US Food Pyramid Challenged by Doctors' Organisation

In March 2011 an unusual consortium of doctors and health-care providers made a public announcement that didn’t create big ripples in the wider world but was a huge an unexpected splash in the small world of dietary research.

The Physicians Committee for Responsible Medicine (PCRM) is an American organisation, it’s a non-profit and, since 1985, has focused on promoting good clinical research and preventative medicine and opposing animal research and unethical human-based research programmes. And the PCRM’s latest target was the most recent set of dietary guidelines from the US Department of Agriculture (UDSA). But rather than simply reviewing the material negatively, they are actually suing the US government in an attempt to drive USDA to change both its recommendations and the language in which they are written.

The substance of the PCRM complaint is that the USDA hides harmful foods behind obscure language and that it does so intentionally.

The Role Of USDA in Food Provision

This is an important point, because the guidelines are not just a set of recommendations and some good advice: the five year update of the guidelines is used as a blueprint for federal nutrition programmes: this means that everything, from the army to the government-funded medical centres, the schools, the prisons and residential homes for children, old people and the mentally ill, all use the guidelines to determine the type and amount of food provided.

The Nature of Dietary Guidelines

The USDA, in conjunction with the US Department of Health and Human Services is charged with providing ‘the most current and sound scientific information available’ in the form of dietary guidelines. These guidelines, say the PCRM, are meant in large part to help Americans avoid the national epidemic of obesity.

The Center for Disease Control and Prevention says that the past two decades have led to a massive increase in the incident of obesity across the USA. In fact only two states (Colorado and the District of Columbia) had less than 20% obesity levels, while 33 states had 25% or more of population considered to be obese and nine of those 33 states - Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia – actually had 30% or more of their population classed as obese.

This is important because obesity (having a body mass index of 30 or above) is the key indicator of further health problems such as cardiovascular disease, certain types of cancer, and type 2 diabetes.

But the PCRM’s lawsuit states that the USDA is failing to give Americans nutritional advice to help them fight obesity because, it claims, the American government has given into the demands of huge agricultural businesses which have a conflict of interest with the guidelines. PCRM says that the influence of the agribusinesses has ‘blurred the message’ about which foods Americans should eat less of. The PCRM President is both supportive of the guidelines and critical of them, “The dietary guidelines are the best they've ever been, but we're pushing to make them better,” was his statement to Medscape Medical News.

He claimed that there was a level of dishonesty about the guidelines because while there is an explicit statement of which foods Americans should eat more of (fresh fruit and vegetables and whole grains), there is less clarity about the foods which Americans must eat less of to become slimmer.

The Language of Dietary Information

He went on to say that “… it doesn't help the school nutritionist designing school lunch menus or a food planner in a rural town,” when the guidelines offer complicated biochemical terms that are unfamiliar to the general public such as cholesterol and saturated and solid fats, without explaining where these abstract items are to be found, for example in fried foods, processed meats and cheeses and pies, cakes and pastries. In particular, the PCRM lawsuit says it is iniquitous to say people should eat less cholesterol without also explaining that meat, dairy products and eggs are the only cholesterol-containing foods in the average American diet.

The lawsuit further alleges that if the guidelines are meant for the general public, rather than scientists, they use “inconsistent language, ambiguous phrases and biochemical terminology to avoid providing clear dietary information due to … conflicts of interest.” And these conflicts of interest, the PCRM say, arise because USDA has to promote agriculture as well as good eating, and to say Americans should eat less meat and fat rich foods could harm the businesses that USDA is required to support!

Other healthcare groups say that they don’t know whether the USDA is being deliberately confusing and vague in terminology but that they agree with the PCRM that the language used does not help people make good food choices.