nutritional deficiencies: dietary advice and its discontents | garrett broad, universityof pennsylvania | adele hite, north carolina state university

Nutrition Troubles

Abstract: This conversation is part of a special issue on ‘‘CriticalNutrition’’ in which multiple authors weigh in on various themesrelated to the origins, character, and consequences of contemporaryAmerican nutrition discourses and practices, as well as how nutritionmight be known and done differently. In this section one author callsinto question the validity and efficacy of the 1977 Dietary Goals for theUnited States that are still widely used in official nutrition information.

A second author considers whether official dietary recommendationsare commonly known, let alone followed, and therefore questionstheir effectiveness at shaping actual dietary practice.

Keywords: dietary guidelines, nutrition science, energy balancemodel, dietary communication, contested science.

Introduction: Julie Guthman

one of the more provocative observations in Michael

Pollan’s widely read book, In Defense of Food (2008), is that

diet-related disease in the United States seems to be increasing

in tandem with the proliferation and popularization of dietary

advice. As he puts it, ‘‘Thirty years of official nutritional advice

has only made us sicker and fatter while ruining countless

numbers of meals.’’ While some, including myself, would con-

test Pollan’s recurring condemnation of fat people as indicators

of a food system gone awry (see, for, example, my 2007 essay,

this journal), he makes a good point: given the ubiquity of

dietary prescriptions in the American media, it seems unlikely

that most people living in America would not have at least an

inkling of what experts say they should or should not eat to

maintain dietary health. Putting aside the fact that many peo-

ple simply do not follow dietary advice, some argue—and I

think Pollan would agree—that the problem lies with nutrition

confusion: dietary messages are not as straightforward as they

seem and can even be conflicting (Scrinis 2008; Yates-Doerr

2012). Yates-Doerr, for example, shows how Guatemalans seek-

ing dietary advice because of their struggles with diabetes may

believe sugar is good for them, because Guatemalan sugar has

been visibly fortified with several different vitamins that these

patients have been taught are essential for health.

Another possible explanation for Pollan’s conundrum is that

current dietary advice is based on weak science. At the very least,

current debates about whether it is calories or carbohydrates that

are most fundamentally responsible for population-wide weight

gain (see, for example, Taubes 2007 vs. Nestle and Nesheim

2012) is evidence that nutritional matters are far from settled.

New knowledge about the etiology of obesity and diabetes that

challenge that these are strictly diet-related conditions further

trouble current nutritional advice (see Guthman 2013, as well as

Beyond the Sovereign Body). Yet another explanation is that

dietary guidelines do not actually reflect the science that is out

there. To explore these latter two explanations, in this section

Adele Hite dives deeply into the controversies surrounding the

1977 ‘‘Dietary Goals for the United States’’ that are still widely

used in official nutrition information. Her interlocutor, Garrett

Broad, considers whether official dietary recommendations have

much reach at all, and therefore questions their effectiveness at

shaping actual dietary practice.

Unquestioned Assumptions, UnintendedConsequences: Adele Hite

As a registered dietitian and student of public health nutrition

policy and nutrition epidemiology, I am acutely aware that

the project of public health nutrition policy for prevention of

chronic disease in America has been carried forward with

little acknowledgment of both existing scientific controversy

within the field and the lives of people and communities who

are affected, in ways large and small, by its consequences.

Until the late twentieth century, public health nutrition

largely involved ensuring a safe reliable food supply and ade-

quate nutrition for all (Edelstein 2006). By the 1970s, the

problem of ‘‘under-nutrition’’ was seen as for the most part

‘‘solved,’’ and focus shifted to what was characterized as a crisis

gastronomica: the journal of critical food studies, vol.14, no.3, pp.5–16, issn 1529-3262. © 2014 by the regents of the university of california. all rights reserved. please direct all requests for permission to

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of ‘‘over-nutrition’’ (Austin and Hitt 1979). Public health

nutrition efforts shifted toward the present view that most

chronic diseases can be prevented through managing dietary

behavior.

In the vast array of sometimes conflicting information

that falls under the mantle of modern nutritional guidance,

I can identify two foundational beliefs upon which current

public health nutrition, as well as its alternatives, has been

built. The first is that individuals can reduce their risk of

chronic disease by choosing diets that contain more of the

‘‘right’’ foods and fewer of the ‘‘wrong’’ ones. This approach

defines ‘‘right’’ foods as ones that do not contain certain food

components thought to be harmful; ‘‘wrong’’ foods, clearly,

are foods that do contain the components so designated

(Drewnowski 2005: 723). Conceptualizing the healthfulness

of a diet in this manner stands in contrast to understanding

dietary adequacy by the presence of nutrients that are consid-

ered essential. Although other approaches to nutrition may

also define a ‘‘healthy diet’’ by what foods and food compo-

nents are excluded, rather than by what essential nutrition is

provided, this approach became the basis of mainstream

nutrition with the creation of the Dietary Goals (later called

Guidelines) for Americans (DGA).

