Archive for December 11th, 2012

December 11, 2012

the HAES® files: Blackboard Bungle−Rethinking Nutrition Education

by Health At Every Size® Blog

by Linda Bacon, PhD, and Lucy Aphramor, PhD, RD

How contemporary nutrition education does more harm than good, and how that can be changed

Nutrition science reaches us in large part through dietitians. If you have heard public health messages around nutrition, you have been influenced by dietitians. If you buy groceries, eat in schools, or patronize restaurants, hospitals or cafeterias – well, if you eat – you have been influenced by dietitians. That’s why the recruitment and training of dietitians matters so much.

And that is a problem. And an opportunity. Nutrition education today woefully misrepresents nutrition science. Its gospel reflects too well the interests of industry and too little the views of environmentalists, consumer, labor, and social justice advocates, and others with a personal (rather than financial) stake in the eating, making and selling of food. It rarely considers the emotional and social dynamics that underlie how food choices are made. It gives a misleading view of the science of health by frequently misrepresenting the role of food in health outcomes. And its teachings (and teach-ers) cling to outmoded biases that end up excluding whole classes of people from entering or succeeding in the field.

Dietetics isn’t working

Membership in the American dietetic organization, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), has soared to 74,000, and dietitians are now on the forefront of health education. Despite the increasing presence of nutrition in public health campaigns – and the increasing visibility of the Academy and dietitians – 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 body image distress has reached epidemic proportions, exponentially outscaling the incidence of nutrition-sensitive diseases such as heart disease or diabetes. Eating disorders are also on the rise.

Rather than improving well being, current public health nutrition education backfires, leading to a heightened preoccupation with food and weight with no concomitant improvement in self-care, health outcomes, or healthy weight management.

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.  This rethink spans a number of inter-related issues, and in this blog post we’re going to get started by discussing industry influence.

Mm-mmm bad: Financial influence skews the field

The disconnect between evidence and belief doesn’t come from nowhere. It’s an unfortunate and inevitable 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.

Nutrition science has financial, medical, social, legal, and cultural implications for the production and consumption of food. In fact, 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 most are funded by corporate grants – or government grants meted out by those with corporate interests. And in nutrition, these grants often align with (you guessed it) corporate interests.

Observe what happens when you follow the money behind published research. Industries with a stake in the outcome often fund nutrition studies. Statistics clearly show that when industry funds research, what gets published is more likely to show beneficial effects than research conducted without industry funding. The most comprehensive study of this topic examined commonly consumed beverages and found that those funded entirely by industry were approximately four to eight times more likely to be favorable to the financial interests of the sponsors than articles without industry-related funding. None of the interventional studies with all industry support had an unfavorable conclusion.

We’re not implying that companies overtly buy the results, although it does seem that way. More likely, scientists who accept corporate sponsorship are well-intended and have internalized the values of the sponsor, and the belief in science as a neutral enterprise, so thoroughly that they think themselves independent. But let’s be honest: Sponsored studies have only one purpose—to establish a basis to sell products, not to understand the science or promote public health.

The result? Many commonly accepted beliefs (promoted by dietitians and published in textbooks) are not supported by data. Consider milk. Would you believe there is no evidence to support the commonly held belief that milk builds stronger bones?  Prospective studies and randomized trials have consistently shown no relation between milk intake and risk of fractures. One of the largest studies, for example, the Nurses’ Health Study, investigated 78,000 women and found no evidence that higher intakes of milk reduced bone fracture incidence or osteoporosis. In fact, they found higher risk of hip fracture for women drinking two or more glasses per week compared to women who drank one or less per week! In contrast, research finds that those who eat the most fruits and vegetables have denser bones. The real reason milk – not fruits and vegetables – is believed to be the ultimate bone panacea is because the produce lobby doesn’t pump nearly as much money into research, publicity, and “education” as the powerful dairy industry.

Studies follow the available grant money, and textbooks, teachers, and dietary recommendations follow the published studies.

Scientific ideas are never the result of 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. This is particularly tricky in the field of nutrition because we all have to eat and there are huge financial stakes in influencing our beliefs. The result is that those seemingly “objective” nutrition truths end up reflecting food industry values much more than scientific fact. Private industry has transformed not just our understanding of nutrition, but our attitudes toward food itself, even our taste preferences. There is nothing inevitable about what you like to eat.

Just because something is conventionally accepted doesn’t mean it’s true. Don’t let the dispassionate voice of a textbook or the authority of a credentialed nutrition “expert” fool you. When bias isn’t acknowledged, count on the source as being a (typically unwitting) conduit for industry values.

And know that there is hope. Bias doesn’t need to be a bad thing: it just is. Awareness can lessen its negative impact and help us uncover what we really need to know. Stay tuned for further blog posts that offer an alternative understanding of nutritional concepts, and the data and reasoning to counter confusing nutritional ideas and shaming cultural messages about the worth of our bodies. We’ll also be providing recommendations to help you nourish yourself well, and to reclaim the pleasure in eating.

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PhD-nutritionists Linda Bacon and Lucy Aphramor, experts in the Health at Every Sizeâ (HAES) approach, are co-authors of the cutting edge Weight Science: Evaluating the Evidence for a Paradigm Shift, a peer-reviewed study that up-ends conventional thinking in weight-loss research. Their forthcoming book, Eat Well: For Your Self, For the World, promises to reboot nutrition education around evidence-based dietetics and the HAES-inspired directive that “the best nutritionist you’ll ever know lives inside your skin.” Stay tuned to the Health At Every Size Blog for excerpts and for more information about other collaborative work.

Lucy AphramorLucy Aphramor, RD, PhD, is a dietitian who pioneered the use of a HAES approach in the UK National Health Service. She is now Director of the not-for-profit organization Well Founded Ltd working to encourage compassionate care and social justice through delivering HAES training, courses and services. Dr Aphramor has published widely in the field of critical weight science and is active in the new Critical Dietetics movement where her research spans issues of ethics, equity and embodied knowledge in the dietetics profession.

Linda BaconLinda Bacon, PhD, is a researcher on the inside track of weight regulation science – a scientist whose three graduate degrees, research, and clinical expertise uniquely prepare her to understand and translate the physiological, psychological, and socio-cultural underpinnings of weight control. An internationally recognized authority on weight and health, Dr. Bacon has published her work in top scientific journals as well as the highly acclaimed popular press book, Health at Every Size: The Surprising Truth About Your Weight.

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