- Rhiannon Lambert, nutritionist and author
- Robert Hobson, nutritionist
- Lucy Jones, chief clinical officer, Oviva
- Bridget Benelam, nutrition scientist, British Nutrition Foundation
- Juliette Kellow, registered dietitian
- Gopika Chandratheva, freelance public health nutritionist
Americans woke up to the mantra ‘eat real food’ when the US Health Department released its new set of five-yearly Dietary Guidelines for Americans this month. A rude awakening for the world’s number one fast-food nation.
With the highest rates of type 2 diabetes in the developed world and a 41% obesity rate, it’s never been so important to get dietary advice right.
At first glance, it looks like US Secretary of Health Robert F Kennedy Jr hit several right notes with the tagline ‘better health starts on your plate’. Positives include reducing highly processed foods, cutting added sugar and eating wholegrains daily. However, the devil is in the detail, and this was the case when nutrition experts took a deeper dive into the advice. We asked top UK dietitians and nutritionists for their takeaway.
Looking at the food pyramid
Dietitian Lucy Jones believes the latest US food guidelines take them one step forward and two steps back. “The new guidelines have helpfully identified the high consumption of ultra-processed foods as a primary driver for the US metabolic crisis, yet they dangerously muddle the message by encouraging a surge in consumption of animal fats and red meat,” she says.
“By flipping the traditional food pyramid and relegating fibre-rich wholegrains to the bottom, we risk trading one chronic disease for another. You cannot effectively tackle obesity and type 2 diabetes while simultaneously promoting a dietary pattern that makes it nearly impossible for the average consumer to stay within the life-saving 10% limit for saturated fat and thus potentially drives increases in chronic heart disease risk,” says Lucy.
“We also need to consider the complete lack of consideration this has for food-based carbon emissions and planetary health. A missed opportunity to champion plant-based proteins,” she says.
Nutritionist and author Rhiannon Lambert thinks the current dietary guidelines have caused confusion. “While they now recommend two to four servings of wholegrains per day, wholegrains are depicted at the bottom of the new food pyramid. This can be misleading, as starchy foods should make up just over a third of the foods we eat. In contrast, foods high in saturated fat, such as full-fat dairy, meat and eggs, are placed alongside fruits and vegetables at the top, which misrepresents their recommended intake. The main concern is that saturated fat is over-represented, encouraging consumption of products like full-fat dairy, butter and red meat, despite research consistently linking high saturated fat intake to elevated cholesterol and increased risk of heart disease,” she says.
Nutritionist Gopi Chandratheva agrees that the way the foods are positioned in the pyramid gives mixed messages. “At a glance it appears to favour proportions and volumes of food groups at the top rather than a well-balanced mix of food groups that we need daily,” she says. “This food pyramid lacks practical information on how the main food groups fit into a healthy diet, overlooks accessibility, affordability and sustainability.”
In contrast, the UK’s Eatwell Guide gives clear proportions for major food groups and many more examples of products within these groups. Starchy foods and vegetables fill much more of a healthy plate, plus we have clearer guidelines on protein as well as alternatives and the emphasis on fibre, she says.
“The US dietary guidelines have missed some fundamentals including fibre and there is an emphasis on red meat and full-fat dairy, which is a concern for heart health when it comes to saturated fat consumption,” she says. For this reason it’s likely to leave people more confused and fearful of foods, and is missing practical guidance on how to eat better for overall health. “As nutrition in science evolves, clarity in guidance is essential to help the public make better choices,” she says.
Rhiannon, too, favours visual guidance, similar to the UK’s Eatwell Guide, showing portion sizes and the importance of carbohydrate diversity could help people make informed choices without unnecessary restriction.
“Greater emphasis and clarity around the recommended limit for saturated fat, set at a maximum of 10% of total intake, is essential. Without this, and following the new advice around full-fat dairy, meat and other fat sources as outlined in the guidance could lead to exceeding this limit very quickly.
“Many people will not read the full dietary guidance and the food pyramid will likely become the main representation of the US dietary guidelines, so it is crucial that this information is presented clearly to help the population make informed choices,” she says.
Overstating the need for protein
Robert Hobson believes no food system or set of national dietary guidelines is ever going to be perfect and thinks the US has taken some positive steps forward. “There’s welcome progress around reducing ultra-processed foods, cutting added sugar, encouraging whole foods, recognising the importance of gut health and acknowledging that getting enough protein matters as we age,” he says.
However, he believes parts of the guidance feel shaped by current food and fitness trends in the US. “The messaging is very protein-focused, it risks normalising higher protein intakes than most people actually need, fibre feels comparatively under-played. There’s also a strong emphasis on performance-style eating, which doesn’t always translate into better long-term health for the average person,” he says.
“The recommendation to increase protein intake needs careful interpretation as most adults in the US already meet or exceed basic protein requirements, so a broad message to eat more protein risks giving the wrong impression.
“I think that for most people the issue isn’t protein quantity, it’s protein quality, balance and where that protein comes from.”
Robert sees moving beans, nuts and seeds into the protein category as a good step as this helps normalise plant-based proteins. “But placing strong emphasis on animal-based protein sources, including red meat and full-fat dairy, while still advising people to keep saturated fat below 10% of calories creates mixed messages. Without clear guidance on portion size and frequency, that’s difficult for many people to apply in practice,” he says.
He believes a more helpful public health message would be to encourage people to diversify their protein sources by shifting some intake away from red and processed meat towards beans, lentils, fish, nuts and seeds. “That approach supports protein adequacy while also improving fibre intake and overall cardiometabolic health. It looks like the meat and dairy industry have had a strong influence on this pyramid,” he says.
