"Tremendous effort was put forth to not stop at pointing to problems, but making specific recommendations on how to address them," says Van Horn. "It's one thing to review the evidence; it's another to take those findings and create implementable strategies that work." And infants, children, and pregnant women, vulnerable subgroups ignored in previous reports, each get individual attention.
Industry opposition and lobbying in response to the report have been intense. The meat lobby opposes the recommended shift toward a more "plant-based" diet. The Salt Institute has aggressively battled the proposed reduction in the daily ceiling on sodium. The dairy industry is wary of recommendations for reduced sugar, lest flavored milk falls out of favor.
But if they are to have real impact, the new guidelines must be aggressive, says Van Horn, who notes that prior guidelines mostly addressed nutrient deficiencies and other nutritional mainstays and generally avoided taking controversial stands. "We need to prioritize obesity," she says. "To do nothing more than we have means that five years from now we'll be in an even worse situation."