The Food Guide Pyramid, released by the U.S. Department of Agriculture(USDA) in 1992, became one of the most recognized and most frequently reproduced nutrition education tools in history.1  In April 2005, the USDA released a new pictorial food guidance system in the form of an interactive website called MyPyramid. The new system is designed to interface with the USDA's Dietary Guidelines for Americans 2005, which were released in January 2005.2  The website(www.mypyramid.gov)includes resources for professionals, as well as printable references and handouts that can be used for patient education. The new food guidance system is designed to provide the general public with usable individualized information to improve health and “improve the quality of an average American diet.”3 

The new pyramid has tools for educating the general population; however,individuals with pre-diabetes, at high risk for developing diabetes, or with diagnosed diabetes will also find it helpful. In this article, we will describe the basic features of the new food guidance system and provide information on both the benefits and challenges for using it as an educational tool, especially for individuals at risk for or with diabetes.

Much of the MyPyramid website contains tools and information intended for consumers as outlined in Table 1. Unlike the 1992 Food Guide Pyramid, this website allows users to personalize the pyramid and obtain an individualized calorie level and food pattern, including a breakdown of recommended servings from each food group per day. Links are provided to the personalized pyramid for more information on each food group, complete with tips for meeting the daily serving recommendations. Users can also print a PDF version of their results and an individualized meal planning worksheet that can be used for logging and comparing daily food choices with the recommendations of the Dietary Guidelines.

Table 1.

Features of the MyPyramid.govWebsite for Consumers

Features of the MyPyramid.govWebsite for Consumers
Features of the MyPyramid.govWebsite for Consumers

The MyPyramid Tracker, another section of the website, is also available to the public. This feature is an online food and activity log, through which users can create a personal profile with their age, sex, height, and weight. This allows users to receive personalized feedback about their food and activity choices through a series of printable reports. Historical data to track lifestyle changes is also available for those who consistently use this tool.

The MyPyramid website also contains resources for health professionals that are available under the For Professionals tab on the site's home page(Table 2). Many of these documents explain the philosophy and uses of the food guidance system to assist professionals with patient education. Links are also provided for many downloadable and printable worksheets that can be used for patient education.

Table 2.

Features of MyPyramid.govWebsite for Professionals

Features of MyPyramid.govWebsite for Professionals
Features of MyPyramid.govWebsite for Professionals

MyPyramid may be useful for many individuals with diabetes. As with any educational tool, its effectiveness will depend on the motivation of the learners as well as their previous level of diabetes self-management education. The website presents some benefits as well as some drawbacks for diabetes education at different stages in the teaching and learning process.

Practical uses for diabetes survival skills

MyPyramid can be an effective educational starting point for individuals who are newly diagnosed with type 2 diabetes because it emphasizes variety within the food groups and proportionality by encouraging more nutrient-dense foods, such as fruits, vegetables, and whole grains, while at the same time suggesting moderation of foods higher in saturated fat, trans fat,added sugars, cholesterol, salt, and alcohol. An added feature in the new interactive pyramid is its emphasis on physical activity, as shown by the figure climbing a staircase on the left side of the pyramid logo(Figure 1)3 .

The MyPyramid Plan section of the website may be used by individuals with diabetes or by any member of the care team to estimate daily calorie needs by entering an individual's age, sex, and activity level and printing an individualized meal-planning worksheet for that calorie level. The worksheet can be used as a tool for logging food choices before the first appointment with a registered dietitian. Although this worksheet does not specifically mention any details about which foods contain carbohydrates, it does emphasize balance and portion control, key concepts to teach early in the diabetes self-management education process.

Figure 1.

The new USDA MyPyramid food guidance system

Figure 1.

The new USDA MyPyramid food guidance system

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It is important to remember that this calorie calculation is not based on an individual's current height, weight, or body composition, but instead it is based strictly on sex, age, and activity level.3  According to the website's education framework document, “Following the food intake pattern at a calorie level identified for the person's age and sex may result in weight loss”3  because the intake patterns are based on energy needs for a person at a healthy weight.

The lowest food pattern calorie level intended for adults on this website is 1,600 calories for adult women and 2,000 calories for adult men. See Table 3 for estimated calorie needs based on sex, age, and activity. However, according to the National Heart, Lung, and Blood Institute, lower calorie levels, perhaps as low as 1,000–1,200 calories/day for adult women and 1,200–1,600 calories/day for adult men, may be needed to produce weight loss.4  For patients for whom weight loss is a goal, a more appropriate calorie level may need to be assessed and recommended.

