Lessons From 40 years of Dietary Guidelines for Americans

The history of the Dietary Guidelines for Americans (DGA) provides a fascinating glimpse into what has stayed the same (eat plenty of fruits and veggies) and what has changed (dietary cholesterol isn’t so evil after all) in the past four decades.

Issued by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS), the DGA have amassed immense influence since the first ones were published in 1980. All U.S. nutrition policy, dietary guidance and feeding programs must align with the DGA, including

• nationwide school lunch and breakfast programs,
• WIC (Special Supplemental Nutrition Program for Women, Infants and Children),
• nutrition programs for older adults, and
• meals served by the departments of Defense and Veterans Affairs.

And that’s not all: From food marketers to dietitians to cookbook authors, a vast swath of professionals monitor changes in the DGA for clues on where nutrition science is going and advice on helping Americans to eat better. With that in mind, let’s review where the DGA came from, how they’ve changed and where they are today.

Before 1980

Federal food and nutrition recommendations had been around for more than a century before the first DGA came along. Dietary advice targeted soldiers in the Civil War (Nicklas & O’Neil 2015), and guides called Foods for Young Children and How to Select Foods focused on children in 1916 and adults in 1917, respectively (USDA NAL 2015). During World War II, the “basic seven” food groups included three vegetable and fruit groups: (1) green and yellow vegetables; (2) oranges, tomatoes and grapefruit; and (3) potatoes and other vegetables and fruits (USDA 1945).

From 1956 through the 1970s, the basic seven were trimmed to the basic four food groups: milk; meat; vegetables and fruit; and bread and cereals (USDA CNPP 2011). Early on, food guides and dietary guidance aimed to prevent nutrient deficiencies and malnutrition (McMurray 2003). By the 1970s, vitamin and mineral deficiencies were overshadowed by a more pressing need to prevent diet-related chronic diseases.

In 1977, the U.S. Senate Select Committee on Nutrition and Human Needs—also called the McGovern Committee after its leader, Sen. George McGovern—issued Dietary Goals for the United States. “We have entered a new era in nutrition, when the lack of essential nutrients no longer is the major nutritional problem facing most American people,” Julius Richmond, assistant secretary of health, said at a hearing in 1977. “Evidence suggests that the major problems of heart disease, hypertension, cancer, diabetes and other chronic diseases are significantly related to diet. We believe it is essential to convey to the public the current state of knowledge about the potential benefits of modifying dietary habits” (SSCNHN 1977).

1980: Short and Sweet

The first DGA asked a simple question: “What should you eat to stay healthy?” (DGA 1980). Back then, the guidelines were published as a short brochure called Nutrition and Your Health: Dietary Guidelines for Americans. The brochure provided seven concise recommendations for preventing chronic disease in healthy people, based on the 1977 Dietary Goals and the 1979 Surgeon General’s Report (DGAC 2015, Appendix E-6).

DGA 1980

1. Eat a variety of foods.
2. Maintain ideal weight.
3. Avoid too much fat, saturated fat and cholesterol.
4. Eat foods with adequate starch and fiber.
5. Avoid too much sugar.
6. Avoid too much sodium.
7. If you drink alcohol, do so in moderation.

1985: Expert Review, Same Guidelines

After the 1980 guidelines were released, scientists and industry groups argued that they weren’t based on adequate scientific evidence (DGAC 2015, Appendix E-6). In response, the USDA and HHS assembled the first Dietary Guidelines Advisory Committee (DGAC), with nine “nationally recognized experts in the field of nutrition and health to provide independent, science-based advice and recommendations” (Millen et al. 2016).

In a marvel of government efficiency, the nine experts approved a second brochure—also titled Nutrition and Your Health: Dietary Guidelines for Americans and nearly identical to the 1980 version (DGA 1985).

DGA 1985

1. Eat a variety of foods.
2. Maintain desirable weight.
3. Avoid too much fat, saturated fat and cholesterol.
4. Eat foods with adequate starch and fiber.
5. Avoid too much sugar.
6. Avoid too much sodium.
7. If you drink alcoholic beverages, do so in moderation.

(Did you spot the only change? “Maintain desirable weight” replaced “Maintain ideal weight.”)

1990: Keeping It Positive

In 1990, the new National Nutrition Monitoring and Related Research Act mandated that the USDA and HHS issue a new Dietary Guidelines report every 5 years. The DGAC approved subtle changes: “Maintain healthy weight” replaced the less-precise “Maintain desirable weight,” and information about body composition and waist-to-hip ratio was added. The guidelines added portion-size suggestions and upper limits for intake of total fat (30% of calories or less) and saturated fat (10% of calories or less) (DGA 1990).

The old advice on “starch and fiber” became guidance on vegetables, fruits and grain products to emphasize foods people could readily understand, rather than abstract nutrients.

