Did the Food Pyramid Ruin American Health?

The Food Good Pyramid, introduced to the United States in 1992, was scrapped over a decade ago after becoming commonplace in student classrooms, but it still stirs controversy. Its critics — often proponents of low-carbohydrate diets — blame it for the epidemic of chronic diseases. Experts say while the Pyramid had its flaws, only a few followed its advice.

Eric Berg, a well-known chiropractor and promoter of the ketogenic diet, recently said on Fox News that he hoped that the Make America Healthy Again (MAHA) movement would first address the Food Pyramid, claiming that grains have no nutritional value.

He echoed the criticism of many other health influencers who call the Pyramid a 'scam' and attribute its advice to severe health conditions, many of which have multiple and complex causes.

The introduction of the Food Guide Pyramid in the early 1990s was indeed riven by controversy, mainly because the agency in charge of its creation bowed to the pressure of the food industry.

Ashley DePriest, a clinical nutritionist, pointed out on Bluesky, a social network, that many 'anti-science' people who think they are advocating for good nutrition cite dietitians using the Food Pyramid, although it hasn't been used since 2011.

DePriest wrote, "I would venture to guess that newer dietitians might not even know what it is; it's so outdated. The fact that many don't even know what the Dietary Guidelines for Americans are should be the biggest red flag, but here we are."

Experts interviewed by WellnessPulse say the impact of the dietary advice laid out in the Food Guide Pyramid is difficult to measure because many Americans didn't follow it. Instead, many continue overconsuming fat, added sugar, and alcohol, foods that are strongly associated with chronic health conditions.

Was there a conflict of interest?

The Food Pyramid's controversy stems from its creation being overseen by the Department of Agriculture (USDA). Critics say that the department's dual mandate to give healthy eating advice and promote the use of agricultural products created a conflict of interest.

The initial Pyramid, called the Eating Right Pyramid, was composed after consulting a group of nutrition experts and sent for print in 1991. The process was widely covered in the media.

However, the design was met with a backlash from the meat and dairy industries. For example, the National Milk Producers Federation complained about stigmatizing dairy products as they were placed next to the fats and oils on the pyramid.

The USDA withdrew the Pyramid, citing the need to reevaluate the design and evidence behind it. A year and nearly $900,000 later, the department reintroduced what was then called The Food Guide Pyramid.

In her book Food Politics, Marion Nestle, PhD, MPH, a world-renowned nutritionist and public health advocate, writes that the new version differed in at least 33 ways, most of them "utterly trivial."

However, according to Nestle, two significant changes were made to appease food producers. The number of recommended servings was moved outside the design and set in boldface, suggesting that people should eat at least 2–3 servings of meat and dairy foods daily.

Ironically, given who had registered most complaints, the Pyramid had increased the upper range of the meat allowance. It specified that the two servings should be the equivalent of 5–7 ounces of cooked lean meat, rather than the 4–6 ounces suggested in the Basic Four guide.

Marion Nestle, PhD, MPH

Basic Four refers to the USDA's dietary recommendations until 1990, which emphasized consuming four groups of foods: milk, meat, vegetables and fruits, and bread and cereal.

What's wrong with the Food Pyramid advice?

The Food Guide Pyramid displayed the major food groups proportional to consumption recommendations per day, including the following:

• 6–11 servings of foods from bread, cereal, rice, and pasta
• 3–5 servings of vegetables, 2–4 servings of fruits
• 2–3 servings of milk, yogurt, and cheese group
• 2–3 servings of meat, poultry, fish, dry beans, eggs, and nuts group
• Sparingly — fats, oils, and seeds

Some nutrition experts have criticized the Pyramid since its introduction, focusing on the following aspects:

