Dietary Guidelines

In 1977, in one of the more perverse episodes in the history of our ongoing discourse on obesity, a subcommittee of the U.S. Congress held a hearing in which the assembled congressional members listened to the leading academic experts of the day expound on the cause and treatment of obesity and its supposedly vital relationship to calories consumed and expended. 

The testimony left Henry Bellmon, a senator from Oklahoma, scratching his head, perhaps because Bellmon seemed to know what it was like to fatten easily and struggle with his weight. Maybe he was talking about himself. If not, it was surely a loved one who had opened his mind. “I want to be sure we don’t oversimplify,” Bellmon said. 

“… We make it sound like there is no problem for those of us who are overweight except to push back from the table sooner. But I watched Senator [Robert] Dole in the Senate dining room, a double dip of ice cream, a piece of blueberry pie, meat and potatoes, yet he stays as lean as a west Kansas coyote. Some of the rest of us who live on lettuce, cottage cheese and RyKrisp don’t do nearly as well. Is there a difference in individuals as to how they utilize fuel?”

 The experts in attendance acknowledged that they “constantly hear anecdotes of this type,” but they could offer no other words of explanation. Their conviction in the primacy of gluttony didn’t allow it. In fact, the evidence has always been clear, but it can’t be reconciled with the notion that obesity is caused by eating too much and exercising too little. Like Senator Bellmon, those of us who want to achieve and maintain a healthy weight can’t afford to think about obesity as an energy balance problem. It gets us nowhere we haven’t already been our entire lives. We have to think about it as a hormonal, metabolic, and physiological problem, perhaps akin to diabetes, as Astwood suggested. Some of us who don’t seem to have it now are going to get it as we age. Some of us aren’t. Some of us can load up on ice cream, pie, meat, and potatoes and stay lean as a west Kansas coyote; some of us can’t. But the foods we eat strongly influence the hormones responsible, as I’ll discuss. That’s textbook medicine. As such, the ubiquitous and seemingly obvious advice to eat “healthy,” as the authorities invariably define it, is not relevant to all of us. The adverb healthy in that advice is a synonym for eating as the lean and healthy tend to do, but we are not them. We fatten easily; they don’t. Doing as they do might surely be better for us than eating the standard Western fare of processed foods—“foodlike substances,” as Michael Pollan memorably called them—and drinking sugary beverages (sodas, fruit juices, energy drinks, mocha latte cappuccinos) morning to night, but that’s not good enough. It may also do harm or at least continue harm to be done. We have to eat differently because we are different.

Gary Taubes. The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating (Kindle Locations 711-718). Knopf. Kindle Edition. 

“We Cannot Afford to Wait”

In the late 1970s in America, the idea that a plant-based diet might be the best for health as well as the most historically authentic was just entering the popular consciousness. Active efforts to demonize saturated fat had been underway for more than fifteen years by that time, and we’ve seen how the McGovern committee’s staff were in short order persuaded by these ideas. Even so, the draft report that Mottern wrote for the McGovern committee sparked an uproar—predictably—from the meat, dairy, and egg producers. They sent representatives to McGovern’s office and insisted that he hold additional hearings. Under pressure from these lobbies, McGovern’s staff carved out an exception for lean meats, which Americans could be advised to eat. Thus, Dietary Goals recommended that Americans increase poultry and fish while cutting back on red meat, butterfat, eggs, and whole milk. In the language of macronutrients, this meant advising Americans to reduce total fat, saturated fat, dietary cholesterol, sugar, and salt while increasing carbohydrate consumption to between 55 percent and 60 percent of daily calories.

While Mottern would have liked the final report to advise against meat altogether, some of the senators on the committee were not so unequivocally confident about their ability to weigh in on matters of nutritional science. The ranking minority member, Charles H. Percy from Illinois, wrote in the final Dietary Goals report that he and two other senators had “serious reservations” about the “divergence of scientific opinion on whether dietary change can help the heart.” They described the “polarity” of views among well-known scientists such as Jerry Stamler and Pete Ahrens and noted that leaders in government, including no less than the head of the NHLBI as well as the undersecretary of health, Theodore Cooper, had urged restraint before making recommendations to the general public.

Yet this hesitation turned out to be too little too late to stop the momentum that Mottern’s report had set in motion. Dietary Goals revived the same argument that Keys and Stamler had used before: that now was the time to take action on an urgent public health problem. “We cannot afford to await the ultimate proof before correcting trends we believe to be detrimental,” said the Senate report.

So it was that Dietary Goals, compiled by one interested layperson, Mottern, without any formal review, became arguably the most influential document in the history of diet and disease. Following publication of Dietary Goals by the highest elective body in the land, an entire government and then a nation swiveled into gear behind its dietary advice. “It has stood the test of time, and I feel very proud of it, as does McGovern,” Marshall Matz, general counsel of the McGovern committee, told me thirty years later.

Dietary Fat Recommendations

1978:

• 30-35% of calories from total fat.

• <10% from SFA, ≤10% from PUFA, remainder from MUFA.

It was Hegsted’s and Foreman’s role to figure out how to implement the Dietary Goals. And this task required at the very least some imagination, because by September 1978, the only thing USDA staffers had published on the subject was a suggested menu of thirteen slices of bread each day in order to meet the report’s recommended amount of carbohydrates. Could no one even come up with some palatable menu suggestions, asked a dietician quoted in the Washington Post.

Well, no, because although Congress had decided upon the components of a healthy diet, scientists were still quarreling over the basic evidence supporting those choices. Hegsted tried to put together an authoritative report on the matter at the USDA, but his effort fell apart amid bureaucratic infighting. Meanwhile, the esteemed American Society for Nutrition, which was also concerned about the need for a stronger scientific consensus before moving ahead with advice for the entire American population, had set up a formal task force to take another look at the diet and disease data and evaluate their strength. Hegsted decided to let his USDA recommendation be guided by the work of that task force. After all, the USDA’s efforts could only be made more credible by having expert support, since it remained true that no group of nutrition scientists other than the AHA nutrition committee (dominated by Keys and Stamler) had ever formally been convened to review the evidence on diet and disease to date. Hegsted knew that he was “taking a big chance . . . since Pete Ahrens of Rockefeller University was co-chairing the committee and was known to oppose general dietary recommendations.” Yet despite that risk, Hegsted agreed to abide by the panel’s decision.

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