Vox Populi

A Public Sphere for Poetry, Politics, and Nature

Dr. Michelle D. Holmes: Black Lives Depend on the U.S. Dietary Guidelines

Don’t water them down.

Most Americans know about the Dietary Guidelines for Americans primarily through their colorful representations: the original food pyramid, which a few years ago morphed into MyPlate. The guidelines represent the government mothering us to choose the healthiest vegetables, grains, sources of protein, and desserts, and to eat them in the healthiest portions.

As innocuous as the food pyramid and MyPlate seem, they are actually a matter of life and death.

The Dietary Guidelines for Americans are, by law, updated every five years. They are often criticized for not clearly and directly condemning red and processed meat and sugar-sweetened beverages, not noting the environmental impact of those foods, and for being heavily influenced by food companies. But the recently released 835-page final draft from the 2020 Dietary Guidelines Advisory Committee, the independent group of nutrition experts charged with the 2020 update, actually represents an important advance for Black Americans.

Poor diets kill nearly 320,000 Americans a year, from heart disease, stroke, type 2 diabetes, and other chronic conditions. That exceeds the combat death toll of 291,000 U.S. soldiers in World War II. In a nation where 42% of Americans are obese, this is of particular gravity to Black Americans, half of whom are obese.

“On the road to making a healthy diet accessible to everyone, the Dietary Guidelines will continue to be an invaluable tool for health professionals, federal nutrition program operators, and many families. But we are far from reaching our destination.”

Sugar added to prepared foods and beverages contribute to weight gain. The average American consumes 22 teaspoons of added sugar a day. That’s 350 calories, or more than 17% of the recommended 2,000-calorie daily diet. The most common sources of added sugar in the American diet are sugar-sweetened beverages, cookies, cake, candy, and ice cream.

This year’s Dietary Guidelines Advisory Committee recommended nearly halving daily sugar intake, from less than 10% of daily calories, as recommended in the 2015 guidelines, to less than 6%. The committee also advises that children under age 2 not be given juice or other sugar-sweetened beverages.

In a daily diet of 2,000 calories, 10% of added sugar represents 200 calories; 6% would be 120 calories. A bowl of Frosted Flakes and a strawberry Pop-Tart, each at 56 calories of added sugar, would put an individual’s breakfast close to the new limit. One 12-ounce can of Coca-Cola is 140 calories of sugar; a 12-ounce can of Pepsi is 150 calories. Both exceed the new recommendation.

While all Americans eat too much sugar, Black Americans consume about 20% more than white Americans. I want to be clear here that I am not blaming Black Americans. Their disproportionate poor health is a direct legacy of slavery, legally enforced housing discrimination, and unattended disparities. Many Black Americans do not have access — financially or geographically — to the healthy food or modes of exercise that white Americans do.

This disparity is brought into even sharper focus by Black Americans dying from Covid-19 at more than twice the rate of white Americans, and at younger ages, partly due to poor diets that make bodies less resistant to the coronavirus. And along with other people of color, they are also overrepresented in so-called essential jobs, in which social distancing is very difficult.

Black Americans need science-based dietary guidelines in an acute way as they disproportionately benefit from federal nutrition programs that are mandated to follow the guidelines, such as school breakfast and lunch programs. For example, 74% of Black children are eligible for school lunch programs, compared to 29% of white children. Other guideline-following programs include Supplemental Nutrition for Women, Infants and Children (WIC); the Nutrition Services Program, mandated under the Older Americans Act; and nutrition programs administered by the Departments of Defense and Veterans Affairs.

If the recommendations by the advisory committee are approved by the Department of Health and Human Services and the U.S. Department of Agriculture and become part of the 2020 Dietary Guidelines for Americans, they will ultimately be reflected in healthier offerings in federal programs. These could go a small way toward righting America’s wrongs by offering African Americans healthier diet options.

That would be particularly remarkable because these recommendations are happening under the aegis of the otherwise anti-science Trump administration. Given the toxic political atmosphere, the Union of Concerned Scientists called these recommendations “a science success story.”

But to make this success stand up, people need to make sure that the USDA and HHS hear their voices. The public can comment on the draft report until Aug. 13.

The Dietary Guidelines Advisory Committee’s report then goes into what in the past has been an almost invisible process where corporate food lobbyists and members of Congress who receive heavy food industry contributions often push back hard against the committee’s science-based recommendations. As my colleague and nutrition expert Walter Willett once wrote, the advisory committee’s report is “yanked this way and that by competing powerful interests, few of which have your health as a central goal.”

The 2015 advisory committee, for example, directly said that Americans should eat less processed red meat, replace sugar-sweetened beverages with water, and that the environmental sustainability of food production should be factored into the guidelines. The language around those issues was either watered down or deleted.

Americans, and particularly Black Americans, cannot afford another watering down of the recommendations. While we are understandably consumed with the horrific death toll of Covid-19, we cannot forget that so many of the deaths are compounded by a poor diet.


Dr. Michelle D. Holmes is an internal medicine physician, associate professor of epidemiology at the Harvard T. H. Chan School of Public Health, and associate professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. The opinions expressed here are solely her own and do not reflect the views and opinions of Harvard University or Brigham and Women’s Hospital.

Copyright 2020 Michelle D. Holmes. First published in STAT. Included in Vox Populi by permission of the author.

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