SPH: Do you think the emphasis on red meat and whole milk to end the “wars” on protein and saturated fats stigmatizes certain people?

Wang: On one hand, pushing back against decades of fear-based messaging around fat and protein can be helpful and corrective. On the other, when guidelines elevate specific foods like red meat or whole milk as defaults, they can unintentionally marginalize people with food allergies, dietary restrictions, or who are navigating tight food budgets. Public guidance works best when it emphasizes patterns and flexibility, rather than signaling that health depends on access to a narrow set of foods.

SPH:  Is it concerning that eight of the nine authors of the guidelines have ties to the meat and dairy industries, or is it common for such panels to include industry experts?

Wang: It’s not unusual for expert panels to include individuals with industry experience, especially in food and agriculture. Expertise often overlaps with industry involvement. The concern arises when those ties are not transparently managed or when they appear to dominate the evidence-review process. What matters most is strong conflict-of-interest safeguards, transparency, and a clear demonstration that recommendations are driven by the totality of independent evidence and not by any single sector’s priorities.

SPH: If you could change anything about the pyramid, what would you rearrange?

Wang: The protein section could be broadened visually and conceptually to more clearly include plant-based proteins like beans, lentils, tofu, nuts, and seeds, alongside animal sources. That would better reflect both the evidence and the range of foods that people eat.

SPH: What has your research shown about red meat consumption and cancer risk? Based on your work, should certain groups consider minimizing, rather than increasing, their consumption of red meat?

Petrick: Our prior work in the Black Women’s Health Study has shown that higher intake of red meat is associated with increased risk of both colorectal and pancreatic cancers. These findings align with the American Institute for Cancer Research (AICR) guidelines, which recommend limiting intake of red meat and eating little to no processed meat. When applied alongside the new federal dietary guidelines, a 150-pound adult would ideally limit red meat to approximately 10-20 percent of the total protein intake. This suggests that most protein should come from non-red meat sources, particularly for individuals with elevated cancer risk. More broadly, the new federal guidelines’ emphasis on eating whole, minimally processed foods and avoiding diets high in refined carbohydrates, added sugars, excess sodium, unhealthy fats, and chemical additives aligns well with AICR recommendations for cancer prevention.

SPH: Do you think the guidelines for children are realistic for the average child to adhere to, both at home and in school? Do you foresee any challenges with schools implementing these recommendations, particularly with the recent federal funding cuts to school?

Poblacion: With no mention of the word “school” anywhere in the text,  the guidelines appear to have one audience: stay-at-home women who should cook meals from scratch. That said, we can discuss if these recommendations are realistic for an average child to adhere to at home and whether schools are capable of following these new guidelines, given existing constraints.

It is important to distinguish how the term “highly processed foods” is being used in the guidelines: “Paired with a dramatic reduction in highly processed foods laden with refined carbohydrates, added sugars, excess sodium, unhealthy fats, and chemical additives, this approach can change the health trajectory for so many Americans.” This description appears to overlap with the fourth category of the NOVA classification, a highly accepted definition and classification of processed food. NOVA classifies foods into four categories considering physical, biological and chemical methods used during the food manufacturing process: Non-ultra-processed food groups or Minimally processed foods; processed culinary ingredients;  processed foods; and ultraprocessed foods. This last category is defined by formulations of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes. These foods undergo significant industrial processing, with additives like high-fructose corn syrup, hydrogenated oils, hydrolysed protein, stabilizers, flavor enhancers, etc. In this sense, avoiding children’s exposure to ultraprocessed foods makes sense. However, the devil is in the details. The society we are currently in today precludes both caregivers to be financial providers. So, cooking all meals from scratch is not common given the demands of modern life. 

With regard to schools’ ability to integrate these nutrition guidelines, a nationwide, large-scale, sustained investment of funds in school meal reimbursement would be necessary. Less processed foods are more expensive and current reimbursement structures do not allow schools to meet these guidelines. In addition, similar investments would be needed, as less processed foods inherently require more preparation. In past decades, many school systems eliminated kitchens and relied instead on vendors who provide food that is often prepackaged.

