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Tag: Food pyramid

  • 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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  • A look at what you should be putting in your grocery cart after the recent food pyramid changes – WTOP News

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    WTOP talked with a local nutritionist and a physician about what this means and whether you should adapt your diet.

    Health and Human Services Secretary Robert F. Kennedy Jr. recently unveiled a new food pyramid that prioritized proteins and healthy fats.

    But what does this mean for you and your diet?

    “We see that there’s an emphasis on whole and minimally processed foods, and that really is a welcome shift away from decades of more nutrient-focused messaging,” said Patti Truant Anderson, policy director at the Johns Hopkins Center for a Livable Future.

    She said the focus of the new food pyramid moves away from added preservatives and toward fruits and veggies.

    “We see that fruits and vegetables are prominently in the new food pyramid, which aligns with evidence-based dietary patterns, which we know help people live longer,” she said.

    But there are parts of the new pyramid she thinks people should pay attention to. This includes the added emphasis on protein and meat.

    “I think that there are some aspects that may be misleading to consumers when you look just at the new food pyramid, compared to the actual guidelines,” Truant Anderson said.

    She said the big focus on meat and dairy products might be confusing to some.

    “How do you increase your protein content without increasing your saturated fat content too much? And it is possible, but you have to be really careful about that, and focus more on the plant-based and seafood sources of protein,” Truant Anderson said.

    Dr. Ashanti Woods, an attending pediatrician at Mercy Medical Center in Baltimore, said you should be paying attention to what the inversion of the pyramid means for you and your family.

    “We’re looking down the road and, ultimately, have a goal of keeping our children healthy,” he said.

    He said he liked that the new pyramid encouraged a diversity of foods.

    “We want families to consider a plate that has a little bit of everything on it. We want children to explore. We want families to take their children with them shopping to the grocery store so that children can pick out certain foods and give it a try,” he said.

    Woods said one of the biggest changes when it comes to the food pyramid is the goal for daily protein intake. Currently, the recommendation is 0.8 grams of protein per kilogram of body weight.

    “It’s now been increased to 1.2 to 1.6 grams of protein a day, essentially doubling it. While we don’t think children should be eating, consuming, a lot of anything, protein included, we do think that there are some benefits to children eating lean protein,” he said.

    And Woods said the healthiest habits come not only from watching what you eat but, “anywhere from three to five days of good exercise in the work week, and good exercise to us is anywhere from 30 to 60 minutes of activity that involves sweating.”

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    Valerie Bonk

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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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