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Health

Lessons Learned Developing the Tuscan Food Pyramid

By Germana Foscale
Mar. 21, 2025 01:19 UTC
Summary Summary

Francesco Cipriani, an epi­demi­ol­o­gist and nutri­tion­ist, high­lighted the impor­tance of com­mu­ni­cat­ing health infor­ma­tion clearly and sim­ply to cit­i­zens, espe­cially regard­ing dietary choices, dur­ing a sem­i­nar on the Mediterranean Diet. He dis­cussed the devel­op­ment of the Tuscan Food Pyramid as a tool to help Tuscans make healthy food choices that ben­e­fit their health, the regional econ­omy, and the envi­ron­ment, empha­siz­ing the need for strong insti­tu­tional com­mu­ni­ca­tion and pol­icy coher­ence in pro­mot­ing a bal­anced and sus­tain­able diet.

“Diet is one of the most impor­tant risk fac­tors affect­ing health,” was the open­ing remark at one of the pre­sen­ta­tions of a sem­i­nar held at the end of February, enti­tled ​“Narrating Sustainability: the Mediterranean Diet as an inter­face between art, cul­ture and health.”

These were the words of Francesco Cipriani, an epi­demi­ol­o­gist and nutri­tion­ist mem­ber of the Georgofili Academy in Florence, which dates back to 1753 and focuses on sci­en­tific advance­ments in agri­cul­tural, food and envi­ron­men­tal sci­ence.

His pre­sen­ta­tion — Communicating health at the din­ner table: the Tuscan expe­ri­ence — was a unique oppor­tu­nity to reflect on the impor­tance of insti­tu­tional com­mu­ni­ca­tion with cit­i­zens on health issues. 

The region of Tuscany could be the first in Italy to pro­mote a multi-pro­fes­sional approach to food poli­cies.- Francesco Cipriani, nutri­tion­ist, Georgofili Academy

“We know what to com­mu­ni­cate, but we have to speak with clar­ity and sim­plic­ity,” Cipriani told the audi­ence. The fun­da­men­tal ques­tions were: ​“How best to com­mu­ni­cate what is good to eat and in what amount to enjoy good health? What other impor­tant aspects should be con­sid­ered?”

In 2006, Eva Buiatti and Cipriani, then at the Tuscan regional health agency, together with Maria Grazia Mammuccini and Carlo Chiostri of the for­mer regional agency for the devel­op­ment of agri­cul­ture and forestry in Tuscany, decided to set up a work­ing group of experts to cre­ate a com­mu­ni­ca­tion project for Tuscan prod­ucts, with the main ele­ments of Tuscany’s cul­tural iden­tity at the din­ner table.

The aim was to help Tuscans choose behav­ior that would ben­e­fit their health, the regional econ­omy and the envi­ron­ment.

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This ini­tia­tive was spurred by the fact that, back in 2005, Italy only had one image of a food pyra­mid on the inter­net aimed at nutri­tion­ists rather than cit­i­zens. 

“Even today, Italy lacks a sim­ple and unique evoca­tive image of a food pyra­mid for the whole of Italy, which can show Italians what to eat,” Cipriani said.

A food pyra­mid is a visual rep­re­sen­ta­tion of basic food groups in var­i­ous pro­por­tions sug­gest­ing healthy rec­om­men­da­tions. It pro­ceeds from the bot­tom (foods to be con­sumed in abun­dance) to the top (foods whose con­sump­tion should be reduced com­pared to the rest).

Indeed, ​“at that time, there were food pyra­mid images avail­able world­wide which could facil­i­tate healthy food choices. For exam­ple, there was an American, a Canadian and a Chinese pyra­mid, all indi­cat­ing the dif­fer­ent pro­por­tions of food groups to be con­sumed for a healthy diet.”

Nowadays, ​“there are more than 80 images from 80 dif­fer­ent coun­tries on the FAO web­site that serve the same pur­pose, but there is still none for Italy,” he added.

