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Tag: dietary guidelines

  • Kennedy, RealFood.gov misrepresents chronic health spending

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    Have you seen the Mike Tyson ad telling people to eat “real food?” The black-and-white spot that debuted during the Super Bowl is the latest promotion for the federal government’s new dietary guidelines. 

    With a quick scroll, football watchers who visited the website in the ad would have encountered the statistic that “90% of U.S. healthcare spending goes to treating chronic disease — much of which is linked to diet and lifestyle.” 

    This statistic also appeared in the dietary guidelines and on the CDC’s website. Health and Human Services Secretary Robert F. Kennedy Jr. said it this way in his Jan. 7 announcement: “The CDC reports that 90% of healthcare spending treats chronic disease.” 

    This number grabbed podcaster Michael Hobbes’ attention. “I couldn’t find anyone fact-checking this number,” Hobbes said on the Jan. 30 episode of “Maintenance Phase,” a podcast that digs into the science behind health and wellness trends.

    No worries — PolitiFact is here to answer the call! 

    The 90% figure has roots in a 2017 report by the Rand Corp., a nonpartisan research organization. But one of the researchers told PolitiFact that the claim, as stated by Kennedy and RealFood.gov, didn’t accurately reflect their findings. 

    The Rand report calculated all health spending on people with chronic illnesses, which includes a majority of Americans. It did not isolate the total spending on treating chronic illness itself.

    Here’s another way to think about it: If someone with asthma broke a leg, got glasses or picked up antibiotics, that all counted as spending on a person with a chronic disease — even if it’s not treating the asthma. 

    The department did not respond to our request for comment. HHS relayed the research more accurately in the dietary guidelines document and CDC website. 

    What the report really said

    A trail of footnotes in the dietary guidelines leads to the 2017 Rand report.

    Rand used data from an annual government-run survey. The Medical Expenditure Panel Survey asks families to report a year’s worth of personal health care use and spending — including doctor’s visits, prescriptions and hospital stays. It also collects data on people’s health conditions, which can be categorized as chronic or not chronic.

    The sample size has varied over the years, ranging from about 18,000 to 37,000 people. Experts said it is among the best data sources on personal health spending. 

    The report defines a chronic condition as a mental or physical health condition lasting over a year that either requires functional restrictions or ongoing medical treatment. Many conditions fall into this category, including hypertension, diabetes, depression, anxiety, osteoarthritis, asthma, heart disease, high cholesterol, and cancer. 

    Using survey data collected in 2014, Rand researchers estimated almost 60% of Americans had at least one chronic condition. 

    Then they looked at people’s health care costs, including payments made by insurers and out-of-pocket costs. 

    According to Rand, spending on the 60% of people with one or more chronic conditions made up 90% of all spending. The 40% with no chronic illnesses made up 10% of the spending. 

    “A person in a year spends or incurs health care costs for multiple related things,” said Christine Buttorff, a Rand health policy researcher and study co-author. “It could be their chronic disease, but it also could be something as simple as an acute illness where they had to go to the doctor or go to the emergency room for something totally unrelated to the chronic disease. So our estimates lump all of that together.” 

    The claim that 90% of U.S. health care spending goes to treating chronic disease is “not an accurate reflection of our report,” Buttorff said. 

    Limited data on chronic illness treatment spending

    Estimating how much Americans spend on treating chronic illness is harder. It typically requires using insurance claims data, which is spread across government databases and private insurers. 

    It can be difficult to link expenses and conditions. If, for example, a person with asthma is hospitalized with pneumonia, is that part of their chronic disease treatment or an acute case? If a person pays to see a psychiatrist but has both anxiety and depression, which diagnosis is that cost linked to? 

    University of Washington researchers have been tackling this question. The university’s Institute for Health Metrics and Evaluation in 2025 analyzed personal health care spending from 2010 to 2019 on 148 health conditions, without distinguishing chronic illnesses from other ailments. 

    In 2019, the top three most expensive conditions were Type 2 diabetes ($143.9 billion), musculoskeletal disorders such as joint pain and osteoporosis ($108.6 billion), and oral disorders such as cavities and orthodontia ($93 billion). 

    “Reality is, we spend a ton of money on things that people don’t associate with chronic diseases,” said Joseph L. Dieleman, a University of Washington health metrics sciences professor and study co-author.

