Panoply of Pyramids — Something for Everyone
By Lauren Swann, MS, RD, LDN
Today’s Dietitian
Vol. 8 No. 2 P. 42

African Americans, Latinos, and older adults—many subpopulations are benefiting from adaptations of the food pyramid that meet specific dietary needs.

2005 marked the debut of the highly anticipated USDA MyPyramid—the long-awaited revision of the inaugural 1992 Food Guide. The original graphic for recommended eating inspired many similar representations, modified for targeted audiences and specific needs: cultural and ethnic populations, age groups, health conditions, disease states, and fluid and exercise needs. Turning this symbolic depiction “on its side,” the USDA’s recent revision went from the former horizontal levels of food groups to vertical color banded stripes, undoubtedly creating new considerations for the numerous customized efforts modeled after the original icon.

Cultural Connections
Ethnically specific versions of the guide are among the most popular offshoots. At the 2005 American Dietetic Association (ADA) annual Food & Nutrition Conference & Expo held in St. Louis in October 2005, Hebni Nutrition Consultants, Inc.—developer of the original Soul Food Pyramid culturally sensitive food guide—unveiled its redesign. It was “driven by USDA’s new MyPyramid—to keep in line with their Web site,” says Roniece Weaver, executive director, who founded Hebni in 1994 with her partners Fabiola Demps Gaines, RD, LD, and Ellareetha Carson, RD, LD.

Striving to make nutrition information more appealing to the African American community, Hebni Nutrition Consultants, Inc. is an Orlando, Fla., community-based not-for-profit organization committed to preventing diet-related diseases and improving the health of culturally diverse populations. The organization provides nutrition education, seminars, and programs geared toward the African American community. It determined, through contact with healthcare providers and targeted groups, that there was a need for ethnically specific, culturally relevant nutrition education materials because the standard food pyramid was not effectively influencing African Americans’ eating habits.

Hebni believes a food pyramid must take into account the ethnic background of the targeted group. “The inspiration of the pyramid was simple,” says Weaver. “The USDA Pyramid was generic and culturally didn’t address the needs of folks who ate a southern diet.” Hebni’s pyramid is an educational tool that aims to teach smart choices about diet to individuals who traditionally eat soul food. Consistent with the USDA’s guide, which recommends meals based on grains, fruits, and vegetables, Hebni created its own focus group of 18 RDs in the Orlando area using USDA literature as a springboard to foster discussion about how to revamp its soul food version.

Hebni kept pictures of food in the pyramid for its revision. “We are visual learners,” says Weaver, noting that low literacy was an important consideration. However, the organization chose not to copy the USDA’s vertical bands that now run from top to bottom—the most comparatively significant difference from the government’s 2005 rollout. “We tried that graphically but it didn’t work,” Weaver asserts.

Hebni did update its version to include the same food-corresponding colors as the USDA’s MyPyramid but used individual levels for each major type of food for better visibility—fruits and vegetables, dairy, and meat are no longer compartmentalized in a shared ranking. “So soul food in Hebni’s Pyramid is depicted with colorful photos of grits, collard greens, okra, sweet potatoes, and watermelon in the bottom portion to comprise the basis of a healthful diet,” says Weaver. “Conversely, chitterlings, bacon, pork neck bones, fatback, hog jowls, and pigs’ feet are not on the meat level but placed at the top of the pyramid with fats, oils, and sweets because they contain more fat than protein.

“We added the serving size message and Nutrition Facts labels to show what a serving is,” Weaver explains. Water and physical activity levels were added along with background photos. “It was important for us to show a full-figured woman and we included a Latino man because there are also Black Latinos,” says Weaver.
Promoted at dietetic conferences and state meetings through public speaking and programs such as the “Sisters: Take Charge of Your Health” seminar held each spring, Hebni’s Soul Food Pyramid Guide has annual orders ranging in the tens of thousands. Requests come from health departments, physician offices, dietitians and other healthcare practitioners, universities, and health fair organizers. Posters, bookmarks, and a children’s version—currently under revision—are popular items.