• No distinction between the 'good' and the 'bad' types of fat. Monounsaturated and polyunsaturated fats found in foods like avocados, seeds, and nuts have heart-protective properties. In contrast, excessive intake of 'bad' saturated fat and trans fat from red meat and deep-fried foods, among others, may increase the risk of heart problems.
• Overconsumption of dairy. Many non-White Americans are lactose intolerant — up to 85% of adult African Americans may be lactose intolerant, with higher intolerance rates among people of Asian descent, Hispanic descent, and Native Americans.
• Beef was put in the same category as poultry, nuts, and legumes. Although they are all rich protein sources, poultry contains less saturated fat than beef. Most fats in nuts are unsaturated, while legumes are very low in fat. Moreover, nuts and legumes are rich in fiber.
• Too much emphasis on grains. Not all grains are created equal. Whole grains are higher in fiber, vitamins, minerals, and other nutrients. Meanwhile, excessive intake of refined grains like white bread or white rice is associated with an increased risk of obesity, type 2 diabetes, and cardiovascular disease development long-term.

However, Nestle points out in her book Food Politics that the Pyramid serving numbers refer to serving size standards defined by the USDA, not portion sizes of meals served at restaurants.

Nestle writes, "A standard grain serving is one slice of white bread, one ounce of ready-to-eat cereals or muffins, or one-half cup of rice or pasta. Therefore, a single bakery muffin weighing 7 ounces, or one medium container of movie-theater popcorn (16 cups), easily meets or exceeds a day's grain allowance."

While eating six slices of white bread and three cups of rice may help meet the Pyramid’s daily serving recommendations, these foods may differ in nutritional values. For example, if brown rice is chosen, it may provide more fiber than white bread, or white rice may provide much more carbohydrates than white bread. This highlights the lack of nuance in the Pyramid’s advice.

David Klurfeld, PhD, an adjunct professor at the School of Public Health‐Bloomington and a long-term National Program Leader for Human Nutrition in the Agricultural Research Service of the USDA, says that when the Pyramid was introduced, the Dietary Guidelines for Americans (DGA) still strongly recommended reducing total dietary fat, even though the existing evidence didn't strongly support it at that time.

That idea is a holdover from a 50-year-old thinking that eating fat, which has twice the calories of carbohydrate or protein, would easily make you fat. This gave the food industry a reason to reduce fat, but in practice, it led to the development of fat-free cookies and other foods that should be limited. Consumers saw this as a green light for a free pass.

David Klurfeld, PhD

The current DGA emphasizes the consumption of unsaturated fat over saturated fat, which should account for no more than 10% of daily calorie intake.

Did the Food Pyramid ruin American health?

The advice in the Food Guide Pyramid doesn't align with the current nutrition guidelines, especially in terms of food sources and their nutritional properties. But can it be solely responsible for the epidemic of obesity and other chronic conditions?

The obesity rates in the U.S. increased from 15% in 1980 to 42.8% in 2018. The number of people diagnosed with type 2 diabetes grew from 3.6% in 1980 to 11.6% in 2021.

Gyorgy Scrinis, PhD, an associate professor of food politics and policy at the University of Melbourne, doubts the impact can be measured.

Americans didn't seem to follow that advice and dramatically change their diets in the direction recommended by the guidelines, so it's strange to want to attribute any benefits or harm to them. Americans then, and now, eat a diet largely composed of meat and ultra-processed foods.

Gyorgy Scrinis, PhD

In his book, Nutritionism: The Science and Politics of Dietary Advice, Scrinis criticized the Pyramid for not distinguishing the level of processing of foods that Americans were consuming. Thus, these guidelines did little to prevent the rise in consumption of ultra-processed foods (UPFs).

UPFS are foods formulated from substances derived from foods like fats and starches and contain ingredients we normally wouldn't use at home. They are often high in sodium, added sugars, and saturated fats. Research has associated diets high in UPFs with 32 types of health problems, including cardiovascular disease and type 2 diabetes. However, because UPFs are a relatively new phenomenon and there is a lack of consensus over their definition, it’s hard to measure their impact on human health.

Although the critics of dietary guidelines claim that they contributed to America's obesity problem, a vanishingly small percent of Americans adhere to them, according to Klurfeld.