DGA 1990

1. Eat a variety of foods.
2. Maintain healthy weight.
3. Choose a diet low in fat, saturated fat and cholesterol.
4. Choose a diet with plenty of vegetables, fruits and grain products.
5. Use sugars only in moderation.
6. Use salt and sodium only in moderation.
7. If you drink alcoholic beverages, do so in moderation.

1995: Food Guide Pyramid and New Food Labels

Two key events played a major role in the 1995 version:

• The Nutrition Labeling and Educa-tion Act, passed in 1990, established standards for the food labels we have today (a proposed modern revamp of which the Trump Administration has recently put on hold). The 1995 version also established the Nutrition Facts panel, standard serving sizes, % Daily Value nutrient information per serving, and regulation of claims like “low-fat” and “light.”
• The Food Guide Pyramid, released in 1992, replaced the four food groups (DGA 1995). The base of the Pyramid featured the “bread, cereal, rice and pasta group.” Whole grains were mentioned as a source of fiber but were not particularly encouraged over other “grain products.” This version of the DGA also reflected a growing emphasis on physical activity in addition to weight maintenance.

DGA 1995

1. Eat a variety of foods.
2. Balance the food you eat with physical activity—maintain or improve your weight.
3. Choose a diet with plenty of grain products, vegetables and fruits.
4. Choose a diet low in fat, saturated fat and cholesterol.
5. Choose a diet moderate in sugars.
6. Choose a diet moderate in salt and sodium.
7. If you drink alcoholic beverages, do so in moderation.

2000: Emphasizing Diet Over Nutrients

The DGA grew much more sophisticated in 2000. Seven guidelines were expanded to 10 in an expansive policy document with significantly more explanation of the science than in previous versions (DGA 2000). Suzanne Murphy, PhD, RD, emeritus researcher at the University of Hawaii Cancer Center and a member of the 2000 DGAC, says this panel was the first to see the value in describing healthy dietary patterns as well as highlighting healthy foods and food groups.

“We said, ‘Build your eating pattern on a variety of grains, fruit and vegetables.’ This approach has been utilized by all of the advisory committees since,” notes Murphy. The Guidelines now mentioned whole grains, listed fruits and vegetables as a separate recommendation, and added food safety to the mix. In May 2000, President Clinton promoted the Dietary Guidelines in a radio address.

DGA 2000

Aim for fitness . . .

• Aim for a healthy weight.
• Be physically active every day.

Build a healthy base . . .

• Let the Pyramid guide your food choices.
• Choose a variety of grains daily, especially whole grains.
• Choose a variety of fruits and vegetables daily.
• Keep food safe to eat.

Choose sensibly . . .

• Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
• Choose beverages and foods to moderate your intake of sugars.
• Choose and prepare foods with less salt.
• If you drink alcoholic beverages, do so in moderation.

2005: Embracing Special Populations

In 2005, the USDA and HHS published the longest version of the Dietary Guidelines so far, a 70-page policy document. There were nine major messages and 41 recommendations (23 general recommendations and 18 for special populations that hadn’t been addressed in detail before, including children, pregnant women and older adults) (DGA 2005). The USDA also released MyPyramid, an update to the Food Guide Pyramid.

The term “discretionary calories” described extra calories from added fats, alcohol and added sugars.

DGA 2005 (With Summarized Key Message From Each Guideline):

1. Adequate nutrients within calorie needs: Consume a variety of nutrient-dense foods and beverages within the basic food groups.
2. Weight management: Maintain body weight in a healthy range.
3. Physical activity: Engage in regular physical activity and reduce sedentary activities.
4. Food groups to encourage: [Emphasize] fruits and vegetables, whole-grain products, and fat-free or low-fat milk.
5. Fats: Consume less than 10% of calories from saturated fat and less than 300 milligrams per day of cholesterol; keep total fat intake between 20% and 35% of calories.
6. Carbohydrates: Choose fiber-rich fruits, vegetables and whole grains, and consume little added sugar.
7. Sodium and potassium: Consume less than 2,300 mg
   of sodium per day.
8. Alcoholic beverages: If you drink alcoholic beverages,
   do so in moderation—up to one drink per day for women and up to two per day for men.
9. Food safety: Avoid foodborne illness by washing hands and food-contact surfaces, avoiding cross-contamination, cooking foods to safe temperatures and chilling
   food promptly.

2010: SoFAS and MyPlate

The 2010 DGAC benefited from the USDA’s new Nutrition Evidence Library, which formally reviews scientific evidence on topics considered by the DGAC, including alcohol, carbohydrates, energy balance and weight management. This resource is ongoing and available to the public (www.cnpp.usda.gov/nutritionevidencelibrary/).

