Malaysia and India took bold steps toward promoting healthier, more sustainable consumption patterns by incorporating plant-based foods into their national food-based dietary guidelines. With plant-forward diets gaining global momentum, should Indonesia follow suit?

The science is clear that we must change our diet for many climate and health reasons. Globally, the rising prevalence of diet-related diseases has become a major health burden, with approximately two and a half billion people classified as overweight, contributing to an epidemic of non-communicable diseases (NCDs), such as diabetes, heart disease, and various cancers. This troubling trend is largely driven by suboptimal diets, specifically the low consumption of fruits and vegetables and the high consumption of red meat and processed meats.

This also negatively impacts the environment, as the production of ruminants contributes to the release of 7.59 gigatonnes of CO2, the use of 24.87 trillion square meters of land, and 110.64 trillion liters of water per year. Additionally, unsustainable agricultural practices threaten biodiversity and contribute to climate change, affecting food and nutrition security. When accounting for the impacts of shifting dietary patterns toward plant-forward diets on both human health and (indirectly) on land use, changing diets account for 70% of the benefits of transforming food systems.

The term ‘plant-forward’ was coined by the EAT-Lancet Commission in the 2019 report on Healthy Diets from Sustainable Food Systems, which provides clear scientific guidelines to support human health and protect the environment. Because much of the research on this topic originates from high-income countries, where red meat and processed meats intake are high, shifting toward a ‘plant-forward’ diet encourages plant-based foods as major protein sources, substantially lower consumption of animal-derived products, and generous amounts of whole grains, fruits, and vegetables. This approach was proposed as one of the three key steps to transform food systems: encouraging a global shift toward healthier diets, improving how food is produced, and cutting down on food loss and waste.

Why plant-forward diets?

Shifting dietary patterns refer to changes in the types and quantities of food consumed over time, where public health and environmental concerns are considered as the underlying drivers. Unhealthy diets, characterized by a high intake of highly processed meats, sugar-sweetened beverages, refined grains, refined sugars, processed foods, and foods high in saturated and trans fats, are associated with micronutrient deficiencies and various non-communicable diet-related diseases that pose a greater risk of morbidity and mortality in adults. This ‘nutrition transition’ also contributes to environmental degradation related to food system activities, including soil health, water scarcity, and climate change.

Beyond its negative health impacts, red and processed meat consumption contributes to the largest chunk of food-related greenhouse gas (GHG) emissions (i.e., methane from ruminants’ digestive process).

For example, per serving of bovine meat produces 40 times more GHG emissions than pulses, nuts and seeds, as well as soybeans. Livestock production also negatively impacts water footprint and water scarcity, as it uses 2,714 L/kg of water and pollutes water from manure runoffs. While the consumption of meat and meat-derived products provides an important source of key nutrients, such as proteins, iron, and vitamins, among others, its harmful environmental impact has led to the development of the Planetary Health Diet that encourages healthier, more sustainable dietary patterns through increasing the consumption of plant-based foods as major protein sources, substantially lower consumption of animal-derived products, and generous amounts of whole grains, fruits, and vegetables. 

A study by Bunge et al. (2024) showed that a 50% reduction of animal-source foods replaced by plant-based protein sources (i.e., soy-based products and coconut-based yogurt) can reduce 30% of national GHG emissions. A 2024 multi-model study conducted in China revealed that shifting meat consumption to plant-based foods (i.e., cereals, tubers, legumes, vegetables, and fruits) with current energy and nutritional requirements could achieve maximum water saving by 13% and maximum emissions reduction by 32%. Moreover, an observational cohort study in 2019 found that following a predominantly plant-based diet was associated with a 32% reduction in the risk of death from cardiovascular disease and an 18% to 25% lower risk of all-cause mortality in middle-aged adults. A plant-forward diet is also associated with lower rates of other NCDs risk factors in adults, including obesity, type 2 diabetes, and hypertension.

It is therefore evident that we need to change our current consumption patterns, both for our health and the health of our planet.

