Newsletter

Last month, the Department of Health and Human Services (HHS) released a new set of dietary guidelines, which notably included a new “inverted” visual of the classic food pyramid. Visual food guides have been redesigned about once every ten years since in the 70s, until the widely-used pyramid model most of us know was adopted in 1992. The pyramid was based on then-current nutrition science depicting food groups at the bottom of the pyramid that should make up the majority of the diet, while those closer to the top were to be incorporated more sparingly. However, critics of the food pyramid put forth that the model did not clearly account for portion size, encouraged overconsumption of starches, downplayed the importance of healthy fats (like those in nuts, avocados, and oils), and was vague on protein quality.

In 2011, the US made the biggest departure from the pyramid, and transitioned to the MyPlate model; an image of a dinner plate with color-coded sections, representing how much of each food group should be present in people’s meals. Feedback was that this new model was less complicated than the pyramid, and was easier for people to put into practice in their daily lives.

Now, the HHS has returned to the familiar relic of the ’90s and 2000s, but has effectively turned it on its head. The new “inverted” food pyramid has raised questions for parents about what they should do with this new guidance. As pediatricians, our job is to follow the science and consider federal guidelines within a broader clinical context. Ultimately, we rely on evidence, experience, and individual patient needs to guide families.

To demystify and clarify any confusion over the new recommendations for our families, we sat down with Dr. TJ Gold, one of our long-term, beloved Brooklyn pediatricians, who has a strong background in nutrition. We discussed changes to the guidance, and how parents can keep their kids healthy and happy, eating delicious and nutritious meals.

What should parents know about the new inverted food pyramid released by HHS this year?
When the new guidelines came out, I had a lot of parents asking questions, and I think it is important to start by remembering that guidelines are exactly that – simply meant to be helpful suggestions, not rigid rules. The goal is to help families align their food choices, habits, and overall food culture in a way that supports health over time. In many ways, these recommendations are not especially new. They mostly reflect the direction we have been moving toward for years as we learn more about nutrition.

This version places more emphasis on protein, fewer simple carbohydrates, and less highly processed foods. That reflects both advances in nutrition science and the broader wellness approach that many families are already familiar with. It is not a sudden reversal of everything parents have been doing, instead more of a continuation of a shift that has been happening gradually. I want parents to understand that this is not meant to signal that they were doing something wrong before.

Is there anything problematic or confusing about the visual representation?
I find the visual itself to be very busy. There are many foods included, and it can be difficult to translate what you are seeing into real-life decisions like what to serve for dinner or what to pack for lunch. When visuals become overly complicated, they can lose their usefulness. That is when it is important for parents to step back and rely on common sense rather than trying to decode every detail.

The idea of calling it an “inverted” pyramid can also feel alarming. Turning something “upside down,” naturally makes parents wonder if they have misunderstood nutrition for years or if everything they learned before is now incorrect. In reality, most families are not actively mirroring a food pyramid on a daily basis, so it’s important to instead lean on concrete recommendations from your pediatrician and trusted, science-backed sources like the AAP.

Is there anything the pyramid does well?
One of the strongest aspects of this guidance is the emphasis on quality over quantity. Instead of pushing parents to count servings or aim for precise portions, it encourages families to think more about the quality of the foods they are choosing. This approach is pretty practical and sustainable.

This is especially relevant for school-aged children and adolescents. Many kids have limited time to eat or limited access to ideal food options. In those situations, perfection is not realistic. A value of these guidelines is in reinforcing the idea that prioritizing less processed foods and better quality choices when possible or available.

What about the actual written guidelines? Do they contain well-balanced advice? Are there gaps?
Overall, the written guidelines contain generally well-balanced advice in the sense that they emphasize whole foods, reduced reliance on highly processed options, and an overall pattern of eating that supports long-term health. Much of what they recommend aligns with what pediatricians already discuss with families, including focusing on protein quality, nutrient density, and variety rather than rigid portioning. In that way, the guidance itself is not radically different from prior recommendations.

Where the gaps appear is in how easily the advice translates to real life. The guidelines do not always account for the realities families are dealing with, including busy schedules, limited food access, school lunch options, food allergies, picky eating, and financial constraints. While the recommendations may be reasonable on paper, they can feel disconnected from what families are actually able to implement day to day. That disconnect can make parents feel like they are falling short, even when they are doing the best they can.

Another limitation is that the written guidance, and past iterations of the pyramid as well, can become overly prescriptive if taken too literally. A more realistic and healthier approach is to look at patterns over time, week by week or month by month for a clearer picture of whether a child is getting enough protein, iron, fruits, vegetables, and whole foods. Without that context, the guidelines risk being interpreted as rules rather than flexible support.

