How Should Americans Eat?

1943: The Basic 7

 By Karla Lester

When I asked Jake, a 13 year old patient, why he ate two cheeseburgers, he said, “They’re so tasty and my parents were out of the room.” My response was, “Well, were you hungry? That’s a great reason to eat.” 

He’s so funny and keeps it real. Jake is trying to make some changes for his health, but it’s really hard in our food culture and with what’s marketed to him and other teens. I call that the Digital Marketing Industrial Complex and it’s powerful and drives food noise in teens. Jake’s parents are working to help him, but feel like the food police and feel like they’re causing harm. Now, we have the unveiling of the new food pyramid by RFK Jr, or what I like to call the Clip Art Inverted Triangle, and even more nutrition confusion for Jake. 

Is it low-fat or high-fat? Is protein, which seems to be everywhere, really being demonized? Or, is it the high cost of protein, specifically the rising cost of beef, that we’re all mad about?Should we all be eating keto? Should we all be eating ribeye steaks every day and whole fat dairy and high protein? What if you have a history of high cholesterol and cardiovascular disease and kidney disease and won’t tolerate a high protein diet? Should we eat only Argentine beef? 

Should Americans listen to a lawyer who has undermined experts and spread dangerous misinformation about vaccines? To a lawyer who has undermined scientific research and the evidence base and the agencies he leads? RFK Jr got rid of the experts and self-declared his. The entire country has been waiting on the Republicans to unveil their healthcare plan. And waiting and waiting and waiting. Don’t get distracted from the policy harm this administration is causing. 

The Dietary Guidelines for Americans from 2020-2025, under President Biden, focused on health equity. I guess health equity is out the window and now we’re eating like RFK Jr. and supplementing with beef tallow, his latest grift. Dr. Oz is telling Americans to drink up and party it up when he says that, “Alcohol is a social lubricant.” It seems like a joke or an episode of The Office or Parks and Rec, without the endearing characters, but it’s our actual reality. Brooke Rollins, The Secretary of Agriculture didn’t get the low carb high fat memo and is peddling a low cost meal as a way to fight the rising costs of groceries and inflation, “A piece of chicken, a piece of broccoli, corn tortilla, and one other thing.” That literally makes me hungry and sad. 

What do we make of it and where do we go from here? Let’s take a look back so we can move forward. 

Most of us remember learning about the four food groups in school; dairy, fruits and vegetables, meat, and breads and cereals. Then, in the 90’s came the Food Pyramid. Edits were made and MyPyramid, a revised version came out in 2005. The main criticism was that the pyramid model was ineffective in translating nutritional guidance into actual dietary behavior. MyPlate has been used since 2010 and is a more helpful tool for nutrition education. 

In 1980, the U.S. put out the Dietary Guidelines for Americans for how Americans are supposed to eat. The recommendations, developed by politicians and based on farm policy demonized dietary cholesterol. Our Ultra Processed Food system and a fast food nation was built on High Fructose Corn Syrup and our bodies the dumping ground for refined carbohydrates and metabolic diseases like obesity, type 2 diabetes, and cardiovascular disease . This allowed the explosion of the statin industry. It was simple. Eating fat, specifically foods like eggs that have cholesterol, will equate to higher cholesterol in your body and cardiovascular disease. 

Americans bought into low fat high carb eating, demonized dietary fats, and Big Food and Big Pharma profits skyrocketed. It was based on calories in calories out Energy Balance Theory. And, now the U.S. is swinging back the other way. I’m not saying we haven’t had it wrong in the past or that changes are not needed. 

“The Obesity Code” by Dr. Jason Fung is an incredibly innovative book that turned calories in calories out and the Energy Balance Theory on its head. Dr. Fung talks about how a calorie isn’t a calorie and how obesity is hormonal and not simply caloric. I highly recommend it if you want to learn more about a metabolic health approach. Eating low-carb and high-fat is not for everyone and shouldn’t be recommended for each American to eat one standard diet. There is ample science that shows that eating a Mediterranean diet or a plant based diet is very healthy. 95% of Blue Zones are whole plant based diets. 

