, 2020a). The same resolution also prohibits the purchase of soft drinks, cereals with additives or sweeteners, candy and similar products, cookies and crackers, cakes with frosting or filling, among other foods, using PNAE funds (Anvisa, 2020a; Canella et al., 2022). For children aged 0 to 3 years in daycare centres, there is a complete ban on the provision of added sugar and ultra-processed foods.

Another important measure consistent with the BDG is the legal provision for the use of at least 30% of PNAE resources towards purchases of food from family farming, primarily from local producers (Brasil, 2009). This can not only boost the local economy and increase the production of fresh and minimally processed foods, but it also favours the use of foods with better nutritional value to students, even contributing to their academic performance (Cohen et al., 2021).

3.2 Food labelling

Nutritional labelling is a tool to inform consumers about food composition, thus encouraging healthier food choices (Temple, 2020). Recently, Brazil adopted new rules for front-of-package food labelling, aiming at facilitating the identification of products with high levels of sugars, saturated fats, and sodium, thus following the BDG (Anvisa, 2020a).

Among the changes introduced since the launch of the BDG is the mandatory adoption of the front-of-package nutrition labelling in a magnifying glass format, acting as a warning to indicate excess added sugars, saturated fats, and sodium in products containing these nutrients in high amounts. New rules also define guidelines for the nutrition facts table to make it clearer and more accessible, including adjustments to content, format, and legibility, and restrictions on the use of nutrition claims on foods and beverages, preventing labelling practices that could mislead consumers (Anvisa, 2020b). These changes are aligned with the recommendations of the Food Guide and aim to present consumers, in an objective and easy-to-understand manner, with information about the high content of nutrients that are relevant to health (Rubio, 2022).

3.3 Taxation of ultra-processed foods

Considering the scientific evidence linking excessive consumption of ultra-processed foods to an increase in chronic non-communicable diseases (NCDs) such as obesity, diabetes, and cardiovascular disease, taxing these foods has been proposed as an effective measure to discourage their consumption and promote healthier food choices (Jaime et al., 2015). In this regard, the Brazilian Ministry of Health and the National Council for Food and Nutrition Security (CONSEA) recently proposed increasing taxation on ultra-processed foods as a strategy to discourage consumption of such products (CONSEA, 2024). While this proposition has met considerable opposition (particularly from the food industry), taxation of ultra-processed foods is now on the agenda for policy discussions in the country (Sobrinho, 2024).

Additionally, subsidizing natural or minimally processed foods is an effective strategy to make these products more accessible to the population (Blakely et al., 2020). Subsidies can include tax reductions, the promotion of farmers’ markets, and the direct purchase of products from family farms for school feeding programs (Andreyeva et al., 2020).

4. Final words

The Dietary Guidelines for the Brazilian Population of 2014 pioneered an approach to nutrition recommendations, which takes into account the syndemic nature of malnutrition. It highlights the importance of a systemic view of health problems associated with not only the consumption of food, but also to how food is produced and distributed. The Guide moved away from nutrients to spotlight foods. It did not shy away from pointing out the social and environmental directions the food system should take to promote well-being. Its recommendations are guiding individual food choices, but also considerations for public policies on school food, food labelling, and taxation. The concern with environmental sustainability is also explicit in the BDG, with recommendations for purchasing foods that are local, produced by family farmers and through agroecology.

The importance of the BDG goes beyond their educational role. The Guide stands out as a strategic tool for promoting healthy, just, and sustainable food systems.

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