MyPyramid – MyFriend or MyFoe? – Alison Krajewski

Introduction
Since its inception, the Food Guide Pyramid has used the same nutritional standards for everyone, regardless of age, height, or weight. To address the inadequacies in these nutritional standards, the United States Department of Agriculture (USDA) restructured its design and introduced MyPyramid. The new MyPyramid campaign has began to implement a personalized plan of action; however, there are still many revisions that still must be completed. Some of the modifications to consider are the following: enhance education on how to use MyPyramid, understanding the dietary guidelines, and the importance of healthy eating; incorporate societal input to gain an understanding of how to effectively market their campaign, as well as the public’s knowledge of MyPyramid; and increase accessibility not only to information about MyPyramid, but also to healthy foods, such as fruits and vegetables.

The Food Guide Pyramid was created in 1992 by the USDA. The pyramid provided suggested daily nutritional guidelines for carbohydrates, vegetables, fruits, proteins, and oils through a illustrative diagram of a pyramid (Figure 1). This graphical representation was used a general guide for individuals to choose healthy foods that were right for them. The Food Guide Pyramid was created with three key concepts at its core: variety, proportionality, and moderation (1). Variety was considered to be a balanced mixture of all food groups; proportionality was based on the recommended serving sizes; and moderation referred to the means to control one’s eating from being excessive (1). The Food Guide Pyramid became the basis for nutrition and healthy eating in America, taught in schools, appeared in countless media articles and plastered on cereal boxes and food labels. Every five years, the USDA reassesses the current guidelines for necessary revisions and updating when emerging nutritional issues arise. Such was the case in 2005 when the Food Guide Pyramid was up for review. Consideration of its effectiveness, in addition to how to incorporate new trends in eating, such as vegetarianism and veganism were focal points. Hence, the USDA retired the old Food Guide Pyramid and replaced it with MyPyramid, a new symbol and “interactive food guidance system” (2). Additionally, MyPyramid was supposed to help stop the increase of obesity rates; however, obesity rates in adults and children continue to rise and obesity-related diseases, such as cardiovascular diseases, are also increasing. Thus, MyPyramid has come under scrutiny over its effectiveness. Currently, the United States is once again working to re-evaluate its dietary recommendations for the general population.

MyPyramid was designed to be a simplistic representation for dietary standards. The new design is color coded and depicts a stick figure ascending stairs on the pyramid to represent the importance of physical activity, which the previous pyramid neglected to represent (Figure 2). The core concepts that were previously used for the Food Guide Pyramid were expanded upon to incorporate the necessary changes in nutrition and maintenance of healthy lifestyles. Now, the anatomy of the pyramid consists of proportionality, variety, moderation, activity, personalization, and gradual improvement. Proportionality is represented by the widths of the food bands; variety is symbolized by the six colored bands; moderation is represented by the narrowing of each food group from the bottom to top; activity is represented by the steps and the person climbing them as a reminder of the importance of daily physical activity; personalization is represented by the person on the steps and the word “My” in MyPyramid; and gradual improvement is encouraged by the slogan “Steps to a healthier you” (3). Although this new pyramid is an improvement from the previous design, it still lacks information for people to make informed choices about their diet. With rates of obesity and obesity-related diseases, such as type 2 diabetes and cardiovascular disease, soaring, the pyramid has once again come under intense scrutiny (4). Currently, the USDA is assessing the dietary guidelines, and it is predicted that revisions will be made to MyPyramid in 2010 (3). The question remains whether there needs to be change in how nutritional information is conveyed to the public or if the problem lies elsewhere.


Critique 1: Usability
The new design of MyPyramid was meant to be substantially simpler than the original version. However, there are issues with the new design. The design is ultimately too simple, MyPyramid is impossible to interpret without the accompanying online tool (5). The colored bands are ambiguous as they do not indicate what food groups are associated with which color (5). For example, orange represents grains, green for vegetables, red for fruits, a teeny band of yellow for oils, blue for milk, and purple for meat and beans (3). There is no logic behind the color coding, making it difficult to interpret. Without visiting the website, one would never know what the colors represent. Furthermore, making MyPyramid solely internet based limits the availability to only those with internet access. Millions of Americans who do not have access to the internet, most often those of low socioeconomic status, are considered to have the least knowledge about nutritional information since most people now get this type of material from the web (5). Consequently, the people in most need of MyPyramid are the ones who cannot obtain the information readily. Although the government has made a valiant effort to keep up with the use of modern technology as a way to convey public health messages, the restricted access to MyPyramid as an interactive online tool puts limitations on its usability.

