The 2010 Dietary Guidelines

A poor diet is responsible for a number of chronic illnesses such as high cholesterol, obesity, hypertension, and diabetes, resulting in as much as 75% of the cost of medical care in the United States. Several new articles in the NEJM points out the difficulties in how best to achieve a change in the US diet, presently containing large amounts of salt, high-calorie sweeteners, and unhealthful fats.

The 2010 Dietary Guidelines emphasize:

• Eat more vegetables, beans, fruits, whole grains, and nuts and highlight healthful plant-based eating patterns, including vegetarian and vegan diets,
• Replace some red meat and poultry with fish,
• Replace trans fats and saturated fats with unsaturated fats,
• Limit total calorie intake.

However, recommendations like this are unlikely to have much of an impact on improving people's diets and healthy physical activities.

The original Food Guide Pyramid, which encouraged substituting grain products for dietary fat (irrespective of their nutritional quality), may have inadvertently contributed to epidemics of metabolic syndrome and related chronic diseases by increasing refined-starch consumption. The current administration, motivated by First Lady Michelle Obama's campaign against childhood obesity, has replaced MyPyramid with MyPlate. This image improves on its immediate predecessors, especially with advice to cover half the plate with vegetables and fruits:

Individual responsibility alone is not enough to account for the American appetite for choice, the country's free-market ideals, and the fact that the poor are disproportionately affected by the unhealthful components of our diet. The authors suggest a US “cap-and-trade policy” as a way to encourage a healthier diet, even though possibly at greater costs. Cap and trade could be used to generate revenues and subsidize healthful food options or cover medical costs associated with chronic disease.

The cap-and-trade strategy in the US in the 1990s Acid Rain Program has been successful in cutting pre-existing pollutants in half, and air and surface-water quality have improved substantially. According to the authors, “Setting a cap on the amount of harmful ingredients used in U.S. food production could profoundly affect our diet. This approach could take many forms but would probably work best if applied to entities that supply food products directly to consumers, rather than to the producers of the raw ingredients.

References:

1) Individual Responsibility or a Policy Solution — Cap and Trade for the U.S. Diet? Kristina H. Lewis, M.D., M.P.H., and Meredith B. Rosenthal, Ph.D. N Engl J Med 2011; 365:1561-1563.

2) The 2010 Dietary Guidelines — The Best Recipe for Health? Walter C. Willett, M.D., Dr.P.H., and David S. Ludwig, M.D., Ph.D. N Engl J Med 2011; 365:1563-1565.