Table 3.

Estimated Calorie Needs for Weight Maintenance3 

Estimated Calorie Needs for Weight Maintenance3
Estimated Calorie Needs for Weight Maintenance3

Patients may find the MyPyramid Tracker useful to help them determine whether they are staying within their recommended calorie range for the day. However, this tool gives only nutrient totals for the entire day, not information divided by meal or by snack, which may limit its usefulness for diabetes meal planning. Table 4outlines tips for using MyPyramid as part of diabetes survival skills education.

Table 4.

Tips for Professionals: Using MyPyramid for Diabetes Survival Skills Education

Tips for Professionals: Using MyPyramid for Diabetes Survival Skills Education
Tips for Professionals: Using MyPyramid for Diabetes Survival Skills Education

Practical uses for learning carbohydrate counting

There are some educational uses of the MyPyramid website for individuals with diabetes who are learning carbohydrate counting skills. But because of the design of the website, there are also several limitations. First, the Inside the Pyramid section provides more specifics about the individual food groups and what foods are in each. However, information about which foods contain carbohydrates is not included.

This section also links to the Food Gallery, which helps individuals gain a better understanding of portion sizes and what they look like. Both individuals with diabetes and clinicians should note that beginning with the 2005 edition of the Dietary Guidelines, most food measurements were changed from “servings” to “cups” or“ounces.”2 With this change, individuals who are using carbohydrate counting for diabetes management need to be aware of how this new measurement compares to a 15-g carbohydrate choice because there are several variations. For example, whereas 1 cup of strawberries is equivalent to 15 g of carbohydrates or one carbohydrate choice,5  1 large banana, which is also 1 cup of fruit on the pyramid,3  is equivalent to 30 g of carbohydrates or 2 carbohydrate choices.5  For this reason, patients will need to learn how to use food labels and a pocket carbohydrate-counting booklet for carbohydrate counting.

The tracker tool is set up to track food choices by day and not by meal, so determining carbohydrate intake per meal is not an option. Still, it can provide some benefits for patients to learn more about their food choices throughout the day. See Table 5for tips on using MyPyramid when teaching carbohydrate counting.

Table 5.

Tips for Professionals: Using MyPyramid for Carbohydrate-Counting Education

Tips for Professionals: Using MyPyramid for Carbohydrate-Counting Education
Tips for Professionals: Using MyPyramid for Carbohydrate-Counting Education

Practical uses for patients with diabetes and comorbidities

Counting carbohydrates is often the first priority for individuals with diabetes to manage their blood glucose. However, because patients with diabetes have an increased risk of cardiovascular disease, it is important to manage not only blood glucose, but also blood pressure and blood cholesterol.6  For patients who already have carbohydrate-counting skills and are ready to track or learn more about other nutrients, the MyPyramid Tracker does offer this opportunity. Individuals concerned about blood pressure management can track their intake of sodium, whereas individuals concerned about cholesterol management can track their intake of total fat, saturated fat, and dietary cholesterol.

The American Diabetes Association recommends that saturated and trans fats should compose no more than 10% and preferably < 7% of total calories for patients with dyslipidemia,7  but the MyPyramid Tracker bases its recommendations on < 10% of the total calories consumed as entered by the patient.3  Therefore,patients need to be aware of this discrepancy and of their individual goals when using this tool.

Once again, the tracker tool only provides daily totals for macro- and micronutrients and does not break them down by individual food under the Nutrient Intakes results tab. For patients who are tracking their intake of fruit, vegetables, and low-fat dairy products as part of the American Heart Association's DASH (Dietary Approaches to Stop Hypertension) eating plan to manage their blood pressure,4  the other results screens, such as the Dietary Guideline Comparison or MyPyramid Recommendations, can provide a visual assessment of how their food choices compare with some of these recommendations. The tracker tool provides a very general assessment, yet it serves as a good reminder to all individuals, with or without diabetes, that balance within food choices and in activity level is critical for managing or preventing disease.

There is also a Related Links tab on the main website page, where individuals can access other websites with more information on specific conditions, including diabetes and high blood pressure. See Table 6 for additional tips on using MyPyramid with this population.

