Nutrition FYI
Using the MyPyramid.gov Website as a Tool
for Diabetes Self-Management Education
Amanda Clark, RD, LD; Stephanie Kovarik, RD, LD, CDE; Melissa Voigt, BA; and Joy Hayes, MS, RD, LD, CDE
The Food Guide Pyramid, released by
the U.S. Department of Agriculture
(USDA) in 1992, became one of the
most recognized and most frequently
reproduced nutrition education tools
in history.1 In April 2005, the USDA
released a new pictorial food guidance
system in the form of an interactive
website called MyPyramid. The new
system is designed to interface with
the USDA’s Dietary Guidelines for
Americans 2005, which were released
in January 2005.2 The website
(www.mypyramid.gov) includes
resources for professionals, as well as
printable references and handouts that
can be used for patient education. The
new food guidance system is designed
to provide the general public with
usable individualized information to
improve health and “improve the
quality of an average American diet.”3
The new pyramid has tools for
educating the general population;
however, individuals with pre-diabetes, at high risk for developing diabetes, or with diagnosed diabetes will
also find it helpful. In this article, we
will describe the basic features of the
new food guidance system and provide information on both the benefits
and challenges for using it as an educational tool, especially for individuals
at risk for or with diabetes.
MyPyramid.gov Features for the
Public
Much of the MyPyramid website contains tools and information intended
for consumers as outlined in Table 1.
Unlike the 1992 Food Guide Pyramid,
this website allows users to personalize the pyramid and obtain an individualized calorie level and food pattern,
including a breakdown of recommended servings from each food
Table 1. Features of the MyPyramid.gov Website for Consumers
Feature
MyPyramid Plan
Description
Users are prompted to enter their age, sex, and activity
level. Results show a recommended daily calorie level,
recommended number of daily servings from each food
group, and number of discretionary calories. Users can
print a PDF document showing their results or a personalized meal-tracking worksheet. Available at:
http://www.mypyramid.gov/mypyramid/index.aspx
Inside MyPyramid
Users may click on each of the color bands in the pyramid logo, which represent the different food groups.
Clicking on a band brings up information about which
foods are in that group, tips for achieving recommendations, and a “food gallery” showing pictures of actual
foods in the suggested serving sizes. Available at:
http://www.mypyramid.gov/pyramid/index.html
Tips and
Resources
Links lead users to tips for meeting dietary recommendations, instructions for counting mixed dishes, suggestions for eating out, vegetarian guidelines, and sample
menus. Available at:
http://www.mypyramid.gov/tips_resources/index.html
Dietary Guidelines
Links take users to full dietary guidelines report, executive summary, and key recommendations documents.
Available at:
http://www.mypyramid.gov/guidelines/index.html
Related Links
This section provides links to other government websites on a variety of health topics, such as food safety,
physical activity, chronic disease management (e.g., high
blood pressure, heart disease, and diabetes), and others.
Available at:
http://www.mypyramid.gov/related_links/index.html
MyPyramid
Tracker
This online food and activity log allows users to track
their food choices and activity level. Options to print a
variety of reports are available. Users may also track
their eating and activity history if entering data on a
regular basis. Available at:
http://www.mypyramidtracker.gov/
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group per day. Links are provided to
the personalized pyramid for more
information on each food group, complete with tips for meeting the daily
serving recommendations. Users can
also print a PDF version of their
results and an individualized meal
planning worksheet that can be used
for logging and comparing daily food
choices with the recommendations of
the Dietary Guidelines.
The MyPyramid Tracker, another
section of the website, is also available
to the public. This feature is an online
food and activity log, through which
users can create a personal profile
with their age, sex, height, and
weight. This allows users to receive
personalized feedback about their
food and activity choices through a
series of printable reports. Historical
data to track lifestyle changes is also
available for those who consistently
use this tool.
MyPyramid.gov Features for Health
Professionals
The MyPyramid website also contains
resources for health professionals that
are available under the For Professionals
tab on the site’s home page (Table 2).
