by Marion Nestle

Currently browsing posts about: Dietary-Guidelines

May 16 2023

Dietary Guidelines Advisory Committee: conflict of interest disclosed, sort of

In a strange partnership, the Nutrition Coalition and the Center for Science in the Public Interest (CSPI) are jointly complaining about the way the USDA and HHS have “disclosed” conflicts of interest among members of the 2025-2030 Dietary Guidelines Advisory Committee.

Why strange?  Because the Nutrition Coalition has long urged relaxations on advice about dietary fat, whereas CSPI has long urged restrictions.

Why “disclosed” in quotes?  Because the agencies’ disclosure statement lists the combined conflicts for the entire group, not for individual members of the committee.

Here’s the committee, courtesy of a tweet from Christopher Gardner.

Here is a small part of what the disclosure list looks like.

 

 

 

 

 

 

 

 

Because these are all jumbled together, you have to look hard to pull out the genuine conflicts—-relationships of committee members with food companies with vested interests in the outcome of the guidelines.

The Nutrition Coalition points out that USDA and HHS are failing to:

  • Comply with a National Academies of Science report calling for publicly posting financial and nonfinancial biases and conflicts of interest of committee members.
  • Fully adopt the National Academies’ 11 recommendations.
  • Recognize the significance of the first-ever systematic review of a DGAC’s financial ties. This review found 95% of the 2020 DGAC members had at least one tie with a food or pharmaceutical company and half had 30 such ties or more.

In its statement, CSPI says that it, the Coalition, and 13 other groups are calling on the federal government to disclose potential financial conflicts of interest, including sources of research funding, speakers’ fees, and other relationships.

Press coverage, the statement says, “has already uncovered one 2025 Dietary Guidelines Advisory Committee member with a conflict of interest that seems relevant to their role.”

Comment:  I agree that the credibility of the committee and the guidelines depends on transparency, but it’s hard to know how much of a problem this is.

I wanted to compare the disclosure list to the research questions set by the agencies for the committee, but I can no longer find them online.

This reminds me that’s it’s hard to know how much influence the committee will have, in any case, now that the agencies set the research questions and write the actual guidelines.

The advisory committee is just that, advisory.  The agencies do not have to take its advice.

I will be following this closely.  Stay tuned.

Additions, May 17 (thanks to Jerry Mande)

 

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May 3 2023

The 2025-2030 Dietary Guidelines: an update

Personally, I can’t believe we are going through this again since the result will certainly not differ much from previous versions, except in details (see my previous post on this).
But here we are, so let’s get to it.

ODPHP must be in charge this round (leadership passes back and forth between ODPHP and USDA’s nutrition policy office).  It says:

You can get involved by:

  • Attending virtual meetings: View the recording of the first meeting held in February 2023, and register to view the livestream of the second meeting on May 10th on DietaryGuidelines.gov.
  • Providing public comments: Comments may be submitted online.
  • Subscribing to email updates: Stay informed on each step of the process by registering for updates.

More details on the Dietary Guidelines development process can be found at DietaryGuidelines.gov.

What to expect?

  • Investigative reports on conflicts of interest among members of the Dietary Guidelines Advisory Committee (members must report conflicted interests but the agencies do not make the reports public)
  • Nothing about sustainability (Off the table; the agencies said there will be a separate report on that.  When?)
  • Nothing about meat (Off the table)
  • Debates about the significance of ultra-processed foods (but only with respect to heart disease)
  • Other issues, surely

My prediction: after an enormous amount of work, the guidelines will say, as they mostly do:

  • Balance calorie intake with expenditure
  • Eat more plant foods (foods)
  • Don’t eat too much salt, sugar, saturated fat (nutrients)
  • And, if we are lucky, minimize or avoid ultra-processed foods

Stay tuned.

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Jan 10 2023

Chile’s new dietary guidelines

Twitter still has its uses.  It’s how I found out about about Chile’s new dietary guidelines.

Even without speaking Spanish, you can see what they do that the US Dietary Guidelines do not.  They emphasize:

  • Sustainability (the forbidden word in the 2020-2025 US Guideines)
  • Fresh, minimally processed foods–“Avoid products ultra-processed and labeled as “high in” (“ultra-processed is not mentioned in the US Guidelines)
  • Home cooking
  • Respect for traditional cultural values
  • Farmers’ markets
  • Recycling

One odd message: “Consume làcteos en todas las etapas de la vida,” which I translate as “Consume dairy foods through all stages of life.”

I’m wondering how that got in there and guessing that Chile must have a powerful dairy industry.

But I hope the new, soon to be appointed, I’m told, 2025-2030 Dietary Guidelines Advisory Committee will pay attention to Chile’s version.  It has much to teach us.