"We don't eat enough nutrient-dense foods and eat a lot of snacks and foods with low nutritional quality, which has resulted in more obesity and more chronic diseases," he says.

Americans have long struggled to adhere to nutritional guidelines. Between 2001 and 2004, the majority overconsumed solid fats, added sugars, and alcoholic beverages while failing to meet recommendations for all nutrient-rich food groups except total grains, meat, and beans.

According to 2021 data, Americans don't consume enough grains and dairy, while their intakes of animal proteins, particularly red meat, exceed the recommendations. The Healthy Eating Index, which measures adherence to the federal dietary guidelines, is only 58 out of 100 across Americans 2 years and older.

Melinda D. Maryniuk, MEd, RD, a diabetes educator, wrote back in 2006 in Diabetes Spectrum that the Food Pyramid did not cause the obesity crisis.

"Imagine any illustration that could make such a major impact on behavior. I mean, if the Pyramid caused the obesity epidemic, then fixing the Pyramid could solve the problem of obesity," Maryniuk wrote.

So, what caused the obesity epidemic?

Consuming excessive calories contributes to obesity but is far from being the sole cause. Increasing evidence reveals how the obesity risk is affected by biopsychosocial factors, referring to the interconnection between biological, psychological, and socio-environmental factors:

Genetics have a role in predisposing individuals to obesity. Studies have identified certain genes that are more commonly found in individuals with obesity, high body mass index, and other body composition traits, such as body fat percentage.

The rapid emergence of fast-food chains and the increasing availability of inexpensive UPFs may be among the external factors that make people consume more calories, thus increasing the risk of obesity.

Insufficient sleep may lead to impaired glucose intolerance and insulin sensitivity, and reduce the levels of leptin, a hormone regulating hunger and body weight. Sleep deficiency also increases cortisol and ghrelin levels, both of which are associated with increased appetite.

Medications. Certain drugs like antidepressants, some diabetes management medications, including insulin, and drugs to lower blood pressure may lead to weight gain.

Medical conditions such as Cushing's syndrome, metabolic syndrome, and polycystic ovarian syndrome may contribute to weight gain via different mechanisms.

Socioeconomic status. Low or decreasing socioeconomic status may potentially increase the risk for obesity in those genetically predisposed, likely due to psychosocial distress and emotional eating.

Ethnicity. Obesity rates are higher among non-Hispanic black and Hispanic adults than among non-Hispanic white and non-Hispanic Asian adults.

Psychosocial stress. Continued long-term high-stress levels may increase chronic exposure to glucocorticoids, hormones that may contribute to abdominal obesity and contribute to emotional eating.

Long-term exposure to endocrine-disrupting chemicals that can be found anywhere from food packaging to cosmetics may interfere with the body's appetite control and potentially increase energy storage in fat tissue.

Gut microbiome. An imbalance in the gut microbiota may play a role in metabolic disorder development and act on the brain to increase appetite, contributing to obesity.

Notably, the impact of these factors has varying levels of scientific evidence, with some potentially contributing to obesity more than others. Due to a lack of long-term human clinical trials, some factors are mostly based on animal studies and observations.

What are the current nutrition guidelines?

The U.S. government replaced the Food Pyramid with MyPlate in 2011. The plate image is divided into four sections, each representing the intake of different food groups. Vegetables make up the largest portion, followed by grains, proteins, and fruits.

The dairy products category, presented as a small circle next to the plate, also includes fortified soy alternatives.

Klurfeld says the Food Guide Pyramid and MyPlate are just symbols that reflect the Dietary Guidelines for Americans.

I think it was a mistake to make that switch because the pyramid had high consumer awareness and understanding, both of which cannot be claimed by MyPlate.

David Klurfeld, PhD

The takeaway

Some experts say the creation of the Food Guide Pyramid was heavily influenced by the pressure of food industries, largely due to the USDA's double mandate. However, it cannot be attributed to the rise of obesity and other chronic conditions, as most Americans don't follow nutritional guidelines.