When the Department of Health and Human Services (HHS) and Department of Agriculture (USDA), released new Dietary Guidelines for Americans on Dec. 29, 2020, they looked almost identical to the ones released five years earlier. There were new guidelines related to pregnancy, breastfeeding, and children under two, but to those who'd been paying attention to the process, what stood out was what had not changed.
Most glaringly, the guidelines failed to take up key recommendations from the 2020 Dietary Guidelines Advisory Committee, the group of experts responsible for preparing a detailed report intended to inform the final guidelines. This year, that document was 835 pages long and included recommendations for lowering the amount of recommended daily sugar from 10% of one's daily calories to 6%, as well as limiting alcohol consumption to one drink a day for both men and women.
This marked a shift from the previous guidance of up to two alcoholic drinks for men a day. The committee also noted the need to consider the context of "sustainability of the food supply and food insecurity," which is especially relevant in a time when food's link to climate change has become increasingly clear and food insecurity is at a historic high due to the pandemic.
None of these recommendations made it into the final guidelines.
For years, food policy experts have been concerned that the "go-to source" on healthy eating has failed to keep pace with nutrition science, often to the benefit of major food and beverage companies that wield considerable influence over the guideline setting process.
"This is a movie we've seen before," said Sarah Reinhardt, the lead food systems and health analyst at the Union of Concerned Scientists. "The scientific advisory committee publishes a fairly thorough, scientific report using rigorous methods. And when the final guidelines come out, suddenly the federal government has walked back some of the most significant recommendations."
While the direct impact of corporate influence over the process is hard to quantify, it's worth a look into the many points at which food companies — and the trade groups they pay to do their lobbying — may have impacted this latest process.
The power of the guidelines
Billed as "the nation's go-to source for nutrition advice" by HHS, the dietary guidelines affect the entire food supply chain: what is produced, consumed, and eaten — especially by food-insecure Americans.
And while some food brands modify their products according to the recommendations, it's not clear how the guidelines — or the education campaigns designed to show the makeup of the dinner plate—drive consumer decision making. Only one in 10 Americans eat the recommended allowance of fruit and vegetables, for instance.
But policymakers and educators all rely on these guidelines. And they help shape a wide array of food assistance programs including the National School Lunch Program, the Elderly Nutrition Program, the Food Distribution Program on Indian Reservations, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). All this translates to dollars — and even if it's not apparent to the average consumer, the guidelines play an enormous role impacting the bottom lines of many of the nation's food companies.
The new guidelines also include for the first time advice on the entire lifecycle, from infancy to old age, which extends their impact — and potentially reach of corporations — even further.
A familiar playbook
There are two main avenues for corporations to influence the final guidelines: written and oral public comments, as well as lobbying and undocumented meetings or correspondences with members of Congress.
It's the latter method that tend to have the biggest role in shaping the final guidelines, says Reinhardt. "When the final guidelines come out and you see recommendations that contradict science that's not because someone wrote a compelling public comment. That's because somebody went through the back door and influenced the process in the wrong way," she said.
Case in point: Reinhardt points to a letter sent to Sonny Perdue and Alex Azar, former respective heads of the U.S. Department of Agriculture (USDA) and HHS, in August, in which Congressmembers challenged the recommended daily alcohol limit for men.
"When 28 members of Congress, who are not nutritionists, who are not doctors, are writing to the USDA and HHS secretaries telling them they got the science wrong, you have a pretty good idea [that they've been talking to lobbyists or other industry representatives]," said Reinhardt. (HHS declined to comment for this article.)
In the three years leading up to the guidelines, alcohol industry trade groups and corporations spent an average of $27 million per year on lobbying. The largest donations came from the Distilled Spirits Council, Anheuser-Busch InBev, and the Beer Institute. Rep. Mike Thompson (D-California), one of the signatories on the letter asking for more laxed alcohol guidelines, was the top recipient from the alcohol industry in the 2019–2020 election cycle. Thompson's campaign committee and leadership PAC collectively received over $184,000 from the beer, wine, and liquor industry.
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Several of the politicians behind the August letter include outspoken climate deniers with a history of disavowing established science. For instance, Rep. Andy Harris (R-Maryland) told the Star Democrat in Maryland, "I believe the actual science is uncertain" on climate change. Rep. Doug LaMalfa (R-CA) said that there's "a lot of bad science behind what people are calling global warming" in a town hall meeting. This industry strategy of arguing that established science lacks evidence has its origins in the tobacco industry's downplaying of public health risks, as historian Naomi Oreskes has extensively documented.
