BROKEN PROCESS BEHIND THE U.S. DIETARY GUIDELINES FOR AMERICANS
WASHINGTON – The Nutrition Coalition applauded a report, released today by the National Academies of Sciences, Engineering and Medicine (NASEM) on the process used to develop the Dietary Guidelines for Americans (DGA). A crucial finding of the report is that the current DGA process for reviewing the science falls short of meeting the “best practices for conducting systematic reviews,” and that “methodological approaches and scientific rigor for evaluating the scientific evidence” needs to “be strengthened.” The report states, “To develop a trustworthy DGA, the process needs to be redesigned.”
This lack of a firm scientific foundation for the DGA is emphasized throughout the report:
- “The adoption and widespread translation of the DGA requires that they be universally viewed as valid, evidence-based, and free of bias and conflicts of interest to the extent possible. This has not routinely been the case.” [S-1]
- “The methodological approaches to evaluating the scientific evidence require increased rigor to better meet current standards of practice.” [S-4]
- The process to update the DGA should be comprehensively redesigned to allow it to adapt to changes in needs, evidence, and strategic priorities.” [S-4]
Members of The Nutrition Coalition responded to the report:
Jeff Volek, Scientific Advisory Council Member for the Nutrition Coalition, PhD RD Professor, Department of Human Sciences, The Ohio State University:
“These guidelines don’t operate in a vacuum. Flaws in the DGA process are the major force shaping the U.S. food supply, and they drive dietary advice by all health-care practitioners as well as all federal nutrition policy – from school lunches to food stamps to even the meals served to our active duty military service members.
For years, we’ve been told that the Dietary Guidelines are the gold standard and that if Americans are obese and diabetic, it must be their fault. This report confirms that this is not the case.”
Nina Teicholz, Nutrition Coalition co-founder, science journalist and author of The Big Fat Surprise, whose controversial critique of the DGA published in The BMJ, identified many of the problems cited in the NAM report.
“The good news is that we now have indisputable evidence that the DGA lack a firm scientific foundation, and we finally can chart a path forward for ensuring that this important policy is evidence-based. This report confirms what top nutrition experts have been trying to tell Congress, USDA, and HHS for years—our nation’s top nutrition policy is not based in sound science.”
Sarah Hallberg, Executive Director of the Nutrition Coalition, DO, MS:
“I sincerely hope that as a country this report will put us on a path towards science-based and effective guidelines that help, not hurt, our overall well-being.
“I find my patients get healthier—lose weight and even reverse their diabetes—by doing what the current science says, which is the complete opposite of what the Guidelines tell them. It’s obvious to me, as a practitioner, that these Guidelines do not reflect the best and most current science.
“Whether they realize it or not, virtually all Americans are impacted by the DGA, which is our nation’s top nutrition policy. It is imperative that we get this process right before as we head into the cycle for the next set of guidelines, which are due in 2020.”
Key recommendations from the report, titled Redesigning the Process for Establishing the Dietary Guidelines for Americans, include:
- Strengthen the Evidence Base: Methodological approaches and scientific rigor for evaluating the evidence should be strengthened by using validated, standardized processes and methods with the most up-to-date data. It is critical that, for example, the Nutrition Evidence Library is aligned with best practices for conducting systematic reviews and uses appropriate methods. [4-9]
- Crafting recommendations that address all Americans, not just those who are healthy: Given the prevalence of chronic disease and risk for chronic disease in the population, this National Academies committee believes it will also be essential for the DGA Policy Report to include all Americans whose health can benefit by improving their diet based on the scientific evidence. Without these changes, present and future dietary guidance will not be applicable to a large majority of the general population. [2-14]
- Reducing sources of bias and conflicts of interest: The adoption and widespread translation of the DGA requires that they be universally viewed as valid, evidence-based, and free of bias and conflicts of interest to the extent possible. This has not routinely been the case. [S-1]
- Redesigning the DGA process to be more transparent: To develop a trustworthy DGA, the process needs to be redesigned. […] It will be imperative for the process to enhance transparency, manage biases and conflicts of interest to promote independent decision making, promote diversity of expertise and experience, support a deliberative process, and adopt state-of-the-art processes and methods to maximize scientific rigor. [2-15]
The view that the DGA are not fully evidence based has been echoed by numerous scientific experts, such as:
Dr. Fiona Godlee, The BMJ editor-in-chief, editorialized:
“Given the ever increasing toll of obesity, diabetes, and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science.”
Statements by other experts concerned with the evidence-base of the DGA can be found here.
In 2015, Congress appropriated $1 million for a review of the DGA process after concerns were raised by both researchers and nutrition experts alike during the last development cycle. That review is now complete, and the findings confirm the Nutrition Coalition’s view that the Guidelines are not fully evidence-based and do not adhere to basic methodological standards for reviewing the science.