Should parents put much stock in this new recommendation? Does it really change anything?
Parents should not feel pressure to completely reevaluate how they feed their children because of this update. From a practical standpoint, this guidance reflects what many pediatricians and families have already been doing. It does not introduce a radically different philosophy. The core message remains consistent even if the visual diagram has changed. Focus on less processed food, better quality ingredients, and balance over time.

As a pediatrician, what are your top recommendations for keeping kids healthy when it comes to food?
The most important thing for parents to remember is that nutrition does not have to be perfect. Kids are not going to eat perfectly balanced meals every day, and that is okay. Life happens. What matters is consistency over time. Making steady, incremental improvements and maintaining reasonable expectations is far more effective. Teaching our children how to make good choices at a young age is what will remain with them as they get older and are out at school and after-school making their own choices without our input.

What should parents know about full-fat dairy?
There has been a big shift in recent years, especially with the rise of plant-based alternatives, and I always tell parents that unless it is for an ethical reason, we do not want to confuse the word plant-based with automatically being healthier. Full-fat and even lower-fat dairy products tend to have more protein, more calcium, and more calories, especially for little kids, than many (but not all) plant-based alternatives.

There are pros and cons to each. A lot of plant-based alternatives are filled with emulsifiers, polymers, and added sugars, so there is a trade-off. Even though there may be less cholesterol and saturated fat in some plant products, full-fat dairy also helps children absorb fat-soluble vitamins like A, D, E, and K, which are crucial for our health. If you have full-fat items in the diet, you absorb more of those vitamins.

Nothing is free. It is often one step forward and one step back. That is why the concept of balance is so important. It is not that everything in a child’s life should be plant-based or that everything should be animal-based. It really depends on the individual child and the specific food.

What about saturated fats? How much is too much, and are they okay in moderation?
I don’t think about saturated fat in isolation, and I don’t give families a specific number of milligrams to eat or a cutoff. When this comes up, it’s usually in the context of comparing different food choices. Some foods have less cholesterol and saturated fat, and some have more, but that difference alone doesn’t tell the whole story.

Foods that contain more fat, including saturated fat, also help children absorb the fat-soluble vitamins. When fat is reduced or removed, you change how those vitamins are absorbed. At the same time, some lower-fat or plant-based options replace fat with added sugars or other ingredients, which brings a different set of considerations.

For me, this always comes back to balance and looking at the whole meal rather than focusing on a single component like saturated fat. It’s not about everything being low-fat or everything being full-fat. It depends on the child, the food, and how it fits into the overall diet.

What should parents know about sugar consumption?
Added sugars and highly processed foods often appear in places parents do not expect, including foods marketed as healthy. Sweetened yogurts and snack products are common examples. Rather than focusing on eliminating sugar entirely, prioritizing whole foods and minimizing highly processed options naturally reduces excess sugar intake. This approach is more manageable than constantly scrutinizing labels and creates healthier habits over time.

What if my kid is a picky eater? How can I make sure they are getting enough of what they need?
Picky eating is common, but a lot of the behavior can be remediated by doing early exposure to different types of foods. Introducing a wide variety of flavors, textures, and spices early in life helps normalize different foods. When children grow up with diverse tastes, they are often less likely to reject unfamiliar foods later on.

It is very natural for parents to worry when a child refuses food. However, quickly accommodating that refusal can unintentionally reinforce picky behaviors. Instead, consistent exposure and gentle guidance help children learn how to make good choices. Picky phases are normal and do not mean a child will be nutritionally deficient if their overall intake balances out over time.

Where should parents get information about nutrition for their children?
I always encourage parents to start with their pediatrician and trusted, evidence-based resources. A lot of the guidance I rely on comes from the same places pediatricians use every day, including organizations like the American Academy of Pediatrics and resources such as HealthyChildren.org. Those sources are designed to translate nutrition science into practical guidance that actually applies to families and kids.

There is so much nutrition information online now, and not all of it is helpful or grounded in science. Trends, social media, and politicized headlines can make nutrition feel confusing or stressful when it does not need to be. Good guidance should feel realistic, adaptable, and supportive, not fear-based or guilt-driven. For parents, the most useful information is advice that takes into account a child’s age, growth, medical history, and real-life circumstances. That is why trusted pediatric guidance matters.

Access to healthy food is critically important. Families eat what is available to them, and availability is shaped by time, cost, location, and resources. Guidelines do not always reflect these realities.

That is why flexibility and compassion are essential when talking about nutrition. The goal should be to support families in making the best choices they can within their circumstances, not to create unrealistic expectations or shame.

Resources for food insecurity:

NYC
Hunger Free
City Harvest
Food Bank of NYC

Westchester
Feeding Westchester
Ecumenical Emergency Food Pantry
The Pantry

New Jersey
St. James Social Service Corporation
Human Needs Food Pantry
Community FoodBank of New Jersey