The public comment period also offers a window into some of what the major food and beverage industries sought to influence. More than 70% of the public comments filed by May 2020 were from major food and beverage companies and trade groups, according to research by the international advocacy nonprofit Corporate Accountability. This includes the American Beverage Association, Coca-Cola, the Sugar Association, the Juice Products Association, the Beer Institute, SNAC International(representing the snack food industry), and the National Cattlemen's Beef Association, which counts McDonald's among its many members.
In an oral public comment in August, Samir Zakhari of the Distilled Spirits Council and Jim McGreevy of the Beer Institute both argued for more lax alcohol guidelines, claiming that the new recommended limit was not based on a "preponderance of evidence." McGreevy also argued that the more stringent alcohol limit for men was a disregard of the advisory committee's "charter." The language in their testimonies is strikingly similar to the letter mentioned above, which was sent the very next day.
Potential for influence at every stage
Beyond public comments and lobbying members of Congress, corporations also have the opportunity to influence the guidelines throughout the process, from the selection of the advisory committee to the final guidelines. "At every stage, we are seeing such troubling influence by the industry," said Ashka Naik, the research director at Corporate Accountability. "The process is vulnerable and the industry has been exploiting it for its own good for decades."
Naik says the first point of vulnerability to corporate influence is the nomination process to the advisory committee. It is now commonplace for food industry trade groups to nominate potential members. And while the HHS and USDA secretaries have the final say in the selection process, they often have their own ties to industry. In this latest case, both Azar and Perdue had a legacy of catering to major industries.
As the American Prospect reported, nine out of 20 of the committee members were nominated by the American Society for Nutrition (ASN), which includes 32 corporations as "sustaining partners." These include the Sugar Association, Nestlé Nutrition, Cargill, Kellogg Company, and the National Dairy Association. Trade groups, such as the American Beverage Association, the International Life Sciences Institute (ILSI), and SNAC International, also secured nominees.
As a result of this process, 75% of the participants on the advisory committee have ties to corporations or trade associations representing the food and beverage industries. In addition, Corporate Accountability found that more than 50% of the advisory committee members have ties to International Life Sciences Institute (ILSI), a shadow "pro-sugar" industry group described by the New York Times as "almost entirely funded by Goliaths of the agribusiness, food, and pharmaceutical industries," including Coca-Cola (until earlier this month), DuPont, PepsiCo, General Mills and Danone. (ILSI declined to comment for this article.)
Dr. Elizabeth Mayer-Davis, a participant on advisory committee and the chair of the nutrition department at the University of North Carolina at Chapel Hill, was not nominated by an industry group. And, like Reinhardt, she saw the process as a rigorous one.
"I was disappointed that the recommendations for both added sugar and alcohol were not carried forward in the guidelines," said Mayer-Davis. "That was the best recommendation that we could come up with the data that we had."
But she added that "there wasn't any point in time when I felt like there was industry influence" over the committee's process. And while the final recommendation to keep sugar intake at 10% of daily calories is higher than the committee's recommended 6%, she sees it as a step in the right direction, given the fact that sugar currently makes up 13% the average American's calories.
"The most important message for the public is to reduce intake of added sugar," she said. "Obviously, the current recommendation and our recommendation are both lower than what the average intake is in the population. So, we're consistently saying 'eat less sugar.'"
Nutrients vs. Food
Despite the potential of corporate affiliations, experts say the advisory committee's recent recommendations were nonetheless more scientifically rigorous than the final guidelines, which were shaped by Trump Administration officials. These include the USDA's acting chief scientist Chavonda Jacobs-Young, a government liaison for the ILSI's board of trustees. According to Corporate Accountability, other USDA officials who oversaw the process had ties to SNAC International, the National Grocers Association, and the Corn Refiners Association — all of which likely have a vested interest in seeing that sugar and high-fructose corn syrup remain a significant part of the American diet.
And for the first time, the USDA and HHS also set the research agenda, limiting the scope of what the advisory committee examines, further extending the agencies' influence over the guidelines. Previously, the advisory committee set its own research agenda and prior to 2005, the committee wrote the final guidelines. The latest agenda excluded the health impacts of red and processed meat consumption, sodium, and ultra-processed food, the Washington Post reported. Of the 80 questions explored by the advisory committee, systemic racism's impacts on nutrition were also excluded, despite advocates pushing for its inclusion for years.
