5 questions about the next US dietary guidelines, and the ‘impossible restrictions’ on them

Here’s the thing: The laws that have the most impact on the food we eat are the ones most of us ignore. But they are still important to millions of Americans.

The Dietary Guidelines for Americans, reviewed and issued by the federal government every five years, have a broad influence on what goes into nutrition assistance programs, from WIC for women and toddlers to school lunches to meals for the elderly or adults. Yet 63% to 90% of people in the United States, depending on the nutrient, exceed recommended levels for added sugar, saturated fat, and sodium; 75% fall below the standards set for vegetables, fruit and milk.

Last week, an advisory group made up of academic researchers met for two days of public consultation on what the next set of dietary guidelines should include. Their draft recommendations will go to the US Department of Health and Human Services and the US Department of Agriculture, after which final guidance will be released by the end of the year.

On Monday, the committee, or DGAC, said it was not including alcoholic beverages because a panel within HHS and the National Academies of Sciences, Engineering, and Medicine is already involved in the question. Processed foods are not part of the proposed 2025-2030 guidelines for a different reason: The committee found little high-quality evidence to support any guidelines.

It may seem like two days of lectures after nearly two years of reviewing the scientific literature produced little in the way of concrete changes, so STAT asked three experts for their they take.

How important are these recommendations?

Grace Chamberlin, political friend, Science Center of Public Interest: Dietary guidelines are one of the greatest tools we have in this country to improve food and health and the food system, so they are very important. I mean, dietary guidelines have been called the north star of nutrition programs.

Marion Nestle, distinguished professor of nutrition and public health at New York University: Nobody pays much attention to them when they work. Also, they never change, really. In 1980 they said to eat more vegetables, eat less foods high in fat, sugar and salt. They still do.

Will it take time for answers to be reached about mass-produced foods, for example?

Nestle: We now have two controlled clinical trials on diets that have both been conducted that show that people who eat a diet based on these foods eat more calories… than people who don’t. unused. What else should you know? DGAC ignores these trials because their duration was short.

When I was at the DGAC in 1995, we were tasked with reviewing the science and doing everything we could to explain its implications for dietary advice for the American public. This assumed that the evidence would be difficult to interpret and incomplete. That changed with the 2005 guidelines. Since then, committees have been instructed to make recommendations based on evidence, and do just that. This is an impossible restriction as the situation with mass-produced foods shows.

JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital: I think it is important to have solid evidence before giving guidance on it. And I think one of our findings was the variety of processed foods: it wasn’t one size fits all. I suspect that a much improved diet will be the dietary guidelines of 2030. I think it will probably take a few more years to have a sufficient evidence base but I think it is going that way.

Chamberlin: We generally agree with the DGAC’s draft decisions on the topic. More research is needed to clarify what exactly drives the relationship between high-consumption foods and weight or other health outcomes. So I think that’s a research gap to address. Consumption of processed foods is associated with an increased risk of heart disease, stroke and type 2 diabetes. But it is not clear which components of processed foods cause health effects.

What can be done with limited evidence?

Nestle: Everyone understands how difficult it is to do nutrition research. Just think about this. You can’t lock people up for decades to study what they eat under controlled conditions. You have to trust people to say what they eat (everyone lies or, politely, doesn’t remember). The studies are observational and cannot prove causation.

Chamberlain: As long as we rely on these clinical trials, it will be difficult to reach a strong conclusion, due to the rigor of the science and the standards that the DGAC adheres to, to make recommendations based only on the available research. And recent research has no evidence of pregnancy and postpartum, children and adolescents and with criticism, many racial and ethnic groups. I think that really what they’re presenting at those public meetings, whether it’s intentional or not, is a big call to the research community to make sure that the next time we do this, there’s research that’s needed to make decisions. strong ones.

What do you think the committee added to the discussion?

Chamberlain: This food guide advisory committee has done a very impressive job of starting to integrate health equity into this process. They have made amazing progress as far as they can in trying to combine different research samples and protocols and create unique food patterns. They are modeling the diet of such food types as the American Indian and Alaska Native diet.

Manson: I think that research on food habits has been very helpful, identifying certain habits that allow for flexibility, including other cultural influences and cultural differences can make a difference in not forcing people. into these very restrictive types of incentives. People really want to have latitude. They may understand that certain foods should not be eaten often or rarely, but they do not want it to be a taboo at all.

What is missing?

Chamberlain: [The committee is] limited by the available surveys to ensure that they have nationally representative data. There must be enough money and time to have different models of people. That is very important so that we can have more information about food that includes culture and have these different decisions that are really broken down by race and ethnicity and make sure that we don’t widen the difference though which of health.

We regret that the DGAC has not clarified or reaffirmed the quantitative limits on saturated fat and added sugar. And that’s not because of a lack of research or an evidence-based foundation. Baile failed to bring that up in the meeting. So we’re really interested in learning what their recommendations are going to be for the bulk limits on those.

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