The Dietary Guidelines for Texans offer a clinically actionable, evidence-based, and culturally flexible framework for nutrition counseling in a state with significant dietary health challenges. The three-pillar approach--minimize processing, optimize preparation, and honor dietary diversity--provides a practical scaffold for interprofessional teams to use at the bedside, in clinic, and in community settings. By understanding the evidence behind each recommendation and proactively addressing the social determinants that shape what Texans actually eat, healthcare providers can serve as meaningful agents of dietary change for the patients and communities they serve.
- INTRODUCTION
- THE THREE PILLARS OF THE DIETARY GUIDELINES FOR TEXANS
- WHY PROCESSING MATTERS: THE CLINICAL EVIDENCE
- KEY FOOD GROUP RECOMMENDATIONS
- HOW YOU PREPARE YOUR FOOD MATTERS
- THERE ARE MANY WAYS TO EAT HEALTHY
- ADDRESSING FOOD INSECURITY AND SOCIAL DETERMINANTS
- INTERPROFESSIONAL CLINICAL APPLICATION
- CONCLUSION
- Works Cited
This course is designed for healthcare professionals in Texas who may counsel patients regarding dietary guidelines and healthy eating.
The purpose of this course is to provide healthcare professionals in Texas with the knowledge and skills necessary to improve patients' understanding of and adherence to the Texas dietary guidelines.
Upon completion of this course, you should be able to:
- Describe the three foundational pillars of the Dietary Guidelines for Texans and explain the evidence-based rationale behind each pillar.
- Counsel patients on specific food choices using the key recommendations outlined in the Texas guidelines.
- Identify and address real-world social, cultural, and economic barriers that affect dietary adherence among Texas patients, incorporating the Texas Nutrition Advisory Committee framework of access, time, skills, meaning, and needs.
Mary Franks, MSN, APRN, FNP-C, is a board-certified Family Nurse Practitioner and NetCE Nurse Planner. She works as a Nurse Division Planner for NetCE and a per diem nurse practitioner in urgent care in Central Illinois. Mary graduated with her Associate’s degree in nursing from Carl Sandburg College, her BSN from OSF Saint Francis Medical Center College of Nursing in 2013, and her MSN with a focus on nursing education from Chamberlain University in 2017. She received a second master's degree in nursing as a Family Nurse Practitioner from Chamberlain University in 2019. She is an adjunct faculty member for a local university in Central Illinois in the MSN FNP program. Her previous nursing experience includes emergency/trauma nursing, critical care nursing, surgery, pediatrics, and urgent care. As a nurse practitioner, she has practiced as a primary care provider for long-term care facilities and school-based health services. She enjoys caring for minor illnesses and injuries, prevention of disease processes, health, and wellness. In her spare time, she stays busy with her two children and husband, coaching baseball, staying active with her own personal fitness journey, and cooking. She is a member of the American Association of Nurse Practitioners and the Illinois Society of Advanced Practice Nursing, for which she is a member of the bylaws committee.
Contributing faculty, Mary Franks, MSN, APRN, FNP-C, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
John M. Leonard, MD
Margo A. Halm, RN, PhD, NEA-BC, FAAN
The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Sarah Campbell
The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
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The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.
Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.
#98960: Applying the Dietary Guidelines for Texans in Clinical Practice
Diet-related chronic disease is among the most preventable and most prevalent burdens in American healthcare, and Texas is no exception. As of 2022–2024, Texas ranked 47th in the nation for food security, with approximately 17.6% of households unable to reliably provide adequate food for household members due to lack of resources, a rate significantly above the national average of 13.3% [2]. In 2024, Feeding America identified Texas as the most food-insecure state in the country [3].
These realities make nutrition counseling not just a recommended clinical practice; it is a public health imperative. The Texas Nutrition Advisory Committee (TNAC) has published the Dietary Guidelines for Texans to provide a culturally relevant, evidence-based framework that healthcare professionals can use when advising patients across the diverse communities of Texas [1]. This course translates those guidelines into practical, patient-centered clinical guidance.
The Dietary Guidelines for Texans, developed by the Texas Nutrition Advisory Committee (TNAC) and published by the Texas Department of State Health Services, are built on three foundational pillars [1]:
Foods without a lot of processing are best for your body.
How you prepare your food matters.
There are many ways to eat healthy.
These pillars are intentionally patient-centered and flexible. Rather than prescribing a single rigid eating pattern, TNAC acknowledges that "there is no single eating pattern that is appropriate for every Texan" [1]. This philosophy aligns with the growing clinical understanding that dietary adherence depends heavily on cultural context, individual preference, and practical feasibility.
