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

BACKGROUND: Obesity remains a major public health concern in the UK, contributing towards increased disease risk and premature mortality. The Eatwell Guide - the UK's health eating model - is widely applied in policy and practice, yet evidence linking adherence to this dietary pattern with adiposity is limited. Similarly, understanding whether associations differ across population subgroups, including by level of genetic risk for obesity, is essential to inform equitable and effective dietary guidance. METHODS: In 156,764 participants from the UK Biobank, we explored cross-sectional and prospective associations between adherence to the Eatwell Guide and markers of adiposity (BMI, waist circumference, a body shape index [ABSI], and total and trunk body fat percentage). Differences between population sub-groups including by genetic risk, age, sex, physical activity level and socioeconomic status were explored. RESULTS: Higher Eatwell Guide adherence was cross-sectionally associated with lower BMI (β = -0.032, SE = 0.001, p < 0.001), with higher adherence associated with 25% lower odds of overweight/obesity versus lower adherence (OR = 0.75, 95% CI 0.73-0.77, p < 0.001). Prospectively, greater Eatwell Guide adherence predicted more favourable BMI trajectories over time (β = -0.008, SE = 0.001, p < 0.001). Similar, significant associations were observed for waist circumference, ABSI, and total and trunk body fat percentage (all p < 0.05) and were broadly consistent across key population sub-groups. CONCLUSIONS: Higher Eatwell Guide adherence was associated with beneficial changes in multiple markers of adiposity over time. These associations were consistent across key demographic groups, highlighting the potential role of adhering to UK healthy eating recommendations as part of weight management strategies in the UK.