Current U.S. public health nutrition guidelines suggest that individuals may exert considerable control over future health outcomes related to chronic disease by simply following suggested recommendations; however, these recommendations have failed to result in improved health outcomes for Americans. Although dietary guidance to prevent chronic disease is frequently understood as a straightforward provision of best nutrition practices, the history of controversy over the scientific basis of this guidance and its failure to improve health outcomes of Americans raises a number of ethical concerns. An examination of the origins of federal public health nutrition guidance for prevention of chronic disease provides a background for recognizing ethical issues present in current nutrition guidance and points to problematic assumptions upon which current policy is founded. Attention to evidentiary standards and burden of responsibility for outcomes will lead to a more ethically responsible public health nutrition policy.