Pyramid guides based on worldwide Asian, Latin American, Mediterranean, and vegetarian healthy dietary traditions, along with a unique fusion culminated in the EatWise Food Pyramid, are published by Oldways Preservation & Exchange Trust—a Boston-based organization promoting healthy eating, encouraging sustainable food choices, and preserving traditional foodways—and developed jointly with the Harvard School of Public Health and other institutions. K. Dun Gifford, Oldways founder and president, believes Oldways’s premiere Mediterranean pyramid reflects the kind of food found everywhere; a gold standard of eating with epidemiologically based recommendations that focus on food, not only nutrients.

Regarding USDA’s revision, Gifford concludes that they will probably not change to the vertical color bands. “The Mediterranean version was a huge hit. The horizontal levels work,” says Gifford, who sees the Oldways guides as healthier alternatives to the USDA pyramid. He anticipates Oldways adding tea to its Asian Diet Pyramid and coffee and tea to the others, which already include physical activity and water.

The Hartford, Conn.-based Hispanic Health Council’s Bilingual Puerto Rican food guide pyramid, codeveloped by David Himmelgreen, PhD, and Rafael Pérez-Escamilla, PhD, principal investigator with the University of Connecticut Family Nutrition Program, “will be revised, consistent with the Dietary Guidelines,” says Pérez-Escamilla.

Pérez-Escamilla stresses that while they are still determining a look—one that could be similar to the USDA’s revision—their most important goal is to develop a tool to help users make good choices. “The USDA guide is one that many will see in stores and on food packages,” he points out. “We want to supplement that and use it as an instrument for the best approach.” Focus groups researching reaction to the 1992 USDA graphic revealed that the target Puerto Rican population believed it was not for them. As a result, the council is pursuing research for commentary to arrive at a new graphic.

Lifecycle & Health Needs — Normal and Not
Addressing age-specific needs, The Elder Nutrition and Food Safety Project at the University of Florida Institute of Food and Agricultural Sciences, in cooperation with the Florida Department of Elder Affairs, developed a Daily Food Guide Pyramid for Elders based on the original USDA concept. Linda Bobroff, PhD, RD, LD/N, professor, Food and Nutrition Department of Family, Youth, & Community Sciences, says they saw a need to pursue one for this segment, so they hired an artist and developed their own. As they initiate revisions, she anticipates, “[we] probably will go with similar color banding as MyPyramid since Cooperative Extension is part of USDA.” They plan to emphasize foods, vitamins, and minerals and believe frozen and canned foods are also important depictions for older adults they work to reach.

Capturing food guidance for non-meat eaters, the Baltimore-based Vegetarian Resource Group—a nonprofit organization dedicated to educating the public on vegetarianism and the interrelated issues of health, nutrition, ecology, ethics, and world hunger—has a Food Guide Pyramid for Vegetarian Meal Planning. Reed Mangels, PhD, RD, nutrition advisor, comments on the upcoming revision plans as most likely including activity levels with an emphasis on whole grains, fortified soy, beans, and nuts, but no major changes. “I don’t think we will change levels; we like the hierarchy,” she states.

Jennifer Nelson, MS, RD, director of clinical dietetics at the Mayo Clinic, Rochester, Minn., who, with Donald Hensrud, MD, designed the Mayo Clinic Healthy Weight Pyramid, reports that they are not changing their pyramid as a result of the USDA’s redesign, though their pyramid was inspired by that original shape. “We emphasize the bottom and deemphasize the top, but our food groups are different and based more on a plant-based diet and feature whole grains, fruits, and vegetables.” They adapted the USDA’s original graphic symbol because they found it to be widely recognized with a strong message about which foods should form the basis of a healthy diet.

The Food Pyramid for Healthy Eating with Kidney Disease comes from the Culinary Kidney Cooks partnership. “At this time there is no plan to revise it because we need a visible list of foods,” reports partner Sara Colman, RD, CSR, CDE, and “what we have has worked really well and is such a useful piece.”