Many of these documents explain the
philosophy and uses of the food guidance system to assist professionals with
patient education. Links are also provided for many downloadable and printable worksheets that can be used for
patient education.
Practical Applications for Individuals
With Diabetes
MyPyramid may be useful for many
individuals with diabetes. As with any
educational tool, its effectiveness will
depend on the motivation of the
learners as well as their previous level
of diabetes self-management education. The website presents some benefits as well as some drawbacks for
diabetes education at different stages
in the teaching and learning process.
Practical uses for diabetes survival
skills
MyPyramid can be an effective educational starting point for individuals
who are newly diagnosed with type 2
diabetes because it emphasizes variety
within the food groups and proportionality by encouraging more nutrient-dense foods, such as fruits, vegeta-
Table 2. Features of MyPyramid.gov Website for Professionals
Feature
Getting Started
Description
This document provides an overview of how to navigate
the website for patient education and provides links to
printable handouts available for educational purposes.
Available at: http://www.mypyramid.gov/downloads/
MyPyramid_Getting_Started.pdf
Anatomy of
MyPyramid
This document explains the new pyramid symbol and
the basic messages behind its design. Available at:
http://www.mypyramid.gov/downloads/MyPyramid_
Anatomy.pdf
MyPyramid—
A “peer-to-peer” PowerPoint presentation that
USDA’s New Food discusses the development and implementation of the
Guidance System
food pyramid. It also shows the basic features of the
website and tools that are available to use for consumer
education. Available at: http://www.mypyramid.gov/
downloads/MyPyramid%20Peer%20to%20Peer.ppt
Education
Framework
An overview of the food guidance system, which
includes the 2005 Dietary Guidelines and the website. It
reviews the key educational concepts for each food
group of the pyramid, as well as calories, physical activity, and food safety. Available at:
http://www.mypyramid.gov/downloads/
MyPyramid_education_framework.pdf
MyPyramid Food
Intake Patterns
This section provides a table with calorie levels ranging
from 1,000 to 3,200 calories/day, with a breakdown of
how many servings to include from each food group for
each calorie level. It also includes recommended calorie
ranges by age, sex, and activity level. Available at:
http://www.mypyramid.gov/downloads/MyPyramid_
Food_Intake_Patterns.pdf
Food Intake
Pattern Calorie
Levels
This chart defines how the website assigns calorie levels
for users when they enter their age, sex, and activity
level into the MyPyramid Plan section of the website.
Available at: http://www.mypyramid.gov/downloads/
MyPyramid_Calorie_Levels.pdf
Sample Menu
A 7-day sample menu based on the 2,000-calorie meal
pattern. Available at: http://www.mypyramid.gov/
downloads/sample_menu.pdf
Downloadable
Print Materials
for Consumers
Direct links to materials that are available for patient
education, including a mini poster, MyPyramid
results (printable by calorie level), and food-tracking
worksheets (also printable by calorie level). Available at:
http://www.mypyramid.gov/professionals/index.html
bles, and whole grains, while at the
same time suggesting moderation of
foods higher in saturated fat, trans fat,
added sugars, cholesterol, salt, and
alcohol. An added feature in the new
interactive pyramid is its emphasis on
physical activity, as shown by the fig-
ure climbing a staircase on the left side
of the pyramid logo (Figure 1)3.
The MyPyramid Plan section of the
website may be used by individuals
with diabetes or by any member of
the care team to estimate daily calorie
needs by entering an individual’s age,
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Table 3. Estimated Calorie
Needs for Weight
Maintenance3
Figure 1. The new USDA MyPyramid
food guidance system
sex, and activity level and printing an
individualized meal-planning worksheet for that calorie level. The worksheet can be used as a tool for logging
food choices before the first appointment with a registered dietitian.