The team of regional experts thus worked on defin­ing the tech­ni­cal con­tent of the rec­om­men­da­tions at the din­ing table, which were then shaped into the image of what would soon be called the Tuscan Food Pyramid (PAT), launched in 2008 by the region of Tuscany, which finally adopted the famil­iar shape of a pyra­mid.

Cipriani recalled the long process of look­ing for a spe­cific Tuscan image to illus­trate the pyra­mid, which would have enhanced the typ­i­cal­ity of the Tuscan con­text. 

“The image of the Dome of Florence or the Tower of Pisa could have been used instead, but there was a risk of cre­at­ing a rivalry between regional geo­graph­i­cal areas,” Cipriani admit­ted with a smile.

“A fur­ther pro­posal was the image of a cypress,” a typ­i­cal tree of the Tuscan land­scape. Yet, another idea came up: ​“the Divine Diet, refer­ring to Dante’s cir­cles in the Divine Comedy, with some foods in Hell and oth­ers in Heaven.”

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“However, by putting some foods in Hell and oth­ers in Heaven, the mes­sage would have been inad­e­quate,” Cipriani explained, ​“because the mes­sage is not that some foods should be com­pletely avoided; they should rather only be eaten in the right pro­por­tions.” Since ​“there is no such food as food from hell,” he said with another smile.

The Tuscan Food Pyramid, with its final pyra­mid shape, is based on the healthy eat­ing guide­lines issued by the Italian Council for Agricultural Research and Economics (CREA), whose fourth revi­sion in 2019 also included sus­tain­abil­ity issues.

The Tuscan Food Pyramid

“The PAT does not talk about por­tions or rec­om­mended weekly fre­quency of con­sump­tion because too much infor­ma­tion is con­fus­ing,” he said. 

In fact, ​“we aimed for an extreme sim­pli­fi­ca­tion: foods which should be con­sumed in larger quan­ti­ties are at the bot­tom, and foods at the top should be con­sumed spar­ingly,” Cipriani added. ​“The lat­ter are still suit­able on cer­tain occa­sions because they are rich in good and tasty nutri­ents.”

He also under­lined that ​“the PAT is a unique exam­ple on the national scene because it is the image of an inte­grated pol­icy at the local level. According to the PAT prin­ci­ples, food con­sump­tion is valu­able for health, agri­cul­ture, the econ­omy and the envi­ron­ment.”

Commenting on the PAT’s unique fea­tures and role in pro­mot­ing a healthy Mediterranean diet pat­tern and lifestyle, Cipriani said: ​“The pyra­mid also shows the impor­tance of reg­u­lar phys­i­cal activ­ity and offers a new image, bring­ing sev­eral poli­cies together.” 

“Compared to the pyra­mids from other coun­tries, the PAT is per­haps a lit­tle more veg­e­tar­ian, antic­i­pat­ing the trend which has become estab­lished in recent years,” he added.

Thanks to tele­vi­sion broad­casts on Italy’s state-owned RAI tele­vi­sion broad­caster and the pri­vate Mediaset net­works, pre­sen­ta­tions at dif­fer­ent sym­po­siums and exhi­bi­tions and the dis­tri­b­u­tion of leaflets, posters and brochures, the experts behind the project cal­cu­lated that this infor­ma­tion reached a sig­nif­i­cant share of the approx­i­mately 3.6 mil­lion Tuscans.

Other ini­tia­tives include the region of Tuscany’s Vetrina Toscana, which pro­motes food and wine ini­tia­tives and com­mu­ni­cates with pro­duc­ers of typ­i­cal Tuscan food spe­cial­ties and tra­di­tional recipes.

Moreover, in 2014, the Tuscany regional health agency pub­lished a book with Tuscan recipes and their asso­ci­ated health val­ues accord­ing to the PAT’s rec­om­men­da­tions, enti­tled Tuscan Cuisine, Recipes and Health with recipes put together by a rich net­work of Tuscan experts, asso­ci­a­tions and regional chefs.