Marion Nestle, author and professor of food studies and public health at New York University and a participant on the Dietary Guidelines Advisory Committee in 1995, notes that the exclusion of any recommendation to avoid ultra-processed foods in particular required the committee to overlook the large quantity of research into how "junk food increases body weight, increases risk for chronic disease, and makes people eat more."
Sustainability and the environmental impacts of food production were also excluded from the research agenda. In 2015, the advisory committee recommended a plant-based diet for the first time, linking animal consumption to more greenhouse gas emissions, water, and energy use. Yet, after much pushback and lobbying from the meat industry, USDA and HHS determined that this is outside of the guideline's scope. In 2016, this decision was codified in an appropriations bill limiting the scope of the guidelines to nutritional and dietary information — even as the body of research on the links between nutrition, climate change, environmental degradation, and human health has grown.
This more integrated approach to nutrition is the "current thinking about where nutrition ought to be and these guidelines don't come anywhere close to that," said Nestle. And as she sees it, industry influence over federal dietary guidelines can prevent "clear guidance about diet and health," which makes it easier for industries to evade responsibility to human health.
Ensuring science-based guidelines moving forward
Advocates say there are ways to make the process behind the guidelines more accountable to science and public health. Prohibiting industry and trade groups from nominating participants to the advisory committee, establishing a more transparent process around the committee members' disclosure of financial and industry ties — including speaking fees and research funding — could change the outcome, said Naik. But all that only makes a difference if the officials at HHS and USDA, who determine the final guidelines, are also free of industry ties, she added.
The guidelines can also move away from the narrow focus on specific nutrients such as fat, sugar, and salt to talk about food itself, which would make the information more accessible. "There's a big difference between saying 'eat less foods containing salts, sugar, and saturated fat,' and 'eat less meat, drink fewer soft drinks, and don't eat snack foods,'" said Nestle.
This omission benefits the junk food industry by not singling out their products — and it isn't an accident. Nestle traces this back to the Senate Select Committee on Nutrition and Human Needs' 1977 report, the first dietary guidelines, which recommended eating less meat, less soda, and fewer foods with sugar and salt.
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"The food industry went nuts. There was an enormous pushback," recalled Nestle. "Within a few months, they published a new report in which they switched all the recommendations for eating less to nutrient recommendations." That approach continues to this day.
This myopic focus on nutrition can overlook other important elements of why we eat, including cultural and social relationships to food. "Just focusing on what sugar, salt, and fat one eats can be quite detrimental because you're not looking at the holistic lens," said Naik. This can also lead culturally relevant foods to be ineligible for food assistance, and a food system that often fails to support communities of color get the nutrition they need.
Where to go from here
Despite the degree of corporate influence, food policy experts broadly agree that the new guidelines offer critical nutrition advice and are vital for policymakers to fully implement. And because there has never been funding behind the guidelines beyond promotional materials, there's no consistent way to implement them or ensure they are widely understood.
"They really could have so much more of an impact if we had better policies to help people follow the guidelines," said Jessi Silverman, who works at the Center for Science in the Public Interest (CSPI). "There is a lot more the government can be doing to deliver on the dietary guidelines." For instance, she says the Biden Administration can adopt these guidelines in all federal facilities, including prisons and Veterans hospitals.
The implementation is especially important now in a midst of the worst public health crisis in recent history. "If the public were able to follow these recommendations, that would have huge implications for public health," said UCS' Reinhardt. "We'd be talking billions of healthcare dollars saved every year from reduced cases of diabetes and other chronic diseases."
And while it's not clear how exactly the Biden administration will interact with the guidelines — since they're released every five years — it's possible that their approach will differ given the fact that it appears to be turning to nonprofit leaders to fill temporary appointments rather than former industry executives.
Take Stacy Dean, the USDA's new Deputy Undersecretary for Food, Nutrition and Consumer Services. She comes to the agency after working as the vice president for food assistance policy for the Center on Budget and Policy Priorities. When contacted by Civil Eats, Dean underscored the agency's commitment to "building inclusive dietary guidance that reflects personal and cultural diversity and traditions in a manner that is committed to public engagement, transparency and science-based evidence."