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Aug 18 2022

The Dietary Guidelines process: an analysis

For those of us who have observed the Dietary Guidelines since they first came out in 1980, everything about them is a source of endless fascination, if not exhausting.  They engender enormous fuss, but the basic dietary advice stays the same, year after year.  It just gets presented in ways that are increasingly lengthy and complicated.

I have a vested interest in all this.  I was a member of the 1995 Dietary Guidelines Advisory Committee.

Critics of the 2015 guidelines got Congress to order a review of the process by the National Academies of Sciences, Engineering, and Medicine (NASEM), which produced two reports.  The 2017 report recommended seven improvements to the process.  Congress then mandated an evaluation of how well USDA and HHS had implemented the recommendations.

NASEM has just published the first of what will be two evaluation reports: Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020-2025: A Midcourse Report.  This one responds to the first of three questions and part of the second.

  • Question #1: How did the process used to develop the Dietary Guidelines for Americans, 2020–2025, compare to the seven recommendations included in the 2017 National Academies report?
  • Question #2: Did the criteria used to include scientific studies used to inform the Dietary Guidelines for Americans, 2020–2025, ensure that the evidence base was current, rigorous, and generalizable or applicable to public health nutrition guidance?

My reading of this report is that the agencies and their advisory committee did a pretty good job of producing the 2020-2025 guidelines, given the tight time schedule, the lack of resources, and the fundamental difficulties of producing solid evidence for the effects of diet on disease risk.  The report’s conclusion (p. 106):

Finally, the committee identified many instances of partial implementation of the recommendations from the 2017 National Academies report. Some of these (e.g., recommendation 6) were minor concerns. Many other concerns that might, individually, seem minor represent a more substantial concern  when considered together. For example, the many seemingly small deviations from committee-identified practices for systematic reviews together reduce the quality and utility of this important element of the evidence used to develop the DGA. Moreover, the combined effect of recommendations for which there were substantial concerns with those that were not implemented at all represents a continuing risk to the integrity of the DGA process.

The report, by the way, is 295 pages.

Do we really need all this?  The guidelines stay pretty much the same from edition to edition: eat more fruits and vegetables (plant foods); don’t eat much salt, sugar, saturated fat; maintain healthy weight.  Or, as Michael Pollan famously put it, “Eat food.  Not too much.  Mostly plants.”

The food industry has the biggest stake in dietary guidelines, which is why we have to go through all this.

As I like to put it, I’ve made a career of criticizing dietary guidelines, and I’m not the only one.  I’m ready to move on.  If only.

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Jun 22 2022

Want to develop dietary guidelines? Here’s your chance!

The departments of health and human services and of agriculture have issued a call for nominations to the 2025-2030 Dietary Guidelines Advisory Committee.

Candidates should have an advanced degree in a nutrition- or health-related field, with at least 10 years of experience in academia, research, or as a practitioner or other health professional in a field related to 1 or more of the scientific topics to be examined.

A nomination package must include a cover letter, contact information for the individual being nominated and the nominator (if applicable), and a copy of the nominee’s curriculum vitae or resume. Nominations may be submitted by email or mail. Learn more about how to submit a nomination. 

Work with other experts, evaluate scientific evidence and give expert advice, contribute to the Dietary Guidelines, and use your knowledge to serve the U.S. public

Why not give this a try?

I served on one of these committees in 1995.  Then, the committee:

  • Determined which topics to research
  • Did the research
  • Wote the research report
  • Wrote the actual Dietary Guidelines based on the research report

That process no longer exists.  All you will get to do is write the research report.

One other difference.  My committee was instructed to do the best job we could interpreting the research for the public.

Committes are now told that all recommendations must be research-based—tricky given the complexities of human nutrition research.

But never mind: reaearch committees have one advantage.  You can stick to the research and call it like it is.

So apply.  Nominate yourself.  Nominate your friends and colleagues.  You too can be part of history.

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Apr 19 2022

Again? Yes (sigh). Dietary Guidelines. The research questions

I can hardly believe it but we are going to have to endure another round of dietary guidelines, these for 2025-2030.

Why endure?

Because they have basically said the same things since 1980:

  • Eat more fruits and vegetables
  • Balance calories
  • Don’t eat too much of foods high in saturated fat, salt, and sugar

As I am fond of quoting Michael Pollan: “Eat food.  Not too much.  Mostly plants.”

The wording changes from edition to edition.  The editions get longer and longer.  And the basic problems—nutrients as euphemisms for the foods that contain them, more and more obfuscation–stay the same.

But maybe not this time?