Although this worksheet does not
specifically mention any details about
which foods contain carbohydrates, it
does emphasize balance and portion
control, key concepts to teach early in
the diabetes self-management education process.
It is important to remember that
this calorie calculation is not based on
an individual’s current height, weight,
or body composition, but instead it is
based strictly on sex, age, and activity
level.3 According to the website’s education framework document,
“Following the food intake pattern at
a calorie level identified for the person’s age and sex may result in weight
loss”3 because the intake patterns are
based on energy needs for a person at
a healthy weight.
The lowest food pattern calorie
level intended for adults on this website is 1,600 calories for adult women
and 2,000 calories for adult men. See
Table 3 for estimated calorie needs
based on sex, age, and activity.
However, according to the National
Heart, Lung, and Blood Institute,
lower calorie levels, perhaps as low as
1,000–1,200 calories/day for adult
women and 1,200–1,600 calories/day
for adult men, may be needed to produce weight loss.4 For patients for
whom weight loss is a goal, a more
appropriate calorie level may need to
be assessed and recommended.
Patients may find the MyPyramid
Tracker useful to help them determine whether they are staying within
Women
19–30 years
31–50 years
51+ years
Men
19–30 years
31–50 years
51+ years
Sedentary →
Active
2,000
1,800
1,600
→
→
→
2,400
2,200
2,200
2,400
2,200
2,200
→
→
→
3,000
3,000
2,800
their recommended calorie range for
the day. However, this tool gives
only nutrient totals for the entire
day, not information divided by meal
or by snack, which may limit its usefulness for diabetes meal planning.
Table 4 outlines tips for using
MyPyramid as part of diabetes survival skills education.
Practical uses for learning
carbohydrate counting
There are some educational uses of
the MyPyramid website for individuals with diabetes who are learning
carbohydrate counting skills. But
because of the design of the website,
there are also several limitations. First,
the Inside the Pyramid section provides more specifics about the individual food groups and what foods are in
each. However, information about
which foods contain carbohydrates is
not included.
This section also links to the Food
Gallery, which helps individuals gain
a better understanding of portion sizes
and what they look like. Both individuals with diabetes and clinicians
should note that beginning with the
2005 edition of the Dietary
Guidelines, most food measurements
were changed from “servings” to
“cups” or “ounces.”2 With this
change, individuals who are using carbohydrate counting for diabetes management need to be aware of how this
new measurement compares to a 15-g
carbohydrate choice because there are
several variations. For example,
whereas 1 cup of strawberries is
equivalent to 15 g of carbohydrates or
one carbohydrate choice,5 1 large
banana, which is also 1 cup of fruit
on the pyramid,3 is equivalent to 30 g
of carbohydrates or 2 carbohydrate
choices.5 For this reason, patients will
need to learn how to use food labels
and a pocket carbohydrate-counting
booklet for carbohydrate counting.
The tracker tool is set up to track
food choices by day and not by meal,
so determining carbohydrate intake
per meal is not an option. Still, it can
provide some benefits for patients to
learn more about their food choices
throughout the day. See Table 5 for
tips on using MyPyramid when teaching carbohydrate counting.
Practical uses for patients with
diabetes and comorbidities
Counting carbohydrates is often the
first priority for individuals with diabetes to manage their blood glucose.
However, because patients with diabetes have an increased risk of cardiovascular disease, it is important to
manage not only blood glucose, but
also blood pressure and blood cholesterol.6 For patients who already
have carbohydrate-counting skills
and are ready to track or learn more
Table 4. Tips for Professionals: Using MyPyramid for Diabetes
Survival Skills Education
• Introduce the MyPyramid website by entering the patient’s age, sex, and
activity level into the MyPyramid Plan section to obtain an estimated calorie level.
• Print a meal tracking worksheet for the patient based on this calorie level.
• Work with the patient to divide the recommended serving goals from each
food group into three balanced meals and one or two snacks.
• Make an appropriate referral to a registered dietitian/certified diabetes
educator (RD/CDE) for further nutrition education and individualization
of the plan.
