Here's a quick quiz: What replaced the food pyramid, the government guide to healthy eating that stood for nearly 20 years?
If you're stumped, you're not alone.
More than a decade after Agriculture Department officials ditched the pyramid, few Americans have heard of MyPlate, a dinner plate-shaped logo that emphasizes fruits and vegetables.
Only about 25% of adults were aware of MyPlate - and less than 10% had attempted to use the guidance, according to a study released Tuesday by the National Center for Health Statistics. Those figures for 2017-2020 showed only slight improvement from a similar survey done a few years earlier.
That means that the Obama administration program that costs about $3 million a year hasn't reached most Americans, even as diet-related diseases such as obesity, diabetes and heart disease have continued to rise.
"This is currently the primary education tool that communicates guidelines for Americans," said the study's lead author, Edwina Wambogo, a nutrition epidemiologist at the agency. "MyPlate should be doing a little bit better."
The results are hardly surprising, said Marion Nestle, a food policy expert.
"Why would anyone expect otherwise?" she said in an email. "MyPlate never came with an education campaign, is old hat by now, only dealt with healthy foods, said nothing about unhealthy foods and is so far from what Americans actually eat as to seem unattainable."
A top USDA official said the agency's proposed fiscal year 2023 budget seeks an increase from $3 million to $10 million a year to bolster the MyPlate campaign by extending its reach and making recipes and other materials more culturally relevant.
"We absolutely want to make sure that MyPlate and other critical tools are in the hands of more people," said Stacy Dean, deputy undersecretary for food, nutrition and consumer services.
The new study found that people who rated their diet as excellent, very good or good were far more likely to have heard of MyPlate than those who said their diet was fair or poor. Of those who'd heard of the plan, about one-third tried to follow it, the study found.
MyPlate was introduced in 2011 with high-profile support from former first lady Michelle Obama, who made healthy eating and exercise her focus.
It uses a dinner plate with four colored sections for fruit, vegetables, grain and protein, with a smaller circle for dairy products, such as low-fat milk or yogurt. It encouraged Americans to make half of their meals fruits and vegetables in what was promoted as a fast, easily accessible format.
But the guide left out crucial details, said Dr. Vijaya Surampudi, a nutrition specialist at the University of California, Los Angeles.
"It doesn't differentiate between starchy vegetables and non-starchy vegetables," she said. "There's no fats on there."
Nor does MyPlate acknowledge that vegetables, grains and dairy foods also contain protein, Nestle added.
MyPlate replaced the USDA's food pyramid, which was in use from 1992 to 2011. Although it was recognized by generations of schoolkids, nutritionists were critical of the pyramid for promoting too many carbohydrates through grains and cutting back on fats.
"It wasn't the best set of recommendations on so many levels," Surampudi said. "Our rates of diabetes didn't go down. Our rates of obesity didn't go down. It went up."
The new study called for research into why some groups are less likely to be aware of and follow government guidance - and how best to reach those with poor diets.
But it's tricky, Surampudi said. In general, people know now that they should eat more fruits and vegetables. Beyond that, the message gets muddled.
"The minute it gets a little confusing, people shut down," she said.