One universal diet cannot fit all

Diets are not one-size-fits-all. So why do we treat dietary guidelines that way?
https://www.washingtonpost.com/opinions/diets-are-not-one-size-fits-all-so-why-do-we-treat-dietary-guidelines-that-way/2019/05/02/df089746-62ba-11e9-9ff2-abc984dc9eec_story.html?fbclid=IwAR1bowzSSkpRcgna4EIGPfhfejZDeYxZq8-HRy4NnHb5XbpBwA0AVIFqbmI&utm_term=.403275b18fe3




Clarification: This piece has been updated from a previous version to better describe the USDA's reaction to suggested improvements to the development of dietary guidelines.

"Grab and Go" fruit baskets are available in Cabell Midland High School in Ona, W.Va., offering students a healthy alternative to junk food. (Michael S. Williamson/The Washington Post)

By Nina Teicholz
May 2 at 9:12 AM


Nina Teicholz is a journalist, adjunct professor at New York University and author of “The Big Fat Surprise.”

The Dietary Guidelines for Americans are the single most powerful influence on American food choices. They drive dozens of public and private programs, from school lunches to meals for the elderly, the military, hospitals and more. They’re also adopted as the “gold standard” by health-care practitioners for sick and well alike. When your doctor or nutritionist or diabetes educator hands you a diet to follow for a particular disease, you are given the guidelines. Yet at the kickoff meeting for the next Dietary Guidelines, government officials made clear that this policy is only appropriate for healthy people. The 60 percent of our population diagnosed with nutrition-related diseases — obesity, diabetes, dementia — is excluded. On this path, there’s little question that the government’s guidelines will do virtually nothing to reverse the epidemics of these diseases.

This narrow focus clearly came as a surprise to some members of the 20-person appointed expert committee tasked with overseeing the science of the 2020 guidelines. They’d been gathered in Washington by the Departments of Agriculture and Health and Human Services, which jointly oversee the policy. One committee member asked, for instance, whether a study on obese people that looks primarily at weight loss would be included. The answers, from USDA staffers, came back repeatedly: That study would likely be excluded; that most included studies are only of populations that are healthy or at risk for obesity; and the guidelines are for “prevention” only.

Why is this “prevention” diet not appropriate for sick people? Recent science indicates that many people with nutrition-related diseases typically have a “broken” metabolism that makes them far less able to process starches and sugars. While some people can reverse obesity and diabetes with calorie restriction, others find more success reducing carbohydrates alone — for example, eating fewer grains and/or sugary foods. For these people, USDA and HHS should offer a nutritional option that is lower in carbohydrates than the existing guideline options, which all stipulate eating 50 to 55 percent of daily calories as carbohydrates.


A lower-carbohydrate approach could be a windfall for many. It has been demonstrated to work whether one is merely overweight or formally “obese,” prediabetic or “diabetic.” As a patient slides from the “pre” state of disease into its full-blown horror, a diagnosis is essentially just a name-change. One’s metabolic health has been steadily declining all along, and the solution for reversal, independent of one’s position along that downward slope, is the same. This means USDA and HHS’s hard-line distinction between “prevention” and “treatment” of chronic diseases is often meaningless.

That the guidelines are not for all Americans has been known for some time. It was one of the reasons that in 2015, during the last review of the guidelines, the House Agriculture Committee summoned the heads of both the USDA and HHS to the Hill for a lengthy hearing. Both Democrats and Republicans heavily criticized the current approach, no doubt responding to the law that states that the guidelines should be for a “general public.” Shortly after this hearing, Congress appropriated $1 million for the first-ever outside peer review of the guidelines’ process, by the National Academies of Sciences, Engineering, and Medicine. Regarding the policy’s scope, the report stated, “Given the range in health status and the prevalence of chronic diseases in the population . . . it is essential that future DGA be developed for all Americans whose health could benefit by improving diet.”

The USDA gives a nod to the “general public” requirement in its 2020 charter for the guidelines. However, in practice, the agency is clearly designing a program for healthy people only.


Nutrition-related diseases kill about 4,300 people daily, according to the Centers for Disease Control and Prevention — the equivalent of nearly 11 jumbo jets crashing and killing every person on board, every day. Where are the emergency expert panels, the headlines, the congressional outrage devoted to this massive, unparalleled public health crisis? The guidelines, whether through design or implementation, are clearly a failed policy. It’s time to ground the planes and acknowledge this disaster. Independent experts with no vested interest in the status quo are urgently needed to rethink the problem.

The USDA has already resisted reforms to improve the guidelines development process by avoiding conflicts of interest on the current advisory committee. (One member, for example, is the medical director on a meal replacement program owned by Nestle, one of the world’s largest food companies.) So the committee is unfortunately unlikely to undertake this much-needed radical overhaul. Nor do the odds seem high that the USDA office in charge of this policy for decades will turn a critical spotlight in on itself. But something has to change. The government is spending $12 million on guidelines for 40 percent of us, at most. It’s time we get away from a one-size-fits-all diet and instead have a range of options that could together be a Dietary Guidelines for All Americans.