Rehab time for familiar food pyramid

Washington -- The U.S. Dept. of Agriculture is revamping its food guidance system in an effort to help combat America's obesity epidemic -- a move that could lead to the reconfiguration of the iconic food pyramid.

The need for effective tools is apparent.

"Unfortunately, we are the fattest people in the world," said Eric M. Bost, Agriculture Dept. undersecretary for Food Nutrition and Consumer Services, as an opening salvo for an Aug. 19 public hearing on the department's actions. "If we were just chubby and happy that would be one thing, but over 400,000 people die as a result of obesity-related illnesses."

Rates of diabetes and heart disease are skyrocketing, and much of the blame is attributed to Americans' increasing heft.

Whether blame can also be laid at the base of the food pyramid is another matter. While the symbol is well-known, perhaps because it is often used on food wrappings, scant attention is apparently paid to what is inside the pyramid and even less attention is given to the voluminous written material that is intended to explain it.

"I find [the pyramid] not particularly useful as a physician doing nutrition and obesity counseling on a daily basis," said Robert F. Kushner, MD, medical director of the Wellness Institute at Northwestern Memorial Hospital in Chicago.

Although "it is a nice reminder that a healthy diet includes all the food groups, we rarely use that depiction in our program, and I'm not sure how many physicians actually do use it. I think for many members of the public it's old news," said Dr. Kushner, also editor of an AMA primer on counseling obese patients.

There are others though, who think better of the USDA's graphic. "We use the pyramid every day," said Caroline M. Apovian, MD, director of Boston Medical Center's Nutrition and Weight Management Center. "I think it was beautifully done and intelligently done. I just think you need to add the verbal instruction to go along with the pyramid."

The pyramid is still effective, and it is readily recognized, she added. The problem is that few people actually follow it.

The Agriculture Dept. hopes to change this when it updates the nutritional information the pyramid offers.

A common effort

The project is occurring at a good time, said Eric J. Hentges, PhD, executive director of the USDA's Center for Nutrition Policy and Promotion. Never before has the department been working on the same timetable as another federal committee that is updating dietary guidelines for the nation.

Specifically, the congressionally mandated Dietary Guidelines Advisory Committee offered draft recommendations last month, and the USDA stands ready to incorporate this panel's advice in its new graphic and educational materials, said Dr. Hentges.

The advisory panel's final dietary recommendations are expected to be released in early 2005, which is also when the USDA plans to unveil its new material, he said.

In yet another effort to help Americans eat better, the Food and Drug Administration is requiring food manufacturers to list transfatty acids, or trans fats, on food labels. That requirement takes effect on Jan. 1, 2006, although some larger manufacturers have already begun placing the information on labels.

Such actions by the federal government reverberate throughout the medical community as well as the food and diet industries.

The American Heart Assn., for one, is paying close attention, said AHA President-elect Robert H. Eckel, MD. The association has its own dietary guidelines that already emphasize fruits and vegetables, whole grains and physical activity. Those guidelines were released in 2000, and an update is in the works with a planned release date in 2005.

Which foods are recommended -- or not recommended -- means a great deal to many stakeholders who were presenters for the USDA's hearing. The president of the Sugar Assn. was followed by the executive director of nutrition for the National Cattlemen's Beef Assn. and a representative from the U.S. Potato Board.

Dean Ornish, MD, founder and president of the Preventive Medicine Research Institute in Sausalito, Calif., and author of best-selling health and diet books, presented his own pyramid, which counsels the avoidance of red meat, butter and transfatty acids and the consumption, "in abundance" of fruits, legumes, vegetables and whole grains.

Also testifying were representatives from the Atkins diet and Weight Watchers.

The USDA was reminded that recommendations that people cut the amounts of fat they consume resulted in the proliferation and popularity of low-fat snack food and people gained more weight. The current interest in low-carbohydrate foods has spawned a similar marketing frenzy.

David Katz, MD, MPH, director of the Yale Preventive Research Center at Yale University in Connecticut, delivered an "appeal to common sense."

"I implore you now to be parents and to be protectors of the public health rather than engage in politics as usual," he said.

"The public needs clear guidance on foods they should be eating more of and food they should be eating less of. We can do better than repeat the follies of history; we can create a better nutritional future."