Minimizing food processing, the first pillar, has substantial backing in the peer-reviewed literature. The totality of evidence supports the thesis that displacement of long-established dietary patterns by ultra-processed foods (UPFs) is a key driver of the escalating global burden of diet-related chronic diseases, including type 2 diabetes, cardiovascular disease, and certain cancers [4].
Mechanistically, minimally processed foods (MPFs) contain significantly higher total antioxidant content than processed or ultra-processed alternatives. A 2024 analysis of 1,946 food items found that MPFs had an 11-fold higher mean total antioxidant content compared to UPFs, with plant-based MPFs showing the greatest differential, nearly 15-fold higher than their ultra-processed counterparts [5]. This reduced antioxidant availability in UPFs may partially explain the relationship between UPF consumption and chronic inflammatory disease.
A 2025 randomized crossover trial in Nature Medicine directly compared MPF and UPF diets matched to national dietary guidance. Participants consuming MPF diets lost significantly more weight over eight weeks (–2.06% body weight) compared to those on UPF diets (–1.05%) [6]. These findings suggest that processing level may influence outcomes beyond macronutrient composition.
When advising patients, frame the conversation around whole and minimally processed foods, not just nutrient counts. A patient who understands why processing matters is more likely to make durable changes.
The Dietary Guidelines for Texans specify evidence-based recommendations across food groups [1]. This section summarizes each recommendation and its clinical significance.
TNAC recommends filling half the plate with vegetables and fruit at every meal to support digestion and overall health [1]. The guidelines encourage a variety of colors: red/pink (beets, tomatoes, strawberries), orange/yellow (carrots, sweet potato, cantaloupe), green (spinach, broccoli, okra), blue/purple (berries, cabbage), and white (cauliflower, onion, potatoes). Each color family represents distinct phytonutrients with anti-inflammatory, antioxidant, and cardioprotective effects. Encouraging color diversity is a practical, memorable tool for patients to ensure a breadth of micronutrient intake.
Ask patients which vegetables are familiar in their household cooking. For many Texans, this includes okra, jalapeños, pinto beans, chayote, and collard greens, all consistent with the guidelines and all worth validating as excellent choices [1].
The guidelines recommend three or more daily servings of unprocessed or minimally processed protein to support muscle, brain, bone, and skin health. Acceptable sources include beans, peas, lentils, seafood, poultry, beef, pork, lamb, wild game, eggs, nuts, and seeds [1].
Critically, the guidelines do not exclude animal proteins. TNAC notes that unprocessed or minimally processed meats and dairy can be part of a healthy diet when balanced with high-fiber plant foods [1]. This is clinically useful when counseling patients from cultural backgrounds where animal protein is central to the diet, including many Texas communities with Indigenous, Hispanic, or Southern food traditions.
The emphasis on unprocessed or minimally processed protein is the key qualifier. Baked chicken, canned sardines, or a hard-boiled egg are very different from a packaged deli sausage, even if all are "protein" [4].
Sources highlighted in the Texas guidelines include nuts, seeds, fatty fish, olive oil, and avocados [1]. Avocados and pecans, both produced in Texas, are excellent, locally relevant examples. Clinicians should normalize healthy fat intake for patients who have been counseled for years to avoid all fat, as this outdated messaging may be driving them toward refined carbohydrates and ultra-processed low-fat alternatives [4].
One of the more comprehensive elements of the Texas guidelines is the attention to bone health across multiple food groups [1]. Key nutrients for skeletal health include protein, calcium, vitamin D, vitamin K, and magnesium, and the guidelines provide non-dairy sources for each.
For lactose-intolerant patients or those avoiding dairy (a significant portion of patients with Hispanic or Asian heritage), excellent alternatives include:
Canned sardines and salmon with bones (calcium + vitamin D)
Tofu and fortified plant-based milks (calcium)
Kale, mustard greens, collards, bok choy, and turnip greens (vitamin K, calcium)
Sesame, chia, flax, and poppy seeds (calcium, magnesium)
Black-eyed peas and garbanzo beans (calcium, magnesium)
Many of these foods are already staples of Southern and Tex-Mex cuisine, making this guidance easy to integrate into culturally familiar eating patterns [1].
The Texas guidelines recommend whole grains, including brown rice, corn, barley, buckwheat, millet, quinoa, whole oats, farro, and whole wheat, emphasizing that they should be unprocessed or minimally processed [1].
