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History Reclaimed: Part of The [Missing] HAES Files Series

Blackboard Bungle – Rethinking Nutrition Education

By Lindo Bacon, PhD, and Lucy Aphramor, PhD and RD

Contemporary nutrition education does more harm than good. Here’s an analysis, and a prescription for change. Co-authored with Dr. Lucy Aphramor.

Formerly published on “The HAES files” blog, the Association for Size Diversity and Health. May be slightly edited since original publication.

Why contemporary nutrition education does more harm than good, and why that’s not okay.

If you are among a practicing dietitian, you have been influenced by nutrition teaching. And if you are someone who buys groceries, eats in schools, or patronizes restaurants, hospitals or cafeterias, you have been influenced by dietitians. Because we all eat, the study of nutrition science — unlike say, economics or astronomy — can only make a difference when it touches the larger population, and it reaches them through dietitians. That’s why recruitment and training of dietitians matters so much.

And that is a problem. Nutrition education today woefully lags the latest science in the field. Its texts reflect too well the interests of industry and too little the views of environmentalists, consumer and labor advocates and others with a personal (rather than financial) stake in the making and selling of food.

And its teachings (sadly, many of its teach-ers) cling to outmoded biases that end up excluding whole classes of people from entering or succeeding in the field.

The long overdue fix would open nutrition education to a wider range of voices. It would redirect its focus from weight- and calorie-based assessments and outcomes toward those based on health itself. It would replace food phobia as its standard, and work instead to acknowledge the complexities of taste and respect the primacy of appetite, promoting nutrition understanding over ineffective rules and lists of “good” and “bad” foods. 

At the center of these reforms, the field must recognize – and correct – a longstanding weight-based bias that owe more to Madison Avenue than to any scientific laboratory. Dated notions of what health “looks like” (hint: thin) and who makes a effective dietitian (hint: see above), have made for bad science. And they have barred from nutrition’s ranks some of the very people who may best understand the challenges clients and customers face and how to help them find and sustain health no matter what they look like. 

The purpose of these changes is not to make the nutrition field more open and “fair” (though fairness is nice). Their purpose is to enable the nation’s vast, costly investment in dietetics to yield its first real results, by improving the nutrition of average people in the real world.

Failure to Communicate: Dietetics isn’t working

For all the growth of food education of recent decades, we see the opposite of progress in public nutrition. Membership in the Academy of Nutrition and Dietetics has reached 74,000, but illnesses and symptoms traceable to poor nutrition have risen just as dramatically. Alongside the rise of nutrition science, our national diet has gone, as it were, from rice and beans and roast turkey to Lunchables™ and deep-fried Coca-Cola™. 

There is little evidence that nutrition education effectively motivates people to make better nutritional choices. Studies show that Americans have, however, become more anxious about healthy eating and that eating disorders and body image distress are at epidemic proportions. Concern has been raised that nutrition education, rather than improving these conditions, backfires, leading to a heightened preoccupation with food with no concomitant improvement in behavior or health.

If so little of what is taught in dietetics degree programs actually improves real-world nutrition or well being, it’s time to erase the blackboard and rethink what we’re teaching.

You probably know the old saw about how many psychiatrists it takes to change a lightbulb: One, but the lightbulb has to want to be changed. Given dietetics’ inability so far to reform the popular palate, you would expect to find academics wringing their hands. But the field is suffused more with self-satisfaction than introspection. For the food science academy to fix itself requires, first, an acknowledgment of a problems.

Mm-mmm bad: Financial influence skews the field

The most obvious problem is that nutrition teaching and, as a result, dietetics practice, ignores voluminous data on the futility of conventional weight-based health approaches. Most nutrition education unquestioningly echoes government nostrums, even when recent studies disprove them – suggesting calorie-counting and diets improve health, for instance, when evidence (such as this American Psychological Association journal review]) says otherwise.

This disconnect doesn’t come from nowhere. It’s an unfortunate product of the subtle and not-so-subtle influence of those with a financial stake in food science. More than we realize, private business interests shape and influence much of what we believe or think we “know” about nutrition and our bodies. Private industry has transformed not just our understanding of nutrition, but our attitudes toward food and taste preferences, too. (Ads are but one vector: Think of the homey associations of Campbells Soup “mm-mmm good” ads, or the “take-a-break” come-on of Kit-Kat candy bars, for example.) 

