Public health advocates worry that dietary advice will get lost in translation

By Jane Black
Washington Post Staff Writer
Saturday, October 2, 2010; 5:09 PM

Every five years the federal government updates its dietary guidelines for Americans. This year, with most Americans overweight or obese and at risk of high blood pressure, policymakers are working to reinvent the familiar food pyramid and develop advice that is simple and blunt enough to help turn the tide.

Although most people do not read them, the guidelines have broad impact on Americans' lives. They dictate what is served in school breakfast and lunch, in education materials used by SNAP - formerly called food stamps - and in the development of information on the nutrition labels of food packages.They also underpin education materials that are available in community centers, doctors' offices and hospitals.

What the guidelines will say when they are unveiled in December is still under wraps. But the interagency committee is searching for new ways to communicate lessons about healthful eating and is working to make the food pyramid "more meaningful and engaging," said Dr. Robert Post, deputy director of the U.S. Department of Agriculture's Center for Nutrition and Policy Promotion that is leading the development of the guidelines.

Healthy eating has gained a high profile through Michelle Obama's "Let's Move" initiative to fight childhood obesity. But historically, the government has shied away from offering controversial advice. And with food, everything is controversial: A boost for one type of food in the guidelines can be viewed as a threat by providers of competing products. The result, critics say, is a nutritional education system so politically influenced that it is ineffective.

This year's process appears to be no exception. In public comments, the meat lobby has opposed strict warnings on sodium that could cast a negative light on lunch meats. The milk lobby has expressed concerns about warnings to cut back on added sugars, lest chocolate- and strawberry-flavored milks fall from favor. Several members of the Massachusetts congressional delegation also weighed in against added-sugar restrictions in defense of the cranberry.

"This is the real test of whether this administration is serious about helping people to change their diets," said Margo Wootan, director of nutrition at the Washington-based public health watchdog Center for Science in the Public Interest.

Even if the political will is there, developing useful advice remains a challenge. It has to be broad enough to apply to myriad ethnic and other taste preferences. It must be prescriptive enough to provide guidance to shoppers who have to choose between tens of thousands of products on grocery store shelves and are befuddled by ever-changing nutrition information.

According to a study conducted by the International Food Information Council, an industry trade group, 46 percent of consumers agree that food and health information is often confusing and conflicting. And no wonder: Eggs, once shunned because of cholesterol, are now praised for their protein content. Carbohydrates, once exiled from fashionable plates, are back in vogue, provided they come from whole grains. This year, 88 percent of Americans were unable to accurately estimate the number of calories they should consume, up from 85 percent in 2009.

"We can't load people down with different messages," said the USDA's Post. "We have to focus on practical, simple, easily applied messages that show action that consumers can take."

The food industry has lobbied hard to ensure that the government emphasizes carrots, not sticks, in nutrition messages. Consumers want control over their diet, lobbyists say, and they resent messages that dictate what should and should not be eaten.

Policymakers have long seen the wisdom of this strategy. And when they have strayed from it, the political heat has been intense. In 1977, a Senate select committee led by Sen. George McGovern (D-S.D.) was forced to beat a hasty retreat after it initially recommended that Americans could cut their intake of saturated fat by reducing their consumption of red meat and dairy products. Its revised guidelines suggested choosing "meat, poultry and fish that will reduce saturated-fat intake."

McGovern, whose constituents included many cattle ranchers, lost his seat in 1980. Since then, in case after case, the guidelines have refrained from suggesting that Americans eat less of just about anything.

Public health advocates say that kind of vacuum is precisely the problem: By avoiding blunt messages about what not to eat, the government has spoken in a way that baffles consumers.

"The only time they talk about food is if it's an 'eat more' message," said Marion Nestle, a professor of nutrition at New York University and a longtime critic of the food industry. "If it's a question of eating less, then they talk about nutrients."

Moreover, decades of positive advice to eat more vegetables clearly has not persuaded Americans to do so. In September, the Centers for Disease Control and Prevention released a nationwide study showing only 26 percent of adults eat vegetables three or more times a day - far short of national targets.

For the Obama administration, the dietary guidelines offer an opportunity - one that does not require a vote in Congress. (The anti-hunger lobby and rebellious Democrats recently stalled passage of a child nutrition bill that was a centerpiece of the first lady's Let's Move initiative.)

But as in the past, translating scientific data into clear and useful recommendations poses political pitfalls. The advisory committee's emphasis on a "plant-based" diet, for example, has caused much consternation among the powerful egg and meat lobbies who say the term might be misunderstood as advocating a vegetarian diet. (In fact, plant-based is defined as a diet that emphasizes fruits and vegetables but includes moderate amounts of meat, eggs and milk.) The Salt Institute has mounted an aggressive campaign to battle the recommended 35 percent reduction in the recommended allowance for sodium, saying the advice amounted to an "uncontrolled trial on more than 300 million Americans" that could result in greater obesity as individuals eat more to satisfy their sodium appetite.

By law, the guidelines must reflect the recommendations from the scientific advisory committee. But policymakers have broad discretion about how and whether to update the food pyramid.

The current version, called MyPyramid, was unveiled in 2005 and has been widely judged a failure. Where the original pyramid placed staples in the broad bottom of the triangle and special-occasion foods at the narrow top, MyPyramid is abstract. Six swaths of color, representing grains, vegetables, fruits, oils, milk, and meat and beans, sweep from the apex of the triangle to base. The width of the color bands, which is often difficult to distinguish, is meant to represent the amount of each food group people should eat. For details about serving sizes and other information, consumers must access the Web site,

"We've heard a lot of views about the pyramid," said Post. "The questions we're asking are: Does it convey everything we want? Does it convey anything meaningful?"

Post gave no details about what new concepts the agency is considering. But sources say the CDC, an adviser to the process, has requested information on a proposal that would replace the pyramid with a plate of food that visually demonstrates a healthful meal - an approach developed by the National Cancer Institute.

Whatever policymakers decide, the guidelines must take a new approach, said Linda Van Horn, a professor of preventive medicine at Northwestern University and chairman of the 2010 dietary guidelines advisory committee: "What has been done till now isn't working. To do nothing more effective than we have means that five years from now we'll be in an even worse situation. And that would be unconscionable."

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