Food Pyramid

The Government's Symbol Of Healthful Eating Still Reigns Supreme
But Should It? 

JUDITH WEINTRAUB / Washington Post 15jan03

[ Also see Rebuilding the Food Pyramid - Scientific American Jan03 ]

The Power of the Pyramid

Suppose you started the year determined to eat more healthfully but discovered you weren't really sure how to do that. You're not alone.

With all the talk about which fats are good and which are bad, and which carbohydrates are desirable and which are straight sugar, and how many of anything you can or should include in your daily diet, it can be hard to sort out.

As for the government's Dietary Guidelines for Americans, well, few people really take the trouble to master them -- to apply the one-page version of 10 guidelines, you have to read a 39-page booklet.

You could turn to the USDA food pyramid for guidance. An accessible and simple triangular graphic, it pops up in newspapers and magazines frequently, appears on lots of packaged foods, is part of just about any nutrition lesson kids learn in school and is supposed to reflect those dietary guidelines.

So if you base your eating on the recommendations in the pyramid, you're eating the way you should be, right?

Wrong, says much current nutritional thinking. The dietary guidelines are revised every five years, but the pyramid hasn't changed since it was adopted in 1992. Moreover, even though one of the 10 dietary guidelines directs consumers to the pyramid, the guidelines and pyramid are not consistent with each other. The result: The pyramid is out of date with the latest science, say many nutritionists. Working from its top (as in, eat few of these) down to the base (eat lots of these), these are the primary problems its critics cite:

• By grouping all fats and oils together (with sweets) at its narrow top, it not only doesn't distinguish the difference between good fats (polyunsaturated fats such as olive oil and canola oil and omega-3 fatty acids) and bad (saturated fats and trans unsaturated fatty acids). It also doesn't emphasize the ways in which good fats can actually be healthful or suggest enough examples of them.

• The pyramid isn't up to speed on protein either, lumping meat, poultry, fish, dry beans, eggs and nuts all together without differentiating their health differences, which are many.

• It considers potatoes (which are mainly starch) a vegetable.

• It doesn't distinguish between high-fat and low-fat dairy products.

• And it puts bread, cereal, rice and pasta together at its broad base, even though there are significant differences between refined carbohydrates (like white bread and white rice), which are not particularly good for you, and unrefined ones (such as brown rice, and whole-grain breads and pastas), which are good for you.

"The pyramid is really fundamentally flawed -- so seriously that some people are increasing their risk of disease and death," says Walter Willett, chairman of the Nutrition Department of the Harvard School of Public Health, professor of medicine at Harvard Medical School and the author of "Eat, Drink and Be Healthy: the Harvard Medical School Guide to Healthy Eating."

"The pyramid can be an important educational tool -- especially for children," says Ellen Haas, longtime consumer advocate and the head of Foodfit.com, an extensive interactive Web site devoted to healthful eating. "But it's certainly in need of revision. It needs to evolve as science evolves."

The pyramid was adopted in 1992 after a fractious year debating its details as food industry lobbyists pressed their cases. In the government's struggle to find the best way to convey basic nutritional information, the pyramid replaced a list approach to food groups desirable in a daily diet, such as the basic four of the '50s (milk, vegetables and fruit, meat, bread and cereal) and the basic seven before that.

Eleven years later, it's not surprising that the pyramid's recommendations are not in line with recent work in nutrition -- in particular, with the most current overview on eating and health, a September 2002 report from the National Academy of Science's Institute of Medicine.

The pyramid concept, however, does seem to work. And its shape meshes well with its message that a healthful diet is based on eating a lot of the most highly recommended foods, fewer servings of foods the body needs less, and even fewer of what the body needs the least.

Even nutrition and health professionals who question some of its specific recommendations see the value of the easy-to-understand concept -- so much so that they've developed their own pyramids, among them the Mayo Clinic pyramid, which puts a much greater emphasis on vegetables and fruits and includes physical activity at its center; the New Pyramid for Life Diet, which was developed to help cardiac patients eat more healthfully; and Walter Willett's Healthy Eating Pyramid, co-developed with the Harvard School of Public Health, which relies on daily exercise and foods that have been shown to improve health and reduce the risk of chronic disease.

The concept of a pyramid works well with dietary patterns outside the mainstream American diet too, as was demonstrated by the Mediterranean diet pyramid put forward 10 years ago by the Oldways Preservation and Exchange Trust, a food think tank in Boston that went on to develop Asian, Latin American and vegetarian food pyramids.

The pyramid the government supports, however, is still the original one. Some people don't think that's so bad. Marion Nestle, professor of nutrition and food studies at New York University and the author of last year's "Food Politics," still supports some of it. "I may be the last remaining nutritionist who thinks there's anything good about it," she says. "But I like its hierarchical nature -- the way it shows that it's better to eat some foods than others, and that it's supposed to be illustrating a plant-based diet, which in its way it does; and that foods high in fat and sugar and higher in calories should be eaten less."

But could it be improved, fine-tuned? Like critics of the pyramid, Nestle says yes. "Beans could come out of the meat category; dairy foods could say low fat; the amount of fruits and vegetables could be larger; the grain sectors could emphasize whole grains; and the top of the pyramid could have snack foods, candy, soft drinks. . . . Also the whole question of portion size could be addressed."

