FROM “EAT MORE” TO “EAT LESS,” 1900–1990

The U.S. government has been telling people what to eat for more than a century, and the history of such advice reflects changes in agriculture, food product development, and international trade, as well as in science and medicine. In 1900, for example, the leading causes of death were infectious diseases such as tuberculosis and diphtheria made worse by the nutrient deficiencies and overall malnutrition that were especially prevalent among the poor. Life expectancy at birth for both men and women barely exceeded 47 years. To overcome nutritional deficiencies and related disorders, government nutritionists urged people to eat more of a greater variety of foods. Throughout the twentieth century, an expanding economy led to improvements in housing, sanitation, and nutrition. Diseases resulting from nutritional deficiencies declined, and by 2000 life expectancy had increased to an average of 77 years. Today, the leading causes of death are chronic diseases associated with excessive (or unbalanced) intake of food and nutrients. Table 5 compares the ten leading causes of death in the United States in 1900 and 2000. Despite the great advances in public health during the twentieth century, the leading conditions related to diet—coronary heart disease, cancers at certain sites, diabetes, stroke, and liver cirrhosis, for example—could be reduced in prevalence or delayed until later in life if people ate less of dietary components that increase disease risk. Advice to eat less, however, runs counter to the interests of food producers.

The conflict between more recent ideas about diets that promote health and the interests of the food industry accounts for much of the public confusion about nutrition. As this chapter will explain, dietary advice issued by the government never has been based purely on considerations of public health. The agencies that issue dietary advice inevitably have other constituencies as well as the public, most notably the agricultural and food industries. When the interests of these industries conflict with current thinking about nutrition, as in the examples described here, the result is controversy, confusion, and the invocation of science to support one or another point of view.

“EAT MORE”: PREVENTING DIETARY DEFICIENCIES, 1890s TO 1960s

The federal role in promoting food consumption developed as a result of colonial history. As far as one can tell, the diet of the earliest American settlers depended on foods obtained through farming, hunting and gathering, and—to a limited extent—internal and external trade. As trade increased, and as the country became more industrialized and urbanized, methods of food preservation, storage, and distribution improved. What people actually were eating before the twentieth century, however, is known only from anecdotal accounts or small surveys. The U.S. Department of Agriculture (USDA) began collecting information about the supply of basic food commodities in 1909, about household food consumption practices in 1936–37, and about the food intake of individuals only in 1965.1 Earlier dietary practices can only be inferred, and cannot easily be correlated with health status except indirectly through changes in disease rates or life expectancy.

Nevertheless, from the time of its creation in 1862, the USDA was expected to perform two functions. One was to ensure a sufficient and reliable food supply. The other was to “diffuse among the people of the United States useful information on subjects connected with agriculture in the most general and comprehensive sense of that word.”2 This last was interpreted as a mandate to issue dietary advice. In early years, the two functions seemed perfectly compatible. Both promoted a greater and more varied food supply. By the early 1890s, the USDA began to sponsor studies on the relationship between agriculture and human nutrition, and it appointed W. O. Atwater as the first director of research activities. Atwater published tables that listed the content of calories, protein, carbohydrate, fat, and “mineral matters” in common American foods. He also estimated the amounts of food needed to meet the nutrient requirements of people performing different levels of work. His analysis of the eating habits of New England laborers and professionals, for example, confirmed “the general impression of hygienists that our diet is one-sided and that we eat too much . . . fat, starch, and sugar. This is due partly to our large consumption of sugar and partly to our use of such large quantities of fat meats. . . . How much harm is done to health by our one-sided and excessive diet no one can say. Physicians tell us that it is very great.”3

Atwater believed that American men required more calories and protein than recommended by European physiologists of that era because people in this country worked harder. He suggested that men doing moderate work required about 3,500 calories daily, with a distribution that calculates to about 15% of calories from protein, 33% from fat, and 52% from carbohydrate. This intake level exceeds current recommendations by about 1,000 daily calories, but Atwater was ahead of his time; the proportions of protein, fat, and carbohydrate are quite similar to those currently advised.

Atwater’s advice said nothing about vitamins. Although classic vitamin-deficiency diseases such as scurvy, beriberi, and pellagra were understood to be associated with diet in some way, their specific causes were unknown and no vitamin had as yet been isolated. Early in the twentieth century, as scientists began to identify the structure and function of one vitamin after another, the USDA immediately translated these scientific advances into advice for consumers. By 1915 or so, the agency had produced at least 30 pamphlets to inform “housekeepers” about the nutritive value of foods, the role of specific foods in the diet, and foods appropriate for young children at home or at school.

Food Groups

In 1917, the USDA issued its first set of overall dietary recommendations as a 14-page pamphlet, titled How to Select Foods. This document is remarkable for establishing precedents to which the agency still firmly adheres. It established the food-group format by organizing the food sources of nutrients then known to be needed for health into five categories: fruits and vegetables; meats and other protein-rich foods (including milk for children); cereals and other starchy foods; sweets; and fatty foods. It also established principles that continue to govern USDA policy on dietary advice. The pamphlet did not “recommend any special foods or combinations of foods. It tells very simply what the body needs to obtain from its food for building its tissues, keeping it in good working order, and providing it with fuel or energy for its muscular work. It shows in a general way how the different food materials meet these needs and groups them according to their uses in the body.”4 As we shall see, this approach permits all foods to be recommended as part of healthful diets and precludes suggestions to restrict foods in one or another group.