Food-based dietary guidelines as a starting point for forming (and shifting) dietary patterns

Food-based dietary guidelines (FBDGs) serve as powerful tools for promoting healthier, more sustainable dietary patterns. They provide a framework that can influence consumer choices and guide food policy, which in turn shapes the food environments through the availability, affordability, and accessibility of food. Enabling food environments, characterized by easy access to fresh produce, strong local food networks, and supportive socioeconomic factors, play a crucial role in supporting these dietary goals. FBDGs offer recommendations for healthy consumption patterns grounded in scientific research, guide a wide range of food-related policies and programs, and thus represent a unique opportunity to favorably impact diets and the food systems.

As reflected in cultural heritage and history, Indonesia, Malaysia, and India, share many similarities in food cultures. This is also reflected in the dietary guidelines, specifically by the proportion of ‘My Plate’ in each country, where the recommended quantity of fruits and vegetables on one plate is half of the plate for each meal.

The difference is that both Malaysia and India already have included plant-forward dietary patterns by emphasizing the consumption of fruits and vegetables and substituting animal-based protein for plant-based protein. For example, in Malaysia, it is recommended to consume more than 3 servings of vegetables and 2 servings of fruits per day; whereas in India, the recommended intake is 400 grams of vegetables and 100 grams of fruits per day. For proteins, in Malaysia, it is not recommended explicitly to consume plant-based proteins. But, it is recommended to include one serving of plant-based protein on every meal. Meanwhile, in India, the government recommends the main source of protein should be from pulses/legumes.

In 2014, the Indonesian Ministry of Health introduced an FBDG known as the ‘Balanced Nutrition Rounded Pyramid’ (Piramida Gizi Seimbang) through PMK 14/2014. This guideline promotes the principles of balanced nutrition, emphasizing dietary diversity, food safety, physical activity, and weight monitoring. It illustrates the recommended proportions of food groups in each meal (Isi Piringku), where carbohydrates make up the largest proportion, followed by fruits and vegetables, protein sources (both animal- and plant-based), and limited amounts of sugar, salt, and fat. In practice, however, current dietary patterns in Indonesia still fall short of the recommendations set by the FBDG.

Malaysia's dietary guidelines, last revised in 2020 by the Ministry of Health, aim to promote health among individuals aged 18-59 years. These guidelines are structured around a food pyramid, with four levels representing various food groups, similar to Indonesia’s Piramida Gizi Seimbang. The base emphasizes a high intake of vegetables (≥3 servings/day) and fruits (2 servings/day), while the next level is rice, cereals, noodles, and tubers, recommended in moderate amounts (around 3-5 servings/day). Animal-based foods, including fish, meat, poultry, eggs, legumes, and nuts, should be consumed in moderation (1-2 servings/day), and milk and dairy intake (1-2 servings/day). To support a balanced diet, the guidelines advise limiting fats, minimizing sugar, choosing foods low in salt, and drinking 6-8 cups of water a day.

More recently, the Indian Council of Medical Research (ICMR) and the National Institute of Nutrition (NIN) introduced updated dietary guidelines to address the growing prevalence of NCDs, such as obesity, diabetes, and heart disease. Grounded in extensive research and culturally tailored for India, these guidelines recommend sourcing at least half of cereal intake from whole grains and millets, with pulses providing approximately 14-15% of total caloric intake for essential proteins and amino acids. A balanced encompassing a variety of food groups is encouraged, with cereals limited to 45% of total energy, and vegetables and fruits advised at every meal. Fat intake should not exceed 30% of total calories, emphasizing sources like nuts, oilseeds, and dairy, while limiting high-fat, high-sugar, and high-salt foods. The guidelines also address nutritional needs across life stages, with specific guidance for pregnant and lactating women, advocating exclusive breastfeeding for the first six months followed by a balanced diet.

