Diet’s role in avoiding entanglement with our sick-care system
In 1981, my father had a massive heart attack.
He was 50. His cardiologist advised him to (1) replace butter with margarine, (2) avoid eggs, red meat, and cheese, and (3) eat lots of bread and pasta.
That advice must have been based, at least partly, on a Swedish food pyramid, published in 1974, which recommended margarine, bread, and cereals in abundance, a lot of vegetables and fruits, and only minor amounts of meat, fish, and eggs.
In the 1980s, the nutritional advice from the experts shifted. Avoiding fats and eating carbs was all the rage.
In 1992, the United States Department of Agriculture (USDA), who supplies U.S. nutrition advice, introduced its own food pyramid.
Hmm. Can anyone sense a slight conflict of interest in having USDA define nutritional guidelines? Especially when, in 1992, a popular line of fat-free, grain-heavy cookies loaded with refined sugar was launched?
In 2011, the old pyramid was replaced by My Plate, heavily promoted by Michelle Obama. An outstanding feature of My Plate was the emphasis on limiting portions.
During the time that these guidelines have prevailed, America’s collective waistline expanded.
And something else happened — chronic diseases afflicted the American population at increasing rates.
It wouldn’t be fair to say that Americans became increasingly unhealthy because they followed any of the guidelines faithfully. It would also be a mistake to say that there was no connection between the guidelines and what Americans found in their supermarkets and fast-food eateries.
In light of this history, and acknowledging the principle that “we are what we eat,” it’s fair to ask: Instead of struggling with the chronic diseases after they’ve emerged, what would happen if we focused on maintaining good health through better eating habits?
For one thing, it would be reasonable to assume that we would lower the outlandish amount of money we spend on our sick-care system — now about $4.5 trillion annually. (About 90 percent of that is spent on the treatment and management of chronic disease.)
For another thing, minimizing rates of chronic disease would also keep people out of our predatory sick-care system.
That’s right: predatory. There really is no financial incentive in keeping you well.
And it’s not a health care system. To be brutally accurate, we have a “sick-care system.”
Let’s be candid: All of us, including the author, could benefit from a tuneup and cultivation of better habits.
On January 7, 2026, the office of the Secretary of the Department of Health and Human Services unveiled a new food pyramid, emphasizing that our rates of chronic disease are tied directly to diet.
This new pyramid is striking in its emphasis on meats, eggs, whole-milk dairy, and non-seed oils including butter, right in the middle of the pyramid’s fresh-produce rainbow.
For the first time, fermented foods, rich in the probiotics that feed a healthy gut microbiome, are mentioned.
Why this new thinking?
It’s because we have realized that protein is as essential (and filling) as fiber.
The most up-to-date studies show that carbohydrate-rich grains should be eaten only sparingly, and only if they have not been “highly processed.”
We realize that decades of that processed food and rounds of antibiotics have wreaked havoc on our guts.
Chocolate lovers (the author has her club membership card in her purse) have a legitimate gripe here. But let’s keep our eye on the ball.
While the new pyramid can be helpful, we need “action items” to make even a small dent in American dietary habits.
The apostles of healthy eating can preach until the cows come home, but it’s behavior at the grassroots level that will decide how sick we become as a nation and how much we will squander on our sick-care system.
Here are a few suggestions that our lawmakers, regulators, thought leaders, influencers, and talking heads would do well to champion.
1. Enriching foods should be available in areas that we now see as “food deserts.” That means entrepreneurs living in such areas should be urged and energized to create sustainable jobs for others, ideally through programs that already exist, such as opportunity zones.
2. Public and private schools should be incentivized to use local resources when bringing products into schools. Local resources must have equal opportunity to sell to public schools and be given preference over existing food contracts between schools and corporate vendors of food products.
3. Schools should be encouraged to teach the history and culture of food and gardening. Such teaching can be integrated with math and science as well as home economics and nutrition classes. That’s how lifelong, healthy nutritional habits can be cultivated.
4. Classes can explore international foods — Brazilian Feijoada, Indian Tandoori, Persian kuku, Moroccan tagines, Ethiopian groundnut stew, and more. These are all complex dishes, very healthful, brimming with protein and plant-based ingredients. When you see an eatery specializing in such cuisine, express your inner freak. Try it. Take the magic carpet ride. Taste a whole new world.
5. Cooperative extensions and agriculture-based colleges should work with local businesses to create gardens in schools and communities, teaching people of all ages the skills to be effective in coaxing a bit of food out of the earth. (Wow! Can you say “radical empowerment” and “self-esteem based on actual competence?”)
6. We must scrutinize the conflicts of interest inherent in USDA setting nutrition guidelines.
Sure, we could go on with business as usual.
We could all continue to be dismayed and feel powerless over our rates of chronic disease, how much wealth we squander on our sick-care system, and how much misery we put up with.
Or we could crack the tough nut of our ingrained dietary habits.
Think about it, won’t you?
Marion Mass, M.D., is a practicing pediatrician in Bucks County, a leading member of the Free2Care movement, and a member of The Independence’s advisory board.