Dun Gifford, the president of Oldways, which last weekend celebrated the 10th anniversary of its Mediterranean diet pyramid with a scientific conference in Boston, thinks not only that the USDA pyramid is out of date, but that it may be against the law. "What's wrong with it is that it does not reflect the dietary guidelines," he says. "Federal law requires that any federal food, nutrition or health program conforms to the guidelines. The guidelines recommend a diet moderate in fat. And the pyramid says that dietary fat should be consumed sparingly. It needs to recommend the moderate use of unsaturated fats. And it needs to separate out meat from the legume group so there are two proteins, nuts and legumes. With those two changes, there's not a lot wrong with it."

The urgency that propels the current controversy is driven by American eating patterns that everyone admits are out of hand. Huge restaurant portions are virtually standard. Pervasive snacking is a troublesome affliction. Obesity and diabetes are at record highs.

Last September's Institute of Medicine (IOM) report -- supported and sponsored by governmental bodies including the Department of Health and Human Services, the U.S. Department of Agriculture, the Food and Drug Administration and the Centers for Disease Control -- focused attention on some of these issues. The IOM is part of the National Academy of Sciences, an independent organization chartered by Congress to guide the government on scientific issues, but the government has no obligation to adopt the IOM's findings.

Relying on the most recent nutritional science, the IOM developed new guidelines for eating and physical activity designed to reduce the risk of chronic disease. What captivated the immediate attention of the press and the public was the report's urging that both adults and children should spend a total of at least one hour each day in moderately intense physical activity to maintain cardiovascular health.

What got less attention was the committee's recommendations regarding diet, that is, that adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent from good fats, and 10 percent to 35 percent from protein.

And that isn't the way the current pyramid is constructed.

Does that really make a difference? You bet, say its critics. "The pyramid's main message is that all types of fat are bad and we should avoid them and that we should gorge on starch," says Willett. "That is completely untrue. Some should be avoided -- partially hydrogenated fats and those high in saturated fat such as red meat and butter indeed should be avoided. But unsaturated fats are essential and help reduce the risk of heart attacks and sudden death."

Back at the USDA's Center for Nutrition and Policy Promotion, which oversees the pyramid, the ruckus doesn't go unheeded. But fixing things is another matter. "We probably are at the halfway point of doing a reassessment," says John Webster, the center's director of information. The aim of the reassessment, he says, is to reexamine the pyramid in the light of scientific findings since its inception, to see if the pyramid's recommendations meet the IOM report's recommendation for nutrients and generally to update it.

But not immediately. Says Webster, "It's our intention to have it out at about the same time as new dietary guidelines in 2005."

Nobody expects overnight action. "Many of these things take time," says Eric Rimm, a member of the panel that produced the IOM report, and an associate professor of nutrition at the Harvard School of Public Health. "The dietary guidelines are meant to be scientists getting together saying, 'What's the evidence and what's best to eat.' The Institute of Medicine report was meant to be 'Let's figure out what's the best science.' And it does represent a meaningful body of evidence that maybe we should change what's in the guidelines and what's in the pyramid. Maybe in 2005, they'll say, 'Look, that was the best science. Let's make up new guidelines and a new pyramid.' "

That won't be easy to accomplish. A revised pyramid would reverberate throughout American agriculture -- the beef, dairy and wheat industries, chicken and pork too. So updating it to reflect the latest science could be a political hot potato. "It takes guts and policy leadership to make changes in public policy," says Haas, who as undersecretary of Agriculture for four years in the '90s ran the nation's nutrition programs soon after the pyramid was adopted. "You're affecting people's turf, and livelihood and just the status quo. It takes someone who's willing to go forward to make changes, to get the consensus, to work in coalitions."

Is it fair then to expect the pyramid to be current? "I think it's inexcusable that it's not," says Oldways' Gifford. "It's printed on billions of food packages, which leads hundreds of millions of consumers to believe incorrect nutritional science -- that fats should be eaten 'sparingly,' which is not the case, that the proteins and fats from animals and plants are identical, which they are not. And that shouldn't be permitted. "

And then there's the challenge involved in convincing Americans that they should follow new nutritional recommendations -- to rethink what we spread on our toast, how we shop and plan meals, how we allocate the money in our food budgets, how we plan school lunch programs, how we celebrate meals together.

Is a revised pyramid the best way to do that? Should the pyramid be discarded in favor of a new teaching tool? Do people pay attention anyway? It's a delicate issue. "Whenever you're developing a tool for the masses, you have to find that balance between the optimum and the practical," says Donald D. Hensrud, associate professor of preventive medicine and nutrition at the Mayo Clinic, and the editor in chief of the book "Mayo Clinic on Healthy Weight." "If you become too exclusionary, people aren't going to follow it."

And getting people to follow healthful guidelines, after all, is the point. "A lot of people have the I-want-to-lose-the-weight-now attitude, give me a pill," says Hensrud. "It's immediate gratification rather than investing in nutrition for the long haul. My message to people is that eating healthy, eating well and making incremental beneficial lifestyle changes does not have to be drudgery. It can be wonderfully rewarding experience if people start with the right attitude."