Many countries have found it necessary to implement dietary guidelines in order to influence their populations into making healthy food choices, in an effort to prevent nutrition related diseases. Traditionally these guidelines have been prepared by taking into consideration the minimum recommendations to prevent nutrient and energy deficiencies, as well as imbalances and excesses. They also include the maximum amount or the tolerable upper intake levels of nutrients for individuals.

The process that The Bahamas used to prepare its Food Based Dietary Guideline (FBDG) was based on a model proposed by WHO/PAHO and the Institute of Nutrition of Central America and Panama (INCAP).

This process included obtaining information on:

• The nutritional status of the population.
• The epidemiological profile.
• Food availability.
• Eating habits of the population.

The criteria included elements of social anthropology so that the guidelines could be adapted to the social, culture and economic situation of the population. It also included ideas and perspectives of different public and private sector stakeholders; as far as possible, invitations were extended to agencies that could provide insight into the aforementioned areas, so that the views of areas of society could be adequately represented.

Step 1 Planning

The purpose of this step was to diagnose the health and nutritional status of the Bahamian population, by taking into consideration access to food, eating habits, and socio-cultural characteristics.

The draft Food and Nutrition Policy and Agenda for Action (1999) indicated the development of Dietary Guidelines as a priority action. This action was further incorporated into the National Health Services Strategic Plan. A formal request was made through the Pan American Health Organization (PAHO) to the Caribbean Food and Nutrition Institute in October 1999 for technical assistance. A favourable response was received and Dr. Pauline Samuda of the Institute was assigned.

It was determined that data from National Health and Nutrition Survey (88/89) and more recently, the Draft of the National Food and Agenda for Action (1999), along with data from the Health Information & Research Unit, and the Department of Statistics, would be used to make conclusions regarding the health and nutrition situation. What was needed to complete the picture was information on eating habits of the residents. Data on this was not available from any source known to planners and therefore this aspect would have to be researched.

Letters were sent to potential researchers to submit research proposals on the eating habits of the population. The research Unit of the College of The Bahamas was selected to do the work, and a formal contract was signed on 1 November, 1999. Dr. Pauline Samuda, advisor to the project and the nutritionists from the Nutrition Unit met with the staff of the Research Unit to agree on research methodology. The most cost-effective approach was to use qualitative and semi-qualitative methods to gain insight into the eating habits of residents living in New Providence (that is, focus group and food frequency questionnaire). The results obtained from the focus group were used to guide the development of the food frequency questionnaire. The sample frame consisted of 500 people in New Providence.

The Multi-Sector Meeting

A request was further made by the Nutrition Unit to the Caribbean Food and Nutrition Institute, through the Pan American Health Organization to have Dr. Pauline Samuda facilitate the multi-sector meeting for the development of the food based guideline.

It was expected that this group would:

• Review the findings of the survey and other relevant data.
• Assess the nutrition and health situation in light of the finding of The College of The Bahamas.
• Diagnose the nutrition problems.
• Prioritise the problems.
• Draft a set of objectives that would be used as messages in the guidelines to motivate the population to implement the dietary recommendations.

Step 2 Characterising Target Group

The Committee was able to identify:

• The leading causes of death that were nutrition related.
• Morbidity causes that are attributed to these deaths.
• The lifestyle factors attributing to morbidity.
• Food consumption patterns attributing to the development of these diseases.
• Specific food that is the most frequently consumed by the population and also may be also contributing to the development of these diseases.

Step 3 Setting Objectives

A presentation by Dr. Samuda was made on the development strategy of dietary guidelines and the rational for development of the same. At the conclusion of the meeting, 9 statements were agreed upon.

1. Make physical exercise activity a part of your daily routine.
2. Select food low in salt and sugar.
3. Choose foods that are prepared by boiling, baking or roasting instead of frying.
4. Selecting foods low in fats and cholesterol.
5. Limit your intake (consumption) of alcoholic beverages.
6. Increase the amount of root crops, peas and beans in your meals daily.
7. Drink water instead of sweetened drinks.
8. Breast milk is the first and best choice of food for children from birth to 4-6 months of age.
9. Purchase foods that will provide the best nutritional value for your money.

The Way Forward

The work which was completed by the Multi-Sector Planning Committee represented the first 3 steps in the process of developing the Food Based Dietary Guideline. The next phase (step 4) was preparing the technical guideline. This step required work by nutritionists and consisted of converting the nutritional goals and objectives into the type and quantity of food that the population should eat in order to meet the nutrient recommendations. The nutritional content of the food, the food groups, the profile of nutrients from each group, and the size and number of portions that ensure appropriate food intake in terms of quantity and variety also needed to be considered.

At the conclusion of this phase, a technical document that summarised the nutritional goals, nutrient recommendations, and other additional suggestions for preventing the problems detected and promoting a healthy diet and lifestyle was produced. This document was the scientific foundation that supports the nutritional guidelines.