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    5 Ways the Nutrition Field Hinders Its Own Progress

    I often write about the external factors that pose a threat to the nutrition field, including (but not limited to) Big Food’s egregious advertising budgets, deceptive claims on food packaging, misguided agricultural policies that subsidize foods we should be eating less of, and politics that taint seemingly-subjective processes like FDA-approval of substances that end up in our food supply.

    This time, however, I’m shining the spotlight inward, taking a look at pervasive, accepted, and often times unquestioned concepts, ideas, and issues within the field of nutrition that carry a significant risk of self-harm.  They are dangerous because they don’t allow for growth, critical analysis, or substantive dialogue; instead, they minimize the nutrition field’s importance and have helped create the current free-for-all we are in, where the term “nutrition expert” is as loosely thrown around as “reality TV star”.  Although presented in no particular order; in my mind, they are all equally damaging.

    1) “There is no such thing as junk food”/”there are no bad foods”:

    This is one of the core philosophies that comes up with eating disorder patients.  In that particular context, I comprehend its importance — strip away judgmental labels on food and bring it to its most basic function: nourishment for survival.  However, I’ve increasingly started seeing some people in the nutrition field, who do not work in the realm of eating disorders, bring this up as a ‘take-home’ message for all their clients.

    I understand that, to varying degrees, food is closely tied with emotions.  If a client reports eating a king size Snickers bar as a snack every day, a response of “Ew, why would you eat that?” is unprofessional, unnecessarily aggressive, and not at all helpful.  I am by no means condoning the heinous “Jillian Michaels method” of trying to pass off belittling as “motivation”.

    That said, I believe that the ultimate goal of a nutritionist or dietitian is to help people eat better.  I am not a “weight loss-itian”.  I don’t consider my job done simply because someone loses 10 pounds in 2 months. After all, weight loss can be achieved by eating minimally nutritious foods while keeping calories down.

    My intent is to help people reevaluate how they view food and get them back to “nutritional basics”, so to speak.  In order to do that, I can’t equalize the playing field and say something as disingenuous as “there is no such thing as junk food.”  One individual I’ve worked worked with used to start their day — five days a week — with a diet soda and a fast food breakfast sandwich.  Over the course of several months of working together, he shifted and eventually ended up replacing that with a bowl of “loaded” oatmeal (think fresh fruit, nuts/or seeds/or respective butters, and various spices).  One of the first things he told me was how much better he physically and mentally felt as a result of eating a healthier breakfast.

    So, yes, there most certainly is junk food, which usually makes people feel sluggish, tired, and generally “not good”.  Nutrition professionals need to recognize — and capitalize on — that.  Telling someone  that it’s okay to keep eating a fast food breakfast sandwich,  “but instead of a diet soda, have orange juice” doesn’t do anyone any favors.  Sure, changes do not happen overnight (meaning someone may benefit from stepping down gradually and going from eating something five days a week to three days a week to one day a week), but change should still be encouraged.  It has been my experience that many people eat unhealthy foods simply out of habit and ease; once they begin to appreciate new and different flavors, their tastebuds undergo a metamorphosis as well and they find unhealthy foods less palatable.

    2) “Moderation!”

    To my ears, “everything in moderation!” is the equivalent of six hundreds fingernails on a chalkboard, the never-ending drip of a leaky faucet, and an eternally-ringing phone that never gets answered.  Just like the word “natural” — which food companies love to plaster on the most un-natural of products — the term “moderation” is absolutely meaningless.  Ask twenty different dietitians what it means and you’ll get twenty different responses.

    “But that’s the beauty of it — each person can define it themselves!”, some say.  That doesn’t sound like beauty to me; it sounds like chaos.

    “Everything in moderation” is another way in which we as nutrition professionals do a huge disservice to ourselves by once again unnecessarily equalizing the nutritional field.  “Everything in moderation” operates on the inane — and utterly insane — notion that peaches, Pop-Tarts, muffins, soda, lentils, and tomatoes should all be approached the same way.

    Three cups of mixed greens as part of a salad are not the same thing as three cups of chocolate pudding.  A large Dunkin’ Donuts Mountain Dew coolatta should not be consumed with the same frequency as unsweetened green tea.  It’s silly to pretend that eating a pint of blueberries throughout the course of a day for two weeks should be perceived in the same way as a eating a pint of Haagen Dazs on a daily basis over that same period of time.

    Nutrition professionals should not act like defense lawyers for fast food companies, especially at a time where the average American could seriously benefit from eating less fast food.  Again, this does not mean someone has to be scolded for eating unhealthy foods on occasion.  However, we can not — and should not — deny that certain foods belong in the “eat always” category, others in the “eat sometimes” category, and others in the “eat rarely” category.

