Physicians who follow the latest dietary guidelines should issue this simple but important message for patients: eat real food.
The new Dietary Guidelines for Americans, 2025–2030, marks a shift from nutrient-centric targets. Instead, nutrition experts are advising consumers to avoid highly processed, ready-to-eat products that contain artificial flavors, colors and preservatives, low-calorie sweeteners, excessive sodium, and highly processed refined carbohydrates. These together represent about 60% of the current food supply.
The AMA “has long recognized the important role that diet and access to healthy foods play in the health of our patients,” said AMA President Bobby Mukkamala, MD, an otolaryngologist who also is board certified in lifestyle medicine.
Dr. Mukkamala joined experts Christopher Gardner, PhD, and Dariush Mozaffarian, MD, DrPH, MPH, for an AMA webinar to discuss what physicians should know about the new dietary guidelines and share practical strategies for counseling patients on diet and eating patterns.
Poor nutrition is a driving factor in the rapid rise of chronic disease over the past three decades. Half of U.S. adults either have diabetes or prediabetes, said Dr. Mozaffarian, a cardiologist, public health scientist, and director of the Food is Medicine Institute at Tufts University. Three in four Americans are overweight or obese, and 93% of U.S. adults exhibit suboptimal cardiometabolic health.
Diet-related factors cause 10,000 deaths, 16,000 new diabetes cases, and 1,500 new cancers on a weekly basis, costing an estimated $1.1 trillion annually when accounting for inflation. For these reasons, food must become the top priority in health care, argued Dr. Mozaffarian.
The webinar, “Dietary Guidelines: What Physicians Need to Know,” is available to watch on demand at the AMA Ed Hub™. The AMA has designated this blended live and enduring material for a maximum of 1 AMA PRA Category 1 Credit™.
It was the first of four AMA Ed Hub “Healthy Diet and Dietary Patterns” webinars, all of which are hosted by Dr. Mukkamala and are scheduled as follows:
- “Understanding Processed Food,” April 29, 11 a.m. CDT.
- “Helping Patients Navigate Protein,” May 19, 2 p.m. CDT.
- “Reducing Risk of Chronic Disease Through Diet,” 2 p.m. CDT.
Some foods are “killing Americans”
Dr. Mozaffarian reviewed major changes in the new guidelines, most notably its emphasis on “real” food and avoidance of highly processed foods high in sugar, sodium, refined carbohydrates and artificial flavors and preservatives.
The new guidelines depart from earlier approaches that hid the harms of those foods behind nutrient targets, reinforcing messages like “everything in moderation is OK.” Instead, guideline authors acknowledge that “there are foods that are actually killing Americans and harming Americans,” he said.
The guidelines emphasize language such as “avoid or limit—very, very strong words for dietary guidelines,” he observed.
Key changes include:
- A stronger recommendation that grains be fiber-rich whole grains.
- Embracing healthy fats from whole foods.
- Modestly raising recommended protein intake to 1.2–1.6 g/kg per day—levels most Americans already meet.
- For the first time ever, recommending whole-fat dairy with no added sugar.
Several core recommendations remain the same. Guidance on fruits and vegetables has been “relatively similar … and that’s been consistent really since 1980,” with continued recommendations of two to three servings per day of each, Dr. Mozaffarian said. Limits on key nutrients also didn’t change, including advice to limit sodium and to cap saturated fat at 10% of total daily calories.
In another significant change, the guidelines inverted the traditional structure of the food pyramid.
For the first time, the pyramid places fruits and vegetables at the base alongside protein, dairy and healthy fats, with grains moved off the foundation. Under this new arrangement, roughly 60–70% of the pyramid is plant foods and about 30% is animal foods, suggesting three core pillars: whole grains, fruits and vegetables, and protein/dairy/healthy fats.
The guidelines are a fundamental reset, “a shot at the bow of the food sector” that shifts the focus from abstract nutrient limits to clearer, food-based advice centered on whole, minimally processed foods, Dr. Mozaffarian said.
Most Americans don’t follow the guidelines
A persistent gap exists between guidance and behavior, said Professor Gardner, a nutrition scientist and a member of the 2025 Dietary Guidelines Advisory Committee.
National Health and Nutrition Examination Survey data show that most Americans fall far short of recommendations for vegetables, fruits and whole grains while consuming excess refined grains. Federal nutrition safety-net programs such as school meals are more likely to follow the guidelines, compared with the public, he noted.
Physicians can engage their patients by asking basic questions. What's your typical breakfast? Lunch? Dinner? What are your snacks?
“You can get a pretty good picture of what a person's eating. And then working with them, going through evidence-based lifestyle change therapies, setting proximal targeted, shared goals, have self-monitoring, peer support,” Dr. Mozaffarian suggested.
For older patients, physicians should encourage protein intake in combination with strength training and integrate robust nutrition and lifestyle support in patients taking GLP-1 receptor agonists, he advised.
The guidelines aren’t for all populations, he cautioned. They mostly pertain to the healthy general public. While the authors footnoted certain conditions such as diabetes, there’s not enough science to guide patients with diseases such as cancer.
“We need to fund more nutrition science with observational studies,” Professor Gardner said.
Systemic changes can support doctors
While physicians have a role to play in improving nutrition, individual doctors can’t do this by themselves. Systemic changes need to take place across medical education, EHRs, clinical pathways and payment, the panelists said.
Dr. Mozaffarian’s organization uses a two‑item screening instrument in the EHR that rapidly identifies whether patients face barriers to nutritious food and what those barriers are. Common barriers include cost, access to fresh whole foods, lack of food storage or preparation equipment, time, knowledge and culinary culture, he said.
Data matters, he emphasized. “We shouldn't make assumptions about why somebody is or is not consuming a nutritious food.”
