45 Years of Dietary Guidelines — So Why Is America Still Getting Heavier?

Rethinking Food Policy, Personal Responsibility, and the Future of America’s Health

By Richard W. Schmidt, RDN

Recently it was time to revise the Dietary Guidelines for Americans, and the MAHA initiative completed that task. This marks the 10th revision since the guidelines were first introduced in 1980—the same year I began my career as a Registered Dietitian.

That’s 45 years of nutrition guidance designed to help Americans eat healthier and reduce chronic disease.

But here’s a question worth chewing on:

If we graded the success of those guidelines based on the percentage of Americans whose BMI has increased every five years since 1980, what grade would we give them?

The honest answer might be:

An F.

That may sound harsh, but the data are difficult to ignore. Adult and childhood obesity rates have steadily increased over the past four decades despite repeated updates to national dietary recommendations.

So naturally the question becomes:

Who is responsible for America’s growing weight problem?

The Obesity Epidemic: Who Gets the Blame?

When discussing the obesity epidemic in the United States, there are several potential culprits.

Do we blame individual responsibility—people not taking control of their own health or the health of their children?

Do we blame food manufacturers, who continuously adjust ingredients, portion sizes, and marketing strategies to maximize sales while navigating around dietary guidelines?

Or should we look at government policy, questioning whether stronger regulations should exist for what can be added to foods and beverages?

The reality is that all three factors likely play a role.

Our modern food system is complex. Personal responsibility matters, but so do food marketing, product formulation, and public policy.

And right now, the system is clearly not producing the health outcomes we hoped for.

Would America Be Healthier Without Medications?

Here’s a thought experiment I’ve often considered during my career.

What would the health of America look like if medications for high blood pressure and cholesterol didn’t exist?

Would people make different lifestyle choices if they knew medications like statins and blood pressure drugs were not available as a safety net?

Modern medicine has unquestionably saved lives. But in some cases, medications allow us to manage diseases that might have been prevented through lifestyle changes.

However, when we look at the growing diabetes epidemic, it becomes clear that medication availability alone does not drive behavior change.

Even with warnings and treatments readily available, diabetes rates continue to climb.

Which brings us back to a difficult truth:

Changing behavior is one of the hardest challenges in public health.

A Simpler Food Labeling System

For years I’ve asked a simple question:

What if every food product in America carried a clear letter grade—A, B, or F—based on its nutritional value?

Consumers could quickly see whether a product supports or undermines their health.

Interestingly, France has already implemented a similar concept called the Nutri-Score system, which ranks foods using a color-coded letter grading scale.

Early research and sales data suggest something promising:

Consumers often choose healthier products when nutrition information is easy to understand.

In other words, simplifying nutrition labels may improve dietary choices.

Sometimes the simplest solutions are the most effective.

Should We Tax Unhealthy Foods?

Here’s another idea that would certainly spark debate.

What if there were a 20% tax on all alcohol sold—whether purchased in liquor stores, restaurants, grocery stores, or gas stations?

Would consumers say, “That’s too expensive,” and drink less?

That would be the goal.

Now imagine applying similar taxes to highly processed foods that exceed specific thresholds for:

• Added sugar
• Sodium
• Unhealthy fats

Foods that exceed those thresholds could carry higher prices to discourage overconsumption.

Of course, this raises some interesting questions.

What would happen to chicken tenders and French fries under that system?

And how would the food industry respond?

These ideas would undoubtedly ignite strong debate around personal freedom, government regulation, and public health policy.

Changing the Food Environment

Another idea to consider involves the food environment itself.

What if communities limited the number of fast-food restaurants per square mile?

Cities already regulate liquor licenses and zoning density for certain businesses. Could similar strategies help address public health challenges?

Perhaps.

Or perhaps it would spark a national conversation about consumer choice versus government intervention.

One thing is certain: our food environment today is very different from what it was in 1950, when home-cooked meals were more common and highly processed foods were less dominant.

Today, the environment often encourages overeating rather than supporting healthier choices.

That means new ideas may require us to think outside the proverbial box.

The Exercise Challenge

One area where government influence may be limited is physical activity.

In the early 1900s, most people didn’t need a gym membership because their workday provided the exercise.

Daily survival required movement.

There was no such thing as saying:

“I don’t have time to exercise.”

Today, many Americans spend long hours sitting—at desks, in cars, and in front of screens.

That’s why I encourage what I call an Exercise Prescription.

This involves committing to burning a certain number of calories through activity each year, such as:

• 50,000 calories annually
• 75,000 calories annually
• 100,000 calories annually

Imagine if insurance companies or employers offered financial incentives to individuals who could verify their annual physical activity levels.

It’s another idea worth exploring.

Practical Tools That Help People Lose Weight

In my book You Can’t Outrun That Brownie, I focus on providing practical tools that help people navigate today’s challenging food environment.

These include:

• Food Information Literacy — understanding calories in foods and beverages
• Exercise Prescription — measurable annual activity goals
• Emotional Eating Strategies — managing triggers that lead to binge eating

I also developed an Excel-based system called the Portion Permission System, which helps people gradually reduce calorie intake without feeling deprived.

These tools can be especially helpful for individuals using GLP-1 weight loss medications, because long-term success still requires sustainable habits.

Who Benefits From America’s Health Crisis?

Here’s a difficult question.

Who benefits from America’s current health challenges?

One obvious answer is the pharmaceutical industry.

The rapid growth of GLP-1 medications for weight loss and diabetes highlights both the effectiveness of these treatments and the scale of the underlying problem.

Other sectors benefit as well.

For example, knee replacement surgeries would likely decline if fewer Americans carried excess body weight.

The U.S. healthcare system is extremely complex, and my intention is not to criticize any specific company or industry.

My goal is simply to encourage meaningful discussion about solutions.

Solutions that require bipartisan policy changes and real action—not just updated nutrition guidelines.

Looking Ahead to the 2030 Dietary Guidelines

The next revision of the Dietary Guidelines for Americans will arrive in 2030.

Hopefully, future updates will be accompanied by policy changes that truly improve public health outcomes.

Because when people lose weight and improve their health:

• They feel better
• They live longer
• Healthcare costs decrease

Those are outcomes worth pursuing.

Until then, it’s worth remembering a simple truth that inspired the title of my book:

You really can’t outrun that brownie.

But with the right tools, the right food environment, and smarter policies…

You might not have to try.

You can explore my approach in more detail in You Can’t Outrun That Brownie, or continue learning through the resources and articles available on my website.

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