The Dietary Guidelines for Americans serve as guideposts to the latest scientific thinking for health professionals throughout the country.
What’s the Issue?
The 1990 National Nutrition Monitoring and Related Research Act requires the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) to jointly publish the Dietary Guidelines for Americans at least once every five years. The Dietary Guidelines for Americans: 2015–2020, eighth edition, was released on January 7, 2016. The guidelines were heavily informed by the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC), which was charged with analyzing the latest in nutrition science since the 2010 guidelines were published and coming up with food-based recommendations of public health importance. The secretaries of HHS and the USDA were under no obligation to accept every DGAC recommendation, and, in particular, they pointedly rejected its suggestion that the guidelines should recommend that Americans pay more attention to the “sustainability” of the food they eat.
The guidelines are extremely influential and heavily lobbied; they form the basis for all federal nutrition policies, including the National School Lunch Program, which serves thirty-one million children daily; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and the Supplemental Nutrition Assistance Program (SNAP).
And they serve as guideposts to the latest scientific thinking for health professionals throughout the country.
The DGAC’s 571-page report was made public by its fourteen-member committee on February 19, 2015, nearly a year before the 2015–20 guidelines were released. This brief is based in part on a previous brief published before the guidelines were published.
While the new guidelines are consistent with previous advice—eat more fruit, vegetables, and whole grains and eat less saturated fat, sodium, and added sugars—there are a few noteworthy differences with the 2010 guidelines:
- Although there is still plenty of advice about individual food groups and nutrients, the guidelines’ overall emphasis is now on eating patterns—“the totality of what individuals habitually eat and drink,” as the report puts it in Chapter 1.
- There is a newly introduced recommended limit of 10 percent of daily calories from added sugars.
- Drinking three to five cups of coffee per day is now considered part of a healthy eating pattern.
- The previous 300 milligram restriction on dietary cholesterol has been lifted, in line with many studies that show that dietary cholesterol does not affect blood cholesterol levels.
- The guidelines for sodium consumption remain at 2,300 milligrams per day for Americans ages fourteen and older. But unlike 2010, there is no longer the additional recommendation that everyone older than age fifty; all African Americans; and people with hypertension, diabetes, or chronic kidney disease reduce their sodium intake to 1,500 milligrams per day.
- Men and teenage boys were encouraged to cut back on their protein consumption of meat, eggs, and poultry.
- And, for the first time, the guidelines are officially known by their five-year range, 2015–20, instead of a single year.
The guidelines start from the assumption that there is a link between “poor quality eating patterns and physical inactivity” and the number of Americans—117 million, or about half the adult population—who have one or more preventable, chronic diseases, say HHS secretary Sylvia Mathews Burwell and USDA secretary Thomas Vilsack in their introductory message. These diseases include cardiovascular disease, type 2 diabetes, obesity, and being overweight.
But according to the two cabinet secretaries, the guidelines are limited, noting that chronic diet-related diseases are continuing to rise and that the guidelines are just one part (although an important one) of “a complex and multifaceted solution to promote health and help reduce the risk of chronic disease.”
While accessible to the layperson, the guidelines are intended for policy makers and nutrition and health professionals, and they include ample footnotes citing numerous studies. There are also fourteen appendices, including one each on the three different food patterns and four on different food sources ranging from fiber to vitamin D. There are recommended amounts of different nutrients based on twelve different daily calorie needs, which are further subdivided by an individual’s age, sex, and level of physical activity.
The 2015–20 guidelines have, at the very least, resuscitated a vigorous debate about nutrition health policy, especially the role of saturated fat in one’s diet and the influence of dietary cholesterol on cardiovascular disease.
They have spawned at least one new interest group, the nonprofit Nutrition Coalition, that believes the guidelines “do not appear to reflect the most conclusive and current science available” and that says it plans to push for more clinical trial research in some of nutrition’s most problematic areas. The group is funded by John and Laura Arnold, whose foundation supported the Teicholz article in the BMJ.
It may never be possible to definitively determine the extent to which, if at all, the past decades of dietary guidelines have helped create the country’s obesity and chronic disease crisis. After all, most people ignore them. Three-quarters of the US population don’t eat the recommended amount of vegetables, fruit, dairy, and oils, according to the 2015 guidelines, and most Americans eat more than the recommended amount of added sugars, saturated fat, and sodium.
Yet the guidelines undeniably shape the general perception of what healthy eating means, and that perception is ultimately reflected in the food sold everywhere from the corner store to the supermarket.
A nod to sustainability, for example, and its importance in counteracting climate change, could make a serious dent in meat sales, especially beef. Despite a recommendation from the DGAC that American consumers consider sustainability when making their food choices, that advice was pointedly left out of the guidelines.
But the guidelines, despite vigorous opposition from the sugary beverage industry, do contain unprecedented advice to cut added sugar consumption to no more than 10 percent of one’s daily calories. It will be interesting to see the extent to which this makes a dent in the nation’s obesity epidemic, assuming its impact can be measured.
One thing is likely: The guidelines’ influence is only set to increase. The 2014 Farm Bill requires the guidelines to include nutritional information for infants and toddlers up to two years of age and additional guidance for pregnant women, beginning with the next edition in 2020.