October 2016

    How The Government Decides What You Eat



    In 1980, the USDA released the first-ever dietary guidelines. There were seven simple rules. Today, the 53,000 words in the 2015 guidelines have been scrutinized and fought over by countless factions. Who really has our best health in mind? Here's how the government decides what you eat.



    Portraits of lawmakers in dark suits peered down from the walls as Agriculture Secretary Tom Vilsack and Sylvia Mathews Burwell, the secretary of Health and Human Services, sat inside a congressional hearing room last October. From behind microphones, they braced for an onslaught of questions. Cameras clicked, papers shuffled, heavy doors opened and closed as lobbyists and journalists slipped into the room. Then, after an opening prayer, the hearing began.

    For months, members of Congress had admonished Vilsack and Burwell about how their agencies had handled the Dietary Guidelines for Americans—the government's sweeping and hugely influential nutrition advice to the public about what to eat, which was due to be released within the year. Now the lawmakers had their chance to chastise the secretaries, face to face.

    "You've lost credibility with a lot of people," said Rep. Collin Peterson, D-Minn., jabbing a finger toward them as he blasted them for, in his view, bungling the guidelines.

    Peterson's barb was just one more salvo in a four-decade battle over the guidelines, and only the latest display of how that advice routinely gets hijacked by politics, thanks to a powerful food industry that throws its heft around Congress. The end result, many critics would say, are nutrition recommendations that promote certain sectors of the food industry rather than the health of the American people.

    The guidelines have always been as much a political document as a scientific one. The October hearing was ostensibly about a general dissatisfaction with the way the guidelines are generated. But the real flashpoint was a report issued eight months earlier by an advisory panel charged with evaluating the latest nutrition science and making recommendations for what the guidelines should say. Among the panel's many recommendations was that the guidelines should consider the environmental consequences of food production. More specifically, the report suggested that a diet lower in red meat and processed meat was not only more healthful, but better for the planet.

    That report raised hackles in the livestock industry, already under fire for the environmental toll of its operations. Lobbyists, especially those working for cattle producers and meat processors, launched a full-scale offensive on Capitol Hill, with calls and letters to livestock-friendly lawmakers imploring them to quash the sustainability recommendation.

    Some members of Congress attacked the work of the panel, officially called the Dietary Guidelines Advisory Committee (DGAC), accusing it of straying beyond its mandate to focus only on nutrition. Mike Conaway, R-Texas, chairman of the House Agriculture Committee, and Peterson, both from livestock-heavy states, asked Vilsack and Burwell to more carefully review the scientific reports. Then, concerned their message still wasn't getting through; they hauled the secretaries in for a public scolding.

    "There has been a strong reaction to the Dietary Guidelines Advisory Committee report," Peterson said, adding, somewhat ominously, "Maybe we should reconsider why we are doing this."

    In other words, if the government's nutrition advice threatens the multibillion-dollar livestock industry, maybe that advice should be scrapped altogether.


    Behind the scenes battles

    The dietary guidelines are reviewed, adjusted and re-­released every five years based on the newest scientific evidence in the ever-evolving (and often contentious) field of nutrition research. The first guidelines, issued in 1980, were simple: seven easy-to-comprehend rules, such as avoid too much sugar and saturated fat. But since then they've devolved into a complicated and sharply politicized document, running hundreds of pages and with recommendations that, for better and for worse, influence more than $100 billion in government spending, the $5 trillion food industry and the diets of millions of Americans.

    The process of producing the 2015 version of the guidelines (released in January 2016) was especially fraught. In 2012, the departments of Health and Human Services and Agriculture appointed 15 nationally recognized leaders in public health to its advisory committee. By law, the committee is required to review scientific papers (sometimes thousands) in developing recommendations for the departments to consider. The agencies, in turn, review public comments on those recommendations, conduct their own internal reviews and then release the final guidelines.

    The most recent trouble began when the DGAC decided, for the first time, to designate a subcommittee to study the question of sustainability—a move that touched an already-frazzled nerve in the livestock industry.

    The most recent trouble began when the DGAC decided, for the first time, to designate a subcommittee to study the question of sustainability—a move that touched an already-frazzled nerve in the livestock industry.

