Paul Holmes 01 Aug 2004 // 11:00PM GMT
Eighty percent of Americans recognize the Food Guide Pyramid, the design created by global public relations firm Porter Novelli in the early 1990s to provide an easy-to-understand visual representation of the principles underlying a healthy diet. Yet 66 percent of Americans are overweight, and the number of Americans categorized as obese increased about 60 percent between 1991 and 2000.
“The Food Guide Pyramid was tremendously successful in raising public awareness of basic food guidance, but our national effort to educate the public on building healthy diets has been an abysmal failure,” says Bill Layden, director of the food and nutrition practice at Edelman. “Recent survey data show that most adults have heard of the Food Guide Pyramid. However, only 17 percent of adults report that they use it as a reference and food consumption surveys show that less than one percent of adults actually follow a diet consistent with the pyramid.”
The pyramid recommends consuming six to 11 servings of carbohydrates a day, or the equivalent of six to 11 slices of bread. It suggests that people eat between two and four servings of fruit, between three and five servings of vegetables, two to three servings of meat and other protein sources; and up to three daily servings of dairy products.
The typical American diet, however, does not come close to following that advice. Only 7 percent of people eat the recommended number of fruits and vegetables, for example. The average Americans eats nearly three times the amount of sugar suggested by the pyramid, while only 16 percent of women consume enough dairy products.
Clearly, the pyramid’s message is not getting through. So now there is an attempt underway to revise and improve both dietary guidelines and the way they are communicated. The U.S. Department of Agriculture’s Food, Nutrition and Consumer Service has once again turned to Porter Novelli to develop a new system to help motivate consumers to make healthy food choices.
But as the process moves forward, there are questions about the advice the government should be giving and whether the pyramid is an appropriate visual to communicate that advice. There are concerns that the USDA doesn’t have the resources to market the new pyramid (or whatever shape is chosen) and that major food industry groups will once again do whatever they can to undermine any advice that involves consuming less of their products.
“From my experience, often, industry groups are the ones that have the most accurate information and best trained experts relating to their products,” says Patti Londre, president of Los Angeles-based food public relations specialist The Londre Company. “Unfortunately, they also have their own agendas, so it is a highly charged political battlefield, there is no one source who knows everything.” As a result, she worries, “The process will be a train wreck, nobody will be happy with the results because there are too many differing opinions about what happens to the body when something is consumed.”
The Dietary Guidelines for Americans, upon which the pyramid is based, are constantly reviewed to make sure they are consistent with the latest science, and the Health and Human Services Department’s advisory committee decided last year that the time has come for new guidelines—and a new graphic to communicate the guidelines to consumers.
In September 2003, USDA called for public comments on proposed changes to the food guidance system. The latest request for comments on the graphic—the pyramid or whatever visual is chosen to replace it—is just the latest stage in the revision process. The guidelines and the graphic are expected to be published in early 2005.
Most food experts agree it’s time for a change.
“The food guidance system needs to be revised to reflect significant changes in scientific and medical knowledge, nutritional standards, nutritional composition of the food supply—it’s not your father’s steak anymore, it’s much leaner—and consumption patterns,” says Layden. “How best to communicate these changes to the public to achieve behavior change also requires application of new developments in education, behavioral sciences and communication.”
There have been specific advances in knowledge since the pyramid was introduced.
“Since the pyramid’s inception, we’ve gained more information into beneficial components of the diet including specific fatty acids and new compounds of phytonutrients, but also with potential dietary concerns such as trans fats and our increasing sugar intake,” says Lisa Kelly, senior vice president in the Seattle office of Publicis-Dialog.
In 1992, when the pyramid was introduced, The Wall Street Journal predicted that it would “accelerate shifts in consumption patterns away from products high in fat, such as red meat and cheese, while spurring further development of low-fat products.”
Says activist Marion Nestlé, author of Food Politics: “This prediction proved only partially correct. Consumption of premium ice-cream and American cheese, for example, has increased. Thus the effectiveness of the pyramid as an educational tool to encourage consumption of more healthful diets is debatable.”
Today, some nutrition even blame the pyramid for America’s obesity problems, claiming it oversimplifies the food groups and stresses such food as bread and pasta at the expense of more proteins and unsaturated fats. Carol Tucker Foreman, director of food policy for the Consumer Federation of America, says one problem is that foods that people should eat the least of are at the top, where they get noticed more easily and “people think they are more important.”
