A Guide to the Guidelines

A Guide to the Guidelines | Food & Nutrition Magazine | Volume 10, Issue 1
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What’s new, what stands out and what’s controversial about the most recent Dietary Guidelines for Americans.

Since their debut four decades ago, the Dietary Guidelines for Americans have experienced quite the evolution. It might seem as if the 2020-2025 Dietary Guidelines, released in December 2020, are more of the same compared to their recent predecessors, but there are some significant changes to both the ninth edition as well as the procedures behind the scenes.

Enhanced Transparency
To promote transparency, some notable changes were made to the process of developing the 2020-2025 Dietary Guidelines for Americans and selecting the Dietary Guidelines Advisory Committee. For the first time, the U.S. Departments of Agriculture and Health and Human Services were responsible for selecting topics and scientific questions to be considered by the Committee before the Committee was established.

Furthermore, the agencies allowed for public comment on the topics and scientific questions before the Committee was selected. This change not only supported transparency, but also helped ensure the most appropriate Committee members were selected — members whose expertise matched the topics.

When the USDA and HHS issued a public request for Committee nominations, they also provided an outline of specific information needed in all nomination packages — another first. To better avoid conflicts of interest, everyone under final consideration for the Committee was required to submit a Confidential Financial Disclosure Report before being selected. Previously, this report was submitted after Committee members were already selected.

For the first time, the Committee had a sixth meeting, which was added to focus solely on reviewing the draft report. According to Jackie Haven, deputy administrator of the USDA Food and Nutrition Services’ Center for Nutrition Policy and Promotion, this allowed the Committee to discuss overarching findings and the draft of their scientific report, which previous Committees had not done.

Additionally, the Committee was required to explain how it planned to answer each scientific question — by conducting a systematic review using data analyses, food pattern modeling analyses or the USDA’s Nutrition Evidence Systematic Review — and post it online for public viewing and comment.

Of the six Committee meetings (all open for public viewing and some for in-person attendance), the public had two opportunities to provide oral comments rather than just one. And for the first time in two decades, a meeting was held outside of the Washington, D.C., metro area.

According to the Dietary Guidelines website, these changes were an effort to “promote a deliberate and transparent process, better define the expertise needed on the Committee and ensure the scientific review conducted by the Committee would address Federal nutrition policy and program needs.”

A Brief History

While most nutrition and health professionals know what the Dietary Guidelines are, their coming-to-be may not be as widely understood. The very first Dietary Guidelines for Americans were published in 1980 when the U.S. Departments of Agriculture and Health and Human Services recruited an expert Committee to check the validity of another set of guidelines known as Dietary Goals for the United States, a 1977 publication by the U.S. Senate Select Committee on Nutrition and Human Needs. Following their 1980 publication, the USDA and HHS voluntarily published guidelines in 1985 and 1990 until it became required by law that the two organizations jointly publish an updated version every five years.
Source: History of the Dietary Guidelines

Life Stages
A highly anticipated update to the 2020-2025 Dietary Guidelines for Americans is the addition, or reorganization, of information into life stages. The life stages are organized into infants and toddlers (birth through 23 months); children and adolescents (ages 2 through 18, further broken down into groups of ages 2 through 4, 5 through 8, 9 through 13 and 14 through 18); adults (ages 19 through 59); women who are pregnant or lactating; and older adults (ages 60 and older).

The structural change complements a few overarching guidelines and themes: “Follow a healthy dietary pattern at every life stage,” and, “It is never too early or too late to eat healthy.” Haven explains that organizing the Dietary Guidelines by life stage allowed for more tailored guidance specific to each stage of life and showcased how healthy dietary patterns can be carried forward into the next life stage.

New Populations
Thanks to the Agricultural Act of 2014, guidance for infants and toddlers ages 0 to age 24 months and women who are pregnant or lactating are now included in the ninth edition of the Dietary Guidelines.

Guidelines for infants and toddlers address factors such as when to introduce complementary foods and potentially allergenic foods, how to determine developmental readiness for eating solid foods, and vitamins and minerals of concern. The newly added guidance for women who are pregnant or lactating includes information such as working with a health care provider to achieve weight management goals and special nutrient needs such as increased folate, iodine and iron.

An Emphasis on Culture, Budget and Preference
In every chapter, the guidelines focus on food groups and subgroups rather than specific foods, reiterating that the Dietary Guidelines are not prescriptive, but rather an outline or framework. This links to another key recommendation or overarching guideline: “Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions and budgetary considerations.”

“As our society grows and evolves, so too does our knowledge about the importance of representation and equity,” Haven says. “In the 2020-2025 Dietary Guidelines for Americans, we wanted to be crystal clear about the importance of celebrating the rich diversity of the people who live here and respecting cultural foodways.”

