Public Health

Are Americans following US dietary guidelines? Check the Healthy Eating Index

A USDA expert explains the HEI and what it’s for in a podcast with the editor of the Journal of the Academy of Nutrition and Dietetics

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For National Nutrition Month, Dr. Linda Snetselaar, Editor-in-Chief of the Journal of the Academy of Nutrition and Dietetics, interviewed Angie Tagtow, Executive Director of the US Department of Agriculture (USDA) Center for Nutrition Policy and Promotion, about recent changes in the Healthy Eating Index (HEI) and its impact on the nation's health.

The interview is featured in an Editor's Podcast for the Journal of the Academy of Nutrition and Dietetics. Here, Dr. Snetselaar provides some background and information from the podcast on the Healthy Eating Index and how it's used.


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Linda Snetselaar, PhD, RDN, LD, FANDDr. Linda Snetselaar is Professor and Chair of the Epidemiology Department at the University of Iowa, also serving as the university's Associate Head for Admissions and Curriculum, Director of the Nutrition Center, and Co-Director of the Prevention Intervention Center. She is also the Editor-in-Chief of the Journal of the Academy of Nutrition and Dietetics, published by Elsevier.

Dr. Snetselaar has dedicated her 40-year career to higher education and research, most notably serving as principal and co-principal investigator in the Lipid Research Clinic and other National Institutes of Health studies. As Director of the university's Nutrition Center, Dr. Snetselaar leads projects to guide future health professionals, incorporate wellness in worksites and counsel parents and teens.

The Healthy Eating Index (HEI) is essential in tracking how the population of the United States is adhering to the Dietary Guidelines for Americans (DGA) – the foundation of all federal nutrition guidance. The HEI is a valuable tool for food, nutrition and dietetics practitioners and other healthcare professionals, helping them understand and keep track of public eating habits and areas needed to improve health.

According to Tagtow, the HEI measures how populations or subgroups of people are doing with the quality of their diet. Using data from the National Health and Nutrition Examination Survey, the HEI scores the diet quality of the US population using a 100-point scale, with a score of 100 indicating that people are fully meeting the DGA.

How are HEI scoring standards set?

Tagtow said the HEI scoring standard is set using the USDA Food Patterns, which translate the key recommendations from the dietary guidelines into the specific types and amounts of foods people should eat based on different calorie levels. In essence, she said, the scoring standards inherently reflect what and how much to eat for a healthy diet. Thus, the HEI scoring standards are like a grading scale where a score of greater than 80 indicates a good diet, a score of 51-80 reflects a need for improvement in the quality of the diet, and a score of 51 is reflective of a poor diet.

What is the quality of the American diet?

Based on data from the 2009-10 National Health and Nutrition Examination Survey, Tagtow said, the HEI score of 57 places the US population in the "needs improvement" category. When compared to the 2001-02 HEI score of 52, it indicates that Americans have not made significant improvements in their diet quality over the past 10 years. In the podcast, she said:

As a population, we're still eating too little fruits, too few vegetables, not enough whole grains and not enough low-fat dairy and fish and seafood. And we're still seeing over consumption of empty calories and things such as refined grains.

And while not substantial, Tagtow said, the upward trend of the score over the past 10 years suggests Americans as a whole are moving in a positive direction in the quality of their diet, which is good news. Given the strength of the science behind the DGA, it is important for nutrition and dietetics practitioners and other healthcare professionals to move the nation's HEI score closer to 80 in order to reverse the trend of diet-related diseases.

What are other uses for the HEI?


For a more detailed discussion on the HEI and its relation to the nation's health, listen to the Journal of the Academy of Nutrition and Dietetics' March Editor's Podcast.

Beyond tracking the diet quality of the US population, the HEI's capabilities make it useful in research and other settings. Tagtow suggests that applications can include:

  • Examining relationships between diet and outcomes of public health concern
  • Evaluating the food environment
  • Determining the relationship between diet cost and diet quality
  • Assessing the quality of food assistance packages, menus, and the US food supply
  • Evaluating intervention trials and assessing dietary patterns for epidemiologic and economic research

Last month, an advisory committee submitted its recommendations for the 2015 DGA to the Department of Health and Human Services. The USDA and HHS will evaluate their recommendations and update these guidelines later this year, and will update the HEI most likely in early 2016. Future work may include adapting the HEI for individual data as well as population-based data and development of a consumer-friendly online platform.

As nutrition and dietetics practitioners and other healthcare professionals better understand the HEI, they will learn how it can aid them in their profession and, more importantly, how they can work together to help the public eat a better quality diet for optimal health.

Resources to help professionals and consumers improve their diet

The USDA's Center for Nutrition Policy and Promotiongives researchers and healthcare professionals detailed information on the development, uses and applications of the Healthy Eating Index HEI. They can direct clients and patients to the USDA's consumer website, which has interactive tools that translate the Dietary Guidelines into tips for improving the quality of their diet.

National Nutrition Month

National Nutrition Monthis an annual nutrition education campaign sponsored by the Academy of Nutrition and Dietetics.


Journal-of-the-Academy-of-Nutrition-and-DieteticsJournal of the Academy of Nutrition and Dietetics

As the official journal of the Academy of Nutrition and Dietetics, the Journal of the Academy of Nutrition and Dietetics publishes research on the practice and science of food, nutrition and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. Topics include nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management and dietetics education.

Journal resources

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