The healthy fats and salt conundrum
The British Nutrition Foundation sees there are some positives in the new guidance, such as prioritising wholegrains – wholemeal breads, wholemeal pasta and porridge – that will help to increase fibre intakes, which are lower than recommended in the US and the UK, as well. The BNF sees the focus on fruit and vegetables as welcome, and in line with dietary advice from around the world.
“However, beef tallow and butter are highlighted as healthy fats to cook with, which contradicts a substantial body of evidence showing that diets high in saturated fat can increase blood cholesterol and risk of cardiovascular disease,” says BNF spokesperson Bridget Benelam. “Also, throughout the guidance, advice is given to season with salt if preferred. Decades of research has shown that excess consumption of salt is associated with increased risk of high blood pressure and so advice in the UK and around the world is to reduce salt intake. In the UK, its recommended adults consume no more than 6g salt a day.”
The issue with ultra-processed foods
While the updated guidance around ultra-processed foods is well intentioned, it risks oversimplifying a much more complex issue, says Rhiannon. “During my work on The Unprocessed Plate, it became very clear that avoiding ultra-processed foods isn’t equally accessible to everyone. Time, cost, availability and energy all play a role, and for many people convenience foods are a necessary part of daily life rather than a lifestyle choice.”
She points out that not all ultra-processed foods are bad. “Some of these foods absolutely do have a place in a balanced diet and therefore nuance here is key. Ultra-processed foods were originally developed to improve food access and shelf life, and they continue to play a role in feeding busy families. The challenge isn’t their existence but how often they dominate the diet and what displaces them. Guidance needs to acknowledge this reality and focus on practical, achievable steps rather than simply just avoiding them,” she says.
What about wholegrains?
In the new healthy eating model, the focus is primarily on protein-rich foods, together with vegetables and fruits, says dietitian Juliette Kellow. “These, of course, are important components of a healthy diet. But years of scientific research shows us that fibre-filled wholegrains are also a crucial part of a nutritious, balanced diet, helping to protect against health conditions such as heart disease, stroke, type 2 diabetes and colorectal (bowel) cancer,” she says.
Like many other health experts, she finds it frustrating that the pyramid visual places little emphasis on wholegrains. “A loaf of bread and what looks like a bowl of porridge appear at the very bottom of the pyramid, giving the impression that wholegrains should make up only a very small part of the diet. While it’s positive that wholegrains are mentioned, the visual image seems very misleading. The accompanying advice recommends 2-4 servings of wholegrains a day, but you have to wade through heaps of information to find this detail – something most people are unlikely to do,” she says.
Aside from the proportional misrepresentation of wholegrains, the imagery also raises a question around choice. “Apart from bread and oats, consumers are given few other examples of what wholegrains – or other fibre-rich starchy foods (potatoes are included in the veg and fruit part of the pyramid) – might look like in practice. Where are the images of wholegrain pasta, brown rice, bulgur wheat, wholegrain low-sugar fortified cereals, sweet potatoes or yams?,” she says.
“These foods are important sources of fibre, a nutrient we need to prioritise for our gut health but is lacking in so many people’s diets. The accompanying guidance pinpoints fermented foods such as sauerkraut, kimchi, kefir and miso as ways to support a diverse microbiome. While these foods may have a place, for most people it is far more practical and likely more effective, to support gut health by choosing well-known, commonly eaten wholegrain foods such as pasta, rice, noodles, bread and breakfast cereals. Unfortunately, this message is not clearly communicated in the new guidance,” she adds.
Hydration and alcohol: is this the signal to drink up?
The guidance to prioritise unsweetened drinks is really sensible and well supported by the evidence, Robert observes. “Reducing sugar-sweetened drinks remains one of the clearest wins for metabolic and dental health, and in the UK their intake is big,” he says.
The change in alcohol advice is a bit more concerning though. “Moving away from clear numerical limits towards vague language like ‘limit alcohol for better health’ risks weakening an already challenging public health message. The evidence linking alcohol intake to increased risk of cancer, liver disease and cardiometabolic problems is now very strong, and clearer thresholds help people understand risk in practical terms.
“While simplification has its place, alcohol is an area where clarity really matters. Looser wording may be interpreted as a softer stance, rather than reinforcing the message that drinking less or not at all is better for long-term health,” he says.
The tracking of alcohol units started in the UK in 1987. Advice has changed over the years and the recommendation now is that both men and women drink no more than 14 units of alcohol a week. If you regularly have 14 units a week, the advice is to spread your drinking over three or more days.
What’s the takeaway?
There are positive intentions within the guidance but it falls short on offering the kind of clear, accessible support that many people actually need to make changes, says Rhiannon.
“For guidance to be effective it has to meet people where they are – particularly those who rely heavily on takeaways or convenience foods because of cost, time or access. Affordability is a significant barrier. In many settings foods perceived as healthier can be more expensive, which means advice needs to focus on realistic, low-cost options rather than ideal scenarios,” she says.
Rhiannon, like other dietitians and nutritionists in the UK, points to practical resources such as simple portion visuals, affordable recipe ideas and basic cooking guidance for quick, everyday meals, which would be far more helpful than broad recommendations alone.
“Supporting people to build meals around accessible staples like tinned beans, pulses, frozen vegetables or wholegrains can make a meaningful difference without increasing food pressure,” she says.
It’s also important to recognise that not all processed foods are inherently bad. “Fortified and convenient options, such as tinned vegetables or beans, can play a valuable role when fresh foods aren’t always practical. Clearer guidance that distinguishes between different types of processed foods and focuses on balance and adding in rather than avoidance, would help people make more informed, realistic choices,” she says.
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