Food Guides and Food Fights

Sometime during my childhood the U.S. Department of Agriculture developed and disseminated the Basic Four Food Groups guide to healthy diets.  The focus of this educational device was on assuring the ingestion of recommended nutrients.  Through the lens of history over the decades that have passed since then, the Basic Four seem like shoddy guidelines, riddled with Big Farming and Big Food special interests.  However, when the Basic Four were born, they were quite mainstream, and were considered a serious effort to enhance the dietary intake of Americans. At that time there was broad concern that many individuals and groups were not getting all the vitamins and minerals at the recommended levels.  Later on while the Basic Four were still in place, I was a public health student, and took a nutrition course, in which we learned about diet-related maladies such as scurvy, pellagra, rickets, and kwashiorkor.  We were primarily interested in deficiency, with very little attention given to obesity. 

Aside from the health science merits of the Basic Four Food Groups, it largely failed as a didactic device.  It became the poster child for irrelevant health promotion messages, and was usually discarded if not totally forgotten after middle school health class.  Nevertheless, at the beginning of the establishment of the Basic Four concept, the obesity epidemic we see now had not started, and even the diet-related risk factors linked to heart disease were yet understood.

In the early 19902, the USDA replaced the Basic Four with the Food Pyramid. It was a step forward in including broader health advice, such as "Use fats, oils and sweets sparingly,"  but it still was putting too much emphasis on dairy products and meat sources of protein.  It was not hard to see the influence of food and farming lobbyists at work, but the Food Pyramid was small, incremental progress toward addressing

chronic diseases related to diet, not just the deficiency diseases so common in earlier decades.

The Food Pyramid was recently replaced by a new plan called "MyPlate."  This has been given a lot of energy by Michelle Obama, who has made a focus of her time as First Lady to try to promote better eating and more exercise, as a way to decrease the child and adult obesity epidemic.

My plate represents another increment of progress, with the guideline that half of one's diet should be fruits and vegetables.  No longer is a preference shown for meat protein.  Not shown in the diagram, but in the narrative accompanying the illustration is the encouragement to preferentially select whole grain foods rather than refined.  On the other hand, dairy is still featured, with the stipulation that people should seek low fat and fat free options.  Unfortunately, there are millions of children and adults who are lactose intolerant, so this plan seems to leave them out in this regard.  There is no question that MyPlate could be better in some ways, but it is light years ahead of the Basic Four. 

It is created in the kitchen of national politics.  Given the pressures brought to bear on the White House and the federal government, MyPlate represents a very satisfying achievement in health policy advocacy.

Very recently, the Harvard School of Public Health has release its own rewrite of all these food plans.  The subtext is one of impatience with the political climate that has been imposed on evidence-based health practice.  This plan is called Healthy Eating Plate.  This dietary guideline is absolutely on target with the best evidence of healthy nutrition, suitable for all.  However, the implied criticism of MyPlate is a little unfair, since Harvard does not have to respond to all American stakeholders, just the scholars and

scientists.  The other problem with Healthy Eating Plate is its complexity.  While MyPlate is lacking in a few areas with respect to health guidance, it is a plan that is quite easy to explain to the lay public.  Healthy Eating Plate is more correct, more complete, but also presents a great challenge for disseminating to average Americans. 

If you are reading this you probably have more than a passing interest in health promotion.  What do you think are the challenges of driving the widespread adoption of guidelines as detailed as Healthy Eating Plate?