“The recipes are typ­i­cal for each Tuscan area: starters, first and sec­ond courses, as well as desserts,” Cipriani explained, and ​“all include notes on health and nutri­tional val­ues, indi­cat­ing the posi­tion of every dish in the pyra­mid and whether it should be eaten more or less often.”

“Olive oil fea­tures promi­nently in the PAT, on the sec­ond level from the bot­tom, out of six lev­els,” Cipriani told Olive Oil Times.

Wine also appears in the PAT posters, although the graphic rep­re­sen­ta­tion has been adapted for areas where rec­om­men­da­tions on alco­hol con­sump­tion should be avoided, includ­ing schools.

“Wine must be con­sumed in mod­er­a­tion at the din­ner table, and there is still much debate and uncer­tainty on this point,” Cipriani com­mented.

“The next step will be to revise the tech­ni­cal con­tent of the PAT with updated infor­ma­tion based on the lat­est sci­en­tific evi­dence,” he added, under­lin­ing that ​“for exam­ple, dried fruit, given the numer­ous stud­ies that have shown its effec­tive­ness in the pre­ven­tion of many chronic dis­eases, would most prob­a­bly be moved from level three to level two, and should there­fore be con­sumed more often.”

The PAT review shall also work on estab­lish­ing future agree­ments with other insti­tu­tions to reach a broader pop­u­la­tion, which ​“could ben­e­fit from a sim­ple and easy way to know what to eat at the din­ner table and adopt a lifestyle con­ducive to good health.”

According to Cipriani, in a forth­com­ing PAT review, extra vir­gin olive oil would reaf­firm its cur­rent posi­tion on the sec­ond level of the PAT. 

“A lot of research is being car­ried out on olive oil, and its posi­tion in the PAT is well estab­lished,” he said, adding that ​“the results of sci­en­tific stud­ies on humans involv­ing olive oil are always pos­i­tive and never neg­a­tive. And this, in the nutri­tional field, is some­thing quite unusual.”

However, an impor­tant ques­tion is whether the nutri­tional health claims made are also fea­si­ble and sus­tain­able in every­day life.

As Cipriani under­lined, ​“very often, peo­ple’s diets are far removed from the rec­om­men­da­tions found in a healthy food pyra­mid, and the obsta­cles are not only the taste of the new food that should be eaten, but also its price: healthy food often costs more, and the so-called junk food is usu­ally much cheaper.”

Furthermore, the cur­rent deficit in insti­tu­tional guide­lines on healthy eat­ing and gen­eral well-being should be tack­led, as it is acknowl­edged that ​“cit­i­zens would gladly turn to national or local insti­tu­tions as a source of reli­able infor­ma­tion. This would help them deal with the com­plex­ity and abun­dance of infor­ma­tion on the sub­ject.”

Focusing on effi­cient insti­tu­tional com­mu­ni­ca­tion could pro­vide the nec­es­sary guid­ance for healthy eat­ing. 

“What is needed is a strong polit­i­cal man­date call­ing on national and local health insti­tu­tions to inform cit­i­zens of what is sci­en­tif­i­cally known about the rela­tion­ship between diet and health,” Cipriani said.

Indeed, ​“Tuscan food and eat­ing styles could be the guid­ing thread unit­ing Tuscan tourism, its econ­omy and agri­cul­tural sec­tor with health poli­cies,” he added. ​“The region of Tuscany could be the first in Italy to pro­mote a multi-pro­fes­sional approach to food poli­cies, as it has already done with the PAT.”

These wide-rang­ing ini­tia­tives would sig­nif­i­cantly increase pol­icy coher­ence in pro­mot­ing a bal­anced and pre­ven­tive diet while con­sid­er­ing sus­tain­abil­ity and dietary choices’ social and envi­ron­men­tal impli­ca­tions.

“This is also the path which is being fol­lowed by the vast major­ity of European coun­tries,” Cipriani con­cluded.

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