MyPyramid does not follow the traditional representation of a pyramid. The original Food Guide Pyramid outlined portions American should eat, from the most at the base (grains) to the least at the apex (fats, oils, sugars) (6). With MyPyramid, however, the shape of the pyramid has nothing to do with serving size like the original. Furthermore, without text on the design, it is necessary to visit the website in order to learn what the nutritional recommendations are for each food group. These nutritional recommendations were designed to be personalized, based on age, sex and activity level; however, the online tool makes it optional for the user to include body size (height and weight) – the most important determinant of caloric needs (5). The generated recommended intake can thus be inappropriate for one’s body size or weight, easily recommending hundreds of calories per day too high or too low (5). Additionally, MyPyramid fails to incorporate any other specific dietary needs. Although USDA boasts that the new pyramid is personalizable, the online questionnaire does not take into account adjustments for special dietary needs such as individuals with diabetes, heart disease, high blood pressure, high cholesterol or food allergies.

MyPyramid was designed to be simple. Yet the simplicity of this new design limits its usability. With information about the dietary recommendations only available through interactive online tools, it restricts the accessibility. Furthermore, the dietary recommendations provided by MyPyramid do not take into account the needs of individuals with dietary restrictions due to health-related illnesses, such as diabetes or heart disease.


Critique 2: Dietary Recommendations and Serving Sizes
The Food Guide Pyramid and MyPyramid were created as a way to inform the public about nutritional information through easy-to-read diagrams (3). Dietary guidelines provided individuals with recommended dietary allowance and serving sizes for each food group. USDA defines recommended dietary allowance as the dietary intake level that is sufficient to meet the nutrient requirement of nearly all healthy individuals in a particular life stage and gender group (7). This term is most commonly known as recommended serving, not to be confused with serving size. Serving size, as defined by USDA, is a standardized amount of a food, such as a cup or an ounce, used in providing dietary guidance or in making comparisons among similar foods (7). Adding to the complexity, serving size is sometimes confused with portion size, which is defined as the amount of a food consumed in one eating occasion (7). The terms as defined above are often undifferentiated amongst the general public, and this confusion can result in over or under eating of the dietary guidelines.

The previous Food Guide Pyramid recommended a range of serving sizes without elaborating on why there was a difference in serving sizes. For instance, the pyramid recommended 6-12 servings of grains every day, but did not specify who was supposed to eat 6 servings and who was supposed to eat 12 servings (6). Instead, MyPyramid uses recommended servings in conjunction with the theory of planned behavior, which states that individuals take personal responsibility and utilize moderation to make healthier choices (6). This technique of personal responsibility and moderation to make the “right” food choices is a major downfall for many people because of lack of self-control, lack of knowledge, or even lack of awareness of the issue. Furthermore, the MyPyramid campaign fails to incorporate the importance of self-efficacy, meaning that an individual believes s/he will be able to perform the behavior of healthy eating. It also neglects to incorporate personal empowerment which allows an individual to overcome the obstacles and perform the behavior of healthy eating. Individuals will not be able to successfully navigate their way through MyPyramid if they do not understand the information provided to them or believe that s/he will be able to follow the guidelines.

After using the online form to enter in one’s age and physical activity level – weight and height are optional – the personalized MyPyramid Plan appears. It is when one enters in this information that s/he is able to see the appropriate serving sizes. Nevertheless, as a population, we still have issues understanding what constitutes as a serving and portion control. Portion size per serving has increased in the last thirty years, which continues to affect the rising obesity rates (8). Larger portions encourage people to eat more (8). With the on-the-go lifestyles that many people live, fast food options are ideal. Fast food corporations pride themselves on their larger sizes, like Supersizing at McDonald’s. The Big Mac Meal at McDonald’s has 1350 calories, nearly 68 percent of the total calories an average adult should consume in an entire day (9). Many would take this meal as one portion, which it is clearly is not. Furthermore, chain restaurants promote large portions on their menus and in marketing campaigns, such as the grand slam breakfast at Denny’s. At minimum, this breakfast meal contains 820 calories and 1270 mg of sodium (10). It is difficult for people to control their portions and follow the dietary recommendations of MyPyramid when they are constantly bombarded with media campaigns suggesting that they abandon those principles.

