Building Better Food Pyramids

First introduced in 1992 by the USDA in collaboration with the Department of Health and Human Services, the Food Guide Pyramid (FGP) came on the scene amid much controversy that continues today. Intended to portray an action plan for the Dietary Guidelines for Americans, it succeeded the Basic 4 Food Groups, a simplified version of the original Basic 7 Food Groups. Although a pyramid is a three-dimensional object, the FGP frequently looks like a triangle in its two-dimensional world. Initially, some questioned the pictorial representations of foods and potential consumer confusion with negative foods at the apex in a society where "climbing to the top" is a status symbol.

In 1999, USDA introduced an FGP aimed at children. Gradually, nonprofit, commercial, advocacy and other groups introduced versions that retained the food groups and servings but changed the foods to reflect an ethnic group (e.g., American Indian) or a lifestyle (e.g., vegetarianism).

Today, the FGP continues to be the only science-based food guide derived from the nutrient recommendations of the National Academy of Sciences Food and Nutrition Board's RDAs and the Dietary Guidelines for Americans. However, over the years, some organizations advocating different dietary goals revamped the pyramid by regrouping foods and rearranging the food groups. These variations usually emphasize different foods, such as oils rich in monounsaturated fats, without much guidance on the number of servings. Examples include the Mediterranean and Asian Diet Pyramids, created and promoted by the nonprofit foundation, Oldways Preservation and Exchange Trust, Cambridge, MA.

Epidemiological and other research supports a relationship with these cultures' traditional diets and a lower incidence of chronic diseases and a higher adult life expectancy. These pyramids split up the meat and meat-substitutes group, with eggs, poultry and fish placed in the upper half of the pyramid and meat at the pinnacle above sweets. They also add physical activity as the pyramid's base.

A couple of years ago, Dr. Walter Willett and his colleagues from Harvard School of Public Health, Boston, unveiled their Healthy Eating Pyramid. At first glance, it seems to resemble the Mediterranean Pyramid, with exercise and weight management at its base and an emphasis on plant oils. But, it has a number of differences. For example, it gives daily serving guidelines, adds calcium supplements to the dairy group and recommends multivitamins. However, the major deviation from the government- and culturally based pyramids is the separation of whole grains from refined grains. Whole grains remain at the bottom of the pyramid while refined grains and white potatoes -- with their high glycemic effect -- join sweets at the top of the pyramid to be used "sparingly" along with red meat and butter.

Analysis of eating patterns correlated with chronic-disease risk for large cohort studies provide scientific support for the Healthy Eating Pyramid. A long-term study designed to compare the effectiveness of the original FGP with the Healthy Eating Pyramid is now underway in Denmark.

The latest pyramid variation comes from Atkins. Below the pyramid is the edict of "no added sugars and hydrogenated oils." The actual base is, of course, protein sources and the top is whole-grain foods. The middle sections, in ascending order, are vegetables, fruits and an amorphous group consisting of vegetable and seed oils, cheese and dairy, and nuts and legumes. The instructions say, "Eat until you are satisfied."

Clearly, the plethora of food pyramids offering guidance can easily add to consumer confusion about food and nutrition. Critics contend that the FGP has not done its job and, in fact, may be complicit in escalating some health problems, such as obesity and type 2 diabetes. John Webster, director of public information and governmental affairs at USDA's Center for Nutrition Policy and Promotion (CNPP), Alexandria, VA, says, "Although it is recognized by 80% of Americans, only about 4% actually follow its recommendations."

Currently, USDA is updating the FGP to reflect current nutrition science, as well as recommendations in conjunction with the mandated five-year review of the Dietary Guidelines for Americans. However, Webster says, "Don't confuse the Dietary Guidelines and their review with the update of the Pyramid that is underway at USDA." He explains that although interrelated, they are two separate projects on parallel tracks with an independent Dietary Guidelines Advisory Committee and an internal USDA working group consulting and sharing information throughout the process.

To date, the technical underpinnings of food groups and recommended servings for 12 calorie levels were published in the Federal Register last September with a public comment period that ended Oct. 31, 2003. Eric Hentges, Ph.D., executive director, CNPP, summarized the responses as "clear and to the point ... what the public wants from us is direct, common-sense advice on what and how much to eat." Revisions to the food intake patterns and food groups, an array of energy levels to accommodate needs of sedentary and active individuals, and the replacement of vague "servings" with specific household measures like "cups" and "ounces" elicited the most support.

Webster says that the next step will be a second Federal Register notice and public comment period on consumer education messages and graphics. He adds, "In early 2005, we will release a newly revised food guidance system, currently known as the Food Guide Pyramid, about a month after the Dietary Guidelines are released."

No one knows what the new system and its symbol will look like. "It may be a pyramid shape -- or it may not," says Webster. "Public input and consumer research will ultimately guide the message and design."

Some believe that the pyramid shape lacks the fluidity and elasticity necessary for a good educational tool, even though it rated better than other shapes in consumer tests before its introduction. Internationally, pictorial representations of food guides vary from pyramids to circles, plates, rainbows and a pagoda. So far, suggestions for replacing the FGP include a food wheel, bull's eye, square, rectangle and a "radiant" pyramid. Ultimately, the challenge for USDA is to create a tool that conveys real, actionable recommendations based on the Dietary Guidelines, public health concerns and available food supply; retains flexibility and allows for individualization; and is not "busy" and confusing.

Angela M. Miraglio, M.S., R.D., ([email protected]) is a Fellow of the American Dietetic Association from Des Plaines, IL. Her firm, AMM Food & Nutrition Consulting, provides communications and technical support to the food and beverage industry.

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