    PolitiFact did not find any studies since 2018 that looked specifically at past chronic disease treatment spending. 

    One recent report tried to model future spending on chronic disease. A 2025 report from GlobalData and the Partnership to Fight Chronic Disease estimated an average of $2.2 trillion annually in medical costs over the next 15 years. 

    Given that current health care spending is over $5.3 trillion annually, that rate of spending would put chronic disease spending around 42% annually. 

    Rising chronic illness burden is not all related to diet and lifestyle

    U.S. chronic illness rates are rising.

    In 2010, about 50% of Americans had at least one chronic condition. The number has climbed closer to 75% in recent years, boosted in part by better diagnostics and longer lifespans. 

    “Chronic conditions linked to lifestyle choices such as physical inactivity or diet are a huge issue in the U.S., even if their use of this statistic isn’t quite right,” Buttorff said. 

    Several of the most common chronic conditions — hypertension, Type 2 diabetes, heart disease, and high cholesterol — have been linked to diet and lifestyle related risk factors. 

    Others can’t always be linked to lifestyle, including mental health conditions, asthma, Type 1 diabetes, cancer, rheumatoid arthritis, Alzheimer’s disease, and dementia.

    Our ruling

    Kennedy and his department said that 90% of health care spending is for treating chronic disease.

    The statistic is based on all health spending on people with chronic diseases, not spending on treatment itself. 

    A majority of Americans have chronic illnesses, so it’s likely the real number is high. We were unable to find a reliable report that isolated chronic illness spending in the past few years, but a predictive report estimated it could be around 2.2 trillion annually, which would be less than half of current health spending. HHS did not provide evidence to support the claim about treatment spending. 

    We rate this statement False. 

    Staff Researcher Caryn Baird contributed to this report

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  • How influential was the food pyramid of the 90s?

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    Maybe it was a faded poster in your school cafeteria or a worksheet in health class, but if you attended school in the 1990s or 2000s, you’re almost certainly familiar with the food pyramid. 

    The graphic dominated U.S. dietary education until 2011, when the federal government replaced it with MyPlate, which emphasized fruits and veggies as making up roughly half of a healthy diet. 

    Today, health leaders and some influencers are still lashing out at the old pyramid, with its grain-heavy focus, blaming it for some Americans’ poor health. As Health and Human Services Secretary Robert F. Kennedy Jr. announced December plans to unveil new federal dietary guidelines, we looked back at the old food pyramid. Was it really that bad? And did it actually change how we eat?

    And what do experts (who aren’t trying to sell you something) say is a “healthy, balanced diet,” anyway? 

    Old, but not as old as the pyramids in Egypt

    The iconic food pyramid didn’t make its debut in the U.S. until 1992, but its triangular building blocks date back further.  


    U.S. Department of Agriculture, “The Basic Seven,” 1943 

    The U.S. Department of Agriculture published its first dietary guidance in 1894 as a “Farmers’ Bulletin.” Over the next 80 years, as nutrition and food science understanding evolved, the department issued new guidelines on how to eat. In 1933, guidance advised families on how to get nutrients on a Depression-era budget. In 1943, the USDA’s “Basic Seven” food groups focused on healthy eating during wartime rationing. In 1956, USDA simplified its guidance to the “Basic Four” food groups. 


    U.S. Department of Agriculture, “The Basic Four,” 1956 

    Up until the mid-20th century, nutrition guidance focused on vitamin deficiencies and making sure Americans got enough of certain foods. But as chronic health problems like obesity and cardiovascular disease began to rise in the 1950s and ‘60s, so did concerns about the American menu

    In 1980, the USDA and HHS released the first set of dietary guidelines, which the USDA now publishes every five years. The food pyramid and MyPlate are simple, visual representations of these 100-plus-page guidelines over the years. 

    The dietary guidelines of the 1980s and 1990s focused heavily on reducing fats and cholesterol and eating more carbohydrates such as rice, corn and wheat. 


    U.S. Department of Agriculture, “Food Wheel,” 1984

    “Carbohydrates are especially helpful in weight-reduction diets because, ounce for ounce, they contain about half as many calories as fats do,” read the 1985 dietary guide.