    Beef producers have fretted for decades as beef consumption in the U.S. plummeted amid concerns about red meat's potential link to higher cholesterol, heart disease and colon cancer. In fact, the guidelines and their predecessors have targeted foods high in saturated fat from the start, going back nearly 40 years.

    More recently the industry also has been besieged by accusations that raising beef is especially resource-intensive, requiring huge inputs of petroleum-based fertilizers to produce the grain that cattle are fed, and that the entire process, from feedlot to plate, damages soil, waterways and air quality. Now government advisers were not just flashing warning signals about beef's potential health downside, but also about the consequences of its production—a message that the livestock industry feared would further discourage people from eating meat.

    74% of Americans believe the dietary guidelines should include sustainability.

    In January 2014, the DGAC's sustainability subcommittee gathered in a vast, windowless room outside Washington, D.C., to discuss its findings at a public meeting. The members said that, based on their review of the science, the guidelines should instruct Americans to eat more plant-based foods and fewer animal products, and this would have the added benefit of encouraging a more environmentally sustainable diet.


    Related: 30-Days of Plant-Based Meals

    Publicly, the subcommittee's work barely registered. Behind the scenes, though, the meat industry was mobilizing. And a year later, when the DGAC published its report in February 2015, the industry fired back, calling members of the committee "activists" bent on jeopardizing public health by denying people important nutrients in beef. The lobbying arm of the North American Meat Institute, which represents meat processors, launched a "Hands Off My Hot Dog" campaign, and meat-industry interests forged an alliance that pushed for more time to review the report and the public comments on it—more than 29,000 of them.

    "There's scientific agreement that there are a variety of ways to eat a healthy diet, so now the question is where does red meat fit into a healthy dietary pattern?" said Shalene McNeill, Ph.D., R.D., of the National Cattlemen's Beef Association. "The biggest disagreement we have with the DGAC's work is that they never asked that question. Instead, they reviewed evidence where red meat is part of an unhealthy diet."

    The clamor over sustainability eventually prompted a response from Congress, including the October hearing. But the night before the hearing, Burwell and Vilsack undercut much of the anticipated drama of the showdown, posting a blog in which they pledged that the final guidelines would not include the issue of sustainability.

    Still, lawmakers used the hearing to take some political shots. "They were almost making fun of the expertise of some of the committee members," recalled Kathleen Merrigan, Ph.D., a former deputy secretary at the USDA who is now a professor of public policy and executive director of sustainability at George Washington University.

    The DGAC members had been bracing for the pushback. "We knew it was going to be controversial," said Miriam Nelson, Ph.D., a nutrition professor at Tufts University at the time and head of the sustainability subcommittee. "The meat industry and the commodity industry, they have people in Washington who follow every bit of legislation, so they were all very poised and ready. And they know that the best thing you could do was discredit the science, discredit the scientists and deflect the issue."


    The dirty business of good nutrition

    When Burwell and Vilsack preemptively nixed sustainability from the guidelines before the hearing, it was a major victory for the livestock industry. But the industry still faced the possibility that the final guidelines would advise Americans to eat less red meat and processed meat for health reasons, as the advisory committee's report proposed.

    But the industry still faced the possibility that the final guidelines would advise Americans to eat less red meat and processed meat for health reasons, as the advisory committee's report proposed.

    As the due date for releasing the new guidelines approached, the industry's position took a very public hit when the World Health Organization issued a report saying red meat and processed meat increased the risk of colorectal cancers by 17 and 18 percent, respectively.

    An important counterpunch soon followed. The prestigious science journal BMJ published an article by Nina Teicholz, a journalist and author of The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet. In BMJ, she argued that the DGAC had overlooked important new nutrition research and used "weak scientific standards" to evaluate the evidence it used in making its recommendations about meat and saturated fat.

    There have been, over the last five years, eight or nine review papers challenging the hypothesis that saturated fat causes heart disease.  Why not review that science? Is there a bias to preserve the existing advice?

    Her article gave the livestock industry and its supporters in Congress ammunition. It also prompted 182 scientists to sign a letter calling on the journal to retract Teicholz's piece. The advisory committee itself issued a forceful rebuttal, calling the article "woefully misleading" and in some cases factually incorrect. (The journal did issue a correction, saying Teicholz had failed to emphasize a report that linked saturated fats and heart disease.)

