Assessing the True Impact of the Dietary Guidelines for Americans: Will They Make a Difference?

Are you familiar with the? You may not be unless you work in public health or nutrition. What about MyPlate? Ring any [dinner] bells for you? If that still doesn't help, you are not alone.
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Are you familiar with the Dietary Guidelines for Americans?

You may not be unless you work in public health or nutrition.

What about MyPlate? Ring any [dinner] bells for you?

If that still doesn't help, you are not alone.

The 2015 Dietary Guidelines for Americans (DGA) is currently under development, as a group of academic experts works to review our scientific understanding of nutrition and health. The DGA are issued every five years, since 1980, by the United States Department of Agriculture (USDA) and the United States Department of Health and Human Services (HHS).They are intended to provide science-based nutrition and food safety recommendations to help promote habits that maximize good health and reduce the risk of chronic disease. They also set our nation's nutrition policy, which informs programs like school nutrition, federal nutrition assistance programs like SNAP and WIC, as well as national food and nutrition education efforts. Despite these far-reaching implications, public awareness of the DGA is low and their impact on health is limited.

I. Public Awareness

While the DGA is a technical document intended for policymakers, Food Guides issued by the USDA summarize the guidelines in a visual format for the public. MyPlate, introduced in 2011, is the most recent rendition, replacing MyPyramid, a tool introduced in 2005 as the follow-up to the 1992 Food Guide Pyramid.

In a study conducted with mothers three months after MyPlate was introduced, 70% of those surveyed were not familiar with the icon. Only 9% claimed to be familiar with it and 21% reported being only somewhat familiar. And awareness isn't improving - according to a more recent Harris Interactive survey conducted by Nestle in early 2013, 75% of 1,500 primary grocery shoppers were not familiar or only somewhat familiar with MyPlate, while only 41% were aware of the DGA.

Many experts wonder how we can expect the DGA to have a positive impact on our nation's health if less than half of Americans know about them. According to the What We Eat In America survey, conducted by the Centers for Disease Control and Prevention (CDC), no age group of men or women met the DGA-recommended 1 ½ to 2 cups of fruit and 2 to 3 cups of vegetables per day between 2009 and 2010.

Registered dietitians Dave Grotto, RDN, LDN ("Guyatitian" and media personality) and Annette Maggi, MS, RD, LD, FAND (President of Annette Maggi & Associates) believe creative retail approaches may be effective ways to increase awareness. "Stores should have shelf tags that help guide the public such as 'Meets one MyPlate serving of vegetables'", suggests Grotto. Maggi agrees, stating that "retail grocery stores are ideal places for driving behavior change because that's where the majority of purchase decisions are made."

II. Public Health Impact

The key to improving DGA impact may be focusing less on the "what" and more on the "how", says Maggi. Take sugars, for example - a topic that has appeared in every DGA since 1980. The original recommendation was to "avoid too much sugar", while subsequent recommendations advised Americans to "use sugars only in moderation." In 2005, the concept of a "discretionary" calorie allowance for sweet and indulgent foods was introduced and then dropped in 2010 in favor of more direct language: "reduce the intake of calories from [solid fats and] added sugars."

While these recommendations may be science-based, it's nearly impossible for the public to understand their nuances, let alone put them into action. Grotto hopes that the 2015 DGA are more realistic and helpful in making the guidelines come to life. "Telling someone what they should eat isn't as powerful as showing them how!"

III. 2015 DGA Progress

Now that we're nearly a year and half into the 2015 DGA process, what is the likelihood the new set of guidelines will have more of an impact?

The advisory board responsible for reviewing the available research is the 2015 Dietary Guidelines Advisory Committee (DGAC). For 2015, they are tackling a broad scope of work and branching out into areas never before explored, including sustainability and the effectiveness of policy and behavior change interventions. The implications of this expanded scope may be less of a focus on simple, realistic eating recommendations and more of an expansive but cursory review of a multitude of topics.

Because the DGA informs all national food and nutrition programs, it is vital that the DGAC recommendations are rooted in strong science; for these newer topics, the scientific literature is either emerging or methodologically-weak, or both. This could lead to premature and misleading guidance for the public. As reinforced by Grotto and Maggi, along with current data, translating the DGA into simple, realistic and actionable advice is needed to improve public health in a meaningful way. Compare the U.S. 2010 DGA with the new food-based guidelines recently issued by the government of Brazil. They focus on 10 simple rules for healthy eating, including: "Eat in company whenever possible"; "Prepare meals from staple and fresh foods"; and "Use oils, fats, sugar and salt in moderation." Since their publication, food policy and nutrition experts have lauded the recommendations for their simplicity and straightforwardness.

As the 2015 DGAC continues to develop its report to USDA and HHS, health professionals, industry stakeholders and public health practitioners eagerly await the new guidelines. Whether the evidence review process and expanded scope by this DGAC will improve public understanding of nutrition and health or lead to further confusion and lack of awareness remains to be seen.

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