At the time, the USDA ignored Atwater’s advice to limit intake of fat and sugar, and its publications emphasized the newly discovered “micronutrients,” the vitamins and minerals that are essential for life but are needed only in small amounts. Food manufacturers and agricultural producers readily supported this emphasis because they grasped its marketing potential. They knew that the market for their products was limited. Food already was overabundant in the United States and already supplied more than enough calories for the population. Food producers could exploit the discoveries of vitamins and minerals to promote their products as vital for health and longevity. Because all food animals and plants contain vitamins and minerals, all could be promoted on this basis. A 1923 USDA publication emphasized this point: “The number of different food materials available in most parts of the United States is very great and is constantly increasing as a result of improved methods of agriculture. . . . There is no one of all these many foods that cannot be introduced into the diet in such a way as to contribute to its wholesomeness or its attractiveness.”5

During the 1920s, the USDA used five food groups—still including fat and sugar—as the basis of its dietary advice to families, mothers of young children, and teenagers. By the 1930s, the agency had identified certain “protective” foods as especially rich sources of vitamins and minerals. It issued many pamphlets emphasizing the need to prevent deficiencies of essential nutrients by eating more servings from groups of such foods. The number of these groups varied, however, in part because of concerns about the effect of the high cost of “protective” foods on consumer purchases. A Depression-era food guide, for example, explained that food selection has far-reaching implications for agriculture and that producers want “to know how much of different foods may well appear in the diets of different consumer groups, and to what extent consumption may rise or fall as the economic situation changes.”6 That particular guide increased the number of food groups to 12 and, for the first time, included milk as a separate category.

In 1940, the U.S. National Academy of Sciences established a committee to advise the government about nutrition problems that might affect national defense; this committee became the Food and Nutrition Board in 1941. One of its first tasks was to establish standards for daily nutrient intake for the armed forces and for the general population.7 The committee suggested Recommended Dietary Allowances (RDAs) for energy and eight nutrients at a conference in May 1941. Beginning in 1943, and continuing to the present day, such committees produced revisions of the RDAs at intervals of five to ten years. The USDA responded to the development of RDAs by making sure that its food guides described a dietary pattern that met those standards.

During World War II, the rationing of meat, sugar, butter, and canned goods inspired various federal agencies to develop food guides based on pragmatic considerations of food availability as well as theoretical considerations of nutrient standards. The result was a bewildering array of food groupings issued by various agencies. In 1942, federal pamphlets instructed Americans to “do your part in the national nutrition program” by eating foods from eight groups every day; four of these groups were milk, meat, eggs, and butter—all sources of fat and cholesterol as well as of essential vitamins and minerals.8 The following year, the USDA issued the National Wartime Nutrition Guide: “U.S. needs us strong: eat the Basic 7 every day.”9 This guide combined meat, eggs, fish, and beans into one group, kept milk as a separate category, and retained fats and sugars as separate groups. The changing number of food groups revealed a lack of coordination not only among federal agencies but also within the same agency. In 1943, for example, the USDA published the Basic 7 but also told wartime homemakers how to plan low- and moderate-cost meals based on foods from 11 groups.

Immediately following the end of World War II, USDA publications continued these inconsistencies. In 1946, the agency issued a peacetime version: “This is the Basic 7 guide for well-balanced meals. In time of emergency, you need to eat less of the scarce foods, more of the plentiful. Food is needed to feed the hungry—don’t waste it.”10 Two months later, it issued Food for Growth: Food for Freedom, targeted to children in the fourth through sixth grades. This publication was the first to recommend selections from just four food groups—milk; vegetables and fruits; eggs, meat, poultry, or fish (sometimes dried beans or peas); and a fourth category that included bread, cereal, cookies, and cakes.11 These guides actively promoted consumption of fats and sweets, even to children. Together, they continued to promote “eat more.”

Eating more received further support in the early 1950s when USDA nutritionists compared the results of a survey of nationwide food consumption practices to the most recent RDAs, realized that the diets of many Americans were below standard for several nutrients, and decided to construct a new food guide to help “the average person choose his food more wisely.”12 They simplified the four groups: milk (retaining its position as a separate category); meats (including beans and peas as alternatives); vegetables and fruits; and breads and cereals. To ensure that the guide would describe a diet that met RDA standards they also—for the first time—specified the number and size of servings within each group.

In an effort to achieve consensus on these innovations, the USDA invited leading nutrition authorities in government, research, the food industry, and agricultural commodity groups to review preliminary drafts because it “felt that food industry groups would have a vital interest in any food guide sponsored by the government.” Indeed they did. Dairy producers were pleased with the treatment given to milk and milk products—the guide placed the milk group first. Meat industry groups were said to be “unhappy about the serving size indicated for meat. . . . They pointed out that this size is smaller than average.”12 The proposed serving sizes included two daily portions of 2–3 ounces of cooked meat, then (as now) less than what people usually eat at any one time.

