Diet Guidance in America

 In Preventive Medicine Column

Diet Guidance in America

I was delighted to learn that the USDA was holding a “listening session” about the Dietary Guidelines– process and product- on Friday afternoon (2/19/16) in Washington, DC. I was even more delighted to be invited to offer several minutes of commentary. Unfortunately, I couldn’t be there, so I submitted written comments instead. I thought to share the gist here.

We begin with a thought experiment. Imagine that a major auto manufacturer, pick anyone you like, has its best engineers draw up detailed blueprints for the new lineup of cars. Imagine these blueprints begin with the prior lineup of cars, but then use the best, current engineering and technology to improve on them.

Now, imagine those blueprints are turned over to the marketing department, or maybe even an outside advertising agency, and staff at the ad agency actually build the cars- with no involvement at all by the engineers. Imagine, further, that the marketing and advertising folks are at liberty to keep what they want, discard what they want, and alter the blueprints as inclined to best address the imperatives of marketing, and presumably, profit.

And, in fact, let’s go just one step further. Let’s imagine that the team of expert engineers that drew up the blueprints in the first place, after months or years of exacting and meticulous effort, was disbanded and laid off the moment they passed the blueprints along.

Here’s the question for you: would you drive such a car? Would you load your family into one? If not, you may want to think twice before buckling into the Dietary Guidelines.

Far-fetched, and even outrageous as my car-manufacturing scenario may seem, this is exactly how the Dietary Guidelines for Americans are now manufactured. A multidisciplinary group of highly regarded nutrition experts are exactly analogous to the engineers. They use the best, current evidence to update the prior guidance. Their report- the Dietary Guidelines Advisory Committee Report– is analogous to those engineering blueprints. Neither is likely to be perfect, but both are the honest, best representation of best, current, expert thinking.

Like my hypothetical engineers, the DGAC does, indeed, turn over its report- in this case, to the USDA. Admittedly, the USDA is not a marketing department or advertising firm. But USDA, and its counterpart in this endeavor, the Department of Health and Human Services, are accountable to Congress, which in turn is apt to represent the interests of very well-heeled lobbyists. By proxy, then, the interests of marketing, and corporate profits, are very well represented.

The federal agencies take the “blueprints” in question, and again as in my hypothetical scenario, the “engineers” responsible for them are disbanded, and laid off. The DGAC is undone before the official Dietary Guidelines are produced.

What we wind up with is a rather dubious “vehicle” for carrying Americans toward better diets, and better health. We wind up with a vehicle quite different from what the engineers had in mind, and quite possibly one they would deem unsafe.

My suggestion, then, is to differentiate clearly between the work of actual nutrition experts, and the translation of that work into a guide for national food programming. The former is the best thinking of some of our best scientists based on the best evidence about the best dietary practices for Americans, in general.  The latter is what the feds think the nation should DO with the best thinking from the best experts.  Accordingly, I think the first could be called: The Advisory Committee Report on Best Dietary Practices for Americans. The second could be called: Diet Policy and Practice Guidelines for America. I would actually prefer Guidelines for Balancing Public Health and Corporate Profit, but doubt that one is really viable, by virtue of being too honest. Other names could work as well, provided the distinction is clear.

One way or another, we need more daylight between the two products so the politicization of expert thinking is not routinely mistaken for what experts think.  The result of that conflation of baby and bathwater is distrust of both politicians and experts, and the loss of any opportunity to use what we know about diet to advance the health of people and planet alike.

In the meantime, we the people are well advised to recall those two famous Latin words to the wise, be they about our cars, or the contents of our shopping carts: caveat emptor.

-fin Dr. David L. Katz;www.davidkatzmd.com; author, Disease Proof; founder, True Health Initiative

Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
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