    Fats, sugars and oils appeared at the 1992 Food Guide Pyramid’s top “use sparingly” category, and grains formed the base with a recommended six to 11 daily servings. 


    U.S. Department of Agriculture, “Food Guide Pyramid,” 1992 

    “The pyramid wasn’t ‘bad,’ but it reflected the nutrition science of its time,” said Debbie Petitpain, registered dietician and Academy of Nutrition and Dietetics spokesperson. 

    The thinking at the time was that low-fat diets were protective against heart disease, and carbohydrates were a healthier alternative to fatty foods. “It turned out that was wrong,” said Marlene Schwartz, University of Connecticut food policy and health professor. 

    Research around the turn of the century revealed the reality was more complicated. Added sugars and refined grains also contribute to cardiovascular and metabolic diseases, and not all fats are equally bad for us. “Unsaturated fats from foods like olives, nuts, and seeds can be protective for heart health,” Petitpain said.

    Reflecting this shift, the 2005 dietary guidelines ditched the grain-heavy focus in favor of a more even breakdown across the food groups. For a 2,000-calorie diet, federal guidance recommended six ounces of grains (half of them whole grains), two and a half cups of vegetables, two cups of fruits, five and a half ounces of lean meat or beans and three cups of milk. 

    The USDA ditched the pyramid’s hierarchical sections in favor of vertical colored stripes and added a person walking up the side to represent physical activity. The visual was confusing and hard to parse.


    U.S. Department of Agriculture, “MyPyramid,” 2005

    In search of a more intuitive graphic, the USDA changed to MyPlate in 2011. MyPlate focused on proportions as they might appear on a plate, broken up into roughly even quarters of fruit, vegetables, grains and protein. The underlying portion sizes haven’t changed since 2005.

    U.S. Department of Agriculture, “MyPlate,” 2011 

    Did the food pyramid change how Americans eat? 

    Dr. Dariush Mozaffarian, Tufts University nutrition science professor, described the pyramid as a disaster. “People feared all fats, regardless of the type or the food source,” he said. “Refined grains and starches — which we now know have similar health effects as added sugar — were given a free pass.” Despite the pyramid being retired years ago, Mozaffarian said, “The image is burned into people’s minds, conscious and unconscious.”

    The American diet shifted from the 1970s to the 2000s; fewer daily calories came from fat, and more calories came from carbs. Food manufacturers made more “low-fat” and “fat-free” options. “They sort of took the fat out of the cookies, but then they put in more sugar,” Schwartz said. “And so even though the grams of fat went down, the overall nutrition really wasn’t improved.”

    The trend of less fat and more carbs has shown signs of reversing in more recent data post-2000, when “low-carb” diets took off. However, overall intake of both fats and carbs has climbed as Americans consume more calories overall, eat out more and consume more processed foods. 

    Not all experts blame the pyramid.

    Schwartz said Americans’ finances tend to drive their dietary choices. “If you have a limited income and your goal is to feed your children, your dollars are going to go a lot farther with processed, packaged food than fresh ingredients,” she said.

    Research since 1980 shows Americans have regularly failed to eat according to recommended dietary guidelines. “The pyramid definitely shaped nutrition education and public awareness,” Petitpain said, “but its effect on actual eating habits was limited.”

    Surveys show only about one-third of American adults have heard of MyPlate and even fewer have tried to follow its recommendations.

    Public school lunch programs have been required since 2010 to follow MyPlate guidelines and the dietary guidelines can shape federal food programs like WIC. 

    It’s not clear whether December’s federal dietary guidelines release will include a plan to replace MyPlate and its diet recommendations.

    What is a healthy, balanced diet?

    In a media world inundated by fad diets, supplements and cures, knowing what is healthy can feel overwhelming. The nutrition experts we spoke with offered broad guidance, most of which you have probably heard before.

    A healthy diet is varied but includes generous portions of fruits and veggies alongside whole grains, beans, nuts and lean protein. Cheese, milk, poultry, eggs and unprocessed red meats should be consumed in moderation.

    “Modern nutrition advice emphasizes eating patterns rather than single nutrients,” Petitpain said.

    Cutting out any of the macronutrients food groups like carbs or fats might cause weight loss, because you may be eating less food overall, but it is hard to sustain and won’t be healthy in the long run, Schwartz said.

    Experts said MyPlate isn’t a bad place to start.