Two professors at the Harvard School of Public Health have been promoting what they say is a healthier pyramid since 2002. Their pyramid has 11 food categories as opposed to the six included in the government version, and the base of the pyramid is daily exercise. Next come whole-grain foods and plant oils, which the professors say should be consumed at most meals. Next come vegetables, with the advice that they should be eaten in abundance. The next level comprises nuts and legumes (a recommended one to three servings a day); then fish, poultry and eggs, (zero to two servings a day); then dairy or calcium supplements (one or two servings); then multivitamins “for most people.” At the tip of the pyramid are red meat, butter, white rice, white bread, potatoes, pasta and sweets, which should be consumed sparingly.
That would be particularly bad news for white bread and for pasta, which have already taken a hit because of the recent popularity of low-carbohydrate diets. The base of the pyramid currently recommends six to 11 servings every day of bread, cereal, rice and pasta, making no distinction between whole-grain products and those that contain fortified grains.
Among the most common complaints voiced by nutrition experts:
Grouping all fats and oils together at the tip, without distinguishing between “good” fats (like olive oil and canola oil, which contain monounsaturated fats) and “bad” fats (saturated fats and trans fatty acids); Starchy, carbohydrate-packed potatoes are lumped together with the low-calorie, nutrient-rich fleshy and leafy vegetables;
Sources of protein such as meat, poultry, fish, dry beans, eggs and nuts are together despite many nutrient differences;
No distinction is made between high-fat and low-fat dairy products;
Bread, cereal, rice and pasta are in a group at the base, despite the health differences between refined and unrefined carbohydrates;
The pyramid contains no advice about the importance of healthy exercise.
“The food pyramid’s 80 percent recognition rate among consumers shows that it has been quite effective in raising awareness,” says Jenifer Wayman senior vice president in the social marketing practice at Ogilvy Public Relations Worldwide. “However, it has not been an effective stand-alone education tool for two primary reasons: it doesn’t go deep enough to explain critical nutrition concepts, such as balance and variety; and it leaves too much open to incorrect interpretation by consumers, such as what constitutes a serving size.”
Londre goes even further: “The information it imparts isn’t helpful to the American diet today. The ratio of certain food categories isn’t the healthiest advice, nor does it deal with more complicated food issues today. Americans don’t eat simple foods like an egg or a slice of bread. They eat processed foods. Where does a Lean Cuisine fit on the pyramid?”
But if some experts believe the food pyramid failed to live up to expectations, others say those expectations were unrealistic to begin with.
According to Layden, “The food pyramid that the public knows is a single graphic that was originally intended to help support a fairly complicated food guidance system for the general population. The food guidance system itself was explained in a 32-page brochure that few health professionals, let alone consumers have ever read or understood.
“Food guidance is actually very complex and, thus, defies simplistic messages or images. The 1992 food pyramid attempted to educate the public with three core messages: variety, proportionality and moderation. These core messages haven’t changed in over 100 years. But putting them into practice on a daily basis to meet one’s individual nutritional requirements requires planning and preparation which few individuals really learn and even fewer are truly willing to do.”
Others suggest that the ugly political battle over the introduction of the Food Guide Pyramid, which pitted food industry groups against the nutrition community, reduced the government’s enthusiasm for promoting it aggressively.
In 1991, pressure from corporate interests prompted the newly-appointed Agriculture Secretary Edward Madigan to block the introduction of what was then called the Eating Right Pyramid, which he complained was “confusing to children.” Madigan’s concern was puzzling to nutritionists, because children were never the intended audience for the pyramid.
For the next year, the battle over the food pyramid became front page news, and reporters came to understand that the real problem with the original design was not that it was too confusing but rather that it was too clear. And what it clearly suggested, with its hierarchical structure, was that some foods—most notably fats, oils, and sugars—were not as good for people as some others—such as fruits and vegetables.
The process of developing new dietary guidelines began in the early 1980s, when two federal agencies with conflicting agendas decided to get together to speak with one voice on nutrition issues. The agency with the most interest in the health consequences of the American diet was the Department of Health & Human Services, but the agency with actual lead responsibility for nutrition policy was the U.S. Department of Agriculture, which exists primarily to protect the interests of food producers.
