Delivering on the Dietary Guidelines (2019)

How Stronger Nutrition Policy Can Cut Healthcare Costs and Save Lives
With full buy-in from the federal government, the Dietary Guidelines for Americans could save thousands of lives and billions of health care dollars.

Chronic illness takes a terrible toll on the people of the United States, shortening and diminishing lives while it sends our national health care bill soaring. There is strong evidence that much of this damage is attributable to our diets, which are too light on fruits, vegetables and whole grains, and too heavy on added sugar, processed meats, refined grains, and salt.

We could help ourselves by eating better—but this isn't as easy as it sounds. Cost, availability, time, and other barriers complicate many people’s efforts to enjoy a healthier diet. 

Both the burden of diet-related illness and the obstacles to addressing it through healthier eating are distributed unequally. Rates of diseases such as type 2 diabetes and hypertension are significantly higher for communities of color—particularly African Americans—and for low-income communities. And these same communities are likely to have less access both to sources of affordable, healthy food and to health care services, making chronic diet-related illness an issue of racial and economic justice, as well as public health.


Photo: Melissa Hesse

The role of the Dietary Guidelines

The federal government has a potentially powerful tool for addressing this problem in the Dietary Guidelines for Americans, a set of science-based nutrition recommendations updated at five-year intervals by the Department of Agriculture (USDA) and the Department of Health and Human Services (HHS). These recommendations are important because they inform nutrition standards for federal programs from school breakfast and lunch to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and provide valuable teaching tools for public health professionals and the general public.

The Dietary Guidelines is based on the work of a 20-member expert advisory board, the Dietary Guidelines Advisory Committee (DGAC), and typically reflects the best available science on nutrition and health. In fact, the Guidelines’ advice has changed little over the last 35 years: recommendations typically call on Americans to consume more fruit, vegetables, and whole grains; limit foods that contain high amounts of sugar or sodium; and develop healthy eating habits based on moderation and variety.

But the food industry spends tens of millions of dollars lobbying to weaken the Guidelines, sometimes successfully. In the 2015 version, for instance, forward-looking committee recommendations on the environmental side benefits of a plant-based diet never made it into the final guidelines. Many experts saw this decision as an overt override of scientific evidence by meat industry groups that opposed the recommendations.


Photo: Shutterstock/Rawpixel

What we found 

What could happen if the Dietary Guidelines  made actionable recommendations reflecting current science—and people were able to follow them? To address this question, we looked at the relationships between three specific food types and related chronic diseases, applying recent meta-analyses to quantify the potential benefits of meeting science-based dietary recommendations.


Processed meat and colorectal cancer. Colorectal cancer is one of the most common cancers in the US, and also one of the most strongly linked to diet. Solid evidence shows that eating less red and processed meat can reduce the risk of this cancer, yet the 2015-2020 Dietary Guidelines did not include any specific recommendations to reduce consumption of these foods. We projected the potential benefits for 2018 if adults in the US were eating little to no processed meat. 

  • Deaths averted: 3,900
  • Health care costs saved: $1.5 billion
  • Productivity savings: nearly $1 billion

Added sugar and diabetes. Nearly 10 percent of the US population lives with diabetes, mostly type 2 diabetes. This disease takes an enormous toll in the form of early death and disability, and costs hundreds of billions of dollars in medical expenses and lost productivity each year. Research shows that a diet high in sugar-sweetened foods and beverages increases type 2 diabetes risk. The 2015-2020 Guidelines introduced a new recommended maximum for added sugar consumption—but the evidence may justify an even lower threshold. We projected the potential benefits for 2018 if adults who drink soda and other sugar-sweetened beverages consumed about one cup less per day.

  • Deaths averted: 19,000
  • Health care costs saved: $16 billion
  • Productivity costs saved: nearly $6 billion

Fruits, vegetables and cardiovascular disease. About one in three deaths in the United States are caused by cardiovascular disease, which encompasses a range of conditions including coronary heart disease, heart failure, hypertension, and stroke. Research has shown that increased consumption of fruits and vegetables can have a protective effect against cardiovascular disease. The Dietary Guidelines include strong science-based recommendations on fruit and vegetable consumption, but cost, access and other barriers make these recommendations challenging to follow for many Americans. We projected the potential benefits for 2018 if, aided by public policies and programs, US adults could follow the science on fruit and vegetables.  

  • Deaths averted: 110,000
  • Health care costs saved: $32 billion
  • Productivity costs saved: nearly $20 billion

Policy recommendations

The report recommends five actions for the USDA and HHS secretaries to ensure that the work of the DGAC is effectively translated into guidelines that offer the best opportunities for all of us to achieve healthy diets (see the report document for a detailed explanation of these recommendations):

  • Publish final Dietary Guidelines explicitly recommending that people consume little to no processed meat—for example, less than one hot dog every two weeks.
  • Lower added-sugar limits based on average calorie intake and dietary needs.
  • Develop science-based recommendations for pregnant and lactating mothers, infants, and toddlers, whose dietary needs will be addressed for the first time in the Dietary Guidelines.
  • Make substantial targeted investments in the implementation of the guidelines, including holding federal agencies and programs accountable for applying the guidelines.
  • Identify and commit to complementary actions to support anti-poverty programs and make healthy food more accessible for low-income populations and communities of color. 

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