Ok - we can agree that portions are way out of control!
I'm sure you're more capable of determining the nutritional needs of your patients better than the gov't. While the FP may be helpful to you as a tool, it is equally true that a lot of lobbyist $$ went into creating it.
I've known a couple of people who can go heavy on the grain side as recommended by the FP, but most people I know cannot. Personally, the only time I put on weight is when I add bread or pasta to my diet again (even whole grain). As long as I flip it to veggies and protein on the bottom and grains up with sugar, I'm ok. Anything else makes me bloat up like Rosie O'D.
A lot of it is overall portions and activity. I can go grain/CHO heavy if I'm working in the garden and teaching 10 hours of dance a week.
HOWEVER, my weakness is (was) the free, all you can drink lemonade dispensor. ARGH! I love lemonade :(
I have one brother who is a total vegan and gets probably 65% of his calories from grains, the rest from fats and meat analogs. He can put away more food than any human I've ever seen. He is also whip thin and all muscle.
The reason? He rides his bike everywhere.