The “discretionary calories” of 2005 became SoFAS—solid fats and added sugars. The 2010 Guidelines recommended reducing intake of SoFAS, most of which come from foods like grain-based desserts, cheese, processed meats and sugar-sweetened beverages (DGA 2010).

Eric Rimm, ScD, professor of medicine at Harvard Medical School and director of the program in cardiovascular epidemiology at the Harvard T.H. Chan School of Public Health, served on the 2010 DGAC. His committee reviewed public comments, including those arguing that vegetarianism deserved a home in the DGA. Rimm says the comments “did get us to look at the question and see that there was enough of an evidence base to recommend this as a healthy dietary pattern.”

MyPlate, an updated food guide showing the proportions of foods that should appear on the plate, was released in 2011 (USDA CNPP 2016).

DGA 2010 Key Recommendations

1. Balancing calories to manage weight: Control calorie intake, increase physical activity and reduce sedentary behaviors.
2. Foods and food components to reduce: Reduce sodium, saturated fat, cholesterol, trans fats, refined grains and added sugars. Consume alcohol in moderation, if at all.
3. Foods and nutrients to increase: Increase fruits and vegetables, whole grains, fat-free or low-fat milk products, and a variety of protein foods, including seafood.
4. Building healthy eating patterns: Select an eating pattern that meets nutrient needs at an appropriate calorie level.

2015–2020: Getting Better All the Time

The title of the latest DGA reflect that they cover a 5-year span, not just a single year. That change is welcome, as is the recommendation about coffee—you will be glad to know the DGAC concluded that moderate consumption is part of a healthy diet. Low-calorie sweeteners, especially aspartame, were reviewed and deemed safe (DGA 2015–2020).

Frank Hu, MD, PhD, professor of nutrition and epidemiology and chair of the department of nutrition at the Harvard T.H. Chan School of Public Health, was on the DGAC and says its members extensively reviewed the evidence on fat: “The committee recommended saturated fat in the diet be replaced by unsaturated fats, especially polyunsaturated fatty acids, and that replacing saturated fat with refined carbohydrates is not beneficial for the prevention of heart disease.”

DGA 2015–2020 Five Guidelines

1. Follow a healthy eating pattern across the life span. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy and reduce the risk of chronic disease.
2. Focus on variety, nutrient density and amount.

3. Limit calories from added sugars and saturated fats, and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
4. Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages in place of less-healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain.
5. Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.

What’s Next for the Dietary Guidelines?

Specific Populations

In 1980, the DGA were aimed at healthy people—“most Americans,” they suggested—but didn’t include many recommendations for populations like infants and children under 2, pregnant or breastfeeding women, elderly people, or people with chronic diseases. Over the years, the recommendations have expanded to include some of these special populations. Cutberto (Bert) Garza, MD, PhD, a professor at Boston College, a DGAC member in 1995 and its chair in 2000, thinks that future DGACs must continue to make recommendations “both for the general public and for individuals, given their genetic and environmental differences.”

Environmental Sustainability

The 2015–2020 DGAC addressed food sustainability, or the environmental impact of food production and consumption, in detail in its advisory report, but sustainability didn’t make it into the final DGA document (Nelson et al. 2016). According to Hu, “The committee was able to reach consensus that a dietary pattern higher in plant-based food and lower in animal-based foods is more health promoting and is also associated with lesser environmental impact than is the current average U.S. diet.” He is looking forward to seeing sustainability of dietary patterns included in future DGA updates.

Motivating Americans to Follow the Dietary Guidelines

Janet King, PhD, RD, a nutrition researcher and chair of the 2005 DGAC, says that while the messages of the DGA have been more or less consistent since the 1980s, many people still aren’t following them (King 2007). She argues for greater understanding of economic, social and cultural influences on food habits. In 2000, the DGAC recommended research on “what motivates people, on an individual and societal level, to adopt recommended behaviors, such as engaging in physical activity, making healthy food choices and improving food safety.”
The 2015–2020 DGAC took on this question, looking at methods to help change eating and exercise habits (Millen et al. 2016). The committee reviewed how food environment influences eating habits and recommended more research on ways to change dietary and physical activity behaviors (DGAC 2015). Look for even more emphasis on motivation and behavior change in the future.

Do We Eat Better Now Than Before?

Along the way, the USDA and HHS realized they needed a way to measure how well Americans were meeting the DGA, so they developed the Healthy Eating Index (HEI) (USDA CNPP 2016). If adhering to the Dietary Guidelines means an HEI score of 100, our score rose from an average of 49 in 1999–2000 to an average of nearly 58 in 2009–2010 (DGA 2015–2020). That is a small improvement, but we are still not eating enough fruits and vegetables, while we’re overdoing it on added sugars, refined grains, saturated fat and sodium. Long story short, we eat too many processed foods, too many animal foods, and not enough whole foods and plant foods, including fruits, vegetables, whole grains, legumes, nuts and seeds.