Table 6.

Tips for Professionals: Using MyPyramid for Management of Comorbidities

Tips for Professionals: Using MyPyramid for Management of Comorbidities
Tips for Professionals: Using MyPyramid for Management of Comorbidities

Practical uses for patients increasing their physical activity

A new addition to the USDA Food Guide Pyramid in 2005 is the figure climbing the staircase on the left side of the pyramid. The Inside MyPyramid section of the website states that adults should be physically active for 30 minutes every day or most days of the week, and that children and adolescents should be active for 60 minutes every day or most days of the week.3 

Patients may find the MyPyramid Tracker helpful for tracking activity on a day-to-day basis. There are two options for recording daily physical activity:the standard option and the condensed option.

The standard option provides “the most accurate assessment of your energy expenditure,”3 but it requires users to list all of the physical activities they perform in a 24-hour period, including smaller activities such as personal hygiene and housework or yard work. The time has to equal 1,440 minutes before the day can be assessed, making it very time consuming.

The condensed option is more user friendly. This option is based on the estimated basal energy expenditure (BEE), which is adjusted to include routine activities such as personal hygiene, housework, and light yard work for an estimated duration.3 Users only record additional leisure time activities. The physical activity analysis is calculated by adding together the estimated BEE and the additional leisure activities that users enter. The condensed option may not be as accurate as the standard option, but it takes far less time to enter the information and is accurate enough for most users. The physical activity analysis page allows patients to see the intensity classification, duration of the activity, metabolic equivalents, and total calories expended for each activity, as well as the result summary for the entire day. This information can be useful for patients who have a specific exercise prescription from their health care provider or diabetes educator.

MyPyramid does not offer information about how physical activity will affect diabetes management. Individuals with diabetes need to learn about taking special precautions before starting a physical activity program. The Inside MyPyramid section does caution that those with a chronic health condition such as diabetes should see their health care provider to design a safe physical activity program. Table 7 offers tips for using the physical activity section of MyPyramid with patients.

Table 7.

Tips for Professionals: Using MyPyramid for Patients Increasing Their Physical Activity

Tips for Professionals: Using MyPyramid for Patients Increasing Their Physical Activity
Tips for Professionals: Using MyPyramid for Patients Increasing Their Physical Activity

The 2005 Dietary Guidelines and the MyPyramid website can be used as tools for nutrition education. They fulfill their intention: to improve health and“improve the quality of an average American diet.”3  It is important for individuals with diabetes and the entire health care team to remember that the intended audience for these materials is the general public and that they are not written specifically to be used as part of the diabetes education process. However, the tools provided on the MyPyramid website can be effective when used appropriately in the diabetes self-management education process.

Amanda Clark, RD, LD, and Stephanie Kovarik, RD, LD, CDE, are phone line dietitians; Melissa Voigt, BA, is a worksite health promotions specialist; and Joy Hayes, MS, RD, LD, CDE, is a quality and training coordinator at HealthPartners Health Behavior Group in Minneapolis,Minn.

1.
Goldberg JP,Belury MA, Elam P, Calvert Finn S, Hayes D, Lyle R, St Jeor S, Warren M,Hellwig JP: The obesity crisis: don't blame it on the pyramid.
J Am Diet Assoc
104
:
1141
–1147,
2004
2.
U.S. Department of Agriculture and Department of Health and Human Services: Dietary Guidelines for Americans 2005[article online]. Available from www.healthierus.gov/dietaryguidelines
3.
U.S. Department of Agriculture and Center for Nutrition Policy and Promotion: MyPyramid [article online]. Available from www.mypyramid.gov
4.
National Heart, Lung, and Blood Institute:
Facts About the DASH Eating Plan
. Bethesda, Md., National Institutes of Health,
2003
(NIH publ. no. 03-4082)
5.
American Diabetes Association and American Dietetic Association:
Exchange Lists for Meal Planning
. Alexandria, Va., and Chicago, American Diabetes Association and American Dietetic Association,
2003
6.
American Diabetes Association: Standards of medical care in diabetes (Position Statement).
Diabetes Care
28
(Suppl. 1):
S4
–S36,
2005
7.
American Diabetes Association:Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications (Position Statement).
Diabetes Care
26
(Suppl. 1):
S51
–S61,
2003