Federal Agencies Hijack “Independent Review”
of the Dietary Guidelines
National Academy of Medicine Defies Will of Congress
Post date: February 1, 2017
Frustrated by continued high national rates of diabetes and obesity, the US Congress in 2015 ordered an unprecedented independent review of the nation’s top nutrition policy, the US Dietary Guidelines for Americans (DGAs). It’s the first official peer review of the guidelines, the country’s top dietary recommendations, since they were first launched in 1980.
Judged by its first three public meetings, however, that review, under the auspices of the National Academy of Medicine (NAM), is thwarting the congressional mandate to reform the guidelines in any way that might actually help improve the nation’s health.
The guidelines, jointly issued every five years by the U. S. departments of Agriculture (USDA) and Health and Human Services (HHS), have been increasingly challenged over the past decade. Critics charge that the updating process has been tainted by insufficient scientific rigor, a lack of transparency, and a failure to reflect a “preponderance of the scientific and medical knowledge” as stipulated in the Congressional charter for the DGAs.
Congressional intent for scope of work misrepresented
Congress dictated a scope of work for the NAM review that included, as its first and arguably most crucial point, an instruction to investigate “how the Dietary Guidelines for Americans can better prevent chronic disease, ensure nutritional sufficiency for all Americans, and accommodate a range of individual factors, including age, gender, and metabolic health.”
This mandate was clearly directed at the glaring inability of the guidelines to date to prevent obesity and diabetes among Americans. The USDA’s own expert report has criticized the guidelines’ three dietary approaches ( “Dietary Patterns”)– U.S.-style, Mediterranean and vegetarian — as deficient in potassium, vitamin D, vitamin E, and choline. And despite the intention to provide a range of options, the “patterns” remain a one-size-fits-all approach without accommodation for individual factors, such as “age, gender, and metabolic health.”
These are all grave, substantive problems with the guidelines and clearly what Congress sought to address when it allocated $1 million for the NAM review.
The review scope also listed several points related to the process of producing the guidelines, including the need “to provide more transparency, eliminate bias, and include committee members with a range of viewpoints” and to examine the process of scientific reviews and data analyses to ensure they proceed “according to rigorous and objective scientific standards.”
The trouble is that from its start, the NAM review has focused almost exclusively on questions of process while jettisoning any substantive inquiry into the guidelines themselves. The very title given by NAM to its study –“Review of the Process to Update the Dietary Guidelines for Americans,” [italics added] –reflects this emphasis and therefore directly contradicts Congressional intent for a study meant to encompass both the process and substance of the guidelines.
This end-run around a substantive review of the guidelines was underscored September 1, at the first meeting of the NAM committee, when Angela Tagtow, Executive Director of the USDA’s Center for Nutrition Policy and Promotion (CNPP), the office in charge of the DGAs, explicitly misrepresented Congress’ intent. Tagtow repeatedly discouraged the committee from addressing the substance of the guidelines. “The study is about the process to develop the Dietary Guidelines,” she said, adding, “The study will not…evaluate the content or scientific content of current or previous editions of the Dietary Guidelines….The task of this committee is how to effectively apply the Dietary Guidelines…not to develop new ones.”
Indeed, in the three NAM public meetings to date, stretching in all over 11 hours, only 30 minutes were devoted to questions of substance. This testimony, entitled, “The role of nutrition and diet in preventing and treating chronic diseases,” was given by Culberto Garza, the chair of NAM’s standing board on food and nutrition, who focused on reference values for adequate nutrition.
NAM panel fails to represent a range of viewpoints
A further, serious problem with the NAM review is its defiance of the specific mandate from Congress to “include a balanced representation of individuals with broad experiences and viewpoints regarding nutritional and dietary information.” An emphasis on the importance of balance is echoed throughout the authorizing language. The overall goal of the report is “to ensure the Dietary Guidelines reflect balanced sound science,” with a stipulation that the NAM study should investigate “whether scientific studies are included from scientists with a range of viewpoints.” [Italics added.]
Yet not only is the panel made up almost entirely of government insiders – ensuring a biased outcome, as we reported here last summer –but government officials invested in the status quo have so far dominated the meetings. The bulk of the testimony has come from silver-haired senior scientists on first-name terms with each other, a generation whose ideas have governed while obesity and diabetes rates have skyrocketed.
Thus, with the panel now a third of its way through its 18-month process, it has been thoroughly dominated by the very government agencies it was meant to review and has yet to hear from a single speaker challenging the USDA and HHS consensus on a healthy diet. Strikingly, there has been no discussion whatsoever of the large body of scientific literature, pioneered by a young generation of scientists and medical doctors, demonstrating carbohydrate restriction as a new and promising approach to treating obesity and diabetes.
Tagtow and fellow CNPP employee Eve Essery Stoody were the only two invited speakers at the review panel’s inaugural meeting. The pair returned to address the second meeting one month later, joined by three other speakers from the USDA and HHS. Altogether, they spoke for more than half of the total time allotted to invited speakers. Nor did other attendees add balance to the input for the panel, given that they included Walter Willett, whose department at Harvard University routinely supplies members of the DGA advisory committees, and Richard Black, a former Vice President of PepsiCo and Kraft Foods, as well as the former Executive Director of the International Life Sciences Institute, a food industry group with members such as Mars, Coca-Cola, Dow Chemical, and Hershey Foods. The only known invited critic of the guidelines, nutrition scholar Cheryl Achterberg, a dean at The Ohio State University, did not ultimately appear or provide testimony, for reasons that were not publicly explained.
The third public meeting, on January 10, began with nearly an hour of testimony from Barbara Millen, chair of the 2015 DGA advisory committee, who defended the guidelines as “a beautiful, comprehensive report.” Millen’s appearance directly defied specific instructions from Congress that members of the 2015 DGA advisory committee “recuse themselves from this [NAM] process to ensure objectivity.”
Millen’s testimony was followed by more than an hour of comments by, once again, Eve Essery Stoody, along with two of her colleagues, one from her own office at USDA and the other from their counterpart office at HHS, the Agency for Healthcare, Research, and Quality (AHRQ). Of the six remaining speakers that day, three were either government or former government employees (Patricia Mabry from NIH, Shawna Mercer from CDC, and Patricia Britten from USDA), while one served on the HHS Secretary’s Advisory Committee on Healthy People 2020, and a fifth was Garza, the NAM appointee.
A large part of the NAM panel’s proceedings have been closed to the public. Following its first session, the committee met in private for several hours, with no public record of its discussions. Its third meeting, November 3, 2016, was entirely closed to the public, and there have been at least two subsequent meetings (Jan 30th and Jan 31st) that appear to have been closed and as of this posting, are not listed on the study website.
Last week, a new study by the marketing intelligence agency Mintel found only 23 percent of Americans polled believe the Dietary Guidelines are good for them.
“This biased, unbalanced review by the NAM gives new reasons to be skeptical. It’s a patent waste of $1 million in taxpayer money, and a tragic, missed opportunity to make progress in reversing the tremendous, budget-breaking load of chronic disease in America,” said Sarah Hallberg, medical director of an obesity clinic at Indiana University and executive director of The Nutrition Coalition.