Since their inception in 1977, the DGA have been a guid-

ing force in mainstream nutrition, forming the basis for all

federal nutrition programs, ‘‘including research, education,

nutrition assistance, labeling, and nutrition promotion’’

(US Department of Agriculture, Center for Nutrition Policy

and Promotion 2011: 2). Furthermore, public health profes-

sionals, dietitians, nutritionists, and other healthcare provi-

ders use the DGA as the basis for dietary recommendations

and nutrition advice; the DGA version of nutrition is taught

in public schools and universities; and the DGA shape how

food manufacturers formulate products. As the primary

authority on nutrition in America, for the past thirty-five years

the DGA have asserted that saturated fat, cholesterol, sodium,

and sugar are food components to avoid in order to reduce

risk of chronic disease, specifically heart disease; more

recently, trans fats and refined grains have been added to that

list (US Department of Agriculture and US Department of

Health and Human Services 2011: 20–21). Foods that are

recommended by the DGA include fruits, vegetables, whole

grain products, fat-free and low-fat dairy products, lean meats,

seafood, and vegetable oils. Many of these foods are consid-

ered desirable primarily because they do not contain food

components considered to be unhealthy, such as saturated

fat and cholesterol. Foods to reduce or avoid are ones that

do contain these food components—fatty meat or meat with

the fat and skin intact, butter, cream, eggs, whole milk, and

cheese—along with processed foods high in sodium, trans

fats, refined grains, and added sugars.

The other foundational belief of modern nutrition is that

‘‘a calorie is a calorie’’ and that ‘‘the total number of calories

consumed is the essential dietary factor relevant to body

weight’’ (US Department of Agriculture and US Department

of Health and Human Services 2011: 15). This tenet asserts

that the primary operating principle in maintaining or achiev-

ing a healthy weight is the energy value of food (‘‘calories in’’)

relative to the energy expended by the individual (‘‘calories

out’’). According to the ‘‘energy balance’’ principle, in order

to maintain current body weight, an individual should not

consume more calories than are expended; ‘‘calories in’’ must

equal ‘‘calories out.’’ In order to lose weight, an individual

should consume fewer calories than normal while becoming

more physically active. The corollaries to this principle are

that each side of the ‘‘energy balance’’ equation operates

independently of the other, and each can be controlled by

the individual. For example, it is assumed that if ‘‘calories in’’

are reduced, this will have no effect on an individual’s ability

to increase or maintain ‘‘calories out’’ through metabolism

and/or activity.

Although ‘‘calorie counting’’ has been part of white,

middle-class culture, particularly among women, since the

early twentieth century (LaBerge 2008: 141), it was not always

considered the most important factor in body weight regula-

tion (Taubes 2007: 406). Weight was not addressed in the

1977 DGA, but the 1980 DGA urged Americans to ‘‘Maintain

a healthy weight,’’ and to do so by selecting foods that contain

fewer calories or increasing activity or both (US Department

of Agriculture and US Department of Health and Human

Services 1980: 7). When the rising rates of overweight and

obesity became a public health concern in the early 1990s,

the DGA recommendation became more specific, calling for

Americans to ‘‘Balance the food you eat with physical activ-

ity—maintain or improve your weight’’ (US Department of

Agriculture and US Department of Health and Human Ser-

vices 1995: 15). Although environmental and genetic factors

are acknowledged as factors that may affect body weight, the

DGA and most nutrition and healthcare professionals assert

that ‘‘calorie balance over time is the key to weight manage-

ment,’’ and it is up to individuals to ‘‘control what they eat and

drink, as well as how many calories they use in physical

activity’’ (US Department of Agriculture and US Department

of Health and Human Services 2011: 8). While foods desig-

nated as healthy are preferable, ‘‘the number of calories con-

sumed related to those expended matters more to weight loss

than where the calories come from. To lose weight, eat less; it

works every time’’ (Nestle and Nesheim 2012).

