Challenging Dogma - Fall 2009

Thursday, May 20, 2010

“Steps to a Healthier You” Holds No Big Promises: A Critique of MyPyramid – Adiana Castro

The United States Department of Agriculture (USDA) and the Center for Nutrition Policy and Promotion (CNPP) adopted a new pyramid named MyPyramid in 2005 that would be accessible online (1). MyPyramid replaces the old Food Pyramid from 1992. The old food pyramid consists of the five food groups’ vegetables, fruits, dairy, meat and grains. The old food pyramid had a standard recommended serving size for each food group with grains at the widest and lowest level of the pyramid, then fruits and vegetables on the second level, dairy and meat on the third level and sweets sparingly at the highest and smallest level (1). The old food pyramid gave general guidelines and was similar to a one-size fits all design for individuals. Furthermore, the old food pyramid was a poster that was placed in schools, hospitals, building etc. MyPyramid uses the internet as its form of media instead of a poster. This version of the pyramid contains vertical color bands to represent the food groups as well as a person climbing the stairs to promote physical activity. The vertical color band widths that represent the food groups vary the recommended serving sizes depending on one’s age, gender, height, and weight. The goal is to create a personalized nutrition guide to acknowledge the fact that people have different dietary needs. It is not a diet but rather a suggested eating pattern. The recommendations were based on the 2005 Dietary Guidelines and are touted as an evidence-based approach to promote healthy eating and living (1).

Over 300 million people live in the United States and yet there are only 3 million registered users for MyPyramid that is less than 1% of the population (1). An individual can browse the site without becoming a registered user but a registered user visits the site frequently to use the nutrition tools. Millions of dollars have been spent to address the nutritional deficit knowledge yet our waistlines keep growing and the website is not frequently visited.
According to the National Center for Health Statistics from 2006, two-thirds of adults are overweight or obese.2 The state obesity maps from 2005 to 2008 have shown in overall increase in obesity across the nation (Figure 1, 2) (3,4). All of the states either maintained or increased their prevalence of obesity. According to the five-a-day campaign there has not been in increase in fruit and vegetable consumption since 2005 (5).

The MyPyramid program does state the importance of variety and moderation with the food groups as well as promote physical activity. In addition, MyPyramid is web-based which encourages access and convenience for the public. The goal of MyPyramid is to educate the American public on healthy food selection and support physical activity (1). However, it fails to address the lack of health interest that the population has, assumes individual responsibility for food choices and fails to support self-efficacy. Since these considerations were failed to be met the intervention has proven to be ineffective in helping individuals stay healthy since it was released in 2005.

MyPyramid Assumes Health as a Main Priority for Americans

In general, immediate health is a basic need. According to Maslow’s Hierarchy of Needs, individuals have needs that are prioritized on different levels with physiological needs being the starting point and include sex, homeostasis, food, breathing, water, sleep (6). The second level is safety which includes health (not health behaviors), family and resources. The third level is love/belonging, followed by esteem and ending with self-actualization (Figure 3) (6). The health behaviors that MyPyramid is trying to change are poor eating habits and physical inactivity. However, Michael Siegel supports the idea that health behaviors are needs that occurs in the last level known as self-actualization (8). Maslow said a person that has a desire for self-fulfillment and can act on his/her full potential are characteristics of the self-actualization level (6). However, this need can’t be actualized unless there is complete satisfaction with prior levels. MyPyramid has a logo that states “Steps to a Healthier You” (1). This message does not resonate with individuals that do not have a roof over their head, food if any on the table, clothes on their back, do not feel safe, loved, or with self-esteem. In this recession, Americans have put health on the back-burner because they feel there are more pressing matters to be addressed. The MyPyramid program should have packaged a message aside from health behaviors since Maslow’s states individuals will not make it a priority. Human behavior is not motivated by health (8).