Despite the complaints, the USDA incorporated these serving sizes first into a handbook for nutrition professionals and later into a guide for the general public known popularly as the Basic Four. This last is illustrated in Figure 6. Remarkably, the USDA used versions of the Basic Four for the next 22 years, although it continued to base family meal and cost plans on 11 food groups. Except for the concern about portion size (an early warning of battles yet to come) food producer groups supported the USDA’s efforts to promote consumption of more—and more varied—foods.

More “Eat More”: Preventing Hunger

In the late 1960s, support for promoting “eat more” came from an entirely new direction. In 1967, a report of an investigation of hunger and malnutrition among low-income groups in the United States became the subject of a CBS television documentary, Hunger in America. At the time, the idea that people were going hungry in the land of plenty seemed so shocking that the program elicited widespread demands for expansion of federal food assistance programs. As a later report explained, “The failure of federal efforts to feed the poor cannot be divorced from our nation’s agricultural policy, the congressional committees that dictate that policy, and the Department of Agriculture that implements it; for hunger and malnutrition in a country of abundance must be seen as consequences of a political and economic system that spends billions to remove food from the market, to limit production, to retire land from production, to guarantee and sustain profits for large producers of basic crops.”13

In July 1968, the Senate responded to the public outcry by appointing George McGovern (Dem-SD) to chair a Select Committee on Nutrition and Human Needs that would lead “the war against hunger among the nation’s young, old and poor.”14 For the next nine years, McGovern’s committee created laws to expand food assistance for families, children, and the elderly through programs such as Food Stamps that still constitute the basis of the nation’s “safety net” for the poor. Both the public and Congress strongly encouraged these “eat more” activities, giving the McGovern committee license to meddle in other areas of nutrition and health.

THE SHIFT TO “EAT LESS”: PREVENTING CHRONIC DISEASE, 1969–1990

The ironic result of the McGovern committee’s subsequent meddling was a sharp transition in federal dietary advice from “eat more” to “eat less” and from dietary advice as a relatively uncontroversial government activity to one that brought on outraged protest. By telling the public about dietary risks for chronic disease, the committee alarmed producers of foods that might be targeted as “bad.” As one of its first actions, for example, the committee helped organize the 1969 White House Conference on Food, Nutrition, and Health. Participants not only discussed nutritional deficiencies in the United States, but also the “health problems of adults in an affluent society—the degenerative diseases of middle age” caused by “overconsumption of calories with food choices that are not necessarily the wisest on the basis of available nutritional information.”15 Among hundreds of conference recommendations were suggestions to eat less of the “unwise” food choices—those containing too many calories and too much fat, cholesterol, salt, sugar, and alcohol.

Ancel and Margaret Keys’ 1959 dietary guidelines for prevention of coronary heart disease
1.Do not get fat, if you are fat, reduce.
2.Restrict saturated fats, the fats in beef, pork, lamb, sausages, margarine, solid shortenings, fats in dairy products.
3.Prefer vegetable oils to solid fats, but keep total fats under 30% of your diet calories.
4.Favor fresh vegetables, fruits, and non-fat milk products.
5.Avoid heavy use of salt and refined sugar.
6.Good diets do not depend on drugs and fancy preparations.
7.Get plenty of exercise and outdoor recreation.
8.Be sensible about cigarettes, alcohol, excitement, business strain.
9.See your doctor regularly, and do not worry.
(Keys A, Keys M. Eat Well and Stay Well. New York: Doubleday, 1959.)

The “affluent-society” panel at the conference—and the staff of the McGovern committee—were well aware of the emerging research that linked the high levels of these factors in American diets to risks for chronic disease. Much of this research had been accomplished by cardiologists appalled by the apparent “epidemic” of coronary heart disease among Americans that followed World War II. They could not help but be impressed by the contrasting absence of this disease among populations consuming largely plant-based diets. In 1959, the physician-researcher Ancel Keys and his wife published a “healthy-heart” cookbook suggesting the now-classic dietary principles summarized above. The American Heart Association had sponsored research on dietary fat and atherosclerosis in the mid-1950s; in the 1960s, it advised people to reduce calories from fat, and it recommended dietary changes and public policies to reduce risk factors for coronary heart disease in the early 1970s. These changes were to reduce intake of fat (to 35% of calories or less), saturated fat (to 10%), and cholesterol (to 300 milligrams per day) and by implication to eat less of foods containing those substances.

On that basis, the McGovern committee urged the National Institutes of Health (NIH) to support research on the ways in which dietary changes might prevent coronary heart and other chronic diseases. Committee staff members considered it odd that so little attention had been paid to the role of diet in health. They viewed classic problems of undernutrition as “a problem for a small but significant part of the population.” As they explained, “malnutrition had two faces and . . . overconsumption was a major health concern for at least 30 million Americans.”16 To focus national attention on the overconsumption aspect of malnutrition, the committee held hearings on how diet affected obesity, diabetes, and heart disease in 1973 and issued a staff report on diet and chronic disease in 1974. In 1976, the committee initiated a new series of hearings with the riveting title “Diet Related to Killer Diseases.” At the very first of these hearings, more than 30 witnesses described how eating too much of the wrong kinds of food would increase risks for cancer, cardiovascular disease, and obesity.17 “Eat less” recommendations had become inevitable.