The dietary recommendations for MyPyramid are supposed to be the most up-to-date and based on scientific evidence (3). There has been speculation that the USDA is influenced by the agricultural and food industry groups such as the National Dairy Council, the National Cattlemen’s Beef Association, and the U.S. Potato Board, to incorporate their products in MyPyramid rather than solely depending upon scientific research to make dietary recommendations (11). The tiniest change to the guidelines or pyramid can swing food companies’ sales by millions of dollars, either way (11). Thus, it is suggested that the guidelines are promoting the sales of certain types of foods rather than promoting healthy eating. For example, the guidelines suggest that it is fine to consume half of our grains as refined starch. However, since refined grains behave like sugar, they act simply as empty calories when incorporated into the diet (2). The U.S. Potato board and baked goods lobby groups are depending on this recommendation to keep sales steady by continuing to have recommendations for refined starches (11). The guidelines continue to lump together red meat, poultry, fish, and beans and ask consumers to judge these proteins by the total fat content to make choices that are lean, low-fat, or fat free (3). This guideline ignores scientific evidence that all these proteins have different types of fat, like the heart healthy omega-3 fats found in fish. Furthermore, this recommendation completely ignores the scientific evidence and research studies which have found that replacing red meats with a combination of fish, poultry and beans provides numerous health benefits, such as a reduction of the risk for coronary heart disease (12). This recommendation could be the result of pressure from the National Cattlemen’s Beef Association on the USDA to keep consumption of red meats in the guidelines to keep their products in demand (11). Although recommending fish as a replacement for red meat has been shown to have a multitude of health benefits, this recommendation does not address the issues of methylmercury found in fish. Methylmercury can have profound adverse side effects of the nervous system, especially in pregnant women (13). The recommendation should include which types of fish contain the least amounts of methylmercury or a caution that fish should be consumed sparingly. Lastly, MyPyramid recommends consuming either three glasses of low-fat milk or other dairy products per day even though such a recommendation adds more than 300 calories to one’s daily intake (3, 2). It is unclear whether the recommendation is based on scientific research that says consuming dairy products has health benefits or if it is based on pressure from the National Dairy Council to keep dairy sales steady. These recommendations need to be reassessed to incorporate the most accurate scientific research studies, instead of integrating the interests from agriculture and food industry lobbyists.

In a recent interview with restaurant chefs, it was found that 60 percent of chefs serve steaks that are 12 ounces or larger, which is four times larger than the recommended three ounce serving according to the MyPyramid dietary guidelines (3, 14). In addition, the survey found that most restaurant chefs dish up one to two cups of pasta with a meal; a serving is half cup (14). When eating at restaurants or fast food establishments, people automatically assume that what they are ordering and eating is one serving. It is difficult to see how people are supposed to make healthy food choices when they are confused about what is a recommended serving versus serving size or how a portion size relates to MyPyramid dietary recommendations. If the USDA hopes to be successful in promoting their campaign of MyPyramid, then they need to simplify what a serving size is versus a portion size and how the recommended dietary allowance fits into everyday life.


Critique 3: The Use of Theory of Planned Behavior
MyPyramid is based on the theory of planned behavior (TPB). TPB focuses on rational, cognitive decision-making processes, meaning that people think about what they are going to do before they actually do it (15). TPB derives from the theory of reasoned action (TRA). TRA is defined as behavioral intention that is influenced by an individual’s attitude toward performing a behavior and by beliefs about whether individuals who are important to the person approve or disapprove of the behavior, the subjective norms (16). TPB includes one additional construct - self-efficacy. Self-efficacy, or perceived behavioral control as applied in context with this intervention, means that a person believes that they can control a particular behavior, in this case, food consumption (16). This decision-making process does not apply here because eating, the defined behavior, is not always planned and rational; sometimes it is based on spontaneous, irrational decisions. A person may believe that they can control their food intake but in reality may not be able to do so.

MyPyramid was designed to be an interactive online tool. As stated above, the details of how to use the pyramid, dietary recommendations, and physical activity advice is only available on the website. Only the most motivated people will take the time to fully explore the website (5). The majority of people will not utilize the tools on the website to find out their specific caloric needs and plan their meals accordingly. One study found that 47 percent of the household food budget is consumed out of the home, which translates to the increased consumption of fast food or take out (5). With the on-the-go lifestyle that many people have, their dietary recommendations as provided by MyPyramid are the least of their worries. Thus, people are more likely to neglect their dietary recommendations and disregard planning their meals based on MyPyramid guidelines for whatever is most convenient.

