by Connie Ray
On January 7, the US Department of Health and Human Services (HSS) and the US Department of Agriculture (USDA) released the highly-anticipated Dietary Guidelines for Americans for the years 2015-2020. The guidelines, released every five years, always brew up some controversy among food and nutrition professionals, but this year’s may be the most hotly debated in history.
The process of developing the Dietary Guidelines is a complex one, involving health and nutrition professionals, public input, lobbyists, the HHS, and the USDA. The general timeline is as follows:
- A Dietary Guidelines Advisory Committee (DGAC) is formed, made up of nutrition, health, and medical researchers. This year’s DGAC included 14 professionals (2 from Friedman: Alice Lichtenstein, DSc, Committee Vice Chair, and Miriam Nelson, PhD). Of those 14 members, here is a breakdown of the specialties of members of the committee:
The Committee reviews current scientific evidence on the relationships between diet and health, including original systematic reviews (analyzing and grading evidence based on its strength); a review of existing systematic reviews, meta-analyses, and reports by scientific organizations (reviewed for quality); data analyses gleaned from national data from federal agencies; and food pattern modeling analyses.
- The DGAC submits its report to the Secretaries of the HHS and USDA. The recommendations are made public and are open to commentary for 45 days. The committee report is subject to further analysis by both federal and nonfederal nutrition and health experts. Ultimately, the document is approved by the HHS and USDA Secretaries.
- Referencing the previous edition of the Dietary Guidelines, the DGAC Report, and public and federal agency comments, the HHS and USDA develop a new edition of the Dietary Guidelines.
As previously mentioned, this version of the Dietary Guidelines has been a controversial one from the very beginning. What follows is a brief summary of some of the major debates and controversies along the way.
The House Appropriations Bill
Congress got involved in the formation of the Dietary Guidelines this time around when the House of Representatives passed the Agricultural Appropriations Bill in July 2015, with a few pointed and controversial riders. These amendments aimed to directly impact the 2015 Guidelines, imposing an impossibly high evidentiary standard (i.e., only evidence that can receive a Grade 1: Strong Evidence grade by the Nutrition Evidence Library). This would disallow the inclusion of any recommendations with “Moderate” evidence, including recommendations to select a diet rich in fruits, vegetables, and whole grains; to decrease sodium intake for individuals with high blood pressure; and to limit sugar to help prevent dental caries, all of which receive a grade of “Moderate.” It would also prevent any mention of physical exercise, food safety, or sustainability, limiting the Guidelines exclusively to diet and nutrient intake.
Many leading health and nutrition groups strongly opposed these riders and accordingly wrote to the House Appropriations Committee in protest. The Academy of Nutrition and Dietetics, American Diabetes Association, American Heart Association, American Academy of Pediatrics, CSPI, Friends of the Earth, the American Public Health Association, and others cosigned a letter disagreeing with the Bill. In an unprecedented move, the Dietary Guidelines Advisory Committee sent its own letter delineating the detrimental effects that the Bill would have on the Dietary Guidelines.
Although the Dietary Guidelines were due to be released by the end of 2015, they were further delayed. In December 2015, the omnibus spending bill passed and made into law along with a further provision allocating $1 million to fund an investigation of the Dietary Guidelines process by the Academy of Medicine to search for scientific bias.
Ultimately, the 2015-2020 Guidelines skated by; they were already completed by December and were released January 7, 2016 before any of these provisions could affect them. It is unlikely, however, that the next Dietary Guidelines will escape these newly imposed congressional regulations.
Issues of Sustainability
USDA and HHS announced earlier last year that, despite inclusion of recommendations in the DGAC report, the official Dietary Guidelines would not include recommendations based on sustainability. Their press release stated that sustainability is beyond “the scope of our mandate.” The issue was further highlighted by the aforementioned rider attached to the 2016 spending bill, limiting the Guidelines in scope to nutrition/dietary recommendations only. Many leading experts believe the decision to exclude sustainability was made in response to meat industry lobbyists who were outraged that the DGAC concluded a sustainable diet is one that limits animal products
During the typically allotted 45-day public commentary period, comments on the DGAC can be submitted for consideration. These include comments by lay people, academics, lobbyists, and businesses. That period was extended to 75 days this time around. A group of 30 senators, led by Sen. John Thune (R-SD), requested the extension, concerned that the committee’s report “greatly exceeded their scope in developing recommendations.” Thune specifically discussed concern about the recommendations to limit red meat as well as the commentary on sustainability. Indeed, a large percentage of the public comments submitted expressed concern or outrage about one or both of these issues.
According to The Hill, “In March, 71 GOP representatives and 30 Republican senators signed letters critical of the Advisory Committee Report, specifically attacking the recommendations against eating less red meat and lowering sodium on behalf of the cattle and restaurant industries, among others. Those same politicians received more than $3 million in donations from food-related donors from 2013 to 2014 alone. Senators who signed the letter received almost half a million dollars just from the beef and cattle industries, according to campaign contribution records from OpenSecrets.com.”
The sheer number of comments submitted is indicative of the level of controversy and outrage. Compared to the just over 2,000 comments submitted in 2010, there were over 28,000 comments submitted this time around.
And many people believe the actions of meat industry lobbyists paid off. Not only was sustainability not mentioned in the final Dietary Guidelines, but neither was the DGAC’s recommendation to limit red and processed meat.
The wording from the DGAC report reads (emphasis added):
A healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and drinks and refined grains.
Rather than recommending a diet lower in red and processed meat as did the DGAC report, the final Dietary Guidelines state that a healthy eating pattern includes: “A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products” and limits “Saturated fats and trans fats, added sugars, and sodium.”
Much of the nutrition community is certainly in an uproar over this change. Rafael Perez-Escamilla, a Yale epidemiologist and member of the 2015 DGAC, attributes this change in wording to the effectiveness of meat industry lobbyists and calls it “a major gap.” Dr. Walter Willett, head of the nutrition department at the Harvard School of Public Health, goes so far as to call the exclusion of the recommendation to lower red meat “censorship.”
The American Cancer Society is also disappointed. “The science on the link between cancer and diet is extensive. By omitting specific diet recommendations, such as eating less red and processed meat, these guidelines miss a critical and significant opportunity to reduce suffering and death from cancer,” said Dr. Richard Wender.
However, as usual, not everyone is in agreement. The Academy of Nutrition and Dietetics sent out a press release praising the Dietary Guidelines for their science-based approach, claiming that they will “provide a solid basis for federal nutrition policy, identify future research needs and equip health professionals and employers with the tools necessary to benefit the public.”
Tufts’ own Dr. Alice Lichtenstein, vice chair of the DGAC, describes the Guidelines as a “very good document. I think it’s a big step forward from the 2010 Guidelines. It isn’t written exactly as I would have done it, but from a public health perspective, focusing on the negative and sidestepping the positive is not particularly useful to anyone. If you follow the basic guidance that’s given in terms of eating patterns, you will end up consuming a healthy diet.”
Referencing criticisms of the Guidelines’ wording, she offers the opinion: “These are centered in minor points, not major points.”
For better or for worse, the 2015 Dietary Guidelines are here to stay for the next five years. If nothing else, the complicated road we’ve traveled to get to this point has proven that releasing a national document with a federal agency’s stamp of approval is anything but simple. When there are so many with vested interests, it will certainly be interesting to see what the 2020 process has in store.
Connie Ray is a first year MNSP student at the Friedman School. She currently lives in Virginia, where she raises her two sons and teaches yoga.