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FIGURE 1: Reflecting the recommendations of the Dietary Guidelines, nutrition labels on packaged foods emphasize calorie counting and thereduction of food components—specifically fat, saturated fat, cholesterol, and sodium—thought to contribute to chronic disease.image courtesy of the u.s. food and drug administration

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The creation of these guidelines has a telling history. In

1977, Senator George McGovern, a Democrat from South

Dakota, led a Select Committee on Nutrition and Human

Needs in releasing a report blaming what they saw as an

‘‘epidemic’’ of killer diseases—obesity, diabetes, heart disease,

and cancer—on changes in the American diet that had

occurred in the previous fifty years, specifically the increase

in ‘‘fatty and cholesterol-rich foods’’ (Select Committee on

Nutrition and Human Needs, United States Senate 1977a:

3). About to be defunded for lack of work, the committee felt

it could extend its tenure, as well as respond to political

interests and popular trends, by doing for diet and chronic

disease what the 1964 Surgeon General’s Report on Smoking

and Health had done for cigarettes and cancer, namely draw

a clear connection between lifestyle choices and health

outcomes (Hegsted 1990). Policymakers were concerned

about rising healthcare costs, which were seen as a threat to

economic growth, impacting prices, wages, and profits, as

corporations passed on the costs of medical benefits to con-

sumers (Crawford 1977: 666). Public anxiety—particularly in

white, middle-class populations—encompassed issues of

health, but also extended to concerns about the environment,

world hunger, and energy use, issues that cookbook author

Frances Moore Lappe maintained individuals could influ-

ence by switching to a vegetarian diet. The committee’s

report used her cookbook, Diet for a Small Planet (1971),

along with research on vegetarian diets, to argue that a shift

to plant-based protein could reduce intake of calories, cho-

lesterol, and saturated fat, as well as reduce blood pressure,

risk of cancer, use of natural resources, and food costs (Select

Committee on Nutrition and Human Needs, United States

Senate 1977a: 29). Although some benefits not directly related

to nutrition were also implied, the primary message asserted

that risk of chronic disease could be reduced by decreasing

consumption of foods containing animal fats, salt, and sugar

and, in lieu of these foods, consuming more fruits, vegetables,

grains, cereals, and vegetable oils.

The 1977 DGA were met with tremendous controversy

among scientists, doctors, and public health professionals, who

raised concerns that specific recommendations were unsup-

ported, unclear, and potentially harmful; the reliance on obser-

vational studies as evidence was inadequate for establishing

relationships between diet and chronic disease; and the crea-

tion of untested one size fits all dietary guidelines was inappro-

priate as a public health intervention (Select Committee on

Nutrition and Human Needs, United States Senate 1977b).

A primary concern was the lack of evidence to support specific

proposed measures. Responses to the 1977 DGA pointed out

that current science also supported recommendations that

were diametrically opposed to the guidance suggested by the

committee. For instance, while the DGA called for increases

in dietary starches such as grains and cereals, available evi-

dence also indicated that reducing consumption of these foods

reduced the risk of heart disease (ibid.: 19). Although the DGA

suggested consumers should increase vegetable oil consump-

tion, dissenting scientists argued that increased consumption of

vegetable oils and decreased consumption of saturated fats

were, according to data supplied by the 1977 DGA themselves,

associated with increased levels of heart disease (ibid.: 42).

They also raised doubts regarding the appropriateness of a sin-

gle, population-wide dietary prescription, applied to all indivi-

duals regardless of level of risk, to prevent diseases that were not

established as nutritional in nature (Harper 1978: 310–11). In

addition, they strenuously objected that these recommenda-

tions had not been tested for safety or efficacy and would be

the equivalent of conducting a population-wide dietary exper-

iment (Weil 1979: 369).

The science behind the DGA has remained a contested

area. Science journalist Gary Taubes and neuroendocrinolo-

gist Robert Lustig assert that the controversy surrounding the

first DGA raised legitimate scientific and public health con-

cerns (Taubes 2007: 46; Lustig 2012: 112), while nutrition pol-

icy expert Marion Nestle contends the controversy ‘‘derived

more directly from the profound economic implications of

the advice’’ on egg and meat producers (Nestle 2007: 41).

Unlike manufacturers of dairy products, vegetable oils, and

processed grain and cereal foods, all of whom stood to benefit

from the changes recommended by the 1977 DGA, egg and

meat producers could not easily alter their products to reduce

or replace fat, saturated fat, or cholesterol. These producers

argued that only a small portion of available science sup-

ported the recommendation to reduce consumption of meat

and eggs and insisted on hearings that presented existing

evidence that saturated fat and cholesterol were not related

to risk of chronic disease. While some of the scientists who

supported these views had been funded by those industries,

others had no such affiliation and raised the same objections,

along with additional and more general concerns. However,

the press at the time—and many food reformers since,

including Nestle and food writer Michael Pollan—inter-

preted the minor changes that the committee made to the

second edition of the 1977 DGA as ‘‘caving in’’ to the

demands of these industries and endangering the health of

Americans (Nestle 2007: 41; Pollan 2007). The potent rhetor-

ical device of pitting economic interests against the health

of the American people sets up a discursive stance still

employed today that deflects continued doubt regarding the

scientific foundations of national dietary guidance: namely,

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those who propose that evidence linking saturated fat and

cholesterol to heart disease is weak or inconsistent are char-

acterized as industry flacks, fad diet doctors, or fringe scien-

tists (Nestle 2013; Nainggolan 2010).