Although TPB considers the influence of peers, it underestimates how influential peers can be on an individual, ultimately deterring that person away from the desired healthy behavior. Individuals who work in corporate settings are often persuaded into making unhealthy decisions during the work week. Many corporations order fast food on a daily basis and provide light snacks like starchy cookies and sugar-laden sodas. Even if an individual packs a brown bag lunch, these day-to-day temptations lure otherwise healthy people into the fattening and detrimental world of fast food. It is easy for many employees to disregard their healthier meals from home for those with little nutritional value and thus abandon the principles of MyPyramid in order to join their co-workers in an unhealthy lunch time meal. Though they may have been good intention to eat food that is healthy, the need to go along with the majority is stronger than individual choice in this case. Therefore, the TPB did not work for this group of individuals. They planned a behavior and performed a behavior that was based on the subjective norms of their peers. The intended behavior was to eat a nutrient-rich lunch, which was replaced by eating the catered fast food. The planned behavior was neglected, which demonstrates the failure of TPB.

The guidelines of MyPyramid assume that people are eating for the sole purpose of nourishment and does not take into consideration the phenomenon of emotional eating. People use eating as a sort of emotional crutch and will eat out of depression, happiness, or even boredom. When an increase in food intake is in response to negative emotions it is called emotional eating (17). Emotional eating can be considered to be an ‘inapt’ response (17). Emotional eating is a consequence of the inability to distinguish hunger from other aversive internal states, or of using food to reduce emotional distress, probably because of early learning experiences (18). Research studies have found that emotional eating increases the consumption of sweet and high-fat foods in particular (19). Emotional eaters overeat in response to negative affects because they have learned that it alleviates them from aversive mood states (17). When people eat for emotional reasons, it is spontaneous and irrational; they are not going to stop their behavior because it does not fit into their dietary recommendations, thus, abandoning the principle theory for which the intervention was created.

As humans, our actions are not always rational or planned. Using a social behavioral theory like the theory of planned behavior for the MyPyramid campaign, will often result in failure. Norms created by larger society will often influence the behavior of an individual. The previous examples demonstrated that people do not always use logic to make nutritional choices. Sometimes when individuals do plan to make rational decisions, those plans are thwarted by peer pressure. Human behavior is a dynamic process that does not always rely on sensible decision making and thus, using a model that is too rigid to predict health outcomes will be unsuccessful.


Proposed Intervention
While MyPyramid has its faults, there are a few things that are beneficial about it. First, regardless of whether people understand MyPyramid or even the older Food Guide Pyramid, it is widely recognizable. The pyramid shape divided into the six food categories is an iconic symbol in the world of nutrition. Secondly, the new design incorporates the importance of physical activity, which was neglectfully left unincorporated in the last design. Lastly, MyPyramid employs the use of current technologies to try and circulate information about dietary recommendations. Any successful intervention will continue to use these principles and then expand on them to further utilize the MyPyramid campaign to its fullest potential. It is also commendable that USDA did not use statistics and information that is unfamiliar or incomprehensible to the general public in this campaign.


Defense of Intervention: Education
Possibly the simplest but most necessary addition to the MyPyramid campaign is education. Not only because of the simplicity of the design, but in general, people still do not fully understand that the symbol represents dietary recommendations. It is important for people to understand that the balance of nutrition, exercise, and eating healthy does not need to be a difficult process. Education that clarifies definitions like the recommended dietary allowance and serving size will simplify the MyPyramid campaign. The addition of clear and straightforward explanations to the MyPyramid campaign will encourage members of the general public to look into MyPyramid.

Using the online tools for MyPyramid is beneficial, but first, people have to know the website exists, have access to the internet, and then understand how to navigate the website. To fix this issue, there first needs to be awareness of the MyPyramid campaign and that there is an accompanying website. Although one may use the website, it does not mean that the individual will understand the information provided. Information on the website, including the recommended dietary allowance and serving size, needs to be stated in way that is understandable to the general public. Information about how healthy eating and physical activity relates to obesity and obesity-related diseases should be made available for all. Furthermore, in addition to the online tools, local community centers need to have copies of MyPyramid and supporting documents so that those without internet access can have the information. In addition, the local community centers should hold classes on nutrition, guiding people on how to properly utilize the resources of MyPyramid.