Dietary Goals: Issued, Opposed, Revised, 1977

On the basis of such testimony, the committee staff wrote the soon-to-be-infamous report, Dietary Goals for the United States, and released it at a press conference in January 1977. The report stated six goals, of which the first was to increase carbohydrate consumption to 55–60% of caloric intake. The remaining five, however, clearly meant eat less; reduce fat (to 30% of calories), saturated fat (to 10%), cholesterol (to 300 milligrams per day), sugar (to 15% of calories), and salt (to 3 grams per day). To meet the goals, Americans would need to eat more fruit, vegetables, whole grains, poultry, and fish. However, they also would have to reduce their intake of meat, eggs, and foods high in fat, butterfat, sugar, and salt, and to substitute nonfat milk for whole milk. These last recommendations generated nothing less than an uproar.

Cattle ranchers, egg producers, sugar producers, and the dairy industry registered strong protest at the very idea that Congress might be telling the public that their products were bad for health. The cattle industry, especially in McGovern’s home state of South Dakota, demanded the report’s immediate withdrawal. Meat and egg producers called for—and got—additional hearings to express their views. The hearing transcripts make fascinating reading that clearly reveals the interests at stake. For example, Senator Robert Dole (Rep-KS), then a minority member of the committee, offered the president of the National Cattlemen’s Association, Mr. Wray Finney, a compromise on the wording of the most disputed recommendation, “decrease consumption of meat” (here referred to as No. 2):

SENATOR DOLE: I wonder if you could amend No. 2 and say “increase consumption of lean meat”? Would that taste better to you?

MR. FINNEY: Decrease is a bad word, Senator.18

Members of the committee who represented states with large meat producer constituencies insisted that the report be revised. Senator McGovern himself was quoted as saying that “he did not want to disrupt the economic situation of the meat industry and engage in a battle with that industry that we could not win.”19

In all fairness, food producers had plenty of company in their objections to the Dietary Goals. Some scientists were unhappy with the report, citing unproven science and the need for further expert review. One went so far as to call it “a nutritional debacle.”20 The American Medical Association (AMA) argued that treating individual patients (by its physician members of course) was preferable to the government’s giving dietary advice that applied to everyone. The AMA also noted that “the recommendations carry with them the underlying potential for . . . discouraging the agricultural production of certain food products which may not in the view of the government be supportive of the dietary goals.”21

Although opposition to the Dietary Goals often was expressed as skepticism about the quality of the underlying science, it derived more directly from the profound economic implications of the advice. For example, meat (beef, lamb, pork), poultry, fish, dairy foods, and eggs provided 50% of the fat, 62% of the saturated fat, and 94% of the cholesterol in the food supply in 1970.22 To advise the public to consume less fat, saturated fat, and cholesterol was to advocate eating less of these foods, as well as of processed foods high in fats and oils. By 1977 this message was well understood by nutrition scientists, dietitians, and consumer activists and had already been reflected in declining sales of whole milk and eggs. When these trends continued—and beef sales also began to decline—food producer groups made more serious attempts to discredit, weaken, and eliminate dietary advice to eat less of their products.

Under intense pressure, the McGovern committee capitulated and issued a revised edition of the Dietary Goals late in 1977. The second edition strengthened advice about obesity and alcohol but made three changes designed expressly to placate food producers. The new recommendations:

1. Increased the salt allowance from 3 to 5 grams per day.
2. Added the statement “some consideration should be given to easing the cholesterol goal for pre-menopausal women, young children and the elderly in order to obtain the nutritional benefits of eggs in the diet.”
3. Replaced the statement “reduce consumption of meat” with the less offensive “choose meats, poultry, and fish which will reduce saturated fat intake.”23

The aftermath constituted its own drama. Nick Mottern, the committee staff member who had drafted the original report, objected to the compromises and was asked to resign. When Senator McGovern said that McDonald’s and other such foods were “on the whole . . . a nutritious addition to a balanced diet,” it seemed that “still another industry has thrown its weight around.”24 Regardless, publication of the Dietary Goals was the committee’s last accomplishment. In February 1977, shortly after the appearance of the first edition, the Senate voted to “merge” McGovern’s committee into a subcommittee of the Committee on Agriculture, Nutrition, and Forestry by the end of that year. The furor over the Dietary Goals did nothing to help Senator McGovern’s political career. He was defeated when he ran for reelection in 1980.

Mobilizing Support for “Eat Less” Advice, 1978–1979

Despite the compromises, the Dietary Goals proved to be a turning point; the report set a standard for all subsequent dietary recommendations and changed the course of nutrition education in the United States. For example, the American Society for Clinical Nutrition (an organization of professors and physicians who conduct research on human nutrition) convened a committee in 1978 to respond to the “biased arguments” of scientists who had opposed the Dietary Goals and to conduct a major review of the existing research. The committee would “avoid the advocacy role and . . . constitute a consensus that would be of help to public officials in formulating national policy.”25 To the surprise of many, the committee concluded that research demonstrated impressive increases in disease risks from consuming too much fat, cholesterol, salt, sugar, and alcohol, and that the risks could be reduced by eating less of these factors and, therefore, their food sources.

