Special Report: Access concerns fuel debate over new Dietary Guidelines

In episode 7 of this Special Report, Colleen Sloan, PA-C, RDN, joined Catherine McManus, PhD, RDN, LD, and Viet Le, DMSc, MPAS, PA-C, FACC, to discuss how access, affordability, and food availability influence the real-world application of the 2025–2030 US Dietary Guidelines.

Sloan opened the discussion by noting criticism that the guidelines may feel “elitist” to families living in food deserts or with limited financial resources. She emphasized that such perceptions can create shame or guilt for caregivers who feel unable to meet idealized recommendations, despite doing the best they can within their circumstances.

McManus highlighted that access has both physical and financial dimensions. Foods emphasized in the guidelines—such as fermented products linked to gut health—may be costly, culturally unfamiliar, or unavailable in many communities. She stressed the importance of cultural sensitivity and practicality, noting that recommendations must align with what patients can realistically purchase, prepare, and enjoy.

Le reinforced that the Dietary Guidelines are designed to outline optimal choices, not to assign blame. He emphasized that clinicians should focus on helping patients make the best possible choices within their environment, prioritizing quality of life alongside long-term health. “These are optimized recommendations,” he noted, “but we have to optimize what people actually have access to.”

The panel agreed that clinicians play a critical role in translating population-level guidance into personalized, achievable strategies. Removing guilt, acknowledging barriers, and emphasizing incremental improvements can help families engage with nutrition guidance without feeling judged or excluded.

Our Experts:
Colleen Sloan, PA-C, RDN, pediatric physician assistant and registered dietitian; host of The Exam Room Nutrition Podcast.
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.