It is hard to determine whether or not individuals con-

cerned about nutrition know of, agree with, or follow the

specific recommendations prescribed by the DGA, although

the belief that risk of chronic disease can be modified by diet

has become pervasive. Without specifically defining what

such a diet is, an FDA survey found that the majority of those

surveyed agreed that they could reduce their chance of heart

disease and cancer by eating a ‘‘healthy diet’’ (US Department

of Health and Human Services, Food and Drug Administra-

tion 2014). Still, it is important to consider whether popula-

tion measures of health have improved since the release of

the guidelines. Since the late 1970s, some health markers in

Americans have certainly improved. Rates of hypertension

have gone down, as have serum cholesterol levels, and heart

disease mortality has declined, although this decline began

a decade before the DGA were created. At the same time,

rates of a number of chronic diseases have gone up signifi-

cantly. Prevalence of heart failure and stroke has increased

dramatically (National Heart, Lung, and Blood Institute

2007: 37, 43). Rates of new cases of all cancers have gone

up (Jemal et al. 2005: 15). Rates of diabetes have tripled

(Centers for Disease Control and Prevention 2013). And

although the measurements themselves are problematic,

most measures indicate rates of overweight and obesity have

increased (Ogden and Carroll 2010: 3). Some researchers

have attributed the reduction in cardiovascular mortality and

positive changes in health biomarkers to the consumption of

more grains and cereals and less animal fats; others have

suggested that has these same changes in consumption have

contributed significantly to the rapid rise in obesity and dia-

betes (Carroll et al. 2005: 1780; Marantz, Bird, and Alderman

2008: 2).

The cynical response to the lack of improvement in

health outcomes following the creation of the DGA is that

such results are to be expected since no one follows the

recommendations anyway (Slavin 2011: 46). But this response

conflates two different questions. First, there is the question

of efficacy: Would the DGA recommendations result in

a reduction of chronic disease if they were adhered to closely

in an experimental setting? The answer to this question is

unknown. ‘‘Intervention studies, where diets following the

Dietary Guidelines are fed long-term to human volunteers,

do not exist’’ (ibid.), and the food patterns recommended by

the DGA ‘‘have not been specifically tested for health bene-

fits’’ (US Department of Agriculture and US Department of

Health and Human Services 2011: 50). Then, there is the

question of effectiveness: Do the DGA recommendations

work in ‘‘real life’’? This question can be addressed from an

‘‘intention-to-treat’’ framework, which answers ‘‘the public

health question of what happens when a recommendation

is made to the general public and the public decides how

to implement it,’’ apart from whether or not the recom-

mended intervention works under controlled circumstances

(Dallal 1998). Framing the usefulness of the DGA this way

directly confronts the question of whether health outcomes

are improved by the provision of these recommendations as

public health policy. The answer to that question appears to

be no.

The two primary ways to evaluate whether or not Amer-

icans are following DGA recommendations are US food sup-

ply patterns and dietary intake surveys. Even though they

make some adjustments for loss, food supply estimates are

usually assumed to be overestimates of consumption because

they do not include losses that occur before food reaches the

retail level (US Department of Agriculture, Economic

Research Service 2013). Surveys, on the other hand, are fre-

quently criticized as inaccurate due to assumptions that

respondents underreport intake. While both have flaws,

together these two methods indicate the same pattern: Amer-

icans have increased their intake of flour and cereal products

and the vegetable oils that could be added to them, changes

that are in line with DGA recommendations. From 1970 to

FIGURE 2: This National Cholesterol Education Program posterpromotes beans as a low-fat, plant-based alternative source of proteinfor Americans trying to reduce their consumption of meat and eggs, asdirected by the Dietary Guidelines.image courtesy of the national cholesterol education program, national institutes

of health, 1994

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2010, the energy available from flour and cereal products and

the oils added to foods increased by over 400 calories/person/

day, while the energy from milk, meat, eggs, and nuts

increased by less than 20. Energy from added sweeteners in

our food supply increased by only about 35 calories/person/

day, about two teaspoons’ worth of sugar (ibid.). Consump-

tion data gathered from national health surveys indicate that

virtually all of the increase in calories in the past thirty years

has come from carbohydrate foods (starches and sugars such

as would be found in flour and cereal products), while calo-

ries from saturated (animal) fats have decreased (Wright et al.

2004: 82). In terms of macronutrient content, these changes

are in accord with recommendations from the DGA.