The American Heart Association provided additional professional support for the Dietary Goals in 1978 when its scientists reiterated their long-standing advice to eat less fat, saturated fat, and cholesterol. In 1979 the National Cancer Institute (NCI) issued recommendations consistent with the Dietary Goals in its first statement on the role of diet in cancer risk. By the late 1970s, scientists were in substantial (if not perfect) agreement that similar dietary changes could help prevent the two most important causes of death in the United States—coronary heart disease and cancer.26

Healthy People    

In 1979 the Department of Health, Education, and Welfare (DHEW) issued Healthy People, a report from the surgeon general, intended to “encourage a second public health revolution in the history of the United States. And let us make no mistake about the significance of this document. It represents an emerging consensus among scientists and the health community that the Nation’s health strategy must be dramatically recast to emphasize the prevention of disease.”27

This report kicked off the Public Health Service’s subsequent—and still ongoing—development of ten-year plans to improve the health of the nation. In a small section on nutrition, Healthy People advised eating more complex carbohydrates, more fish, and more poultry but less of the usual culprits (calories, saturated fat, cholesterol, salt, and sugar) and also less red meat. Noting that half the diet consists of processed foods, it also suggested that the nutritional qualities of those foods needed attention. Because advice to eat less meat and be wary of processed foods might be expected to attract unwelcome attention, officials released the report without a press conference as one of the last official acts of Joseph Califano, who had been fired from his position as DHEW Secretary by President Carter the month before. Even so, the report elicited a “storm of protest” from the meat industry. The president of the National Live Stock and Meat Board summarized industry views by noting that the report started with the words “the health of the American people has never been better, and we think it should have ended right there.”28

Healthy People became the last federal publication to explicitly advise “eat less red meat.” When later questioned about that statement, Surgeon General Julius Richmond speculated that subsequent editions of the report might instead advise people to switch to lean meat.29

The USDA’s Food Books    USDA nutritionists, meanwhile could not believe that people might actually follow diets that seemed “so disruptive to usual food patterns,” and they wrote a series of publications to help people meet the Dietary Goals.30 Their first attempt, Food: The Hassle-Free Guide to a Better Diet, appeared cautiously neutral on matters of diet and health: “Many scientists say the American diet is contributing to some of the chronic diseases that hit people in later life. . . . Other scientists believe just as strongly that the evidence doesn’t support such conclusions. So the choice is yours.”31 This guide, however, displayed the vegetable/fruit and bread/cereal groups above the dairy and meat groups, and it added a fifth group of foods at the bottom—fats/sweets/alcohol—that keep bad “nutritional company” (see Figure 7). To reduce fat intake, it suggested, “cut down on fatty meats.” This time, the meat, dairy, and egg industries complained not only about the eat less advice, but also about what they perceived as the unfavorable placement of their food groups below the plant food groups.

According to Carol Tucker Foreman, then Assistant USDA Secretary for Food and Consumer Services, Food was the USDA’s most requested publication in 1979.32 After the 1980 election, however, she and other proponents of such advice lost their politically appointed positions, and food producers found a more favorable reception for their complaints. The new regime at the USDA did not reprint the guide and suspended work on subsequent publications in the series. Instead, the USDA gave the completed page boards to the American Dietetic Association, which issued the guide as two separate booklets in 1982.33 Food was the last USDA publication to suggest any restriction on meat intake for the next 16 years.

Seeking Compromise: Dietary Guidelines for Americans, 1980

In an attempt to give the public advice that would not cause a political backlash, the USDA and the agency that succeeded DHEW, the Department of Health and Human Services (DHHS)—“with the fanfare of Moses unveiling the tablets,” —jointly released the Dietary Guidelines for Americans in February 1980.34 Its seemingly innocuous recommendations were to “Eat a variety of foods; Maintain 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; If you drink alcohol, do so in moderation.”35

Because they had replaced the unacceptable eat less phrases with the vague avoid too much, agency officials expected few objections from food producers. As USDA Secretary Bob Bergland said during the press conference, “They feared we might issue edicts like eat no meat, or eggs, and drink less whole milk. They have been waiting for the other shoe to fall. There is no shoe.”34 Indeed, the Food Marketing Institute (FMI), a trade organization representing supermarket chains, promised to distribute the Guidelines to its members because they are “simple, reasonable and offer great freedom of choice.” Even the American Meat Institute (AMI) found the Guidelines helpful as they called for “a continuing and central role for meat.”29

Other segments of the food industry, however, read between the lines and realized that the Guidelines merely repeated the Dietary Goals in less direct terms. Although they might have seemed bland and uncontroversial, they too elicited an “unbelievable outcry of charges and countercharges, editorials in prestigious newspapers, and congressional hearings.”36 One reporter readily explained the outcry: “The political raison d’etre for the Department of Agriculture is to make it easier for farmers to make money. And that purpose is not well served by permitting the people in Bethesda, Md., to run loose on such politically sensitive matters as red meat, butter, and eggs.”34