    PolitiFact Researcher Caryn Baird contributed to this report.

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  • RFK Jr. promised to ‘Make Our Children Healthy Again.’ Here’s how he plans to do it

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    (CNN) — President Donald Trump’s strategy to ‘Make America Healthy Again’ includes investigating vaccine injuries and pharmaceutical practices but stops short of new regulatory action, for now.

    US Health and Human Services Secretary Robert F. Kennedy Jr. unveiled the MAHA strategy on Tuesday, joined by Agriculture Department Secretary Brooke Rollins, Environmental Protection Agency Administrator Lee Zeldin, and other top Trump officials.

    The report hews closely to a draft document circulated in August that cites earlier Trump administration announcements — developing a definition for ultraprocessed foods, educating the public about synthetic kratom — but largely bypassed industry crackdowns.

    Language around pesticides strategy also remained unchanged. Environmental and food activists had rallied for the administration to include steps to reduce pesticide usage and probe potential health risks of commonly used chemicals such as RoundUp.

    The report says that USDA, EPA and the National Institutes of Health will develop a framework to study cumulative exposures to chemicals including pesticides and microplastics. USDA and EPA will also invest in new farming approaches to reduce chemical use, and EPA will launch a public awareness campaign about the limited risk of approved products.

    The commission’s first report this May suggested a broad range of factors driving chronic disease in the US, including ultraprocessed foods, environmental exposures, and overprescription of pharmaceuticals like antidepressants.

    The report noted previous announcements that HHS, the NIH and the Centers for Medicare and Medicaid Services are studying the causes of autism. Kennedy had previously promised some answers on the root causes in September; NIH is expected to announce autism research grants this month.

    Recent reports suggest that HHS will issue a report that links the development of autism to taking Tylenol during pregnancy.

    Medicines and vaccines

    Kennedy has drawn criticism for suggesting antidepressants, particularly those that are part of a family known as SSRIs are as addictive as heroin and can be dangerous. Following the August 27 shooting in Minneapolis, he told Fox News that HHS is launching studies “on the potential contribution of some of the SSRI drugs and some of the other psychiatric drugs that might be contributing to violence.”

    SSRIs, or selective serotonin reuptake inhibitors, are the most prescribed class of antidepressants for depression, anxiety disorders and many other mental health conditions. Several SSRIs have been on the market in the United States since the 1990s, including Prozac, Zoloft and Celexa. Experts agree that there is no scientific evidence or correlation between these drugs and violence towards others.

    Tuesday’s report states that HHS will assemble a working group of federal officials to evaluate SSRI prescribing patterns, specifically among children. HHS will also “evaluate the therapeutic harms and benefits of current diagnostic thresholds,” or the current common practices doctors use to diagnose patients with mental health disorders.

    Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association said access to care, not over-medication is the bigger problem when it comes to helping kids’ mental health in the country, and there is no mention of the issue in the report. The report said addressing a child’s nutrition, screen time, and exercise can improve their mental health, but can’t address everything. “Psychiatric conditions are complex in nature,” she said. Extreme poverty, post traumatic stress disorder, trauma-related factors should also be addressed, but there is no mention in the report of any of those issues either.

    “In terms of over medication, that’s not what we do. We have a comprehensive evaluation and we are evidence based. We diagnose than create a comprehensive treatment plan, “ Miskimen Rivera told CNN. “Medication can save lives, not only in children, but in adults and elderly.”

    When asked about whether or not the commission chose to consider gun violence – the leading cause of death for children – as one of the issues to be investigated, Kennedy doubled down on the issue of prescription drugs, saying “We are doing studies now, or initiating studies to look at the correlation and the connection, potential connection between over medicating our kids and this violence.”

    HHS will also work with the White House Domestic Policy Council on a new vaccine framework that, the report said, will ensure “America has the best childhood vaccine schedule” and ensure “scientific and medical freedom.”

    The report comes as Kennedy continues to defend his shakeup of the US Centers for Disease Control and Prevention over vaccine policy, including the ouster of CDC Director Dr. Susan Monarez.

    The administration will also increase oversight of “deceptive” direct-to-consumer advertising of pharmaceutical products, including from social media influencers and telehealth companies, it said.