    Still, after the considerable political dust settled, the meat industry was left virtually unscathed. When the final guidelines emerged earlier this year, the recommendation to eat less red meat and processed meat was gone. Instead, Americans were advised to eat a "variety of protein foods," including lean meat, while men and teens were advised to lower their "overall intake of protein foods"—exactly the kind of mushy language critics of the guidelines have long decried. The sustainability provision, as promised, was also left out.

    Despite the omission of sustainability and cutting the recommendation to eat less meat, many nutrition experts, including the DGAC, are celebrating the new guidelines. Among other victories is the recommendation to consume no more than 10 percent of your calories from added sugars. "The new [guidelines] have some important positive conclusions, the most important being the elimination of a restriction on an upper limit for total fat, which had been driving people to high-carbohydrate diets," explained Walter Willett, M.D., M.P.H., chair of the department of nutrition at Harvard's T.H. Chan School of Public Health. "The limit on added sugar is also important."

    Still, Willett and others felt the agencies had again, as with previous guidelines, caved to political pressure. "I was disappointed," he said. "This corruption of the scientific conclusions by industry and political influences has many serious implications."


    An agency pulled in two directions

    The Department of Agriculture took on the job of creating the guidelines in the late 1970s, largely because half its budget at the time went to nutrition programs, including Food Stamps and school lunch. (Today that figure is closer to 75 percent.) Given the billions of dollars the department was spending on these programs, and the increasing evidence linking poor nutrition with chronic disease, department officials figured they should develop some sort of guidance informing what the government would, and would not, pay for.

    "These programs were providing some good, nutritious food," recalled Carol Tucker Foreman, who was a driving force at the USDA behind the creation of the original guidelines. "But at the same time, a basic in the school breakfast program was the fortified Twinkie."

    The first draft of the government's dietary advice, in 1977, explicitly said to eat less meat and reduce consumption of eggs and dairy.  "The red-meat industry went into high gear to undo that, and that really set up the tone of the controversy" that persists to this day, Tucker Foreman said. The final guidelines, released three years later, dropped the recommendation on meat.

    That the guidelines always retreat on the eat-less-red-meat advice isn't surprising given that the USDA has always had a conflicting mission. The USDA's primary functions include regulating the meat supply, running nutrition programs and promoting American agricultural commodities, of which red meat is by far the most valuable. Critics of the guidelines process say the department shouldn't have any role in crafting them because of this inherent conflict.

    The USDA's primary functions include regulating the meat supply, running nutrition programs and promoting American agricultural commodities, of which red meat is by far the most valuable.

    When the first guidelines came out in 1980, even though the direct assault on red meat had been cut, the meat industry was incensed at the government's recommendations to reduce fat and saturated fat. (Red meat and processed meat contain high levels of both, as do some dairy products and oils.) Many politically connected farmers felt betrayed by an agency that was supposed to promote their businesses.

    The incoming agriculture secretary, John Block, a hog farmer from Illinois, publicly questioned whether it was the department's place to tell people what to eat. Responding to the controversy, Congress ordered that an outside panel of experts—what became the Dietary Guidelines Advisory Committee—would craft the guidelines going forward. In theory, the committee was supposed to operate beyond the reach of politics and the food industry. Over time, though, it didn't work out that way.


    Nutrition guidance for the public

    The first guidelines had seven pieces of advice: eat a variety of foods; maintain an ideal weight; avoid too much fat, saturated fat and cholesterol; eat foods with adequate starch and fiber; avoid too much sugar; avoid too much sodium; and if you drink alcohol, do so in moderation. The next three sets of guidelines maintained those recommendations.

    The first guidelines had seven pieces of advice...By 2005, though, the guidelines had ballooned to 41 recommendations.  This dramatic expansion, some argued, reflected deliberate attempts by the food industry to dilute the advice and confuse the public.

    Marion Nestle, a member of the 1995 advisory committee, has written extensively about the food industry's efforts to blunt the guidelines by softening and generalizing the language. For instance, when the 2010 iteration of the guidelines appeared, she and other critics blasted them for relying on confusing acronyms and burying key details about sugar and fats in dairy and meat. "The previous guidelines obfuscated this issue by referring to SOFAS—solid fats and added sugar," Harvard's Willett noted, "and then deep in the document was a footnote saying solid fats were mainly from red meat and dairy."

