Readers with an interest in food and health might have been intrigued by full-page ads in the New York Times and Washington Post calling for an overhaul of our nation’s official Dietary Guidelines for Americans. After all, as the ad argues, national obesity and diabetes rates have more than doubled since introduction of the Dietary Guidelines in 1980. They must be doing something wrong.
The problem with this seemingly sensible appeal is that it is misleading—not the least for being led by a company, Atkins Nutritionals, with a clear conflict of interest in that its transparent intent is to drum up business by arguing for a shift to a dubious low-carbohydrate regimen. But moreover, the ad’s basic premise is flawed: if we just had better information about healthy diets, we would all be healthier. But there’s an obvious difference between knowing what to do and being equipped with the right environment, genes, gut microbiota, health care, resources, or social support to do it successfully. And obesity in particular is a condition with a complex etiology. The notion that we could have curbed obesity rates in recent decades with stronger dietary recommendations alone is both inaccurate and insulting to the millions of Americans who wage war against their weight each day.
The reality is, with some notable exceptions, we do have strong science-based dietary recommendations. Historically, the process for developing Dietary Guidelines has employed some of the most rigorous methodology available for reviewing scientific nutrition literature. If we’re doing something wrong, it isn’t that we’re publishing Dietary Guidelines that are woefully inadequate. It’s that the food industry spends billions of dollars annually to fight medical advice, nutrition recommendations, and common sense to promote their products at the expense of our health—Atkins being one of any number of examples—and by and large, it has done so unchallenged by the federal government.
There are hundreds of decision points between accessing information and acting on it. And in all the places we make decisions about our diets, from the cafeteria to the checkout lane, we are likely to find that industry is there to whisper in our ears. By comparison, the federal government has done very little to bridge the enormous gulf between the scientific recommendations contained in the Dietary Guidelines and the effective implementation of those recommendations. Although law requires that the official dietary guidelines be integrated across all federal agencies carrying out federal food and nutrition programs—programs used by approximately one in four Americans over the course of a year—there is little enforcement or accountability to ensure that this happens. Our country spends $3.5 trillion in health care costs each year, the vast majority of which are attributable to chronic disease. The government allocates no funding to the implementation of our federal nutrition guidance.
So, yes, we need to take drastic action to change the current trajectory of population health. But overhauling the Dietary Guidelines isn’t going to do it. To counter the market power and sophisticated techniques of the food industry to promote unhealthful eating, the public sector should be implementing measures commensurate with the gravity of our public health crisis—particularly when it comes to the industry’s deliberate practice of influencing lifelong eating patterns by heavily targeting their advertising to children. This starts with thorough integration of the Dietary Guidelines into public spaces where federal nutrition programs operate, but it should also manifest in stronger funding and support for policy, systems, and environmental changes within the private sector. Our health care system, in particular, would benefit enormously from greater investment in nutrition, both for the prevention and treatment of disease.
That’s the political economy of the matter.
Now, for the nutrition science. The ad calls for a “controlled carbohydrate eating approach” as a viable option for Americans. While there isn’t a set definition of a controlled carbohydrate diet, it sounds similar to carbohydrate counting—a legitimate dietary approach, endorsed by organizations like the American Diabetes Association, that can help people with type 2 diabetes manage their blood glucose. If the Dietary Guidelines were designed to cater to different chronic disease states (and they’re not), this would be reasonable enough. Controlled carbohydrate diets would, indeed, be a choice for Americans with diabetes.
But the signers of the letter aren’t just talking about diabetes; they’re talking about obesity, too. Which makes me think they’re not really talking about carbohydrate counting; they’re talking about low-carbohydrate, or low-carb, diets. Which would make a whole lot of sense for a company called Atkins Nutritionals. Unfortunately, there have been mixed results at best on the efficacy of low-carb diets, particularly when it comes to long-term health outcomes. And even where research shows promising results, the success of the low-carb diet depends on what you put on your plate instead—and your ability to stick with it.
Don’t get me wrong: we have a complicated relationship with carbs, and it’s hurting our health. As a nation, we eat far too much refined grains and not enough whole grains. Research also suggests that highly processed foods—of which refined grains are a common ingredient—are also likely harming our health by promoting weight gain. But the answer isn’t simply to eat less. It’s also to eat better. Science continues to show that whole grains are an important part of a healthy diet, and can help prevent chronic diseases like cardiovascular disease, cancer, and—you guessed it—type 2 diabetes.
Readers concerned that their eating choices are their own business—and not any affair of the government’s—should reflect that the nation’s dismal public health status (intrinsically and by contrast with other wealthy nations) is both a first-order crisis as well as a massive market failure, reflecting the disproportionate power of industry messaging over that of the public sector. Trillions of dollars of profits are gained on one side and trillions of dollars of healthcare costs are lost on the other, not to mention the years and quality of lives lost. The market failure is clear in that—contrary to the expectation that in a market economy the best outcomes for all are produced with open competition and perfect information—in the real world, the more profit the food sector makes, the sicker we all seem to get. Per the social contract that undergirds all modern democracies, it is the proper role of government to step in when such obvious and catastrophic market failure occurs.
Rather than undermine or relinquish the rigorously evidence-based Dietary Guidelines—least of all in favor of a niche special-interest business—we should double down on the government’s role and responsibility to the public. As we and many others have documented, we must create social and economic conditions where access to nourishing food and routine physical activity result in default healthy lifestyles.