In May, the National Academy of Sciences’ Food and Nutrition Board issued a counter-report stating that healthy people should not have to restrict intake of fat or cholesterol. Critics charged that the report’s dissent from the new Dietary Guidelines came from scientists with demonstrable ties to the meat, dairy, and egg industries.37 Embarrassed by the disclosure, the Academy reorganized the Board. In 1982 its new members—with fewer ties to industry—issued a report on diet and cancer that supported the Guidelines and advised limits on intake of meats high in fat and salt, particularly cured meats such as bacon, hot dogs, and sausages, to reduce carcinogens. Meat producers, incensed, held the report responsible for a subsequent fall in livestock prices, and pork producers induced seven members of Congress to demand an investigation.38 Protests were joined by some scientists concerned that the evidence relating diet to cancer was less than compelling: “The credibility of nutritional science is not enhanced by lowering the standards for critical assessment of evidence.”39

Heading toward Consensus, 1981–1990

One of the more ironic aspects of this history is that federal agencies were able to forge a broad—and unexpected—consensus on dietary advice during the conservative era of the Reagan administration. When Ronald Reagan was elected president in November 1980, the Dietary Guidelines seemed doomed. Congress, ostensibly to ensure that all government agencies would speak with “one voice” on the subject of diet and health, immediately directed federal agencies to work with the Food and Nutrition Board to revise them. The new USDA Secretary, John Block, was an Illinois hog farmer; during his confirmation hearings, he had remarked that he was “not so sure government should get into telling people what they should or shouldn’t eat.”40 Two high-level USDA positions had been filled by a former executive director of the American Meat Institute and a lobbyist for the National Cattlemen’s Association (a tradition cherished to this day). In addition, one of Secretary Block’s first acts had been to eliminate the USDA’s Human Nutrition Center, a unit that promoted the interests of consumers rather than producers. Further, when the USDA and DHHS first appointed the new committee to revise the Dietary Guidelines, consumer groups charged that five of the six USDA nominees had close connections to food companies with vested interests in the advice. One prospective DHHS appointee threatened to resign, stating that he had “no intention of being part of a process that guts the guidelines.”41

To the surprise of critics, however, the revised Guidelines appeared in 1985 with trivial changes in just three words: “maintain ideal weight” became “maintain desirable weight,” and “alcohol” became “alcoholic beverages.”42 USDA Secretary Block, joined by the National Cattlemen’s Association, endorsed the new Guidelines, explaining that “all of us have changed in our thinking.”43 This reversal came about as a result of a growing agreement that the preponderance of scientific evidence really did support Dietary Goals and Guidelines. One group after another issued dietary recommendations for prevention of one disease or another, all of the advice strikingly similar. The strongest support continued to come from heart disease groups such as the American Heart Association, which issued policy statements on diet and heart disease risk throughout the 1980s; its recommendations were endorsed by many other groups such as the American Medical Association and an NIH consensus panel. In the mid-1980s, the National Heart, Lung, and Blood Institute (NHLBI) announced a national campaign to lower blood cholesterol across the entire population, beginning with advice to reduce intake of fat and saturated fat. Although some physicians argued that people did not need to restrict their diets until doctors told them to, the NHLBI judged scientific support for a population-wide campaign sufficiently strong to justify its implementation. Groups concerned about cancer, diabetes, and high blood pressure also issued guidelines. Because the similarities of the various sets of recommendations far exceeded their differences, the Dietary Guidelines appeared to constitute a universal and commonly accepted approach to reducing risks for a broad range of chronic diseases.

The idea that the Dietary Guidelines represented a broad consensus received substantial support when four authoritative research reviews appeared one right after the other in the late 1980s. Oddly, the first was a report on meat from the National Academy of Sciences’ Board on Agriculture. It had been sponsored by trade associations such as the American Meat Institute, the National Cattlemen’s Association, and the National Pork Producers Council, whose members were becoming alarmed about the potential effect of fat guidelines on meat consumption. Indeed, the report confirmed the need to reduce fat intake and challenged the industry to start raising leaner meat. It was followed just months later by the massive Surgeon General’s Report on Nutrition and Health and by the even lengthier Diet and Health report from the Food and Nutrition Board in 1989. An analogous summary from the World Health Organization’s 32-country European region also had been issued in 1988.44 All four reports identified the need to restrict fat, particularly saturated fat, as a public health priority. Because none elicited much critical comment, it appeared that scientists at last had agreed on dietary principles and that the food industry was resigned to dealing with the consensus rather than fighting it. We shall soon see that neither of these assumptions proved correct.

Consensus at the Expense of Clarity: Dietary Guidelines, 1990

Despite the apparent scientific agreement, USDA political appointees argued that emerging research established a need to reexamine the Dietary Guidelines. Claiming that the USDA was the “lead agency” for dietary advice to the public, they pressed for and obtained appointment of yet another new committee to reconsider the issue. This one consisted of nutrition scientists and physicians with few apparent ties to the food industry, although groups representing food producers, trade associations, or organizations allied with industry submitted written suggestions, as had become customary during committee reviews.