ODPHP, the Health and Human Service Office of Disease Prevention and Health Promotion (of which I am an alum) has just announced “Proposed Scientific Questions to Inform the Development of the Dietary Guidelines for Americans, 2025-2030: Available for Public Comment April 15 to May 16!”

The questions whose answers will form the research basic of the forthcoming guidelines are listed here.

Several break new or necessary ground:

  • What is the relationship between consumption of dietary patterns with varying amounts of ultra-processed foods and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: This was one of my big criticisms of the 2020-2025 guidelines; the word “ultraprocessed” was never mentioned, yet I consider it the most important nutrition concept to come along in decades.  So this is a big step forward.
  • What is the relationship between beverage consumption (beverage patterns, dairy milk and milk alternatives, 100% juice, low- or no-calorie sweetened beverages, sugar-sweetened beverages, coffee, tea, water) and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance? risk of type 2 diabetes?  Comment: it will be good to have this clarified.
  • What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?  Comment: This is an old issue but one under attack as being irrelevant.  Let’s get it settled, if that is possible.
  • What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: With luck, this will resolve the diet wars over low-carb v. low-fat, etc.  My prediction: they all work for some people.
  • What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment:  Finally, an unambiguous demand for research on diet and obesity (as opposed to euphemisms).

What’s missing here?  I think they should have a question on meat, since evidence on risk/benefit is also controversail.  OK, saturated fat is a euphemism for meat, but let’s stop using euphemisms.

What’s being ducked, at least in the guidelines?

There are two topics not on the list of questions to be examined by the 2025 Dietary Guidelines Advisory Committee that will be addressed in separate processes.

  • Alcoholic beverages remain a high priority topic, but because it requires significant, specific expertise and has unique considerations, it will be examined in a separate effort led by HHS Agencies that support work on this topic.
  • Sustainability and the complex relationship between nutrition and climate change is an important, cross-cutting, and high priority topic that also requires specific expertise. HHS and USDA will address this topic separate from the Committee’s process to inform work across the Departments.

Want to weigh in on this (please do!):  here’s how (read and follow the directions carefully to have maximum impact)

As usual ConscienHealth has interesting things to say about all this.  I particularly enjoyed:

So it’s both unsurprising and unimpressive to hear that people with strong views about nutrition believe the process is rife with conflicts of interest. A group that is disenchanted with the last output from this process lays it out with a new paper in Public Health Nutrition. But Tamar Haspel made the same point much more efficiently in a recent tweet:

“I think they should just let me write the Dietary Guidelines and call it a day.”

This also reminds me about the need to select a scientific committee as free of conflicted interests as possible.  The last committee was rife with them.  HHS/USDA ought to be starting the committee selection process fairly soon.  Stay tuned.

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Nov 16 2021

The American Heart Association’s new and groundbreaking dietary guidelines

The American Heart Association (AHA) has just issued its latest set of dietary guidelines aimed at preventing the leading cause of death in the United States: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Because AHA guidelines apply not only to coronary heart disease but also to all other chronic disease conditions—and sustainability issues—influenced by dietary practices, they deserve special attention.

Most of these repeat and reinforce the 2020-2025 Dietary Guidelines for Americans.

The two big differences in the recommendations:

  • Clarifying protein recommendations: these include all sources but emphasize plant sources (#4)
  • Including a new one: minimize ultra-processed foods (#6)

These recommendations are way ahead of the US Dietary Guidelines in recognizing how much ultra-processed foods contribute to poor health, and how important it is to minimize their intake.

Also unlike the US guidelines, these are unambiguous and easily summarized.

 

The statement is worth reading for its emphasis on two other points.

  • This dietary pattern addresses problems caused by other chronic conditions and also has a low environmental impact.
  • Following this dietary pattern requires much more than personal responsibility for food choices.  It requires societal changes as well.

The press release summarizes the problems in society that make following healthy diets so difficult, if not impossible:

  • Widespread dietary misinformation from the Internet;
  • A lack of nutrition education in grade schools and medical schools;
  • Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
  • Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
  • Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

As the statement concludes: “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”

Amen to that.

Comment: From my perspective, this statement thoroughly supersedes the 2020-2025 Dietary Guidelines for Americans, which—because they say nothing about ultra-processed foods , differential protein sources, sustainability, or doing anything to counter societal determinants of poor diets—were out of date the instant they appeared.

Some of the details of the AHA statement will be debated but its overall approach should not be.

The committee that put these guidelines together deserves much praise for basing its advice on today’s research and most pressing societal needs.

Additional AHA Resources:

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Jul 16 2021

Weekend food for thought (a good one!)

I saw this in a tweet from the Politico cartoonist, Matt Wuerker.  It’s too good not to share.

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