Why have the DGA not worked as intended? Some think

the DGA would prevent obesity and chronic disease if only

Americans followed them more closely and if public health

messages did more to address caloric intake, portion size, and

inactivity (Woolf and Nestle 2008: 264). Others feel the DGA

would be effective if they contained different recommenda-

tions, such as specific guidance for quality and quantity of

protein intake or further reductions in use of animal products

(Layman 2004: 6; Bertron, Barnard, and Mills 1999: 206). Still

others, including Joanne Slavin, a nutrition epidemiologist

who participated in writing the 2010 DGA Committee

Report, echo the original controversy surrounding the 1977

DGA, namely, that public health experts and nutrition scien-

tists lack adequate scientific support to create effective

population-wide recommendations concerning diet and

chronic disease (Slavin 2011: 46).

Many predicted all along that the uptake of DGA recom-

mendations to increase consumption of grains, cereals, and

vegetable oils and decrease intake of meat, eggs, and whole

milk might result in increases in some types of chronic dis-

ease. One egregious example of where the application of the

guidelines went astray was in their promotion of trans fats,

which are now associated with increased risk of disease, as the

‘‘healthier’’ alternative to saturated fats in many processed

foods (Schleifer 2012: 96). Experimental trials also found links

between omega-6 fatty acids in vegetable oils and heart dis-

ease, even as vegetable oils took the place of animal fats in the

food supply (Ramsden et al. 2013: 6; Blasbalg et al. 2011: 952).

Even scientists involved in the creation of the DGA have

questioned the effectiveness of low-fat, high-carbohydrate diet

recommendations, concluding that the ‘‘previous priority

given to a ‘low-fat intake’ may lead people to believe that,

as long as fat intake is low, the diet will be entirely healthful.

This belief could engender an overconsumption of total cal-

ories in the form of carbohydrates, resulting in the adverse

metabolic consequences of high carbohydrate diets’’ (Dietary

Guidelines Advisory Committee 2000: 36). Concerns have

also been raised regarding the effects that following DGA

recommendations would have on a nutritionally adequate

diet. For example, reducing egg consumption also reduces

intake of choline, an essential nutrient important for neuro-

logical development (Herron and Fernandez 2004: 189). Die-

tary patterns that meet the DGA restrictions on sodium may

fail to provide adequate potassium and other micronutrients

(e.g., vitamins and minerals) (Maillot, Monsivais, and Drew-

nowski 2013: 192).

Fundamentally, by implying a certainty that does not

exist regarding clear links between diet, food choices, obesity,

and chronic disease, the DGA established that individuals

could now be held primarily responsible for disease preven-

tion. In this regard, the official acceptance of a link between

diet and chronic disease may have shifted attention away

from the government’s responsibility to improve economic,

environmental, and social conditions related to health

(Eisenberg 1977: 1231). In 1977 and 1980, the institutionaliza-

tion of the DGA may have helped reverse the momentum

towards a national health insurance program (Crawford 2006,

409). The ability of an individual to make prudent foods

choices, whether in alignment with DGA advice or with

alternative recommendations, became ‘‘insurance’’ against

future health problems. As public health policy, this

approach appears flawed, but, as Crawford puts it, ‘‘As an

ideology, it simplified the world. . . . One either changed diet

and exercised and thereby avoided heart disease and fatness

or not’’ (ibid.). In that way the DGA were part and parcel of

the establishment of a neoliberal social order where ‘‘collec-

tive responsibility for economic and social well-being’’ was

FIGURE 3: The rapid rise in overweight and obesity began after, ratherthan before, the creation of the 1977 Dietary Goals, a set of nationalnutritional recommendations designed as a public health interventionto prevent ‘‘epidemics’’ of obesity and chronic disease. Data fromOgden and Carroll (2010).

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eclipsed by ‘‘privatized, market solutions to public problems’’

(ibid.)—ideas that are discussed in other sections of this spe-

cial issue. While there are undoubtedly many factors at play

to explain the rapid rise in obesity and rates of some chronic

diseases after the creation of the DGA, the influence that

these recommendations exerted on the food supply, federal

nutrition policies and programs, health practices of indivi-

duals, and institutionalized beliefs regarding individual

responsibility for prevention of disease should not be consid-

ered benign with regard to health outcomes.

Narrowcasted Nutrition Sciences: Garrett Broad

Adele’s historical exploration of the constructed and con-

tested nature of the Dietary Guidelines for Americans (DGA)

raises fundamental questions about the ways in which these

seemingly authoritative pronouncements should be handled

by nutrition practitioners and policymakers. As a researcher

in the field of communication and media studies, I find

myself particularly interested in the dynamics through which

everyday people define concepts like ‘‘healthy eating’’ and

conceptualize what types of foods are ‘‘good for them.’’

Adele’s intellectual skepticism about the DGA has inspired

me to ask a new set of questions in my own research—notably,

when members of the eating public ask themselves what

a ‘‘healthy diet’’ really looks like, do the perspectives of nutri-

tion professionals or the DGA matter at all?