As an obesity medicine doctor and a founding member of the Society of Metabolic Health Practitioners, it would seem I should be excited about the new Clip Art Inverted Triangle. But, I’m a pediatrician first and a child health advocate and have done a lot of work in the public health sector and I can’t sign on to it fully. It's a clinical recommendation, not inclusive or feasible for an entire population. 

First, protein has not been demonized. The cost of protein and all other groceries, is what the real problem is. In fact protein is everywhere and added to everything these days. Should we be dumping a scoop of protein powder in everything we eat and drink? 

Dr. Marion Nestle in her book, “Food Politics” lays out how food and farm policy have driven the epidemic of obesity, cardiovascular disease, and metabolic diseases. Reading the new guidelines, you would think that nutrition alone determines health. That’s just not the case. Socioeconomic factors, behaviors, and healthcare access drive health outcomes. The new guidelines shift the blame to individuals, specifically Americans who are already marginalized, which gets the administration out of addressing the root causes, the systems and structures in America that are making people sick. 

“Our nation is finding its footing again, moving past decades of unhealthy eating and rebuilding a food culture rooted in health, science, transparency, and personal responsibility.” - RFK Jr. 

Personal responsibility is really Individualism, which is Healthism, which is really You are in control of your health, which is really Your bad health outcomes are your fault, which is really "Buy my supplements and latest gadgets". The new guidelines are infused with the toxic wellness industry with lobbying interests with the beef, dairy and alcohol industries on full display. Anytime insurance companies hear personal responsibility, they hold an exec only lunch meeting to celebrate. I don’t think it’s usual practice for the Secretary of HHS to be out doing TikTok trends (AI, by the way) while promoting whole milk. Pushing whole milk reeks of nostalgia for a time that was white washed and a nod to policies that still are. 

No one is going to argue that it's good for your health to reduce intake of refined sugar and ultra processed foods. We can all agree that Americans need to eat more protein. In the end, the Clip Art Inverted Triangle is a distraction from a harmful administration continuing to cut public health funding, food assistance, cut Medicaid by $880 Billion, closing down rural hospitals, making our foods and citizens less safe and silencing evidence-based research and experts. 

Working on a local level is where policy implementation happens. The Places matter work in Lincoln demonstrates that a person’s zip code is a determining factor of health outcomes. I think back to my nonprofit, Teach a Kid to Fish, and all of the families who came to BodyWorks, a family based healthy eating and active living program, held in 20 different sites throughout Lincoln. Outcomes demonstrated increase in family mealtimes, increased fruits and vegetables, decreased screen time, decreased sugary beverages, and increased water intake. MyPlate was used as a good visual for how to eat a balanced meal with protein, grains, fruits and vegetables. MyPlate is customizable to your individual eating traditions and health needs. 

More than the positive health outcomes, I remember the families and the struggles they were facing with costs of food, cooking skills, safe places to play, transportation, housing, utilities, joblessness, healthcare access, and other health issues they were facing. There were many wins, but they needed more than that. They will continue to be left out with the Clip Art Inverted Triangle and new guidelines and blamed for their poor health outcomes. 

Registered Dietitians who work with patients and families say, “We don’t want new guidelines. We want change. An upside down pyramid isn’t going to fix the health of Americans, but will cause more nutrition confusion.”

America doesn’t have a food culture. We have a capitalistic, profit driven, politically motivated food system that benefits the very wealthy few. A pyramid or whatever you call it will not be the answer to America’s problems. It starts with policy and supporting basic human needs. 

The next time I see Jake in the clinic, I will approach the nutrition part of his treatment plan, as I have been. Jake is neurodivergent and is a picky eater and has a lot of food noise and loss of control eating, especially with sugary foods. Telling Jake to eat high amounts of protein, cut out all refined carbohydrates and transition to whole fat dairy, will likely be a big nothing burger he won't eat!