Growing up in rural Oklahoma, weekday lunches felt like navigating a minefield. With my family adhering to a vegetarian diet due to our Hindu beliefs after immigrating from Pakistan, meat was not an option. This led to some uncomfortable moments at school, where tempting meals like cheeseburgers and pepperoni pizza filled the cafeteria.
On days when the cafeteria staff recognized my dilemma, they would quickly whip up a peanut butter and jelly sandwich for me, but there were many times I found myself hungry. Eventually, I took matters into my own hands and began bringing lunches from home. My Tupperware was filled with flavorful dishes like biryani and saag paneer, which were rich in spices that I initially found off-putting due to social pressures and a sense of shame. Now, I wish I had those meals back, yet back then, they carried an unspoken label: un-American.
Those reflective lunchtime memories came back to me as I reviewed the recently released federal dietary guidelines. Much of the discourse around the guidelines has revolved around familiar debates in nutrition, such as the appropriate amount of saturated fats to include or the emphasis on animal-based proteins. However, the essential science and content of these guidelines haven’t shifted significantly from previous editions.
What is noticeably different is the framing. The accompanying visuals feature a reimagined food pyramid filled with items that may bring nostalgia to many: a wedge of cheese, a stick of butter, and a whole roasted turkey. Shortly after their unveiling, the National Design Studio released limited-edition posters that mimicked Norman Rockwell’s style, showcasing meat options like steaks and salmon labeled as “real food.”
These patterns, combined with the language used in the guidelines, seemed deliberate. Early in the document, authors acknowledged a conscious neglect of “considerations of race, ethnicity, culture, or socioeconomic status.” By intentionally omitting these aspects, the guidelines appeared less focused on promoting health in America and more intent on reinforcing a singular notion of what constitutes legitimate food.
Fast forward over two decades from those lunchroom hurdles: I am now finishing my training as a cardiologist. Much of my daily work includes patient consultations in exam rooms and hospitals. While we often discuss medications and procedures, I make a point to ask about their eating habits, if time allows. I’ve discovered that food is not only a vital factor in managing cardiovascular health, but it also opens doors into my patients’ lives. The diversity in America is evident in these conversations as I hear about plantains enjoyed before early shifts, jollof rice packed for lunch, and cod served for dinner. These are the diets of individuals striving to confront obesity, diabetes, and atherosclerosis, seeking professional advice on managing these conditions.
However, when it comes to dietary guidance, the rich variety of foods shared with me begins to fade. Despite the disproportionate impact of chronic cardiovascular diseases on communities of color, medical and public health advice has historically leaned toward a singular “American” diet.
Earlier versions of the federal dietary guidelines have briefly acknowledged but largely marginalized the connections between food, culture, and identity. Even the frequently recommended Mediterranean diet, long regarded as a gold standard for reducing heart attack and stroke risk, faces criticism for being culturally one-dimensional.
Leading up to this year’s dietary guidelines, a working group was formed to evaluate how health equity and diversity could be incorporated into future guidelines. Unfortunately, instead of progress, the new federal dietary guidelines dismissed the group’s findings, claiming they “would not meet the American public’s need for objective, evidence-based nutrition guidance.” This decision effectively erased any advancements made.
That said, there are commendable elements in the new guidelines from a public health viewpoint. It’s widely recognized that ultra-processed foods, though difficult to define, are associated with various chronic health issues, and reducing their intake is likely beneficial.
However, the overarching focus of these guidelines doesn’t seem to be about refining macronutrient intake. Instead, they tend to narrow the scope of American life, introducing a form of food nationalism that impacts school cafeteria menus, food assistance programs, and even meals in hospitals and prisons.
In doing so, these guidelines inadvertently undermine their mission to enhance public health. By conjuring images of past dinner tables, they risk becoming irrelevant in the present context.
Reflecting on my hometown, it has transformed over the years. A hibachi restaurant and family-owned Mexican eateries have complemented the usual fast-food chains and diners. The local casino, once an inconspicuous gas station, has evolved into a world-class resort and entertainment hub. Its advertisements now greet me at the Dallas/Fort Worth airport whenever I return home, drawing visitors for gambling, rodeos, comedy shows, EDM events, and even K-pop concerts.
Recently, after the presidential inauguration, my parents attended a concert by Kumar Sanu, a beloved Indian playback singer from the 1990s. They filled our family group chat with excitement. To my surprise, the audience consisted not only of South Asians but also local residents enchanted by music that once blared from my father’s car during my school drop-offs—music that had once embarrassed me.
American culture has evolved beyond a narrow historical lens. Public health recommendations regarding diet should evolve as well.
Vishal Khetpal is a fellow in cardiovascular disease writing the STAT column, The Workup.