Arguments that foreground the DGA in discussions about

diet and health tend to assert that, from the time they were

first drafted in 1977, the recommendations have served to

‘‘shape the cultural norms regarding what foods and eating

patterns are considered appropriate for a healthy diet’’ (Hite

2012). As Denise Minger has argued, when it comes to advice

about nutrition in the United States, the scientific assertions

of groups such as the National Institutes of Health, the US

Department of Agriculture, and the American Dietetic Asso-

ciation ‘‘congeal into a glob of so-called conventional wis-

dom—an inventory of beliefs so widespread that we no

longer bother questioning them’’ (Minger 2014: 2, emphasis

in original). While I do not doubt that mainstream nutrition

science has had a number of tangible impacts on social policy

and practice, I remain unconvinced that this so-called conven-

tional wisdom holds true. Instead, when it comes to cultural

narratives about food and its relationship to health, it seems

that nutritional contestation preceded the development of the

DGA, endured throughout its political ascendance, and has

become increasingly salient in an age of digital technology and

media fragmentation (Larsen and Martey 2011; Yager 2010). For

scholars with a desire to understand how people make sense

of their own nutritional worlds, it is important to investigate

these oppositional nutritional stories, ultimately decentering

the role of formal institutional knowledge practices and

granting closer attention to the cacophony of voices that

people actually listen to when they wonder what would be

‘‘good for them’’ to eat.

Many advocates who support the status quo of the DGA,

of course, have actually lamented the fact that nutrition pro-

fessionals and public health experts have been unable to

move the public’s dietary philosophy or eating practices more

closely in line with the USDA’s governmental recommenda-

tions (Rowe et al. 2011). In a recent Family Nutrition and

Physical Activity Survey, the American Dietetic Association

(now the Academy of Nutrition and Dietetics, or AND) found

that, ‘‘Less than 25 percent of parents and children correctly

identified grains as the food group from which the most ser-

vings should be consumed daily’’ (American Dietetic Associ-

ation 2010). Why would this guiding logic of the DGA not

come through in the nutrition knowledge of the public? In

another recent survey, the ADA/AND asked respondents what

sources they depend on for information about nutrition.

Nutritionists and Registered Dietitians ranked near the very

bottom—mentioned by just 2% and 1% of the sample, respec-

tively—while the USDA/My Pyramid was not mentioned at

all (American Dietetic Association 2011).

In order to uncover then what does shape cultural defini-

tions of healthy eating, we need to figure out what commu-

nication and information sources individuals actually depend

upon when they seek out nutrition-related knowledge. I refer

to this network of interpersonal, institutional, and mediated

communication connections as a person’s nutrition-oriented

communication ecology (Ball-Rokeach et al. 2012; Broad et al.

2013). When we commence this type of investigation, we find

that the communication ecologies of the eating public are

hardly characterized by a single narrative of nutrition science

from above. Rather, this contested nutritional space is occu-

pied by a host of competing expert and lay nutrition

sciences—ranging from the governmental assertions of the

DGA, to the weight management guidelines of Jenny Craig,

Inc., to the spiritually infused regimen of Macrobiotic advo-

cates and many more in between. In their attempts to vie for

the trust and attention of food consumers, the stories these

sciences tell are grounded in an array of different motivations,

cultural assumptions, philosophies, and levels of empirical

validity. Some remain mostly in line with the ‘‘conventional

wisdom’’ of the nutrition science gatekeepers; others present

themselves in fundamental opposition to the status quo.

Together, they construct the complex discursive environments

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in which members of the eating public must decide for them-

selves what a ‘‘healthy diet’’ really means.

The ADA/AND survey I mentioned above gives us a bit

more insight into the communication sources that play key

roles in characterizing definitions of healthy eating in the

United States today. In that survey, the largest stated influ-

ences were media sources—with television way ahead, men-

tioned by 67% of respondents, followed by magazines at 41%

and the Internet at 40%. These media were then followed by

medical doctors and friends/family, both of which registered

at 16% (American Dietetic Association 2011). Each of these

communication connections can give voice to diverse nutri-

tional stories that reflect different understandings of the rela-

tionships between food and health. Television and the

Internet—two of the most powerful purveyors of nutritional

narratives—provide prominent platforms for diet-book

authors, fitness aficionados, and food-industry celebrity

spokespersons of varied competence levels and often oppos-

ing dietary viewpoints. Across much of daytime television,

trusted personalities like Dr. Mehmet Oz remain attached

to the energy balance mantra of ‘‘calories in’’ versus ‘‘calories

out’’—a viewer can even take the ‘‘Calories Count’’ quiz on

his program’s official website to ‘‘test your calorie smarts’’

(Dr. Oz Show, n.d.) Yet, even this foundational belief of the

DGA—that a ‘‘calorie is a calorie’’—has increasingly been

pilloried as oversimplified and inaccurate in a variety of

broadcast and online media settings, including on the

Dr. Oz Show’s very own website (Shute 2013; Zelman 2012).