The cardiovascular case for whole grains is among the strongest in nutrition science. A landmark 2026 meta-analysis of 87 randomized controlled trials found that consuming 60–100 grams of whole grains per day (approximately 4 to 6 servings) provided high-certainty evidence that intake reduced body weight, waist circumference, total cholesterol, and IL-6 (a marker of inflammation), plus moderate-certainty evidence for improvements in LDL cholesterol, triglycerides, fasting glucose, and systolic blood pressure [7]. The American Heart Association has similarly noted that replacing refined grains with whole grains leads to improvements in cardiovascular risk factors, citing observational data linking whole grain consumption to lower risks of cardiovascular disease (CVD), coronary heart disease, stroke, type 2 diabetes, and metabolic syndrome [8].
A patient swapping white rice for brown rice or moving from refined corn tortillas to whole-grain corn tortillas is making a meaningful, evidence-backed shift, one that aligns with culturally familiar foods [1,7].
The guidelines name water as the primary fluid source and recommend reducing or eliminating sugar, sugar substitutes, and artificial creamers in tea and coffee. Perhaps most notably, TNAC states there is no safe amount of alcohol and recommends considering reducing or avoiding it entirely [1]. This is a stronger position than many other guidelines and reflects emerging evidence on the relationship between alcohol and cancer risk.
The second pillar of the Texas guidelines focuses on food preparation, an often-overlooked dimension of dietary counseling [1]. Key recommendations include [1]:
Preferred cooking methods: Bake, broil, roast, poach, lightly sauté, stir-fry, or steam to preserve nutrients.
Use caution with: Smoking, frying, and grilling, as these methods can generate harmful compounds (e.g., heterocyclic amines, polycyclic aromatic hydrocarbons). The guidelines recommend using these methods less often rather than eliminating them, which is a realistic and respectful position.
Season with herbs and spices rather than excess salt, sugar, or fat to enhance flavor while helping prevent disease.
Avoid heating food in plastic packaging, which can transfer endocrine-disrupting chemicals.
Frozen, canned, or jarred produce without added salt, sugar, or preservatives are good choices, validating convenient, affordable options that are often dismissed.
This pillar is clinically significant because patients may be choosing appropriate whole foods but preparing them in ways that negate their nutritional value. Counseling on cooking method is therefore a legitimate and high-yield component of dietary education, especially relevant for nursing professionals who often provide hands-on patient education.
The third pillar is one of the most clinically practical: the explicit recognition that multiple dietary patterns can support health [1]. TNAC states [1]:
Traditional diets emphasizing seafood, vegetables, fruits, whole grains, and healthy fats support health and help prevent chronic disease.
Mostly minimally processed, plant-forward eating is a healthy approach.
Foods from animals, including unprocessed meat and dairy, can be part of a healthy diet when balanced with high-fiber plant foods.
This framework directly counters the "one-size-fits-all" approach that has historically alienated patients from dietary counseling. Texas is one of the most ethnically diverse states in the nation, with significant Hispanic, Black, Asian American (including Vietnamese), and Indigenous communities, each with distinct food traditions. Providers who dismiss culturally significant foods (e.g., beef, pork carnitas, rice, tortillas, black-eyed peas) risk damaging trust and reducing adherence. The TNAC guidelines explicitly affirm that cultural relevance is a core feature of sound dietary guidance, not a compromise of it [1].
TNAC developed a five-factor patient-centered framework to help clinicians and patients filter dietary guidance through real-world circumstances (Table 1) [1]. Incorporating this framework into dietary counseling transforms a generic recommendation into a personalized, actionable plan [1]. For nursing professionals conducting patient education prior to discharge, this framework offers a structured approach to identifying barriers before they become obstacles.
THE TNAC DECISION-MAKING FRAMEWORK
| Factor | Clinical Application |
|---|---|
| Access | Does the patient live near a grocery store? Do they rely on a food pantry or SNAP? |
| Time | Are they working multiple jobs? Caring for dependents? |
| Skills | Do they know how to cook? Are kitchen tools/facilities limited? |
| Meaning | What cultural, religious, or personal significance does food have for them? |
| Needs | Do they have chronic conditions (diabetes, CKD, CVD) with specific dietary requirements? |
No discussion of nutrition in Texas would be complete without addressing the stark reality of food insecurity in the state. Texas ranks among the bottom five states for food security nationally, and food-insecure families have annual healthcare expenditures nearly $2,500 higher than food-secure families, creating a direct link between food access and healthcare utilization [2,9].