MyPyramid like many other government programs has followed the traditional health paradigm that asks the question “What is the product that people should want?” and then sells that product and in this case the desire for eating well and being healthier. However, health is not a core value for people unless they are on the verge of becoming sick (8). Using Marketing Theory, the marketing paradigm asks the questions “What is it that people want?” and then creates and packages the product so that it fulfills those needs and wants.7 Using this alternative theory it appeals to more basic core human values for American culture such as control, security, love, freedom, family, hope and independence (7,8). However, MyPyramid did not follow this rationale. The CNPP used intuition to sell the MyPyramid design instead of researching the target audience and then launching a campaign. The basis of MyPyramid was evidenced-based scientific studies and then public health practitioners designed a new version of the pyramid (1). Then MyPyramid was unveiled to the public. Marketing theory incorporates an intensive psychosocial profile for potential customers which the CNPP and USDA do not do thus creating a failed public health intervention.

MyPyramid Assumes Individual Responsibility for Food Choices

Although MyPyramid is personalized and demonstrates that dietary needs are individualized, it assumes foods choices are also individualized. MyPyramid does not take into account individual control, cost of healthy foods and the food environment/culture in the Unites States. The MyPyramid structure acts on the principals of Theory of Reasoned Action, which states people, are rational and static beings. The theory does say perception of other people matter and takes into account social norms influence human behavior (8,9). However, there is no room for spontaneity, and assumes that character, beliefs and traits do not change. This antiquated theory has been a staple in many public health programs including MyPyramid. People’s daily lives are a dynamic process, especially when it involves food. In a fast paced country like the United States where context plays a big role in where and when you get your food it is not fair to assume food decisions are made in advance. Many meals are not planned and individuals tend to feel not in control when making food choices.

MyPyramid can also be intimidating for families that can’t afford the fruits and vegetables. Farmer’s markets are growing around the country and are providing a great resource to find fresh produce. However, these markets are typically not in low-income neighborhoods where people would benefit from the savings. Furthermore, many inner-city neighborhoods do not have supermarkets and rely on the corner store for their groceries (10,11). For example, Whole Foods Supermarkets are located in upper- middle class neighborhoods because that is there target population (10). Corner stores in low-income neighborhoods have little variety for produce that is if they carry produce at all. MyPyramid does not address the accessibility of the foods they are recommending. Since the program focuses on the responsibility of the individual to make healthy choices it limits the impact since individuals don’t live in a bubble. Individuals can be affected by their finances, neighborhood and the corporate food industry.
MyPyramid fails to address the power of the food industry and how influential these companies are in the United States. Consumers spend about $1 trillion dollars annually on food, almost 10 percent of the Gross Domestic Product (12). The food industry is a profitable business yet MyPyramid places all of the responsibility on the consumer and does not make recommendations for the food companies to make healthier products. Corporate responsibility could play a huge role in health policy (13.)

The CNPP did not include monitoring corporate practices or implementing strategies, including public education to enable the consumer to make a healthy choice that would fit within the guidelines of MyPyramid. Food companies put labels on products that state 3 cups of fruits or contain half of a cup of vegetables. However, these products may have enormous amounts of added sugar or high sodium. The consumer is led to believe they are making a healthy choice if they see that positive claim however in reality it may be a poor food choice. In short, MyPyramid should have created regulations on the food companies so individuals could make correct decisions without confusion or bias.

MyPyramid Fails to Support Self-Efficacy

MyPyramid does not address an individual’s desire for self-efficacy. According to the Theory of Planned Behavior, self-efficacy is the belief that you are capable of performing a behavior and it is a critical component to behavioral change.8,9 Individuals may have the intention to act but will fall short if they don’t believe they can do it. For instance, if a web-surfer were to visit the MyPyramid website and enter their personal data they would receive numerical recommendations for each food group (1). Then it is the responsibility of the individual to incorporate those recommendations. This could be a daunting task if a person does not have a nutritional background. It also may leave an impression that the numbers for each of the food groups can’t be modified or changed.