    Food policy stays the course

    FDA will continue work on developing a definition for ultraprocessed foods, but the report bypasses recommendations, like those of former FDA Director Dr. David Kessler, to essentially order certain additives off the market until they are reviewed.

    Dr. Dariush Mozaffarian, director of Tufts Food is Medicine Institute said a definition of ultraprocessed foods would be “really important.” With more than half of calories in the food supply coming from ultraprocessed foods, addressing this and other issues involving the nation’s diet would mean a “massive fight with the industry and is going to be incredibly controversial, but is much needed.”

    “Overall, this is really quite thorough, quite specific, and even if parts of this are accomplished, this could have tremendous positive impact for Americans,” Mozaffarian told CNN.

    Other experts, like Marion Nestle, agreed the report was ambitious in scope, but noted it fell short on regulatory action. “What’s still missing is regulation. So much of this is voluntary, work with, promote, partner,” said Nestle, who is the Paulette Goddard professor emerita of nutrition, food studies and public health at New York University.

    The report also nods to new, user-friendly dietary guidelines expected later this year. Kennedy has promised a vastly shortened set of recommendations that will emphasize whole foods.

    The commission also cited ongoing work to reduce ultraprocessed foods in the Supplemental Nutrition Assistance Program (SNAP) and Head Start.

    While the report also touches on agriculture deregulation with the aim of making it easier for small farms to get greater access to markets and schools, Ken Cook, co-founder of the Environmental Working Group, a health advocacy organization said the report abandons earlier MAHA promises to ban toxic pesticides and instead “echoes the pesticide industry’s talking points.”

    “Secretary Kennedy and President Trump cynically convinced millions they’d protect children from harmful farm chemicals – promises now exposed as hollow,” Cook said in a statement.

    There were minor changes from the draft document leaked in August. For instance, the August 6 draft stated that the FDA and other agencies will crack down on “Illegal Chinese Vapes,” while the final version promises enforcement on vapes more broadly.

    “We support the goal of making children healthier and addressing and preventing chronic disease, but unfortunately, the recommendations fall short in some really critical ways,” Laura Kate Bender, vice president nationwide advocacy and public policy for the American Lung Association told CNN.

    “They continue to cast doubt on vaccines, one of the most, important, proven public health interventions that we can have for kids health. They don’t address some major contributors to diseases in kids like pollution, tobacco use, beyond the mention of vaping, and this report is coming out at the same time that we’re continuing to see dramatic cuts in staff and funding of a lot of the programs that could make the good parts of the report a reality.”

    The report’s emphasis on kids’ health can help overall, Dr. Michelle Macy, director of the Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center in Chicago told CNN. “I’m really trying to look for bright spots in this report, and I think that the focus on data and infrastructure for us to be able to answer big questions about what environmental and food exposures and medication exposures do to shape the trajectory of someone’s health and chronic disease across the lifespan is something that has promise and potential.”

    Dr. Richard Besser, pediatrician and president and CEO of the Robert Wood Johnson Foundation said that having a focus on preventing chronic disease in children is a good thing, but he said, with Kennedy’s track record that includes firing thousands of federal health employees, slashing millions in health research funding, dismantling entire offices that managed important issues like smoking and chronic disease specifically, in addition to his “assault on vaccinations” will undermine any potential good of this kind of report.

    “Neither RFK Jr.’s record, nor his policies outlined in the report give me confidence that he is going to make any difference whatsoever on chronic diseases in children,” Besser told CNN.

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    Sarah Owermohle, Jen Christensen and CNN

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  • How Much Added Sugar Is Okay?  | NutritionFacts.org

    How Much Added Sugar Is Okay?  | NutritionFacts.org

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    Public health authorities continue to lower the upper tolerable limit of daily added sugar intake.

    Dating back to the original “Dietary Goals for the United States” in 1977, also known as the so-called McGovern Report, leading nutrition scientists didn’t only call for a reduction in meat and other sources of saturated fat and cholesterol, such as dairy and eggs, but also sugar. The goal was to reduce America’s sugar intake to no more than 10 percent of our daily diet.

    “The conclusions would hang sugar,” reported the president of the Sugar Association. “The McGovern Report has to be neutralized.” The National Cattlemen’s Association was on its side and, just like Big Sugar, appealed to the Senate Select Committee to withdraw the report.

