Breaking Down the New Dietary Guidelines 2025–2030: Evidence, Gaps, and Real-World Practice - Episode 7
Food Access, Equity, and Removing Shame From Nutrition Guidance
In part 7 of the discussion, experts reflect on access issues regarding foods recommended in the guidelines.
In part 7 of the discussion, Colleen Sloan returned to a theme that had surfaced repeatedly throughout the discussion: access. She noted that a significant portion of the pushback surrounding the new dietary guidelines has centered on the perception that they feel elitist.
In many parts of the country, food deserts and limited access to affordable, “whole” or minimally processed foods remain a reality. For families living in these environments, Sloan emphasized that the guidelines can unintentionally create feelings of shame, guilt, or fear, particularly if patients feel that what they are able to feed their families falls short of what is being recommended.
Catherine McManus expanded on this by framing access as having two distinct components: physical access and financial access. Even when foods are theoretically available, they may not be accessible at a local grocery store, or they may be cost-prohibitive for many families. She pointed to examples within the guidelines, such as recommendations related to probiotics and gut health, that reference foods like kimchi, kefir, and miso. These items, she noted, are often more expensive and not widely available, making them unrealistic options for large segments of the population. McManus emphasized the responsibility of clinicians to recognize these barriers and to offer more accessible alternatives when discussing topics like the gut microbiome.
She also highlighted the importance of cultural sensitivity when translating guideline recommendations into practice. Many patients may be unfamiliar with or uninterested in foods such as kimchi or miso, may not know how to prepare them, or may not view them as culturally relevant. Understanding what foods patients are willing and able to incorporate into their diets and meeting them where they are was a central theme in her remarks.
Viet Le reinforced this perspective by returning to the idea of quality of life as a guiding principle. While the guidelines outline optimal choices based on population-level data, he emphasized that these recommendations are about risk reduction, not guarantees. In his view, counseling should focus on helping patients make the best choices possible within their individual circumstances, rather than striving for perfection. He stressed the importance of removing guilt from the conversation and reframing guidelines as aspirational rather than punitive.
Ultimately, Le argued that the role of clinicians is to translate the science into realistic, compassionate guidance that reflects each patient’s community, resources, and lived experience. By focusing on incremental improvements and achievable changes rather than idealized standards clinicians can help patients engage with nutrition recommendations without feeling judged or excluded.
Our Experts:
Colleen Sloan, PA-C, RDN, pediatric physician assistant and registered dietitian.
Catherine McManus, PhD, RDN, LD, assistant professor of nutrition, Case Western Reserve University; Cleveland Clinic Foundation.
Viet Le, DMSc, MPAS, PA-C, FACC, preventive cardiology physician assistant and associate professor of research, Intermountain Health.