Ettinger de Cuba: Schools would also need sustained support for widespread, integrated nutrition education. Science shows us that rapid changes to diet are unlikely to be well-accepted, leading to food waste. Prior successful efforts at dietary improvement in schools required repeated taste tests, integration of nutrition and healthy eating into other curricula, including math, science, and social studies. Other key audiences for nutrition education and support include teachers, kitchen and school staff, including custodians, and parents. 

And we can’t forget young children. Children’s dietary preferences are set early. Children in early education and care are served by the Child and Adult Care Food Program or CACFP. CACFP, while very important to young children’s health and nutrition, has extremely low reimbursement rates and a great deal of administrative burden for participating early education providers. Just like in the K-12 setting, early education providers need real-world reimbursement rates, less red tape, and support for nutrition education for their young charges, their teachers, and the children’s parents. 

SPH: Many states are beginning to restrict SNAP recipients from purchasing junk food, sugary drinks, and hot/prepared foods with their benefits. Do you think these restrictions will ultimately benefit their health?

Ettinger de Cuba: For many years, groups purportedly interested in improving the nutritional status of people with low incomes have focused on restricting SNAP as a way to reach this goal. However, these restrictions will harm health and ignore important facts. SNAP benefits, including the maximum monthly benefit, have been repeatedly demonstrated to be insufficient for purchasing a healthy diet. The calculation upon which the maximum benefit is based does not reflect modern food prices or demands on household budgets. On average, SNAP benefits provide $5.90-$6.20 per person per day, or, $1.96-$2.07 per person per meal. This is insufficient to purchase a meal—unless it is ultraprocessed—or cook a meal from scratch. How can we expect people to eat well when the benefit does not match the cost of food? SNAP benefits are set nationally, which means the calculation does not adjust for regional prices and, thus, families in high cost areas are at an additional purchasing power disadvantage. Research examining SNAP benefit amounts and their connection to health outcomes tell a consistent story. For example, women who had higher SNAP benefit amounts had lower BMIs than those with low benefit amounts, pointing to the role of purchasing power in the relationship between food and healthy weight. Similarly, in examining how benefit amounts relate to health and health care utilization, children in areas of the country where the SNAP benefit had lower purchasing power were less likely to get needed preventive health care and more likely to miss school due to illness.

Poor eating habits are also not limited to those with low incomes. The entire US population eats too much saturated fat, sodium, packaged food, and sugar-sweetened beverages, thus, the solutions need to be society-wide. Targeting poor people misses the mark that US eating habits and the whole US food system need change. These changes include reducing the excessive influence of corporate food and agriculture industries on the US food system, for example, by subsidizing fresh fruits and vegetable farmers and providing additional support to small farmers;  fundamental systemic changes in food advertisement to children and adults;  ensuring that work pays real cost-of-living wages; reining in rampant “financialization” of the economy; and eliminating inequities in education attainment, earnings, and incomes by race, ethnic origin, nativity, and gender. 

The bottom line is that it is important to recognize systemic causes of low prices and unlimited availability of poor quality, energy-dense, nutrient-sparse foods, and limited availability and high costs of healthful foods, instead of blaming the high prevalence of noncommunicable diseases on people’s poor choices—and, more specifically, poor people’s “choices.”

SPH: Is the shift in guidance around alcohol consumption problematic, and do you think it will have a real impact on the public’s drinking behaviors? Do you agree with the previous recommendations for women to consume no more than one drink per day and men to consume no more than two drinks per day?

Jernigan: This change in the guidelines ignores significant research that found that the prior limit of two drinks per day for men was too high, as low risk for men and women is a maximum of one drink per day. The new guideline does not tell people much of anything. Asking people to “drink less,” when 17 percent of US adults age 18+ report binge drinking—which is four or more standard drinks for women and five or more for men, on a single occasion—in the last 30 days, gives people permission to keep drinking at high-risk levels. This is like telling drivers to “speed less”—we have specific speed limits for a reason, we should do at least as well for a product that kills 178,000 Americans a year. Once again we have failed to follow the science.