After nearly two years of review and discussion, scientists charged with advising federal health and agriculture agencies on the next edition of dietary guidelines issued their report Tuesday, clarifying the role of food in health promotion and disease prevention.
It’s not quite food writer Michael Pollan’s famous “Eat food, not a lot, mostly plants” prescription, but it comes closer than the current guidance. The mantra the advisers want Americans to adopt: “Eat Healthy Your Way.”
The overarching theme of the 20-member committee’s report emphasizes consuming vegetables, fruits, legumes (as in beans, peas, lentils), whole grains, nuts, and fish and seafood throughout the lifespan. Low-fat and non-fat dairy (cow or alternative) as well as unsaturated fats are encouraged, while red or processed meats, saturated fats, and salty or sugary snacks are discouraged, along with sweetened beverages and foods. The 2020 guidelines had emphasized curbing added sugars and alcohol intake, in line with limits from the 2015-2020 edition.
The report captures dire statistics about Americans’ burden of chronic disease, many related to diet and getting worse: Prevalence of overweight and obesity is 73% among U.S. adults 20 and older and 36% among children and adolescents 2 through 19 years old. Prediabetes prevalence is 38% among teenagers.
Therefore, it says: “Nearly all U.S. individuals can benefit from shifting to healthier dietary patterns.”
“The committee recommends that proposed Eat Healthy Your Way Dietary Pattern emphasizes dietary intakes of beans, peas, and lentils while reducing intakes of red and processed meats, as supported by systematic reviews as well as food pattern modeling analyses indicating that nutrient goals are generally met with such a shift from the 2020 HUSS [healthy U.S.-style,] to include more plant-based protein foods,” the report added.
The academics’ work provides expert opinions derived from their systematic reviews of medical evidence available for developing the 2025-2030 Dietary Guidelines for Americans. These are not the recommendations themselves. That falls to the U.S. Department of Health and Human Services and the Department of Agriculture, which together may reject or accept the scientific committee’s conclusions after a period for public comment. The next edition of the guidelines will be published by the end of 2025.
Coming as the Make America Healthy Again movement animates the next administration’s policy and potential HHS leadership by Robert F. Kennedy Jr., the forthcoming guidelines are likely to be more than academic. MAHA adherents draw a direct line between ultra-processed foods and chronic disease, for example.
Dietary guidelines are updated every five years. In January 2023 the committee set out to use a health equity lens throughout its evidence review. Social determinants of health, which include economic, environmental, social, educational, and structural factors, play a role in dietary intakes throughout the lifespan, limiting how individuals and population groups find healthy foods and meet nutrition goals.
Compared to the current guidelines, Tuesday’s report also adds a new recognition of dietary patterns that take into account cultural differences in how healthy nutrients are included in meals, with special attention to intakes of iron, folate/folic acid, iodine, and choline in pregnancy and postpartum periods. These fall into food patterns, seen as less prescriptive and more flexible in reaching the same goal of high-quality, nutrient-dense meals.
Previous food patterns were sorted into healthy U.S.-style, healthy vegetarian, and healthy Mediterranean-style. A pilot project this time around simulated foods identified in select American Indian and Native Alaskan diets to see if they met nutritional goals. They did, with one exception: Sodium intake exceeded recommended limits even when foods lower in nutrient density were excluded from the simulations, spurring the committee to call for “considerable efforts to decrease sodium in the U.S. food supply,” and to suggest more groups be considered next time around.
HHS and USDA will open a 60-day public comment period and also hold a public meeting on Jan. 16 to hear comments from the public on the scientific report. (Pre-registration is required for the public meeting.)
Two separate entities will release their advice for guidelines on alcohol, also after analyzing current evidence. The Interagency Coordinating Committee on Prevention of Underage Drinking and the National Academies of Science, Engineering, and Medicine will each weigh in on risk estimates and other research on alcohol consumption and health outcomes.
Conspicuously absent from the scientific report on diet is any position on ultra-processed foods, a decision made public in October when the committee also deferred to ICCOUD and NASEM on alcohol. High-quality research — including a definition that would allow a systematic review — does not exist for processed foods, the committee found. The umbrella term has come in for criticism because it can cover snacks high in fats, sugars, and non-food additives as well as less-processed bread found on grocery shelves.
Marion Nestle disagrees with the committee’s lack of a position. The emeritus professor of nutrition and public health at New York University has cited observational research led by Kevin Hall showing people who ate ultra-processed foods consumed an average of 500 extra calories per day compared to people who ate unprocessed food in a lab setting. She said the advisory committee’s hands are tied by rules excluding small observational trials from the body of evidence they review.
A paper published in the Journal of the American Heart Association in November also contends a definition of processed foods already exists, in the Nova food classification system, first proposed in 2009 and finalized in 2014.
JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, thinks it will take several more years to amass sufficient evidence for recommendations, possibly in time for the 2030-2035 dietary guidelines. She led a team that reported in Lancet Regional Health in September on a large analysis of long-running studies studying links between ultra-processed foods and cardiovascular disease, but says more research is required.
“It’s important to focus on a whole-food diet, primarily plant-based,” Manson said in October, after the advisory committee discussed draft advice in an online forum. “Certain types of ultra-processed foods can be incorporated into a healthy diet. They don’t need to be eliminated entirely. They don’t need to become taboo. We know that doesn’t work with dietary guidelines.”
Processed foods weren’t the only ones without a strong conclusion from the committee. Portion size and its connection to growth, body composition, and risk of obesity in children or adults also failed to meet the bar for solid evidence. “A lack of evidence also exists on the role of portion size in achieving or maintaining a healthy weight and growth, body composition, and risk of obesity overall,” it said.
Even so, the report suggests what may seem like an obvious fix: smaller portions and more fruits and vegetables within those portions to increase nutrients for children. Adults could plan meals at home in pre-portion sizes and choose smaller amounts away from home. And, the committee said, portion size should be revisited in federal food programs in order to move people toward healthier diets.
Some of the proposals seem more in the weeds, such as how high on a list of food groups legumes appear, and whether they should fall under “vegetable” or “protein.” A clearer message calls for drinking water as “the primary beverage for people to consume.” Milk and fortified soy beverages should be unsweetened and milk should be low in fat or fat free.
The committee also suggested surveying consumers on what to call food groups, saying the “protein group” excludes some food that contain protein. For “dairy and fortified soy alternatives,” it recommended not referring to lactose-free options and fortified soy milk and yogurt as “alternatives” because they are part of the dairy group.
The guidelines are more than aspirational, even though fewer than 1 in 5 Americans follow advice consistently delivered since 1980 to limit saturated fat, a message specified in 2005 to be less than 10% of the daily diet from age 2 up. What HHS and USDA ultimately adopt does matter, not just to clinical practice but more directly because they dictate decisions on food available via federal nutrition assistance programs. About 1 in 4 people Americans participate during a given year, from WIC for women and young children to school lunches to meals for veterans or seniors.
The committee also analyzed how Americans eat at different ages. Diet quality is higher in early childhood than later in childhood and adolescence. The scientists called poor nutrient intakes of adolescents, particularly females, concerning. Diet quality was somewhat better for older adults compared to younger adults, although some specific nutrient concerns remain.
The dietary guidelines are intended to make “science-based recommendations on what Americans should eat and drink to promote health and prevent chronic disease – including obesity, type 2 diabetes, and cardiovascular disease,” HHS and USDA said.
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