Dietary Guidelines Panel to Take Input From Public

This month, the federal panel charged with offering guidance on what Americans should eat will try to make up for lost time, when it meets January 13-14, 2014, in Bethesda, Maryland, to hear comments from the public.

In June 2013, the Dietary Guidelines Advisory Committee (DGAC), a 15-member group that includes experts in nutrition, epidemiology, obesity, cancer prevention, cardiovascular disease, and pediatric health, kicked off the process that will end with the publication of the 2015 Dietary Guidelines for Americans. A meeting planned for early October was canceled due to the government shutdown, making for a full January agenda.¹

US dietary guidelines have been issued every 5 years since 1980 and are now mandated by Congress. The lengthy process that creates them invites plenty of scrutiny. Given the stakes, lobbyists for the food industry and nutrition advocates alike prepare well in advance for the meetings. Even though the 2010 process produced innocuous sounding edicts like “Avoid oversized portions” and “Drink water instead of sugary drinks,” it also produced highly specific instructions that caused an overhaul of school lunch programs.²

Dietary Guidelines for Americans drives regulations from the US Department of Agriculture (USDA) and the US Food and Drug Administration (FDA). Besides school lunches, the guidelines dictate the shape of huge programs, such as meals for the military and values in the Supplemental Nutrition Assistance Program (SNAP).³

Interest in the guidelines has increased with first lady Michelle Obama’s focus on childhood obesity, especially given the fallout from the 2010 report. That process, which straddled the end of the Bush Administration and President Barack Obama’s first 2 years, resulted in the well-publicized scrapping of the “food pyramid” for “MyPlate,” a visual representation that won some praise for promoting fruit and vegetable consumption but was seen by others as a concession to the food industry, with too much emphasis on protein and dairy.⁴ Companion legislation passed in 2010 overhauled school lunches, removing popular fried foods, imposing calorie caps, and inviting complaints from around the country that districts were losing money when students refused to eat the healthier fare.⁵

The guidelines’ role in reining in obesity was highlighted when the last edition was issued. “The 2010 Dietary Guidelines are being released at a time when the majority of adults and 1 in 3 children is overweight or obese, and this is a crisis we can no longer ignore,” US Agriculture Secretary Tom Vilsack said at the time.⁶ In a process outlined by statute, Vilsack’s department took the lead on the 2010 report, while the Department of Health and Human Services (HHS), led by Secretary Kathleen Sebelius, will be the lead agency this time. Staff from both departments have input, although HHS will be responsible for incorporating DGAC’s recommendations into the final report.⁷

The 2015 panel is composed almost entirely of new members, led by Chair Barbara Millen, DrPH, RD, who is a professor at the Boston University School of Medicine. Millen is also founder and president of Millennium Prevention, Inc, a startup with significant funding from the National Institutes of Health (NIH) that develops web-based and mobile applications to encourage healthy ifestyles.^8,9 Including Millen, the panel includes 5 registered dieticians, as well as 3 members affiliated with cancer centers: Lucile Adams-Campbell, PhD, professor of oncology at the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center; Marian Neuhouser, PhD, RD, of the Cancer Prevention Program at the Fred Hutchinson Cancer Research Center in Seattle, Washington; and Steven Clinton, MD, PhD, of the Ohio State University Comprehensive Cancer Center.⁸

Members of the committee contacted this fall by Evidence-Based Diabetes Management referred all questions back to agency staff, saying they could not discuss the process prior to making recommendations. Thus, gaining a sense of the committee’s output requires a look at what topics panelists are prioritizing. This reading of the tea leaves can cause intense reaction to developments that are seen as fodder for the committee’s work. For example, a May 2013 report from the Institute of Medicine (IOM) that clarified recommendations on salt intake provoked such outcry that IOM President Harvey V. Fineberg issued a letter critiquing press coverage.¹⁰

Registered dietician Lori Kaley, MS, RD, LD, MSB, writing for Fooducate, a nutrition website that claims it is not “funded or influenced” by the food or supplement industry, in July 2013 took note of the items labeled “high priority” or “new” by one of the panel’s original working groups.¹¹ High-priority items included sodium, omega-3 fatty acids (seafood), fortified foods and beverages, trans fatty acids, processed meats, dairy, and whole fruit and juice. New topics included food and cognitive function, nutrient “overconsumption,” supplements and athletic performance, sugar-sweetened beverages—the term for soda—and finally, “gene-food interactions.”¹¹

A notice on the committee’s website states that the subcommittee structure has been revamped since June, and 5 new subcommittees have been created.¹