The Diabetes Food Pyramid, developed by the American Diabetes Association with the ADA, utilized the theory behind the Exchange Lists for Meal Planning and is the basis for a brochure as the first step in diabetes meal planning. “The visual is to get people to plan meals from the food groups,” says spokesperson Lynn Wheeler. Any future revisions are dependent on updated nutrition recommendations agreed upon by both associations.

Power of the Pyramid
Regardless of the detailed differences within the graphic format, where does the effectiveness of the pyramid lie?

Chef J. Hugh McEvoy, CRC, CEC, president of the Chicago Research Chefs Association, who, with his partner, conducts “healthful” eating and food preparation classes with a recent focus on young children, adds his culinary perspective. “One fact has become totally clear from the feedback we have received from all age groups, income levels, and educational backgrounds, and that is that the vast majority of Americans do not use the pyramid when making food decisions. Most never have. Most never will. It is simply not a format that the end-user finds easy to understand or use. It does not reflect the way average people think about meals or make eating decisions. Geometric objects on a menu or diagram are not part of any society’s culinary cultural background. Perhaps we could find an icon that is already in use by our target market, then adapt that method to communicate our vital message.”

Nancy Magaña-Alexander, MS, RD, who designed the original Hispanic adaptation—likely the first modified version—of the USDA’s initial guide clarifies that her original goal was to address low literacy. “People understand hierarchal levels because that exists in other parts of their lives, like jobs,” she observes. “We need to take research and bring it to a practical, pragmatic level for the people we are trying to reach so they can follow it because behavioral change happens when the scientific finding has meaning.”

Frances Cronin, PhD, RD, a nutritionist who worked on the research resulting in the USDA Food Guidance system that ultimately became the pyramid, stresses that for any such effort, “it’s important that there has been testing, that strategy and goals are stated and objectives are appropriate for clients. For modified diets, practitioners make the judgment call.”

Numerous graphics have been explored to symbolically capture concise food recommendations, including soup and cereal bowls, grocery shopping carts, building blocks, wheels and circles, dinner plates, placemats, and bulls-eye targets. Yet one thing is for sure—once released in 1992, the USDA Food Guide Pyramid became the first to graphically depict what was once the basic food groups, the government’s prior food recommendations that lacked a distinct visually symbolic presence.

Whether its bands run top to bottom or side to side within its various renditions, this icon has truly made its mark as the first established food guidance graphic—a symbol that’s here to stay. The triangular shape and concept has taken root, making it a first in U.S. government food guidance history—a symbol that, like a logo, conveys instant identity for recommended eating patterns.

— Lauren Swann, MS, RD, LDN, runs Concept Nutrition, Inc., a Bensalem, Pa., consulting business specializing in food and dietary supplement labeling, marketing communications, and cultural foodways.

Web-Based Resources

American Diabetes Association Diabetes Food Pyramid
www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp

Culinary Kidney Cooks Food Pyramid for Healthy Eating with Kidney Disease
www.culinarykidneycooks.com/dialysis_food_pyramid.htm

Elder Nutrition and Food Safety Daily Food Guide Pyramid for Elders
http://edis.ifas.ufl.edu/pdffiles/FY/FY05300.pdf

Hebni Nutrition Consultants, Inc. New Soul Food Pyramid
www.soulfoodpyramid.org

Hispanic Health Council & University of Connecticut Bilingual Puerto Rican Food Guide Pyramid
www.hispanichealth.com/pana.htm

Mayo Clinic Healthy Weight Pyramid
www.mayoclinic.org/news2000-rst/772.html

Oldways Preservation and Exchange Trust Healthy Eating Pyramids
www.oldwayspt.org/pyramids/pyramids.html

Tufts University Food Guide Pyramid for Older Adults
http://nutrition.tufts.edu/pdf/pyramid.pdf

University of Michigan Integrative Medicine’s Healing Foods Pyramid
www.med.umich.edu/umim/clinical/pyramid

Vegetarian Resource Group Food Guide Pyramid for Vegetarian Meal Planning
www.vrg.org/nutrition/adapyramid.htm