The revision process revealed that a consensus of sorts had been achieved—but at the price of clarity. To address concerns that some foods might be perceived as “bad,” the committee noted that any food that supplies calories or nutrients should be recognized as useful in a nutritious diet. Furthermore, the committee altered the wording of some guidelines to make them more positive and less restrictive. For the phrase “avoid too much,” it substituted “choose a diet low in.” For “choose lean meat,” it substituted “have two or three servings of meat.” The committee did suggest upper limits of 30% of calories from fat and 10% from saturated fat—precisely those recommended by the 1977 Dietary Goals—but lest that advice appear too restrictive, it emphasized that the goals for fat “apply to the diet over several days, not to a single meal or food. Some foods that contain fat, saturated fat, and cholesterol, such as meats, milk, cheese, and eggs, also contain high-quality protein and are our best sources of certain vitamins and minerals.”45 This edition of the Guidelines elicited no public complaints from food producers, reinforcing the apparent consensus.

Thus many scientists in government and in the private sector had become convinced by 1990 that the preponderance of evidence supported recommendations for dietary restrictions. Increasing public interest in nutrition during the 1980s also had affected receptivity to such advice. Consumer demands for information, purchase of foods perceived as “healthy,” and rejection of foods perceived as “unhealthy,” created a public base of support for federal pronouncements on the role of diet in health. As a result—and perhaps most important—the food industry came to recognize the potential uses of dietary goals and guidelines for marketing purposes. Companies stopped complaining about dietary precepts and instead began using them, noting that guidelines “will encourage companies to develop products for nutrition conscious consumers” and that consumer demand would prompt “food companies to call attention to healthful properties of existing products and introduce a wide array of high fiber, low sodium, low fat and low cholesterol products.”46

The food industry also pressured federal agencies to develop labeling regulations that would permit them to use health claims on food products. By 1989, some of us who had worked on the Surgeon General’s Report on Nutrition and Health concluded that “the fundamental consistency of dietary recommendations for health promotion and disease prevention, though long obscured by controversy, is now generally accepted.”47 We believed that with consensus achieved and the controversy resolved, we could now focus attention on ways to put the guidelines into practice.