• Ask the patient to use either the meal tracking worksheet or the
MyPyramid Tracker to keep a food log before the first appointment with
an RD/CDE, based on the patient’s motivation and/or ability to access the
Internet.
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about other nutrients, the
MyPyramid Tracker does offer this
opportunity. Individuals concerned
about blood pressure management
can track their intake of sodium,
whereas individuals concerned about
cholesterol management can track
their intake of total fat, saturated fat,
and dietary cholesterol.
The American Diabetes Association
recommends that saturated and trans
fats should compose no more than
10% and preferably < 7% of total
calories for patients with dyslipidemia,7 but the MyPyramid Tracker
bases its recommendations on < 10%
of the total calories consumed as
entered by the patient.3 Therefore,
patients need to be aware of this discrepancy and of their individual goals
when using this tool.
Once again, the tracker tool only
provides daily totals for macro- and
micronutrients and does not break
them down by individual food under
the Nutrient Intakes results tab. For
patients who are tracking their intake
of fruit, vegetables, and low-fat dairy
products as part of the American
Heart Association’s DASH (Dietary
Approaches to Stop Hypertension)
eating plan to manage their blood
pressure,4 the other results screens,
such as the Dietary Guideline
Comparison or MyPyramid
Recommendations, can provide a
visual assessment of how their food
choices compare with some of these
recommendations. The tracker tool
provides a very general assessment,
yet it serves as a good reminder to all
individuals, with or without diabetes,
that balance within food choices and
in activity level is critical for managing or preventing disease.
There is also a Related Links tab
on the main website page, where individuals can access other websites with
more information on specific conditions, including diabetes and high
blood pressure. See Table 6 for additional tips on using MyPyramid with
this population.
Practical uses for patients increasing
their physical activity
A new addition to the USDA Food
Guide Pyramid in 2005 is the figure
climbing the staircase on the left side
of the pyramid. The Inside
MyPyramid section of the website
Table 5. Tips for Professionals: Using MyPyramid for
Carbohydrate-Counting Education
• Instruct patients about which foods and food groups contain carbohydrates.
• Use the Food Gallery as an alternative to or in addition to food models to
demonstrate serving sizes and carbohydrate choices.
• Because MyPyramid does not specifically address carbohydrates or carbohydrate choices, educate patients about label reading and provide other
resources for this information, such as a carbohydrate-counting booklet.
• Encourage patients to schedule a follow-up appointment with an RD to
individualize their carbohydrate-counting plan.
Table 6. Tips for Professionals: Using MyPyramid for
Management of Comorbidities
• Teach patients to use the MyPyramid Tracker to see daily intake of sodium
for hypertension management or fruits, vegetables, whole grains, and low
fat dairy products for the DASH eating plan.
• Teach patients to use the MyPyramid Tracker to see daily intake of total
fat, saturated fat, and dietary cholesterol for lipid management.
• For patients whose goal is weight reduction, work with them to establish a
calorie goal and use the MyPyramid Tracker to assess total calories in
daily food choices.
• Use the website as a starting point to link to other resources for condition
management via the Related Links. From here, patients can access other
websites with more information on multiple topics, including diabetes,
high blood pressure, and weight management.
• Encourage patients to follow up with an RD for diabetes and comorbidities, such as hypertension and dyslipidemia.
states that adults should be physically
active for 30 minutes every day or
most days of the week, and that children and adolescents should be active
for 60 minutes every day or most days
of the week.3
Patients may find the MyPyramid
Tracker helpful for tracking activity
on a day-to-day basis. There are two
options for recording daily physical
activity: the standard option and the
condensed option.
The standard option provides
“the most accurate assessment of
your energy expenditure,”3 but it
requires users to list all of the physical activities they perform in a 24hour period, including smaller activities such as personal hygiene and
housework or yard work. The time
has to equal 1,440 minutes before
the day can be assessed, making it
very time consuming.
