2024-2025 Topic Proposal: Reforming Federal Dietary Guidelines and Nutrition Policies
Draft proposal for national debate topic on nutrition and public health
[Draft report submitted to national debate topic selection committee.]
Gregory Rehmke, April 28, 2023 [Updated May 1]
• History of Federal Dietary Guidelines and Nutrition Policies
• Discussion and debate over the origins of America’s obesity and type 2 diabetes epidemic
• The problem of engineered addictive sugar and carbohydrate-rich foods
• Healthier food as alternative to diets, pills, and surgery
• The core obesity debate: energy balance theory vs. carbohydrate-insulin model
Possible Resolutions (notes from Nutrition Coalition):
Resolved: The federal Dietary Guidelines for Americans should be significantly reformed.
In 1980, when the Guidelines were launched, they were meant to help healthy Americans prevent diseases such as obesity. At the time, the majority of Americans were healthy, so focusing on prevention made sense. … Over the years, however, Americans have largely lost their good health. Now, some 93% of Americans have at least one symptom of metabolic disease, such as abdominal obesity or high blood pressure, for which they are taking medication. The Guidelines are therefore now out-of-step with the majority of Americans. (Guidelines Not For People with Diet-Related Diseases, Nutrition Coalition)
Resolved: The federal Dietary Guidelines for Americans should be trustworthy and evidence-based. Dietary Guidelines have historically excluded vast majority of rigorous evidence on diet and health. The 2025-2030 Dietary Guidelines for Americans, Nutrition Coalition.
Resolved: The Dietary Guidelines for Americans should lift limits on saturated fat intake.
(US nutritionists call for dietary guideline limits on saturated fat intake to be lifted, BMJ The letter concludes that “there is no strong scientific evidence that the current population-wide upper limits on commonly consumed saturated fats in the US will prevent cardiovascular disease or reduce mortality. A continued limit on these fats is not justified.” US nutritionists call for dietary guideline limits on saturated fat intake to be lifted, from BMJ.
Resolved: The Dietary Guidelines for Americans should include research on the effectiveness of Low-Carb Diets in reducing obesity and type 2 diabetes.
“I was wondering if we should have a separate section on low-carb diets rather than burying it,” wrote Harvard nutrition professor Frank Hu about the official expert report for the 2015 U.S. Dietary Guidelines for Americans…. and USDA Ignoring the Science on Low-Carb Diets, Unsettle Science, June 26, 2022.
Reforming the Federal Dietary Guidelines and Nutrition Policies
Gregory Rehmke • DRAFT • April 28, 2023 [Updated May 1]
Over forty years ago the Dietary Guidelines for Americans were established, setting federal public health and nutritional policies and programs:
In 1980, the first publication of the Dietary Guidelines for Americans was released. Since then, the Dietary Guidelines have become the cornerstone of Federal food and nutrition guidance.
The Dietary Guidelines for Americans followed hearings chaired by Senator George McGovern:
In 1977, after years of discussion, scientific review, and debate, the U.S. Senate Select Committee on Nutrition and Human Needs, led by Senator George McGovern, released Dietary Goals for the United States.
However, of the seven Dietary Goals recommended, all but one (reduce sugar) were controversial dietary advice at the time and, critics charged, based on limited epidemiological studies. Passage of the Dietary Guidelines was rushed due to fears that saturated fat was causing an epidemic of heart attacks and heart disease. The theory advanced by the influential Ancel Keys was that saturated fat was “clogging” arteries.
So the Dietary Guidelines first and foremost advocated reducing fat, especially saturated fat in the American diet. (See, for example: Diet and Fat: A Severe Case of Mistaken Consensus, John Tierney, New York Times, October 9, 2007. And, supporting Keys: Defending Ancel Keys: Bad Science or Bad Journalism?, Bluezones.com, 2017, and critical: The hidden truth behind Ancel Keys’ famous fat graph (Andreas Eenfeldt, DietDoctor, September 19, 2016 and Sugar Wars, The Atlantic, Jan/Feb 2017).
What if its all been a big fat lie? (Gary Taubes’ 2002 New York Times Magazine cover story)
Growing networks of doctors, nutritionists, and researchers argue that America’s escalating rates of cardiovascular disease, obesity, and type 2 diabetes since the 1980s are consequences this misguided dietary change: increased low-fat foods required increased carbohydrates (since protein levels stay about the same).
Americans have mostly followed the Dietary Guidelines as the processed food industry, responding to public health authorities, developed and marketed hundreds of new low-fat foods. (See, for example Why We Got Fatter During The Fat-Free Food Boom (NPR, March 28, 2014)
Expanding federal nutrition programs and policies also increased low-fat, high-carbohydrate meals in federally-funded food assistance programs, schools, hospitals, nursing homes, military bases, and prisons that served foods based on the Dietary Guidelines. For an overview of this history see Did the Government Make Us Fat? (Goodman Institute Brief Analysis No 142, February 24, 2022).