In 1984, the USDA’s Human Nutrition Information Service, after extensive research, issued its guidelines and produced something called the Food Wheel. It recommended daily servings of each of the major food groups: 6-11 grains; 3-5 vegetables; 2-4 fruits; and 2-3 each from the meat and dairy groups. Fats and sweets were placed in a narrow sector, with the recommendation that they should be eaten only in moderation.
In 1988, HNIS approached Porter Novelli to design a graphic that would convey the key concepts, including variety, proportionality, and moderation. The firm conducted focus groups, and found that people responded best to the pyramid. Said one focus group participant: “One thing the pyramid gives you… you look at it, and you know you are supposed to eat more of the bread and cereal and less of the dairy.”
Over the next couple of years, the pyramid design was sent to leading nutrition experts, presented at more than 20 professional conferences, and discussed with editors. In February 1991, the design was sent to the printer, but by early April food writers—many of whom had seen the pyramid during the review process—were reporting on the advice that people should eat less meat and dairy as if it was news, and quoting troubled industry sources.
On April 15, Secretary Madigan paid a visit to the annual meeting of the National Cattlemen’s Association and told them he had learned of the pyramid for the first time in the previous weekend’s newspaper (despite the fact that it had been widely circulated within his department for at least a year). The cattlemen demanded the withdrawal of the pyramid, as did the National Milk Producers Federation. Two weeks later, Madigan yielded to the industry pressure, under the pretext of protecting kids from potential confusion.
A pitched battle ensued. Organizations such as the American Cancer Society, the Society for Nutrition Education, and the Center for Science in the Public Interest protested Madigan’s decision. The American Cancer Society wrote to then-President George H.W. Bush and asked that he transfer responsibility for nutrition advice from USDA to DHSS. Nutrition experts at the USDA began leaking internal memos to the media.
In 1992, after spending almost a million dollars on additional research, the USDA released a revised version, the Food Guide Pyramid, that differed from the original just enough to appease the meat and dairy producers. The major changes were the name change—the words “Food Guide” replaced the words “Eating Right”—and the numbers of recommended servings had been moved outside the pyramid, and suggested that a healthy diet should include at least 2-3 servings for meat and dairy. (In addition, the size of a serving of meat had increased, from 5 to 7 ounces, an increase from the 4 to 6 ounces suggested in the outdated Basic Four foodgroups.)
Certainly there is the potential for the process to become similarly politicized this time around. Earlier this year, the Sugar Associates responded with fury after the World Health Organization revised its nutrition guidelines to recommend that people get no more than ten percent of their calories from sugar—and won support for its case from the U.S. government, an ominous sign for those who would like to see sound science triumph over corporate interests.
And food industry groups are expected to wait until close to the August 27 deadline to send in their ideas, giving the nutrition experts less time to rebut them. That’s something you do if you’re concerned about influencing the process; it’s not something you do if you’re interested in helping the agency come up with the best possible nutrition advice.
Still, many public relations professionals believe the transparency of the process this time around—the USDA has solicited public (and corporate) opinion at every stage of the process—reduces the risk of an outcry from industry.
“More than any other food and nutrition campaign led by the federal government, the process to revise this latest edition of the educational tool has been extremely transparent and inclusive,” says Kellly. “Even so, the field of nutrition is comprised of grays versus black and white, resulting in many opinions, interpretations, and emotions about what we as a population should or should not be eating. Dietary recommendations are complex, and national guidance benefits from a variety of voices, from those who grow, produce and eat foods and beverages to those professionals who strive to keep us healthy.”
The USDA “should be commended for conducting an open and transparent review process for the food guidance system based on science and in tandem with the Department of Health & Human Services and the Dietary Guidelines Advisory Committee,” says Layden. “Such a process helps ensure that science rules. All parties have been invited to provide comments and input. And all comments submitted have been posted to USDA’s and DHHS’s websites for public scrutiny.”
That’s a change from a decade ago, when there were limited opportunities for public comment, Layden says.
Of course, skeptics worry that the food industry might have too much influence—a reasonable assumption given that the current administration has been accused of putting special interests ahead of sound science in a wide range of issues, from climate change to stem cell research. That could reducepublic acceptance of the eventual pyramid, particularly if it appears to have been unduly influenced by corporate interests.
But most public relations experts feel such concerns are misplaced.
