Following UK healthy eating recommendations more closely was associated with lower odds of obesity and more favorable body fat trajectories, regardless of physical activity level or genetic susceptibility to obesity.

Study: Adherence to the Eatwell Guide and associations with markers of adiposity: a prospective analysis within the UK Biobank cohort. Image Credit: Shutterstock

Higher adherence to the Eatwell Guide, the UK’s healthy eating model, was associated with lower adiposity and lower odds of overweight or obesity, according to a new study published in the International Journal of Obesity.

Background

Obesity remains a major public health concern in the UK, contributing to increased disease risk and premature mortality. In England, 28% and 36% of adults were categorized as having overweight and obesity, respectively, in 2022.

Adopting a healthy dietary pattern is considered to be an important component of weight management. High-quality diets, such as the Mediterranean Diet, have been linked to lower adiposity.

Healthy eating recommendations in the UK are visually represented and communicated in a public-facing tool called the Eatwell Guide. This healthy eating model focuses on a variety of fruits and vegetables, moderate consumption of starchy carbohydrates, wholegrains, beans, pulses, meat, fish, and eggs, adequate fluid intake, and low consumption of fat-, salt-, and sugar-rich foods.

Although the Eatwell Guide is widely applied in UK nutrition policy and practice, evidence linking adherence to the Eatwell Guide with health outcomes remains limited.

Given this gap in the literature, the current study aimed to explore the association between adherence to the Eatwell Guide and multiple markers of adiposity in the UK Biobank cohort. Data obtained from 156,764 participants from the UK Biobank were analyzed.

Key findings

The cross-sectional analysis revealed that a higher adherence to the Eatwell Guide is associated with significantly lower markers of adiposity, including body mass index (BMI), waist circumference, a body shape index (ABSI), and both total and trunk-specific body fat percentage.

Compared with low adherence, moderate and high adherence to the Eatwell Guide were associated with 9% and 25% lower odds of overweight or obesity, respectively. Moderate and high adherence were also associated with 9-24% lower odds of elevated waist circumference, 10-15% lower odds of a higher body shape index, 8-22% lower odds of a higher body fat percentage, and 10-22% lower odds of a higher trunk fat percentage.

The longitudinal analysis indicated that higher adherence to the Eatwell Guide was associated with more favorable trajectories over time for BMI, waist circumference, total body fat percentage, and trunk fat percentage. A dose-response pattern was also observed, with higher adherence showing stronger associations with BMI, waist circumference, and total body fat percentage than moderate adherence. For trunk fat percentage, moderate and high adherence showed similar associations, while prospective associations with ABSI were not statistically significant in the primary analyses.

The subgroup analysis showed broadly consistent associations across the groups examined. Sex differences were minimal overall, although associations with BMI were stronger in females. Associations were generally stronger in younger and more socioeconomically deprived individuals, particularly for BMI and waist circumference. There was no evidence that physical activity level or polygenic risk for obesity modified the observed associations.

Study Significance

The study found that greater adherence to the Eatwell Guide is associated with more favorable adiposity outcomes over time. The consistency of observed associations across key demographic groups highlights the potential role of adherence to UK healthy eating recommendations in body weight management strategies.

Higher adherence to the Eatwell Guide was associated with more favorable trajectories in both trunk and total body fat percentages. These findings suggest that the associations were not limited to regional adiposity but extended to measures of overall body composition.

The association with trunk fat percentage is particularly noteworthy, as visceral and subcutaneous abdominal fat are associated with insulin resistance, dyslipidemia, and systemic inflammation.

Medications used for obesity treatment, such as glucagon-like peptide-1 receptor agonists, can produce substantial weight loss. However, pharmacologically induced weight loss may also involve less favorable changes in body composition, including loss of muscle mass. In the current study, higher adherence to the Eatwell Guide was associated with more favorable body composition trajectories, including among participants with moderate adherence.

These findings collectively support the need for appropriate dietary support alongside and after pharmacological treatment to promote favorable body composition and longer-term weight management.

The study found no evidence that physical activity level or polygenic risk for obesity modified the observed associations. These findings show that associations between adherence to the Eatwell Guide and favorable adiposity measures were evident across physical activity and genetic-risk groups, with no evidence that these associations differed by genetic susceptibility to obesity.

Given these findings, the researchers highlight the need for person-centered approaches to implementing dietary recommendations that recognize and address potential barriers to dietary adherence, including biological factors such as dysregulated appetite and social, cultural, emotional, and environmental factors.

The study could not establish causality for the observed associations due to its observational design. There remains a possibility of reverse causality, meaning that the relationship between diet quality and adiposity may be bidirectional. However, the study longitudinally assessed the dietary patterns prior to adiposity outcomes and explored the changes in adiposity markers over time, which may mitigate this risk.

The study relied on self-reported dietary intake, which may be subject to measurement error, social desirability bias, and potential underreporting. Moreover, the analytical sample was 96% White, while UK Biobank participants are generally more affluent and more highly educated than the UK general population. These factors may restrict the generalizability of the findings to ethnically or socioeconomically diverse populations. Residual confounding also remains possible despite adjustment for multiple covariates, and formal validity coefficients for the Eatwell Guide scoring system applied to the Oxford WebQ have not yet been established.

Future research is needed to establish causal inference through randomized controlled trials and validate the findings in cohorts with greater representation of ethnic minority groups, including through culturally appropriate Eatwell Guide scoring approaches.