Education about the MyPyramid campaign in schools would also be beneficial. Children are greatly influenced by what they see their parents or other adults around them doing. If a parent is constantly eating fast food, foods high in fats and sugars, children will also develop those habits. Teaching children the importance of healthy eating at an early age will help them develop and stick with healthy eating habits throughout their lives. In addition to educating children, parents need to be educated as well. They are the ones buying the groceries, packing lunches, and preparing meals. They are the food role models for their children, and they need to understand how important it is for children to develop a healthy relationship with food.


Defense of Intervention: Societal Input
To find the best way to reach the target audience for MyPyramid, there needs to be societal input. While education is an important first step in any successful campaign, societal norms and roles need to be accounted for as well. One of the best ways to do this is to go directly to the source. For example, in 1998, Florida launched its own version of the “truth” campaign. This campaign was a youth anti-tobacco education and marketing program that was extremely successful. From the beginning, this campaign involved youth. The marketing team convened a 500 person youth summit to gain insight into where youth felt the effort should head (19). They provided the team with what they did and did not like and provided positive feedback to help guide the creative process (19). One of the successful strategy techniques that the team used was interviewing youth about the reasons behind their decision to smoke. They then used all this information to brand their “product” (the “truth” campaign). The key strategy to this campaign was the direct involvement of the target audience. By utilizing the resources available to them, the team was able to build a campaign that proved to be a success – teen smoking decreased by 7.4 percent in middle school and 4.8 percent in high school (19).

The strategy that was employed by the Florida “truth” campaign could also be fruitful in branding MyPyramid. The USDA should employ a marketing team to research the reach and awareness of the MyPyramid campaign. This outreach program could be done through surveys. In addition, the team should interview individuals from all different age groups to fully understand what compels them to eat, their awareness of MyPyramid, their knowledge portion sizes and serving sizes, and the feelings towards following the USDA’s dietary recommendations. Conducting interviews, surveying the target audience, and having the direct involvement of that audience will strengthen the power of the campaign.


Defense of Intervention: Accessibility
The main goal of the dietary recommendations set forth by USDA is to promote eating a healthy balanced diet among the six food groups; however, solely promoting this is not enough, there needs to be accessibility too. National data indicates that less than three percent of men and less than six percent of women aged 19 to 50 years consume the daily servings of fruits and vegetables recommended by MyPyramid (20). National surveillance data and numerous other research studies consistently indicate that low-income populations are less likely to meet recommended fruit and vegetable intake levels, compared to high-income populations (20). Whole grains, fruits, and vegetables tend to be higher in price than other groceries; consequently, millions of Americans either cannot afford these items or would prefer to purchase more affordable items. One research study found that low-income neighborhoods had more convenience stores and fast food establishments and fewer supermarkets, fruit and vegetable markets, specialty stores and natural food stores (21). If the MyPyramid campaign is to be used by all people, regardless of socioeconomic status, then all people need to have equal access to healthy foods like fruits and vegetables.

A solution to the disparities in the accessibility to food is community gardening programs. Community gardens are defined by the American Community Gardening Association as any piece of land gardened by a group of people (20). Researchers have found that community gardening readily provides opportunities for community involvement and experiential education about growing, as well as opportunities to strengthen community ties and build social capital (20). Researchers have concluded that community gardening programs increase the intake of fruits and vegetables in low-income communities (19). By involving the community directly in gardening programs, it gives people the opportunity to access fruits and vegetables. Research has illustrated that when people are directly involved in the process of planting and harvesting, they tend to be more willing to increase their intake of fruits and vegetables, which ultimately reinforces the goal and outcome expectancies of the MyPyramid campaign (19, 20).


Conclusion
The Food Guide Pyramid and now MyPyramid were created to promote nutritious, well balanced eating among Americans; however, these tools have been unsuccessful for the most part. In order to increase the successfulness of MyPyramid, there needs to be substantial modifications to the current campaign. Public health officials, nutritionists, and physicians need to better educate people of the importance of maintaining a healthy lifestyle through eating sensibly as well as engaging in daily physical activity. In addition to education, there needs to be access to healthy foods such as fruits and vegetables. Creating community gardening programs gets people directly involved in the process, while providing them with produce they may not have access to otherwise. Lastly, societal input is key in developing a successful campaign. Knowing how to reach the target audience and what is important to them will create a more successful campaign for nutrition and healthy eating.


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