America’s obesity epidemic has also been blamed on other causes, from the fast-food industry (expanding from 100 McDonald’s in 1960 to 250,000 total today), to highly-processed junk foods and candies for sale today at 40% of all retail outlets, to oversized portions served at restaurants, and to less active work and lifestyles. (Noted in The Blue Zones Challenge by Dan Beuttner, National Geographic, 2022, p. 7.)
Some blame increased consumption of sugar and high-fructose corn syrup in foods and soft drinks. Dr. Robert Lustig and other medical researchers argue fructose consumption causes increasing obesity. Still others blame “industrial seed oils,” marketed as vegetable oils for cooking and as an ingredient in packaged high-carb foods. These polyunsaturated oils (PUFAs) are considered healthy by public health authorities, but have been documented to be a source of oxidation and inflammation by others. So there is an ongoing debate over PUFAs as good or bad for our health, along with a similar debate over saturated fats as healthy or dangerous.
Other research points to changes in our gut microbiome from overuse of antibiotics as a major contributor to obesity, along with overconsumption of processed foods. Research continues at The Center for Human Microbiome Studies at Stanford University. See Tim Spector’s The Diet Myth, for example, or the 2022 documentary The Invisible Extinction.
Still others point to dieting itself as unnatural and disrupting our natural instinct to eat until full. Constant fears of being overweight, promoted by thin culture and diet industry have unfortunate metabolic and mental health consequences. Books like Don’t Diet and Intuitive Eating offer “eat until full” dietary advice. However, most doctors, nutritionists, and public health officials advise “eat less and exercise more:” based on the misleading energy balance theory of obesity that suggests people are overweight due to gluttony and sloth. Instead, obesity is now thought to be a problem of impaired blood glucose metabolism, that is, carbohydrate intolerance and insulin resistance.
The problem of engineered addictive sugar and carbohydrate-rich foods
Ultra-processed snacks are designed by the food industry to be addictive (say critics), and a culture of snacking and sipping through the day has been encouraged. Consuming many small meals each day is recommended by nutritionists and the federal dietary guidelines. But critics make the case that snacking is harmful and fewer larger meals was and is a healthier tradition and lifestyle (intermittent fasting also called time-restricted eating). Most religions and cultural traditions include fasting as well as feasting, rather than all-day snacking on small meals. See for example, Jay Richards’ 2020 book Eat, Fast Feast Heal Your Body While Feeding Your Soul―A Christian Guide to Fasting.
Public health policies face challenges when new research appears to undermine existing policies and programs. Nutritional science is rarely settled and disagreements continue on ethical, religious, and environmental grounds, as well as on conflicting nutritional theories and research. The current Dietary Guidelines are based on weak epidemiological studies rather than more recent and reliable randomized controlled trials (RCT).
Time magazine provides a history of federal dietary policies in The U.S. Food Guidelines Have Always Been Controversial (Time, Jan. 7, 2016). The 2016 date is important since the article is reviewing the then new 2015-2020 Dietary Guidelines (health.gov).
Scientific and policy controversy over the 2015-2020 and the current 2020-2025 Dietary Guidelines (pdf) can support a dynamic and educational national high school debate season. Student’s health is at stake, along with their parents and grandparents.
Childhood obesity worldwide has increased ted-fold since the 1970s. And “In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.”
Critics claim the federal Dietary Guidelines (see DietaryGuidelines.gov) are biased and not based on current nutritional research. The Departments of Health and Human Services (HHS) and Agriculture (USDA) appoint members of each Dietary Guidelines Advisory Committee to review the Guidelines. Critics claim most have strong biases and financial ties to industry. (“95% of Expert Committee for the 2020 Dietary Guidelines Had Tie with a Food or Pharmaceutical Company”). Of course it is not unusual for experts in a field to have been employed or have funding ties to the industry where their expertise is valued.
Majorities of Americans, young and old, suffer from chronic diseases, though many are as yet undiagnosed (“Approximately 96 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% don't know they have it.”). A 2018 University of North Carolina study reported: “Only 1 in 8 Americans are achieving optimal metabolic health, which carries serious implications for public health.”