    This time around, the livestock industry broadened its attack to say that, by introducing the issue of sustainability, the DGAC had strayed beyond its mandate—and its expertise. It wasn't truly beyond their scope, though, proponents would argue: the DGAC tackled sustainable diets in an effort to address long-term food security. "The key element here is that food security has always been a central issue for the guidelines," Miriam Nelson said. "In fact, it was the reason they were developed in the beginning."

    Plus, the DGAC has ventured into terrain that isn't strictly nutrition-focused before. For example, in 1995 the committee recommended that Americans get more exercise to combat growing rates of obesity—a recommendation that the guidelines ultimately adopted.

    One thing everyone agrees on: the issue of a sustainable food supply is complicated and goes beyond meat. "The debate over the past year has really been too focused on meat consumption," said George Washington University's Merrigan, noting that livestock production is just one piece of a very complex food system and that other foods also pose serious environmental questions. Merrigan pointed to healthful but resource-depleting foods like almonds, which require an extraordinary amount of water to grow, and to some fish stocks that are being obliterated by overfishing.

    Whether environmental considerations make it into the 2020 guidelines will, of course, still depend on politics. "The political pressure is so profound," Nelson said. "It'll take research, a legal case, political will, consumer demand and significant thought leadership to move this forward."

    But there is evidence that some of those elements Nelson cites are shifting in sustainability's favor. Americans are indicating that they care—and largely because they have been getting a more holistic picture, in the media and elsewhere—about problems with the modern food system. The 2015 guidelines, for example, received 29,000 public comments, compared to just 1,400 in the last round five years ago. Concerns about what's in food and how it's produced are registering in the national consciousness, and in the marketplace, in unprecedented ways.

    Americans are indicating that they care—and largely because they have been getting a more holistic picture, in the media and elsewhere—about problems with the modern food system.

    For proof, look no further than the growing response from the food industry: the move toward cage-free eggs, attempts to trim antibiotics, labeling GMOs, and so on,predominantly inspired by public demand. If the trend continues, it will be hard for the USDA to ignore the growing public concern over the environmental costs of food—and that could have the added benefit of improving public health.

    So while the livestock industry and its allies will no doubt continue to try to keep sustainability out of future guidelines, they may find it a much harder sell to an increasingly tuned-in public. A recent survey by the food industry found that half of Americans now say they consider health and wellness, safety, social impact and transparency when buying groceries.

    "Some people are highly motivated to eat well because of nutrition and wellness; others are highly motivated around saving the planet," Merrigan said. "By bringing sustainability into dietary guidance there's the potential that more people will be interested in taking up that guidance."


    The future of the guidelines

    In the meantime, though, is there a realistic way to remove politics from the process of producing the government's dietary advice? Before 2005, the guidelines were written and released by the advisory committee without direct agency interference. But since then, the USDA and HHS make whatever changes to the committee's report they deem necessary, then release the guidelines without further input.

    Walter Willett and others have advocated moving the process outside of government entirely. "The major problem is meddling by the food industry, often through their congressmen... or directly through the USDA," Willett noted. "It would be better to have the guidelines developed by a body that was more insulated from politics and industry influences, and rested only on the best available science. The National Academy of Medicine would probably be a better home."

    Given the deeply partisan divide in Congress these days, it's difficult to say whether such a move is plausible anytime soon. Last fall, for instance, Congress passed a massive spending bill with a meat-industry-backed provision tucked inside that called for an external review of the dietary guidelines process to make sure it is based on science and a "consideration of all of the latest available research and scientific evidence."

    Sounds reasonable. But, of course, "the scientific evidence and research about dietary guidance is always going to conflict and disadvantage some farmers and food producers, and benefit others," Carol Tucker Foreman said. In other words, one politician's "scientific evidence" is another's "biased activism."


    Georgina Gustin

    This article was produced in collaboration with theFood & Environment Reporting Network, an independent, nonprofit news organization producing investigative reporting on food, agriculture and environmental health.