“The nutrition community has a great deal of influence,” says Wayman.. “The Dietary Guidelines Advisory Committee—the panel reviewing and recommending revisions to the Dietary Guidelines—is comprised of leading nutrition experts from around the country. These are the people who will make the ultimate recommendations and it is clear from their meetings that they have been grappling with very basic nutrition issues—unencumbered by special interests.
“At the same time, interested parties should have the ability to comment on emerging guidelines that will impact the public’s health—this open process ensures that all relevant information is taken into account.”
So what form should the new pyramid take?
“I wouldn’t make a pyramid, for one thing,” says Londre. “I would abandon that model as ‘old’ and not applicable to today’s American food scene. I’d made a different visual, probably a dinner plate. We eat off of plates, not pyramids. There are more lessons to teach than what a pyramid can offer. For example, how many people know what a portion size is?” Beyond that, she says, the new visual should communicate two messages: everything in moderation; and eat less than you burn off.
Kelly has similarly straightforward advice: “Eat sensibly. Enjoy regular exercise.”
One challenge will be overcoming the suspicion that since dietary advice is constantly changing, making healthy choices is impossible. The changing of the pyramid may be seen as just more evidence that there’s consistency to nutrition advice.
Says Londre, “Food is science, and most people are a bad at science, so they are best at picking up and remembering nuggets of information. The more you repeat the nuggets, the more they will remember them. Unfortunately, people don’t act on good advice a lot of the time. Science evolves, we are constantly learning things. Who knew when margarine first was introduced the effect it would have on our arteries because the vegetable fat was hydrogenised?”
In fact, there may be a need to explain how science works before explaining what a healthy diet looks like.
“To the extent that dietary and food guidance are based on science, it is important to recognize that science is a knowledge process not a truck stop,” says Layden. “Because science is going to evolve so is food guidance. Communicating the science as it evolves also bears a responsibility for putting it into proper context because, surprisingly, the fundamental tenets from the nutrition community have changed really very little over the last 25 years. What has changed is the proliferation of promotion of one-off studies of limited quality.
“The public relations profession itself should exercise discipline in helping to improve nutrition literacy, not spread confusion.”
Perhaps more important, the new visual can’t be viewed as a solution to the problem. It needs to be seen as part of an ongoing communications process.
The new guide “must be personalized for consumers to make it relevant and fit within the context of Americans’ busy lives,” says Wayman. “The success of this new guide will also depend largely upon the marketing power that is put behind it, and upon the emergence of changes in grocery store, cafeteria and restaurant offerings that make it easier and more inviting for consumers to choose healthy foods over less healthy ones.”
“We don’t expect people to learn how to drive cars with a single graphic at the gas station, why should we expect that they will learn how to build healthy diets with a single graphic on a cereal box?” Layden wonders. “Because we all eat multiple times every day and have so since before our first memories, t is all too easy to dismiss the idea that learning how to build a healthy diet is complex. Unfortunately, no amount of revision to the Food Guide Pyramid is likely to compensate for the lack of national priority on nutrition education.”
The USDA has already indicated that after it revises the Food Guide System, it has no money to implement nutrition education. So Layden is pessimistic: “When all the hoopla and food fights over the current revisions die down in a year, the nation will be faced with the same problem in another 10 years unless we get serious about nutrition education.”
There also needs to be an effort to tailor customized messages to different segments of the population.
“Ultimately, general population messages can increase awareness, but in themselves are unlikely to motivate and change behavior,” says Layden. “We need to apply a ‘marketing’ approach to promote healthier eating, building upon taste, convenience and price—the principal criteria by which people make food choices.”
For example, when USDA publishes the final food guidance system, it has indicated that there will be 12 food patterns for different life stage groups. While these patterns have been shown to work on paper—that is the calculations show an individual can meet all the DRIs and dietary guidelines—they will be dramatically different, Layden warns, from the diets most Americans currently enjoy.
“Adopting these new dietary patterns will require dramatic changes in what and how individuals eat. And the new patterns will not have undergone consumer testing to see if they can actually be put into practice. This is not a trivial matter. USDA has announced a desire to help individuals ‘individualize’ their food guidance via a website and other sources. But this is not the same as helping consumers adopt a plan of small changes shown to be effective in achieving sustainable behavior change.”
Clearly, creating a nutrition education approach that has a real impact on the American diet is one of the biggest communications challenges of our time.