MyPyramid endorses high fruit and vegetable consumption but the message is not being realized. According to the five-a-day campaign, participants realize high consumption of fruits and vegetables are important yet for some reason they still did not consume them. Some of the reasons reported were healthy foods were expensive, supermarkets not in the area and difficulty in preparing vegetables (5). MyPyramid does not give suggestions to help give people control on food choices. It reiterates what they should be doing instead of how they can do it. This message has the potential to leave a lasting feeling of hopelessness and guilt.

American culture has many holidays and events around food. As such, the diet of an individual will be dynamic and will vary from day to day. Without the supplemental education and tools needed to help make an individualized nutritional plan a reality, the person is less confident in themselves to make the behavioral change (14). If the person does not feel capable of changing their eating habits then MyPyramid has failed the consumer.

MyPyramid Gets a Make-Over: An Alternative Public Health Intervention for MyPyramid

The current version of MyPyramid places all of the responsibility on the individual and sells health as the product. In this proposal, MyPyramid is designed and implemented using principals of advertising theory, ecological systems theory and control theory (15,16,17). These alternative social science/psychological models can correct the flaws in the program that have been argued above. MyPyramid could be a more successful public health campaign if they sold a promise that is desired, used a multi-level approach, and acknowledged that a person likes to be in control. These points will demonstrate that a public health intervention is compelling when many theories are used and can target a person’s wants, needs, and abilities.

Advertising Theory – An Alternative Model to Apply to MyPyramid

MyPyramid is selling health as the promise for the product. As discussed earlier, health is not a great selling point for the consumer.15 Ogilvy states a good advertisement is one which sells the product without drawing attention to itself (18). The consumer should think “I never knew that before, I must try this product.” The promise is at the core of Advertising Theory and states the bigger the promise the more effective the campaign, where the product is defined by the benefits (15,1819). In order to support the promise, advertisers tell stories, use symbols/metaphors and use images to demonstrate the promise. MyPyramid did not package their message in a desirable way to the public since their promise was health. The CNPP did not get to know their consumers.
In advertising theory, what you say is more important than how you say it. Framing in a campaign is crucial (15). Instead of saying steps to a healthier you, why not say steps to a sexier you? Draw on societal values of youth, fitness, sex, physical attraction and acceptance. This is the promise, values that are sought-after. The selection of the right promise is so vitally important that you should never rely on guesswork; if the target audience is the American people than the CNPP should have researched what they wanted. Holding focus groups, filling out surveys that rate different promises and asking them which of them would be most likely to make them buy into the product (18,19). For example, MyPyramid could have created consumer cards that listed: Improves Health, Clean and Clears Skin, Prevents Dry Skin, Keeps your Figure, Makes Skin Look Younger, Improves Hair Growth, Improves Nail Growth, Increases Life Expectancy, Increases Physical Strength, Improves Mental Clarity, and Increases Quality of Life. All of these promises can occur from eating healthy. However, the American public would not know this due to the ill-packaging of MyPyramid. If MyPyramid had given out these consumer cards and used the voting to drive the slogan it would have read more like “The Secret to Looking Young” instead of “Steps to a Healthier You” (15).

Give the facts. Consumers are not dumb. MyPyramid should have touted all the research behind the image. It should have been clearly stated next to the image that 25+ scientific studies were used to formulate this model (1). It gives the consumer a benchmark of the amount of work in creating this product. It also shows the consumer that the creators did their homework so they didn’t have to. Consumers like honesty and it is only sensible to let them know about all the grunt work behind the final product (18).

Advertising must stay contemporary. MyPyramid wanted to target the whole population. However, during the designing phase of the policy only public health practitioners drew up the image and marketing plan. If they had invited consumers of different ages to help during the designing phase then they would have better understood the psychology of consumers instead of assuming they know the psychology of the consumer.

Lastly, MyPyramid has to sell the brand in way that is a consistent image to the world. As stated by Evans “the significance of the brand is in the associations they represent, and the resulting behavior they can engender.” (19). MyPyramid is brand that is associated with USDA and that can affect how consumers respond. In short, MyPyramid should stop selling health as a product and redefine their marketing to the deep aspirations that people want such as youth, acceptance, freedom and sex (8).