    “The Sugar Industry Empire Strikes Back”—and it appeared to work. When the official U.S. Dietary Guidelines were released in 1980 and again in 1985, it was without a specific limit, like 10 percent. It “said, simply, and in just four words, ‘Avoid too much sugar.’” (Whatever that means.) “In 1990, it went to five words, ‘Use sugars only in moderation,’ and in 1995 to six: ‘Choose a diet moderate in sugars.’” In 2000, it at least went back to limiting intake—specifically, “‘Choose beverages and foods to limit your intake of sugars’ (ten words), but even that was too strong. Under pressure from sugar lobbyists, the government agencies substituted the word ‘moderate’ for ‘limit’ so it read ‘Choose beverages and foods to moderate your intake of sugars.’” Then, the 2005 guidelines committee dropped the s-word completely, encouraging Americans to “Choose carbohydrates wisely…” Again, what does that mean? If only there were a dietary guidelines committee that could guide us….

    The Sugar Association expressed optimism about that 2005 Committee. In its Sugar E-News, it wrote that Sugar Association Incorporated (SAI) “is committed to the protection and promotion of sucrose [table sugar] consumption. Any disparagement of sugar will be met with forceful, strategic public comments”—and it wasn’t kidding. “In 2003, [the World Health Organization] WHO released a joint report with the Food and Agriculture Organization entitled Diet, nutrition and the prevention of chronic diseases which, for the first time [since the McGovern Report], called for a reduction in sugar intake to under 10% of total dietary energy [caloric] consumption.” The Sugar Association responded by threatening to get the United States to withdraw all funding from the WHO. You can see it yourself in black and white at 2:22 in my video Friday Favorites: The Recommended Daily Added Sugar Intake. The Sugar Association threatened to pressure Congress to withdraw funding from the World Health Organization—polio vaccinations and AIDS medications be damned! Don’t mess with the candy man. The threat was described as “tantamount to blackmail and worse than any pressure exerted by the tobacco lobby.” 

    Fifteen years later and 40 years after the first proposed McGovern Report, the 2015 to 2020 Dietary Guidelines for Americans lays out the 10 percent limit as a key recommendation: “Consume less than 10 percent of calories per day from added sugars.” This is currently exceeded by every age bracket in the United States starting at age one, as you can see in the graph below and at 2:58 in my video, with adolescents averaging 87 grams of sugar a day. That means the average teen is effectively eating 29 sugar packets a day. 

    The Sugar Association describes the 10 percent limit as “extremely low.” Well, I mean, it is only up to about a dozen spoonsful a day. Of course, there is no dietary requirement for added sugar at all, and every single calorie we get from added sugar is a wasted opportunity to get calories from sources that provide nutrition. To the American Heart Association’s credit, it went further by trying to push added sugar intake down to about 6 percent of calories, for which a single can of soda could send you over the limit. That’s an added sugar limit exceeded by 90 percent of Americans.

    In 2017, the American Heart Association (AHA) released its guidelines for children, recommending they get no more than about six teaspoons per day. In that case, a single serving of nearly a hundred cereals on the U.S. market would exceed the entire recommended daily limit. The AHA recommends no added sugars at all for children under the age of two, a recommendation that’s violated in up to 80 percent of toddlers, as you can see below and at 4:20 in my video. 

    In the United States, “at least 65 countries have implemented dietary guidelines or public health policies to curb sugar consumption to encourage maintenance of healthy body weight.” In the United Kingdom, the Scientific Advisory Committee on Nutrition made new recommendations to reduce added sugars down to 5 percent, which is also the direction the World Health Organization is headed. The WHO always seems to be ahead of the curve. Why? Because its policy-making process is at least partially protected “against industry influence.” Unlike governments, which may have competing interests in commerce and trade, “WHO is exclusively concerned with health.”

    I spoke at a hearing of the 2020 Dietary Guidelines Committee. Watch the highlights and my speech here: Highlights from the 2020 Dietary Guidelines Hearing.

    The sugar industry keeps pretty busy, as you’ll see from my recent videos, Friday Favorites: Are Fortified Kids’ Breakfast Cereals Healthy or Just Candy? and Flashback Friday: Sugar Industry Attempts to Manipulate the Science.

    Check the related posts below for my other popular videos and blogs on sugar.

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    Michael Greger M.D. FACLM

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