NOTES

1. DHHS and USDA. Nutrition Monitoring in the United States: A Progress Report from the Joint Nutrition Monitoring Evaluation Committee. Washington, DC, 1986.
2. Department of Agriculture Organic Act, 12 Stat. 317, May 15, 1962. USDA. Some Landmarks in the History of the Department of Agriculture. Washington, DC: USDA Bureau of Agricultural Economics, 1951.
3. Atwater WO. Foods: Nutritive Value and Cost. Washington, DC: USDA, 1894:25.
4. Hunt CL, Atwater HW. How to Select Foods. I. What the Body Needs. Washington, DC: USDA, 1917.
5. Hunt CL. Good Proportions in the Diet. Washington, DC: USDA, 1923:1.
6. Stiebling HK, Ward MM. Diets at Four Levels of Nutritive Content and Cost. Washington, DC: USDA, 1933.
7. Roberts LJ. Beginnings of the Recommended Dietary Allowances. J Am Diet Assoc 1958;34:903–908. Harper AE. Origins of Recommended Dietary Allowances—a historic overview. Am J Clin Nutr 1985;41:140–148.
8. Office of Defense Health and Welfare Services. U.S. Needs Us Strong. Washington, DC, 1942. Bureau of Home Economics. When You Eat Out: Food for Freedom. Washington, DC, 1942.
9. War Food Administration. National Wartime Nutrition Guide. Washington, DC: USDA, 1943.
10. Bureau of Human Nutrition and Home Economics. National Food Guide. Washington, DC: USDA, 1946.
11. Bureau of Human Nutrition and Home Economics. Food for Growth: Food for Freedom. Washington, DC: USDA, 1946.
12. Hill MM, Cleveland LE. Food guides—their development and use. Nutrition Program News. Washington, DC: USDA, 1970.
13. Citizens’ Board of Inquiry into Hunger and Malnutrition in the United States. Hunger U.S.A. Revisited. New York: Field Foundation, 1972:4.
14. George McGovern. Letter of transmittal. In: U.S. Senate Final Report of the Select Committee on Nutrition and Human Needs. Washington, DC, December 1977:1.
15. White House Conference on Food, Nutrition, and Health. Final Report. Washington, DC, 1970.
16. Austin JE, Hitt C. Nutrition Intervention in the United States: Cases and Concepts. Cambridge, MA: Ballinger, 1979:331.
17. U.S. Senate. Final Report of the Select Committee on Nutrition and Human Needs. Washington, DC, December 1977:17–20.
18. U.S. Senate Select Committee on Nutrition and Human Needs. Diet Related to Killer Diseases, III. Hearings in Response to Dietary Goals for the United States: Re Meat. Washington, DC, March 24, 1977.
19. Mottern, N. Dietary goals. Food Monitor March/April, 1978:8–10.
20. Truswell AS. Evolution of dietary recommendations, goals, and guidelines. Am J Clin Nutr 1987;45:1060–1072. Also see: Harper AE. Dietary goals—a skeptical view. Am J Clin Nutr 1978,31:310–321.
21. U.S. Senate Select Committee on Nutrition and Human Needs. Dietary Goals for the United States—Supplemental Views. Washington, DC, November 1977:677.
22. Putman JJ, Allshouse JE. Food Consumption, Prices, and Expenditures, 1970–1997. Washington, DC: USDA, 1999:83.
23. U. S. Senate Select Committee on Nutrition and Human Needs. Dietary Goals for the United States, 2nd ed. Washington, DC, December 1977:4.
24. Broad WJ. NIH deals gingerly with diet–disease link. Science 1979;204:1175–1178.
25. Report of the task force on the evidence relating six dietary factors to the nation’s health. Am J Clin Nutr 1979;32:2627–2748.
26. American Heart Association Committee on Nutrition. Diet and coronary heart disease. Circulation 1978;58:762A–765A. Upton AC. Statement on Diet, Nutrition, and Cancer. Hearings of the Subcommittee on Nutrition, Senate Committee on Agriculture, Nutrition, and Forestry, October 2, 1979. Washington, DC, 1979.
27. U.S. Department of Health, Education, and Welfare. Healthy People: the Surgeon General’s Report on Health Promotion and Disease Prevention. Washington, DC, 1979:vii. The first public health revolution was the fight against infectious diseases.
28. Monte T. The U.S. finally takes a stand on diet. Nutrition Action September 1979:4.
29. USDA and HEW unveil guidelines for healthy eating. CNI Weekly Report 1980;10(6): 1–2. CNI is the Community Nutrition Institute.
30. Wolf ID, Peterkin BB. Dietary Guidelines: the USDA perspective. Food Technology 1984;38(7):80–86.
31. Science and Education Administration. Food: The Hassle-Free Guide to a Better Diet. Washington, DC: USDA, 1979:3.
32. Foreman CT. Remarks prepared for a press briefing on the release of Ideas for Better Eating. Washington, DC: USDA, January 8, 1981. Ms. Foreman, then in her last month in office, stated that USDA had distributed more than 950,000 copies of Food and that another 490,000 had been requested.
33. Food 2: A Dieter’s Guide, and Food 3: Eating the Moderate Fat & Cholesterol Way. Chicago: American Dietetic Association, 1982.
34. Greenberg DS. Nutrition: a long wait for a little advice. Science 1980;302:535–536.
35. USDA and DHHS. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC, 1980.
36. Miller SA, Stephenson MG. Scientific and public health rationale for the Dietary Guidelines for Americans. Am J Clin Nutr 1985;42:739–745.
37. Food and Nutrition Board. Toward Healthful Diets. Washington, DC: National Academy of Sciences, 1980. Brody JE. Experts assail report declaring curb on cholesterol isn’t needed. New York Times June 1, 1980:A1. Wade N. Food board’s fat report hits fire. Science 1980;209:248–250.
38. Food and Nutrition Board. Diet, Nutrition, and Cancer. Washington, DC: National Academy Press, 1982. U.S. General Accounting Office. National Academy of Sciences’ Reports on Diet and Health—Are They Credible and Consistent? Washington, DC, 1984.
39. Mendeloff AI. Appraisal of “Diet, Nutrition, and Cancer.” Am J Clin Nutr 1983;37:495–498. Pariza MW. A perspective on diet, nutrition, and cancer. JAMA 1984;251:1455–1458.
40. Maugh TM. Cancer is not inevitable. Science 1982;217:36–37. USDA, HHS disagree on diet-cancer report. CNI Weekly Report 1983;13(22):1.
41. Schwartz R. The big fuss over good food. New York Times April 24, 1983:C15. USDA readies to carve up the Dietary Guidelines. Nutrition Action 1983;10:3–4.
42. USDA and DHHS. Nutrition and Your Health: Dietary Guidelines for Americans, 2nd ed. Washington, DC, 1985.
43. Reagan administration OK’s dietary guidelines. CNI Weekly Report September 26, 1985:2.
44. Board on Agriculture. Designing Foods: Animal Product Options in the Marketplace. Washington, DC: National Academy Press, 1988. DHHS. The Surgeon General’s Report on Nutrition and Health. Washington, DC, 1988. Food and Nutrition Board. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press, 1989. James WPT. Healthy Nutrition: Preventing Nutrition-Related Diseases in Europe. Copenhagen: World Health Organization, 1988.
45. USDA and DHHS. Nutrition and Your Health: Dietary Guidelines for Americans, 3rd ed. Washington, DC, 1990.
46. Surgeon General’s dietary recommendations support need for health messages on foods (press release). Washington, DC: The National Food Processors Association, July 27, 1988.
47. McGinnis JM, Nestle M. The Surgeon General’s Report on Nutrition and Health: policy implications and implementation strategies. Am J Clin Nutr 1989;49:23–28.

Written by Marion Nestle in "Food Politics - How the Food Industry Influences Nutrition and Health", University of California Press, USA, 2013, excerpt chapter 1. Digitized, adapted and illustrated to be posted by Leopoldo Costa.