Putting plant-forward dietary guidelines into practice: Case studies in Malaysia and India

In more detail, rising concerns over chronic illnesses linked to suboptimal diets, as well as environmental and food security risks from unsustainable agricultural practices, prompted Malaysia to establish national dietary guidelines in 2020, followed by additional guidelines for vegetarians in 2023. These guidelines were developed in response to the high prevalence of NCDs: 15.6% of the population have diabetes, 29.2% have hypertension, and 33.3% have hypercholesterolemia. Furthermore, rates of overweight (32.6%) and obesity (21.8%) have increased by nearly 10% from 2011 to 2023.

While these updated guidelines also address undernutrition issues (e.g., anemia, stunting, and wasting), rising rates of overweight and obesity suggest limited effectiveness. Contributing factors include rapid urbanization, easier access to a wider range of foods, sedentary lifestyles, and a broader nutritional shift in consumption patterns shaped by government policies, lifestyle changes, and the food environment. Additionally, 95% of Malaysian adults do not meet the recommended daily intake of fruits and vegetables, and the increasing consumption of ultra-processed foods (UPFs) likely exacerbates these trends, indicating low adherence to the guidelines and the ongoing challenge in promoting healthier diets.

In India, dietary guidelines reflect unique cultural, regional, and religious factors that shape plant-based diets. However, these dietary patterns come with challenges, such as the high phytate content in plants, which inhibits iron absorption and contributes to a high prevalence of anemia. In 2015, anemia affected 28.4% of children and adolescents aged 1-19 years. Additionally, suboptimal diets account for 56.4% of India's overall disease burden, highlighting the urgent need for dietary improvements to address both nutritional deficiencies and health risks. Revised in 2024, India’s dietary guidelines aim to increase protein intake from 6-9% to 14% of total daily intake and reduce cereal consumption from 50-70% to a maximum of 45%, to achieve better health outcomes across the population, though data on their impact is not yet available.

Shifting toward more plant-forward diets for Indonesians: Necessity or mere trend?

While the widespread consumption of UPFs and sugary beverages is on the rise (19.5% of total daily calories as of 2018), public health issues of concern in Indonesia remain largely painted with undernutrition (e.g., stunting, wasting, underweight, anemia). These trends suggest that national food priorities should carefully accommodate both issues with proportion.

A recent analysis of adopting the Planetary Health Diet in Indonesia highlights the complexities of the shifts toward ‘plant-forward’ diets: While it reduced rice consumption and increased dietary diversity, it resulted in GHG emissions that were one-third higher than current dietary patterns–double the 2050 target level–and failed to meet nutrient requirements. This suggests that strategies for dietary shifts should be tailored to demographics, health, and nutrition concerns across geographical contexts (e.g., urban, peri-urban, rural) while remaining context-specific and aligned with local production capacities.

In urban and peri-urban areas, for example, the prevalence of overnutrition–characterized by higher rates of overweight and obesity–is notably linked to increased consumption of UPFs. In contrast, rural areas continue to struggle with issues of undernutrition and insufficient calorie intake. Rather than a uniform shift toward a plant-forward diet, region-specific strategies offer a more appropriate approach.

For urban and peri-urban populations, promoting the consumption of minimally processed, locally sourced foods over UPFs can help address overnutrition. In rural areas, encouraging community gardening to increase calorie intake and dietary diversity can be more effective in combating undernutrition. Tailoring interventions to the nutritional challenges of each region ensures that solutions are both relevant and sustainable.

When evaluating whether a country is suited to adopt plant-forward diets, multiple factors must be carefully considered, as dietary guidelines should do more than follow current trends–they must directly address specific national health and nutritional challenges.

In food- and nutrition-secure countries with higher rates of overnutrition and related diseases, a plant-forward approach may be effective. However, this strategy is less suitable for populations facing undernutrition and poverty. In Indonesia, dietary guidelines must address the triple burden of malnutrition–an urgent public health issue–by providing balanced strategies for overnutrition, undernutrition, and micronutrient deficiencies. Ultimately, each country requires dietary guidelines that support the unique health and nutritional needs of its population.

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