Yale School of Public Health Professor Rafael Pérez-Escamilla served on the 2015 Dietary Guidelines for Americans (DGAs) advisory committee, a panel of 15 national experts who formulate recommendations that shape federal nutrition policy as well as education about nutrition and healthy eating. The new guidelines go public today and Pérez-Escamilla discusses what he sees as the strengths—and weaknesses—of the government’s nutrition policy for the next five years. The U.S. Departments of Health and Human Services and Agriculture, along with members of Congress and others, finalize the guidelines. Pérez-Escamilla, who also served on the 2010 advisory committee, said that the guidelines are of enormous importance for public health as they are the foundation for federal food and nutrition policies and programs across the life course and have a strong influence on food product formulation by the food industry. They also have a strong impact on nutrition advice delivered through the health care system. The new guidelines can be seen at http://health.gov/dietaryguidelines/2015/
As a member of the scientific committee that laid the groundwork for this new edition of the Dietary Guidelines for Americans, what do you think of them?
RPE: Overall, I am very happy that the 2015 DGAs took into account the great majority of the recommendations made by the scientific committee. I am particularly pleased with the simple yet substantive way in which the five core guidelines were “packaged.” The 2015 DGAs send a strong message that the dietary pattern as a whole is what individuals should be focusing on rather than in isolated foods or food groups. It also strongly emphasizes the fact that beverages are very much a part of a dietary pattern and do suggest, although not directly state, the need to bring the consumption of sugar sweetened beverages under control. The nicely developed sample of diverse healthy dietary patterns that are aligned with the 2015 DGAs is indeed a major innovative contribution to the field of dietary guidance. I was also particularly pleased to see the incredibly important topic of household food insecurity being fully recognized and for the first time to see acknowledged the need to take the food preferences of immigrants into account in the design and implementation of food assistance programs. The 2015 DGAs embrace the social-ecological model for providers and policy makers to understand that it takes a complex mutli-sectoral village for individuals to be empowered to make food choices well aligned with the DGAs.
What are the specific strengths that you see compared with previous versions of the dietary guidelines?
RPE: The 2015 DGAs are exceptional at illustrating graphically the dire state of the American diet and provide specific recommendations as to how to address dietary changes or “shifts” needed to turn things around by focusing on selecting nutrient dense nutritious foods and healthy beverages staying within calorie needs. The 2015 DGAs took the bold step of setting up an upper limit of 10 percent from daily calories from added sugars (this is likely to have huge implications for food label legislation and changes in product formulation by industry) as well as omitting cholesterol as a nutrient of concern. In addition removing an upper limit for fat consumption, in terms of percent from total calories, ushers dietary recommendations into a new era that fully recognizes the strong scientific evidence behind the fact that not all fats are created equal and that indeed healthy oils should be a part of a recommended dietary pattern.
Do you have any disappointments?
RPE: Of course I’m very disappointed that the sustainability issues were left out due to pressure from certain sectors of the food industry through Congress. However the 2015 Dietary Guidelines Advisory Committee report has planted a very important seed that I hope others will see blossom and thrive. There is no doubt that on the one hand food choices do have an important impact in environmental sustainability and climate change and that at the end of the day it is totally within the purview of the DGAs to empower consumers to know the carbon footprint of the products they buy. On the other hand, it is crucial for the national security of our country to understand how to develop a sustainable food chain that is aligned with the DGAs and that can be secured for future generations of Americans.
As expected, due to strong lobbying by the meat industry and the resulting strong pressure that Congress put into the developers of the 2015 DGAs the recommendation to reduce consumption of red and processed meats was not included. In my view this is a major gap given the evidence provided by our committee, part of which was subsequently confirmed by the World Health Organization on meat and cancer risk. However, the fact that the 2015 DGAs maintained the upper limit for saturated fat of 10 percent from total calories (clearly recommending to replace saturated fat with healthy oils and not refined or simple sugars) will undoubtedly have an impact on the consumption of red and processed meats as they are very rich in this nutrient. Maintaining the recommendation to reduce sodium intake will also influence the consumption of meat products, especially processed meats as they are very heavy on salt (as many other processed and ultraprocessed foods are).
The 2015 DGAs do a nice job of identifying processed and ultra-processed foods and beverages as key sources of sodium, saturated fat and added sugars. However there is no specific guideline in the 2015 DGAs to lower the consumption of heavily processed foods and beverages. This evidence based and common sense recommendation is already included in the dietary guidelines from countries as diverse as Brazil, Mexico, and several European countries. I hope the USA will follow suit in the not too distant future.
Do the guidelines go far enough regarding policy recommendations?
RPE: I do think that the 2015 DGAs are quite “light” on policy recommendations and do not endorse the recommendation from the 2015 Dietary Guidelines Advisory Committee to consider the evidence-based policy of taxing sugar sweetened beverages. Research studies are showing that this policy appears to be working quite well in Mexico and now in Berkley, California. So hopefully our committee was able to also plant another important seed in this regard for others to follow suit.