This study aims to tease out why the Dietary Guidelines for Americans (DGA) have largely failed to support positive attitudinal and behavioral dietary change in the U.S. over the past decade. Dervin\'s sense-making methodology (SMM) is employed as a theoretical framework to postulate why DGA has not been more successful with its past communication approaches. A brief history of DGA is shared along with criticisms and literature discussing its potentially politicized nature. Thirteen semi-structured qualitative interviews with individual people and various experts (government, dietitians, communicators, and school-lunch administrators) reveal successes and failures and, ultimately, gaps in the communication process. Key themes emerged indicating the importance of mothers, coaches, and significant others, but rarely DGA, in American\'s nutritional upbringing. Industry expert interviews exposed areas where competing systems may cancel out efforts and how too many people are looking at narrowly focused details without seeing the big picture. Systems thinking embedded in social change theories may be advantageous over traditional, less coordinated linear-thinking approaches to improve awareness and attitudes. A systems map is proposed to guide the process and bring key parties together to move beyond the contentious, only one winner mentality that has dominated in the past. In conclusion, this article adds qualitative insights to this area of inquiry and makes suggestions to improve organizational communication and policy.

Guidelines on public health and health system interventions often involve considerations beyond effectiveness and safety to account for the impact that these interventions have on the wider systems in which they are implemented. This paper describes how a complexity perspective may be adopted in guideline development to facilitate a more nuanced consideration of a range of factors pertinent to decisions regarding public health and health system interventions. These factors include acceptability and feasibility, and societal, economic, and equity and equality implications of interventions.
A 5-step process describes how to incorporate a complexity perspective in guideline development with examples to illustrate each step. The steps include: (i) guideline scoping, (ii) formulating questions, (iii) retrieving and synthesising evidence, (iv) assessing the evidence, and (v) developing recommendations. Guideline scoping using stakeholder consultations, complexity features, evidence mapping, logic modelling, and explicit decision criteria is emphasised as a key step that informs all subsequent steps.
Through explicit consideration of a range of factors and enhanced understanding of the specific circumstances in which interventions work, a complexity perspective can yield guidelines with better informed recommendations and facilitate local adaptation and implementation. Further work will need to look into the methods of collecting and assessing different types of evidence beyond effectiveness and develop procedural guidance for prioritising across a range of decision criteria.

The objective of this article is to explain the process of the development of and to assess the Mexican food-based dietary and physical activity guidelines (FBDGs). The FBDGs were developed by an intersectoral and interdisciplinary committee of 11 national experts with input from 11 external advisors. The sectors represented were research and academic institutions, the Ministry of Health, and a nongovernmental organization. The evidence-based process included the following: literature reviews of local, national, and international evidence; review of dietary patterns of the Mexican population; key national and international recommendations; and review of FBDGs and visual icons from other countries. The guidelines\' report follows the life-course socioecological model rooted in a deep understanding of the epidemiology and underlying causes of malnutrition in Mexico. The guidelines are summarized in 10 pretested main recommendations that include, and go beyond, simply promoting the consumption of a healthy and varied diet that includes fresh fruits, vegetables, legumes, and whole grains and staying within caloric needs and staying active. The guidelines strongly emphasize healthy cooking habits, enjoyable meals with family and friends, drinking water, and avoiding the consumption of sweetened beverages, grain-based desserts, and highly processed foods. Detailed guidelines specific to different groups (on the basis of age and physiologic status) are also included. An innovative aspect of the Mexican FBDGs is the inclusion of dietary guidance of children <2 y of age. Future editions of these guidelines should consider removing their emphasis on dietary cholesterol and total dietary fat and placing more attention on the substitution of saturated and trans fats with healthy oils. The process of national agenda setting, policy articulation, and implementation of the Mexican FBDGs in the context of addressing the national obesity epidemic deserves to be initiated and formally assessed through the lens of evidence-based, public nutrition complex adaptive systems.