If you doubt their influence, scroll the corporate sponsors of the Academy of Nutrition and Dietetics; you’ll find both Coke™ and Pepsi™, the American Dairy Council, and Abbott Nutrition™, makers of infant formula and “nutrition bars,” among numerous others. These unseemly ties underscore that there is nothing inevitable about what we like to eat: Tastes once shaped by hearth, ethnicity and local culture now are more likely to yield to the market influence of food, health care, pharmaceutical, and beauty product companies. 

A key way to shape tastes and beliefs about food is through scientific research, leading to a blurring in recent decades of lines between private industry, science, government, and medicine. As Woodward and Bernstein had it explained to them during Watergate: “follow the money.” We might like to think of scientific inquiry as the pure product of curiosity. But researchers need to make a living, and many are funded by corporate or government grants. And in nutrition, these grants often align with (you guessed it) corporate interests.

Studies follow the available grant money, and textbooks and teachers follow the published studies. The fat-phobic bias of government, media and industry means funding goes primarily toward trying to make people thin, and is sparse for research into alternative, non-weight-based paths toward better health. 

These constraints notwithstanding, studies of weight-neutral approaches (like this one) do get through sometimes. Their results are striking enough to warrant a new course of research and recommendations in the field, as summarized in this 2011 Nutrition Journal analysis.

We’re biased – admit it (as a start)

Like the willing lightbulb, to become effective in their work, dietitians and their teachers will need to acknowledge the biases we are all prone to and examine the ways these inclinations shape their practice. From Aristotle to Freakonomics, no scientific idea springs from objective “knowing.” What any of us believes to be “true” or “tested” – or worthy of study in the first place – is unavoidably influenced by our surrounding culture: by faith, fashion, politics, business, and prevailing scientific trends. (Darwin, for example, for decades doubted his own theories and refused to publish them, because they ran counter to church teachings he was steeped in.) 

Such bias isn’t right or wrong, it just is, quite obviously in the case of nutrition studies, where we all have bodies and all eat. Acknowledging and addressing it opening is the only way our teachings and texts can credibly claim authority. (Without it, a student could assume unquestioning absorption of a mistaken status quo.) 

To convey nutrition information and attract diverse practitioners to dietetics, we must acknowledge our own bias and privilege. Dietetics is a predominantly white, middle class, female dominated profession. (If medical students came predominantly in one shape, color and gender, wouldn’t we say there was something wrong?) Further, the pronounced correlation we see between poverty and obesity reminds us that issues of privilege can never stray far off the radar: Even those of us who work for social justice must acknowledge that race and class might influence our views on body shape and health entitlement. 

We may never eradicate bias from our thinking, but that’s precisely why it’s so important to name it and examine it, To improve nutrition education and its impact and broaden its ranks. The alternative is for the field to remain a cloistered society of (biased), like-minded people with little influence in society. 

If you doubt that weight-bias and privilege narrow access are preventing us from promoting qualified candidates – and may ultimately render us obsolete – read this account from Lindo, previously published elsewhere: 

[O]n a hiring committee interviewing candidates for a nutrition professorship, when it came time to discuss the lone fat candidate, one of my colleagues dismissed her by saying, “Well she really isn’t the role model for someone who eats nutritiously, is she?” My colleague had made this assumption based entirely on the candidate’s weight… That led me to think about the many challenges this job candidate had probably overcome to get her PhD in nutrition..

It’s safe to guess for example, that she took classes from conventional nutrition instructors, like the one we ended up hiring in her stead despite my protests. She routinely starts her weight management section by having people calculate their body mass index, which she uses as a lead in to name health risks for people who are in the overweight or obese categories… That [the fat candidate] managed to withstand that kind of misinformation and stigmatization to actually get her PhD is just extraordinary. 

Up against a similarly credentialed thinner woman, I imagine this fat woman would actually be a supremely better choice – the resilience and survival skills she has developed, her determination, her belief in herself, her ability to withstand a culture informing her that she’s defective, and what an incredible role model she could be for her students. That is, unless she’s internalized the fat hatred, apologizes for her size, and reinforces conventional thought, which is the more common route undertaken by fat dietitians.

[Uh oh. Defective copy. Do not have remainder of article. Sorry. It was formerly published on ASDAH’s blog and retired without notice; check with them perhaps?]