    Some people argue that if we do not preach moderation, we are setting the stage for unreachable perfectionism and eating disorders, a position that I find grossly melodramatic.  Recommending that people shy away from fast food whenever possible is not about perfection; it’s healthful advice.

    3) “Healthy Eater = Red Flag”

    Most of my nutrition textbooks are quick to point out that vegetarians, vegans, and “those who avoid certain food groups” must be dealt with carefully, for if they do not plan their diets adequately, all sorts of nutritional ills could befall them.  Meanwhile, the average American (and by average, that means omnivore) falls short of the recommended intake of fiber and several minerals, including magnesium.  Of course, this is not because omnivorous diets are inherently unhealthy, but because the majority of omnivores are eating highly processed foods with little nutritional value.

    The “vegans must plan their diets adequately or else!” operates under the beyond-elementary assumption that “meat = protein and iron” and “milk = calcium and vitamin D”, and if you don’t eat either of those two things, well, you’ve got your work cut out for you.  Forethought, knowledge, and planning are important for all diets.  Simply being omnivore does not mean one can throw caution to the wind and not worry about nutrient deficiencies.

    It troubles me that, rather than recognize the significant amount of research which shows that plant-based diets (as well as omnivorous ones that are largely plant-centric) provide a multitude of health benefits, most of mainstream nutrition treats these eating patterns as “niche”, “fads”, or ones that need close medical supervision.  Don’t even get me started on the ignorant and fear-mongering magazine articles which warn mothers that if their teenage daughter is considering vegetarianism, she could be on her way to an eating disorder (because, you know, vegetarians just eat a small bowl of salad with no dressing as a meal).

    4) “You Have To Be Realistic”:

    This is often mentioned as a way to justify telling people they can still eat at their favorite fast food chain; “just get the small portion”.  I used to think this way when I first started studying nutrition, before I interacted with any clients.  I now see that the most satisfied individuals I have worked with are those who stepped outside their comfort zone.  Sure, they stop by a fast food place for some fries every now and then, but they can’t believe they once ate fast food several times a week.

    We should not feel “bad” for gently challenging people, or for suggesting healthier meals.  One irritating straw-man argument I often hear is “not everyone is going to eat steamed kale and brown rice”, as if the only options available to people were a quadruple Baconator burger from a fast food chain or a bowl of steamed vegetables.  There are plenty of foods that fit between that spectrum, and which have the added bonus of helping people learn where food comes from and gets them involved in preparation (I’m talking something as simple as buying a sweet potato, washing it, cutting it into planks, mixing that with some olive or coconut oil and spices, and letting it bake for 20 minutes).  Simply because it has become “the norm” to nuke dinner in the microwave or get take-out a few times a week does not mean we as health professionals should encourage that.  After all, it has become the norm for people to have credit card debt, but you’d be hard-pressed to find a financial advisor who will say “eh, $3,000 in credit card debt is no biggie; most people have $20,000!”.

    Instead of telling people to “just choose a diet soda” next time they go out to eat, we should truly tell them why diet soda isn’t that great of a choice to start with.  This is not about scare tactics or “forbidding” foods; it’s about providing people with the gift of information.  Simply parroting the press-release-friendly “well, the research says all artificial sweeteners is safe” is not helpful or even accurate.  The best thing we can truly say is that “the current research, which is limited, politically charged, and says nothing about long-term use, proposes that these artificial sweeteners are safe.”  That at least provides a more realistic overview of the issue.  People have the right to know that Splenda has been found to alter gut microflora and therefore interfere with mineral absorption.  I am not a Splenda executive; I am a nutrition professional, and as such I can’t honestly tell someone “Splenda is totally fine, just have no more than two packets a day.”

    Then there’s the notion that recommending quinoa (which these days is available at Costco and Trader Joe’s) or a vegan bean-based chili or a kale-based salad that takes 15 minutes to prepare is “asking for too much” or “not realistic”.  In my experience, most people are interested in new foods and are willing to try anything once.  Whole grains cook just like refined grains; some just take an additional 10 minutes.  So what?  They are an additional 10 minutes that don’t require someone to be in the kitchen.

    Of course, I am talking about people who live in cities and towns where they can feasibly get these items (food deserts are a different challenge).

    This is not about turning people into vegetarians or vegans, but we can not deny that the average Americans needs to eat more fruits, vegetables, and whole grains.   In order for this to happen, people need to be appropriately challenged and exposed to new ways of eating.