The condensed option is more user
friendly. This option is based on the
estimated basal energy expenditure
(BEE), which is adjusted to include
routine activities such as personal
hygiene, housework, and light yard
work for an estimated duration.3
Users only record additional leisure
time activities. The physical activity
analysis is calculated by adding
together the estimated BEE and the
additional leisure activities that users
enter. The condensed option may not
be as accurate as the standard option,
but it takes far less time to enter the
information and is accurate enough
for most users. The physical activity
analysis page allows patients to see
the intensity classification, duration of
the activity, metabolic equivalents,
and total calories expended for each
activity, as well as the result summary
for the entire day. This information
can be useful for patients who have a
specific exercise prescription from
their health care provider or diabetes
educator.
MyPyramid does not offer information about how physical activity
will affect diabetes management.
Individuals with diabetes need to
learn about taking special precautions
before starting a physical activity pro125
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Nutrition FYI
Table 7. Tips for Professionals: Using MyPyramid for Patients
Increasing Their Physical Activity
Guidelines for Americans 2005 [article online].
Available from www.healthierus.gov/
dietaryguidelines
3
• Educate patients about what types and amounts of physical activity are
safe for them; MyPyramid does not discuss physical activity recommendations for those with diabetes.
• Teach patients to use the MyPyramid Tracker for an accurate assessment
of calories expended during physical activity.
• Discuss with patients how increased physical activity will affect their blood
glucose and explain what precautions they should take before, during, and
after physical activity to avoid hypo- and hyperglycemia.
• Explain how the timing of physical activity is important in terms of peak
action times of insulin and oral medications.
gram. The Inside MyPyramid section
does caution that those with a chronic
health condition such as diabetes
should see their health care provider
to design a safe physical activity program. Table 7 offers tips for using the
physical activity section of MyPyramid with patients.
Summary
The 2005 Dietary Guidelines and the
MyPyramid website can be used as
tools for nutrition education. They
fulfill their intention: to improve
health and “improve the quality of an
average American diet.”3 It is important for individuals with diabetes and
the entire health care team to remem-
ber that the intended audience for
these materials is the general public
and that they are not written specifically to be used as part of the diabetes
education process. However, the tools
provided on the MyPyramid website
can be effective when used appropriately in the diabetes self-management
education process.
References
1
Goldberg JP, Belury MA, Elam P, Calvert Finn
S, Hayes D, Lyle R, St Jeor S, Warren M,
Hellwig JP: The obesity crisis: don’t blame it on
the pyramid. J Am Diet Assoc 104:1141–1147,
2004
2
U.S. Department of Agriculture and Department
of Health and Human Services: Dietary
126
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U.S. Department of Agriculture and Center for
Nutrition Policy and Promotion: MyPyramid
[article online]. Available from
www.mypyramid.gov
4
National Heart, Lung, and Blood Institute: Facts
About the DASH Eating Plan. Bethesda, Md.,
National Institutes of Health, 2003 (NIH publ.
no. 03-4082)
5
American Diabetes Association and American
Dietetic Association: Exchange Lists for Meal
Planning. Alexandria, Va., and Chicago,
American Diabetes Association and American
Dietetic Association, 2003
6
American Diabetes Association: Standards of
medical care in diabetes (Position Statement).
Diabetes Care 28 (Suppl. 1):S4–S36, 2005
7
American Diabetes Association: Evidence-based
nutrition principles and recommendations for the
treatment and prevention of diabetes and related
complications (Position Statement). Diabetes
Care 26 (Suppl. 1):S51–S61, 2003
Amanda Clark, RD, LD, and
Stephanie Kovarik, RD, LD, CDE, are
phone line dietitians; Melissa Voigt,
BA, is a worksite health promotions
specialist; and Joy Hayes, MS, RD,
LD, CDE, is a quality and training
coordinator at HealthPartners Health
Behavior Group in Minneapolis,
Minn.