TNAC explicitly recognizes these barriers: food insecurity, transportation limitations, affordability challenges, time constraints, and geographic differences in food access are all acknowledged as obstacles to dietary quality improvement [1]. The guidelines state that "improving dietary quality requires individual knowledge, skills, and supportive environments that make healthy choices feasible" [1].
What interprofessional teams can do [1]:
Screen for food insecurity using validated tools (e.g., the Hunger Vital Sign two-question screen) at every relevant clinical encounter.
Connect patients with resources such as SNAP, WIC, local food banks, community gardens, and Double Up Food Bucks programs.
Validate affordable, accessible options aligned with the guidelines, including dried beans, canned fish, frozen vegetables, eggs, oats, and brown rice. These foods are both evidence-based and economical.
Avoid dietary advice that increases cost burden. Recommending fresh organic produce to a patient using SNAP benefits is not patient-centered care. Canned or frozen alternatives (without added sodium or sugar) are guideline-consistent choices.
Support community-level advocacy. The TNAC guidelines call on schools, healthcare systems, food assistance programs, retailers, and policymakers to collaborate in making healthy food accessible.
For Physicians and PAs
Integrate brief dietary assessments into chronic disease management visits (diabetes, hypertension, hyperlipidemia, obesity).
Use the TNAC five-factor framework to identify the right level of dietary intervention for each patient.
Consider referral to a registered dietitian for high-complexity cases, but recognize that brief evidence-based dietary counseling (even 5 to 10 minutes) has measurable impact on patient behavior.
For Nurses
Conduct pre-discharge nutrition education using the three-pillar framework: processing, preparation, and flexibility.
Validate culturally familiar foods as health-promoting rather than problematic (e.g., "It's great that your family cooks with dried beans—those are one of the best proteins available").
Use the TNAC framework to identify whether a patient needs a community referral (food bank, SNAP application support) before going home.
Shared Interprofessional Responsibilities
Document dietary counseling in the electronic health record to enable continuity across the care team.
Model non-judgmental dietary conversations. Food is deeply personal, and shame is a barrier to behavior change.
Advocate for system-level changes: cafeteria menus, community health worker programs, and institutional partnerships with food banks.
The Dietary Guidelines for Texans offer a clinically actionable, evidence-based, and culturally flexible framework for nutrition counseling in a state with significant dietary health challenges [1]. The three-pillar approach—minimize processing, optimize preparation, and honor dietary diversity—provides a practical scaffold for interprofessional teams to use at the bedside, in clinic, and in community settings [1,4,5,6]. By understanding the evidence behind each recommendation and proactively addressing the social determinants that shape what Texans actually eat, healthcare providers can serve as meaningful agents of dietary change for the patients and communities they serve [2,3,9].
1. Texas Nutrition Advisory Committee, Texas Department of State Health Services. Dietary Guidelines for Texans. Available at https://www.dshs.texas.gov/sites/default/files/CHI-Chronic/docs/dietary-guidelines-for-texans-infographic.pdf. Last accessed October 31, 2026.
2. America's Health Rankings. Food Insecurity in Texas. United Health Foundation, 2022–2024 data. Available at https://www. americashealthrankings.org/explore/measures/food_insecurity_household/TX. Last accessed October 31, 2026.
3. United Way of Metropolitan Dallas. Texas Leads the Nation in Food Insecurity. Available at https://unitedwaydallas.org/updates/ texas-leads-the-nation-in-food-insecurity. Last accessed October 31, 2026.
4. Monteiro CA, Louzada MLC, Steele-Martinez E, et al. Ultra-processed foods and human health: the main thesis and the evidence. Lancet. 2025;406:2667-2684.
5. Basile AJ, Ruiz-Tejada A, Mohr AE, et al. Minimally processed foods have a higher total antioxidant content compared to processed and ultra-processed foods: results from an analysis of 1946 food items. British Journal of Nutrition. 2024;132(12):1555-1561.
6. Dicken SJ, Jassil FC, Brown A, et al. Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial. Nature Medicine. 2025;31:3297–3308.
7. Naghshi S, Kiani S, Ostadrahimi A, et al. Whole-grain consumption and cardiometabolic risk: a meta-analysis of randomized trials. European Heart Journal. 2026; [Epub ahead of print].
8. Whole Grains Council. Research Update: Why Whole Grains Are at the Heart of Cardiovascular Health. Available at https:// wholegrainscouncil.org/blog/2026/06/research-update-why-whole-grains-are-heart-cardiovascular-health. Last accessed October 31, 2026.
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