    5) The American Dietetic Association Isn’t A Health Organization:

    I am currently studying to take my Registered Dietitian exam.  This past weekend I was reviewing several hundred practice questions provided in a study guide given to me by a fellow intern.  As I flipped through the pages, I felt a mixture of frustration and disbelief that, assuming the exam poses similar questions, this is what the American Dietetic Association considers important information.

    As far as I can tell, these practice questions are from 2003.  Every question that relates to food science involves red meat, eggs, cakes, margarine, and pies.  In fact, the correct answer to a question on the best way to lower sodium in a meal was to use low-sodium margarine in place of regular margarine.  The ADA wants to make sure I know how to prevent a cake from coming out too spongy, and yet apparently doesn’t care if I know the nutritional differences between — and specific health benefits of — chia seeds, hemp seeds, and flax seeds, or the health implications of a diet too high in omega 6 and too low in omega 3 fatty acids.

    Other questions that the ADA considers important — so important, in fact, that they dedicate an entire third of the exam to them — have to do with the layout of a food service kitchen, what cleaning cycle is best for a dishwasher, how to deal with budget reductions in a food service facility, and how much hamburger I would need to make 300 three-ounce patties with a 20 percent shrinkage.  And here I thought it was important to know how the mineral content of whole wheat flour differs from that of white flour.

    Frustrating, to say the least.  Oh, and, of course, I am expected to answer that I should worry about vitamin B12 and vitamin D deficiencies if a client tells me they are vegan.  Funny — thinking back to my outpatient and clinical experiences, about 90% of patients were vitamin D deficient, and I would wager that 98% of them were omnivores.  This question is especially silly given that almost all vegan dairy alternatives are fortified with vitamin D and B12.

    As a future Registered Dietitian, I am beginning to understand why the credential is completely foreign to the average American, why we are often seen by some people as advocates for lobby groups rather than health, and why the field we are supposed to have ownership of is claimed by so many.  I am encouraged, though, to have met Registered Dietitians who are independent thinkers and are passionate about clean and healthful eating.  It’s my sincere hope that we can mobilize and help bring the field we have so much faith in to the forward-thinking place where it truly belongs.

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    113 Comments

    1. Valerie Sims said on August 21st, 2011

      This is my first reading of your website, and it is so insightful that I am eager to read other posts. My disappointment came in learning the the exam for registering dietitians is still as it was 34 years ago when I took it. At the time, I thought the association would soon change its ways, I was going to have a graduate degree in nutrition, and all of the food service management and non-health related food information would make way for information that would truly guide people to make healthy choices. After about five years of sitting through expensive and uninformative continuing education requirements, I gave up on the organization. Since little has changed in all those years, I do not regret giving up, but I do regret that the American Dietetic Association is not the resource that it could and should be.

    2. Laurie Endicott Thomas said on August 22nd, 2011

      Amen! I was especially pleased to see you speak out against “moderation.” As Caldwell Esselstyn wrote, when it comes to lowering cholesterol, moderation kills!

      http://www.gorillaprotein.com

    3. Holly said on September 18th, 2011

      I just passed the rd exam, was amazed at the amount of ‘ dishwasher questions’ and b12/vegan questions ( 3) and constantly thought of similar gripes which you have posted so concretely……thank you! I now feel that its not just me, nice to have support in these ideas.

    4. Lisa said on October 14th, 2012

      Ah yes, no such thing as good or bad foods. The tenet of dieticians everywhere. Unsurprisingly, the first place I was introduced to this mindset was in an eating disorders program. To be fair, I DID have a problem; I wasn’t just stuck in a group because my doctor thought I was too weird about food.

      I clashed a lot with my dietician. If she said potato, I said hell no and rolled my eyes and told her why potatoes were bad for you. If I said I legitimately didn’t like junk (deceptively named ~treat foods~), she’d smile patronizingly and say “okaaaay,” like she was humoring a little kid.

      I was actually horrified by the advice given there. It really opened my eyes to the role they play in setting the body up for disease and, in e.d patients, relapse. What do you do when you relapse? You go back to them! What do they do? Try to stuff the food guide down your throat for the third, fourth, fifth time. Scary cycle.

      I was the only one in the room who laughed the week we talked about fiber. Sitting in the middle of the table were pamphlets for All Bran with little samples.

      All of these came up at some point during the recovery process. You would be amazed at the way these are twisted to appeal to eating disorder patients to get them to “just” eat that ice cream or burger. It’s realistic to eat junk food daily. It’s okay to have what you crave. You might be on a desert island somewhere where the only food source is McDonalds and you’ll HAVE to eat or DIE! etc.

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