Fundamentally, with these contrasting narratives in play, it

seems more likely that a host of contradictory, targeted, and

often profit-driven messages—and not an unquestioned con-

ventional wisdom—characterize today’s landscape of nutri-

tional information.

It is important to recognize, as well, that active

information-seeking about a healthy diet is only part of the

story. Narratives about healthy eating abound in common

conversations, in media products, advertisements, point-of-

purchase displays, and countless other elements of our social

and cultural environments, often going unnoticed as such.

This point connects to another inconvenient reality for nutri-

tional professionals—that is, what one regards as ‘‘good for

them’’ is fundamentally multidimensional in nature. Indeed,

knowledge about food and its relationship to health has deep

social and historical roots, is hardly restricted to concerns that

focus solely on nutrition, and is often conflated with other

embedded cultural values (Ho, Chesla, and Chun 2011; Skia-

das and Lascaratos 2001). Trusted communication sources

will necessarily differ over time and based upon a variety of

identity characteristics, including the age, gender, social

class, and ethnicity of a particular person. Subsequently, sig-

nificant differences will emerge as we look at the types of

dietary narratives that are present in the communication ecol-

ogies of different individuals and groups.

For instance, when the ADA/AND asked Americans of

different ages and ethnicities which food group should be

eaten more than any other, answers varied widely. The leading

response among all the parent groups was vegetables, but this

ranged from a full 47% of Caucasians to only 31% of Hispanics.

Among children, the story was somewhat different—the lead-

ing response among Caucasians was also vegetables, at 25%,

but among Hispanic children, the top answer was meat, fish,

poultry and beans, selected by 23% (Watts et al. 2011). This

divergence in response is reflective of the divergent set of nar-

ratives that characterize the nutrition-oriented communication

ecologies of these different cultural groups.

To explore this communication ecology concept a bit

further, let us conceive of two hypothetical and, for the

purposes of a quick argument, crudely oversimplified

cases—two white, middle-class, unmarried heterosexual

individuals in their early 20s, one female, the other male.

What types of stories might typify these individuals’ commu-

nication ecologies when it comes to what is ‘‘good for them’’

to eat? Well, if our hypothetical young woman is tapping

into the types of popular media sources we know to be influ-

ential purveyors of nutritional information, she is probably

getting a heavy dose of strategies that encourage her to get

FIGURE 4: This presentation slide—produced by the AmericanDietetic Association (now the Academy of Nutrition and Dietetics) tosummarize results from a nationally representative survey of Americanadults—demonstrates the dominance of media as sources fornutritional information.image courtesy of the academy of nutrition and dietetics, www.eatright.org/

nutritiontrends.

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(or stay) thin en route to a healthy and fulfilled life, sugges-

tions that are likely reinforced by friends and family (Stevens

Aubrey 2010). Some variation of caloric reduction and

exercise—in line, perhaps, with elements of the DGA—is

a likely prescription. Or, as Women’s Health magazine

described in a recent ‘‘30-day bikini body’’ healthy meal

plan, ‘‘With 1,500 balanced calories per day, it’ll fill you

up and fuel your active lifestyle. The best part? All you need

to do is follow the plan. And you don’t have to count a single

calorie to meet your weight loss goal, because we’ve done

the calorie counting for you.’’

What about our hypothetical male case? When popular

media directs messages toward young men about what is

‘‘good for them,’’ food is often portrayed as an avenue to boost

strength, muscularity, and masculinity. In the parlance of

Men’s Health magazine, ‘‘Maybe you’ve lost one too many

attainable women to beefier guys. Or maybe you’ve read so

much about weight loss that actually admitting you want to

gain weight is a societal taboo. Whatever the reason, you want

to bulk up. Now’’ (Hansen 2013). Calorie reduction would be

anathema in this setting, with the consumption of animal-

based protein consistently offered by male-oriented maga-

zines, online sources, and peers as the best way to eat a healthy

diet as a young man (Adams 2004; Stibbe 2012). Collectively,

nutritional narratives like these implicitly push back against

the DGA’s emphasis on dietary advice as primarily positioned

to fight the development of chronic disease. Indeed, media

products directed toward young men and women are often

uninterested in exploring the long-term dangers of foods high

in saturated fat or cholesterol, opting instead for a short-term

focus on the links between dietary habits, physical appear-

ance, and personal vitality.