A broad spectrum of food examples is included in the guidelines to fit diverse preferences. For instance, taro leaves are an example of dark green vegetables, calabaza is listed for red and orange vegetables and cassava and plantains for starchy vegetables. Haven says the USDA and HHS made a concerted effort to represent all Americans through careful consideration of the food examples and images selected, showcasing the diversity of food and people through representation in age, life stage, race, ethnicity, body size and ability.

A Change in Name

The vegetable subgroup known as “legumes” is now called, “beans, peas and lentils.” While the foods in the subgroup have not changed, the USDA and HHS say the name is a more accurate description of the foods within the group.

What It Is — and Is Not

The Dietary Guidelines were originally published as a consumer guide or resource for the general public. Today, the target audience is nutrition and health professionals, policymakers and government bodies. MyPlate serves as the consumer-friendly interpretation. The purpose of the guidelines is to relay nutritional and dietary information and recommendations based on the most current scientific and medical knowledge. The content applies to healthy people and is not meant to serve as clinical guidelines for chronic disease. In addition to serving as a guide for practitioners, the information in the Dietary Guidelines for Americans is used to create federal programs and policies, such as the National School Lunch Program and the Supplemental Nutrition Assistance Program.

Sources: Top 10 Things You Need to Know About the Dietary Guidelines for Americans, 2020-2025; Evolution of Dietary Guidelines for Americans

Nutrient Density and Dietary Patterns
A noticeable emphasis of the 2020-2025 Dietary Guidelines for Americans is their reiteration of choosing nutrient-dense foods and focusing on dietary patterns — how someone regularly eats overall, not just a single meal. These are not new concepts to the Dietary Guidelines, but their presence appears more pronounced.

The guidelines state people should strive to achieve healthy dietary patterns that focus on nutrient-dense foods — foods that provide vitamins, minerals and other health-promoting components with little or no added sugars, saturated fat and sodium — to reduce the risk of chronic disease at every life stage.

The Dietary Guidelines also make prominent the percentage of total calories that should come from nutrient-dense foods versus the percentage that might come from other sources, such as foods and beverages that include sources of added sugars and saturated fats. The Dietary Guidelines state 85 percent of total calories should come from nutrient-dense foods to healthfully meet food group recommendations.

“With the limits on added sugars and saturated fat, it is important to underscore that there is not a lot of room for extras,” Haven says. “The majority of the foods people eat should be in nutrient-dense forms to help them meet their nutrient needs without consuming excess calories. For this reason, nutrient-density is a foundational piece of this edition and emphasized throughout each chapter.”

Controversy?
The 2020 Dietary Guidelines Advisory Committee recommended the 2020-2025 Dietary Guidelines for Americans set the limit of added sugars to 6 percent of total calories — a 4-percent drop from the previous guidelines. Essentially, the Committee concluded that if 85 percent of total calories came from nutrient-dense foods and the remaining 15 percent came from solid fats and added sugars, then added sugars should be limited to 6 percent or less to stay within the recommended total calories. The Committee also recommended limiting alcoholic beverages for both men and women who choose to drink to no more than one drink per day on days when alcohol is consumed. Like its predecessor, the 2020-2025 Dietary Guidelines for Americans specify that on days when alcohol is consumed, adults of legal age who choose to drink (and it is not contraindicated, such as during pregnancy) should limit consumption to two drinks or less per day for men and one drink or less per day for women. Ultimately, the USDA and HHS did not adopt the recommendations of the Committee, stating in a report that “there was not a preponderance of evidence in the Committee’s review of studies since the 2015-2020 edition to substantiate changes to the quantitative limits for either added sugars or alcohol.” The full response is available here.

Put It Into Practice
Registered dietitian nutritionists should become familiar with the 2020-2025 Dietary Guidelines for Americans to best counsel patients or clients and adequately answer questions. For a quick overview, the USDA offers the Top 10 Things You Need to Know About the Dietary Guidelines for Americans, 2020-2025. Additionally, RDNs can recommend patients or clients visit MyPlate.gov to take advantage of newly released features such as the new MyPlate quiz and personalized plans. The Dietary Guidelines website also includes additional resources for health professionals.

References

Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. Dietary Guidelines website. Accessed January 22, 2021.
The Process to Develop the Dietary Guidelines for Americans, 2020-2025. Dietary Guidelines website. Accessed January 22, 2021.
Top 10 Things You Need to Know About the Dietary Guidelines for Americans, 2020-2025. Dietary Guidelines website. Accessed January 22, 2021.
USDA-HHS Response to the National Academies of Sciences, Engineering, and Medicine: Using the Dietary Guidelines Advisory Committee’s Report to Develop the Dietary Guidelines for Americans, 2020-2025. Dietary Guidelines website. Accessed January 22, 2021.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. Dietary Guidelines website. Published December 2020. Accessed January 22, 2021.

Esther Ellis
Esther Ellis, MS, RD, LDN, is the dietetics content manager at the Academy of Nutrition and Dietetics and associate editor of Food & Nutrition Magazine.