The largest, with 8 members, covers “Dietary Patterns, Foods and Nutrients, and Health Outcomes.” There is also a committee dealing with sustainability in the food supply, a topic listed on this month’s agenda.¹ What might that cover? In September 2013, the committee received comments from experts at Johns Hopkins’ Center for a Livable Future, which is among the groups asking the committee to reframe recommendations on seafood: consumers, they argue, are consuming so many big fish and shrimp that supplies are dwindling, and the public should be steered toward sardines and other items “lower on the food chain.”¹²

Inclusion of soda is significant given the attention it received in June 2013 at the American Diabetes Association 73rd Scientific Sessions, where researcher Kimber Stanhope, PhD, RD, openly asked whether the panel would have the fortitude to do something about soda during its deliberations.¹³ New York City’s new mayor, Bill de Blasio, has vowed to follow through on soda restrictions, and Mexico — now the world’s most obese nation – just imposed a soda tax.¹⁴

Also, it’s not known how the Dietary Guidelines for Americans will interact with the Affordable Care Act, and its call for healthcare providers and insurers to be rewarded based on population health. HHS will issue the final guidelines around the same time that those who fail to sign up for health insurance will face stiffer penalties in 2015.References

1. Dietary Guidelines Advisory Committee. 2015 Dietary Guidelines for Americans website. www.dietaryguidelines.gov. Updated December 18, 2013. Accessed January 1, 2014.

2. US Dept of Agriculture. 2010 Dietary Guidelines for Americans. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm. Published January 31, 2011. Accessed December 31, 2013.

3. US Dept of Agriculture. MyPlate, Dietary Guidelines and General Nutrition. USDA Resource Library. http://snap.nal.usda.gov/resource-library/eat-healthy-every-day/myplate-dietary-guidelinesand-general-nutrition. Updated December 23, 2013. Accessed January 1, 2014.

4. Harvard School of Public Health. Healthy Eating Plate vs. USDA’s MyPlate. HSPH website. http://www.hsph.harvard.edu/nutritionsource/healthyeating-plate-vs-usda-myplate/. Accessed January 1, 2014.

5. Michelle Obama-touted federal healthy lunch program leaves bad taste in some school districts’ mouths. CBS News website. August 30, 2013. http://www.cbsnews.com/news/michelle-obama-touted-federal-healthy-lunchprogram-leaves-bad-taste-in-some-school-districtsmouths/. Accessed December 31, 2013.

6. USDA and HHS announce new dietary guidelines to help Americans make healthier good choices and confront obesity epidemic [press release]. Washington, DC: US Dept HHS News; January 31, 2011. http://www.hhs.gov/news/press/2011pres/01/20110131a.html. Accessed December 31, 2013.

7. E-mail from Tara Broido, MPH, deputy director of communications, Office of the Assistant Secretary for Health, US Dept of Health and Human Services. July 15, 2013.

8. US Dept of Health and Human Services. HHS and USDA announce the appointment of the 2015 Dietary Guidelines Advisory Committee [press release]. Washington, DC: US Dept of HHS News; May 31, 2013. http://www.hhs.gov/news/press/2013pres/05/20130531a.html2015. Accessed July 15, 2013.

9. Millennium Prevention. Extension Engine, Health + Technology website. http://extensionengine .com/health/?page_id=103. Accessed December 31, 2013.

10. Center for Science in the Public Interest. Institute of Medicine chief knocks press coverage of salt report. https://www.cspinet.org/new/201306171.html. Published June 17, 2013. Accessed January 1, 2014.

11. Kaley L. The 2015 Dietary Guidelines for Americans: here’s how you can help improve them. http://blog.fooducate.com/2013/07/29/the-2015-dietary-guidelines-for-americans-hereshow-you-can-help-improve-them/. Published July 29, 2013. Accessed December 31, 2013.

12. Fry JP, Love DC, Nachman KE, Lawrence RS. Letter to 2015 Dietary Guidelines Advisory Committee. Center for Livable Future website. http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/_pdf/projects/ffp/farm_bill/CLF-public-commentseafood-DGAC_2013.pdf. Published September 25, 2013. Accessed December 31, 2013.

13. Stanhope KL. Symposium speaker, Dietary sweeteners—research, recommendations and the real world. 73rd Scientific Sessions of the American Diabetes Association; June 23, 2013; Chicago, Ill.

14. Page P. Will NYC’s new mayor follow through on soda limits? Am J Manag Care 2013;19(SP11):SP318,SP405-SP406.