The White House Conference on Hunger, Nutrition, and Health (health.gov, March 24, 2023), reports on the September 2022 conference: Ending Hunger and Reducing Diet-Related Diseases and Disparities, from White House Conference on Hunger, Nutrition, and Health:
Millions of Americans are affected by food insecurity and diet-related diseases — including heart disease, obesity, and type 2 diabetes — which are some of the leading causes of death and disability in the U.S. The toll of hunger and these diseases is not distributed equally, disproportionately impacting underserved communities…
Students researching federal nutritional policies and the Federal Dietary Guidelines will face an avalanche of conflicting resources and advocacy, ranging from medical conference presentations, to documentaries, podcasts, medical societies, to hundreds of major nutrition and diet companies selling their services, books, and podcasts. (Many are discussed and linked to in Did the Government Make Us Fat? pdf)
Students can further research the nutritional debates and politics with their school lunches, long a topic of state and federal political wrangling, see How School Lunch Became the Latest Political Battleground, New York Times, Oct. 7, 2014 and still are today, How the Politics of School Food Shape What Kids Eat, (CivilEats, September 26, 2022)
[Added May 1: Washington Post on American Heart Association Dietary Guidance (both April 27, 2023) “Popular keto and paleo diets aren’t helping your heart, report says: An analysis of various diets gave low marks to some of the most popular ones for straying from heart-healthy eating guidelines.”]
Healthier food as alternative to diets, pills, or surgery
• Medical Care Alone Won’t Halt the Spread of Diabetes: Now experts are calling for walkable communities, improved housing, and access to health care and better food, particularly in minority communities., Scientists Say (New York Times, October 5, 2022).
• Why Experts Are Urging Swifter Treatment for Children With Obesity (New York Times, January 27, 2023)
The American Academy of Pediatrics recently issued new guidelines for treating the more than 14 million children and adolescents with obesity in the United States. The recommendations came as a surprise to many parents, and to some experts, as they encourage vigorous behavioral interventions even for very young children, as well as drug treatment or surgery for adolescents.
More Kids Get Weight-Loss Surgery to Treat Obesity (Wall Street Journal, April 19, 2023)
Critics of surgery and pharmacological approaches recommend instead dietary changes: less cereal, sugar, other carbohydrates, fewer sodas and fruit drinks, more fish, meat, whole-fat dairy (for those not lactose intolerant). More sleep and less stress (“bullying” in article above) would help as well.
Reform of the Dietary Guidelines for Americans will impact health care procedures and costs. Reformers advocate lifestyle changes (not diets) and “food as medicine” instead of or in addition to medications for most chronic conditions. Fast-growing companies and expanding networks of direct primary care doctors who focus on metabolic health as they de-prescribe medications to address and resolve chronic health care conditions. See, for example, the doctors, nutritionists, medical researchers presenting at low-carb conferences: Low Carb Denver 2023, Metabolic Health Summit, and Low Carb USA/Society of Metabolic Health Practitioners.
Central to nutritional disagreements are two competing theories: the energy balance theory of obesity and the carbohydrate/insulin theory:
For nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. They stay lean when they don’t.
• How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity (STAT News, September 13, 2021
The paper, published in the American Journal of Clinical Nutrition offers an alternative model to the eat-less-move-more message and argues that success in weight loss, as well as weight-loss maintenance, is more about what you eat and less about how much you eat.
• The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. (The American Journal of Clinical Nutrition (December 2021).
Weight loss, the study found, is all about our hormonal response to certain macronutrients. Study authors include several of the most prominent nutrition scientists in the country.
The calories in, calories out concept is 'tragically flawed,' new research suggests (Today, September 20, 2021)
More on alternative theories to obesity and modern health problems:
• People eat out more and serving sized are much larger. Discussed in Michael Pollan’s classic The Omnivore’s Dilemma (2006, p 100-108).
• Portion size: cause and solution to overweight and obesity? (British Nutrition Fd., Oct. 6, 2022)
• Are Increasing Portion Sizes and Ingestive Frequency Driving Obesity? (Nutrition.org, Dec. 14, 2021) Reviewing an Advances in Nutrition article.
• Warning: Commercial Dishwashers Can Damage the Gut and Lead to Chronic Disease (SciTechDaily.com, Jan 25, 2023)
• Addictive foods as problem: Joan Ifland, author of Processed Food Addiction and other books, At: www.drjoanifland.com. Also, the Food Addiction Institute.
• Classic overview article: How the Ideology of Low Fat Conquered America, (Journal of the History of Medicine and Allied Sciences, April 2008). At:
• “The carbohydrate-insulin model: a physiological perspective on the obesity pandemic” (Clinical Nutrition, September 13, 2021), At:
• Adult Obesity Causes & Consequences (CDC, accessed Dec. 31, 2021). At:
• Nina Teicholz - 'Science and Politics of Red Meat in 2021' (YouTube, April 24, 2021).
• 8 Years of Low Carb at Norwood Surgery by Dr David Unwin | #PHCvcon2021 (May 8, 2021). At:
and What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss, BMJ Nutrition, Prevention & Health (David Unwin, et al, January 10, 2023)
Author note: Many posts on my nutritional research and journey at NormalNutrition.substack.com