Taken together, these examples demonstrate that, in

a media-saturated environment, the public is bombarded

with conflicting, often narrowcasted narratives of nutritional

advice, most of which claim to be definitive guides for opti-

mal health. The DGA is one of many voices in this conver-

sation, deployed by some nutritionists and dietitians,

highlighted in federal nutrition programs, and leveraged

by food producers and marketers as part of a sales pitch

(Poppendieck 2010). From the perspective of a diverse eating

public, however, it seems untenable that any single nutri-

tional science perspective has ever, or will ever, coalesce into

an unquestioned nutritional narrative of conventional wis-

dom. In the context of this contested communication envi-

ronment, rife with a host of divergent perspectives on healthy

food, researchers can do more to explore the landscape of

expert and lay nutrition sciences that shape cultural defini-

tions of what a healthy diet really means.

A D E L E: Garrett is absolutely right that, in order to better

understand the relationships between diet and health out-

comes, nutritionists need to begin with individuals and their

communities and shift their focus to how people make food

choices within the context of their own lives. Yet, it is impor-

tant to recognize that it is not necessary to know about or

follow the DGA to be passively affected by the changes in

the food supply it encouraged. Although many people are free

to choose what foods they eat, the DGA influence what foods

are available and how they are processed. Food manufac-

turers go to great lengths to produce foods that will meet

nutrition labeling and health claims standards. Other indivi-

duals who participate in federal nutrition programs have their

dietary options limited and shaped by mandatory compliance

with the DGA (for example, Women, Infants and Children

Program; Supplemental Nutritional Assistance Program;

National School Lunch Program; food allowances for the

US military; foster care; Older Americans Nutrition Program;

Head Start; and others).

Beyond adverse changes brought on by transformations of

the food supply, the DGA may have shifted efforts away from

more effective policy interventions, placing the task of disease

prevention in the hands of the consumer and creating the

opportunity for dubious diet-health claims to be made from

a variety of sources. While ‘‘magical thinking’’ relating food to

health effects is an ancient phenomenon (Olson 1979: 121),

the current lack of confidence in advice from nutrition pro-

fessionals and the explosion of a ‘‘cacophony of voices’’ offer-

ing promises concerning the relationship between diet and

health, which Garrett highlights above, was forecast by

numerous critics of the 1977 DGA (Harper 1978: 319; Olson

1979: 121; McNutt 1980: 357). Critics suggested that establish-

ing DGA based on inadequate evidence ‘‘has a great potential

for undermining both the science of nutrition and nutrition

education’’ by raising false hopes regarding what dietary

changes could accomplish regarding prevention of disease,

leaving consumers confused, overwhelmed, and susceptible

to nutrition misinformation promulgated by those who could

profit from it (Harper 1978: 319–20). Even though distinct

causal links between diet and most chronic diseases have not

been determined, the assumption of such links may have

focused the public’s attention on trivial, superficial, ineffec-

tive, and possibly detrimental approaches to health, to the

neglect of other health practices that may be more effective

in preventing chronic disease.

Understanding how and why individuals interact with

their nutrition-oriented communication ecologies may help

public health and nutrition professionals ensure that essential

nutrition needs are taken into consideration no matter what

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the context, while honoring individual health responses to

food and individual values surrounding dietary choices.

Relinquishing the certainty of a one size fits all approach to

diet and prevention of chronic disease by public health pol-

icymakers may begin to shift responsibility for health out-

comes at least partially back to institutions, policies, and

practices responsible for conditions that may be more directly

related to disease outcomes than dietary choices. Unfortu-

nately, it remains true now, as in 1977, that making changes

to the food system, environment, labor practices, and health-

care system is much more difficult than telling people what

to eat.

G A R R E T T: I will certainly concede that the DGA have had

a variety of important ripple effects on nutrition in the United

States. Through both direct and indirect means, several of the

underlying logics of this nutritional dictum have found their

way into the everyday eating practices of the American

public—from the cafeteria trays of elementary school students

to the processed food packages that line local grocery store

aisles. It also seems quite plausible that, among certain seg-

ments of the American public, the fundamental claims that

were codified in the DGA have indeed come to appear as con-

ventional wisdom. Still, I remain hesitant to assign overriding

cultural power to any single narrative of nutritional advice, even

one with the type of institutional sway enjoyed by the DGA.

This leads us, though, to a point on which we seem to be

in total agreement. From the time of its inception, the foun-

dational flaw of the DGA—and, by extension, of the main-

stream nutrition profession—is that it made little room for

diversity in thinking at all. Nutrition science, like all sciences,

is full of uncertainty and contestation. It is engagement with

this uncertain reality—and not by moving forward as if all of

the hard questions are already settled—that advances knowl-

edge and can lead us to better policies and practices. Inves-

tigating the collections of stories that Americans already tell

about health and nutrition is one way to more fully explore

and reflect this diversity. Doing so would help position the

field to advance more purposefully and effectively its mission

of encouraging healthy nutrition for all.

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