Ecological Systems Theory – An Alternative Model to Apply to MyPyramid
MyPyramid places all the responsibility on the individual (1). It assumes individuals are static, walking bubbles. However, real-life is a constant dynamic process that can change from minute to minute. Uri Bronfenbrenner developed the ecological system theory that takes into account all of the systems that dictate our lives. Coincidently, social norms arise from the surrounding environment of one’s society. MyPyramid did not look at an individual as part of a greater environment that at times influences their health behavior. The premise of the theory states there are 4 systems including microsystem, mesosystem, exosystem and macrosystem that govern human behavior (16). The microsystem involves our immediate environment, which may include family, school and neighborhood. The mesosystem speaks to the connection between immediate environments such as a child’s home and school. The exosystem states that there are external environmental settings which indirectly affect the behavior of a person (i.e. a place of work). The macrosystem describes the larger Western culture of the United States and shapes the economy, politics, religion and values of a person. In other words, an individual is affected by many places, people and things (8).

MyPyramid does not speak to the many systems we live in. Advertising theory speaks to the core human values while the ecological systems theory describes how those core human values arise. Therefore another approach for MyPyramid would have been a multi-level intervention that addresses the complexity of each system (21). MyPyramid could have launched a campaign in communities across the nation related to healthy eating. Public health professionals and public officials could have joined forces to bridge the gap between the microsystem, mesosystem and exosystem. Some example include creating education spots using different types of media, performing cooking demonstrations with families, nutrition classes in school with a newsletter to bring home, working with office cafeterias to offer healthy food choices and offering recipes from work to bring home. When the systems are connected with each other social norms are likely to be affected because healthy behavior becomes a critical component of life.
Lastly, the government is part of the macrosystem. They should lead by example by setting healthy nutrition as a primary agenda goal. In order to do this, government officials could create policies that promote healthy eating, giving incentives for grocery stores to offer affordable healthy options, tax-breaks for local farmers, increasing access to healthy foods in low-income neighborhoods.

Control Theory – An Alternative Model to Apply to MyPyramid

William Glasser created control theory with the fundamental idea that individuals control their behavior to maximize their need for satisfaction (17). My Pyramid assumes self-efficacy therefore it does not include components to help improve self-efficacy. However, these components are important because not everyone realizes their self-efficacy. MyPyramid tells the individual what to do and expects them to do it. Self-efficacy is assumed to be a trait everyone has. Individuals with self-efficacy feel that they are in control (8).

Glasser explains that people with control have six basic needs, survival, power, love, belonging, freedom and fun (17). MyPyramid should have incorporated those values into the MyPyramid design to promote control. MyPyramid could have listed options for food likes/dislikes, an opportunity to list what hinders them for eating correctly, applauding them for healthy choices they are making, allowing them to choose what would fit in their schedule and making it fun by using games within the site. Furthermore, since self-efficacy is not just a product of individual supports and rewards but also includes have access to healthy, affordable food and clean, safe places to exercise, which requires environmental/systems level change.


MyPyramid was created to integrate science-based evidence from the 2005 Dietary Guidelines for Americans and convert nutrient recommendations for the food groups into household measurements (1). Since its inception it has not proven to be a successful public health intervention. Americans still do not know how to eat right and poor weight management continues to increase. MyPyramid has glaring flaws in particular it assumes that health is a main priority for Americans, assumes individual responsibility for food choices and fails to support self-efficacy. Public health practitioners should revisit the design and try to correct the flaws mentioned in order to create an effective nutritional policy.
MyPyramid has the potential to be a great public health intervention. However, the creators have to be open to the idea of alternative models that illustrate that individuals have core values that impact their behavior, at any moment are affected by context/environment and require self-efficacy and control to make healthy behavioral change.

Figure 1 (3)

Figure 2 (3)

Figure 3 (3)


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