I laughed out loud as I read Dr. Katz’s article today in the Huffington Post. My favorite line referenced the “religion of food.” People certainly voice their opinions about the best diet, the best food, the worst food, taboo food, immoral food, and every other polarizing descriptor. If a specific dietary approach works, or someone is invested in a particular ideology, everyone else is fair game. Let the spewing begin.
I appreciate the need to calm the evangelist rhetoric about food or preferred approaches to food. Maybe the noise will calm down when medicine, public health, and other authoritarian entities step back from their own posturing. People speak with passion about what works for them because medical and nutrition authorities are very busy telling everyone how to eat as if everyone has the same needs.
It is seductive to reduce complex issues to black and white thinking. In the nutrition world, even people who should know better get tripped into good food/bad food thinking. A recent tirade by John Stewart offers evidence that reductionist thinking compromises more thoughtful discussion and intelligent debate about everything. I understand that when someone feels overwhelmed they are likely to think abut issues in more simplistic terms, if merely to calm their anxiety.
Some of the issue may be linked to a fixed mind set–found in consumers and health care practitioners alike. A fixed mind set invests more in intelligence and talent as opposed to learning and growing. A natural extension of a fixed mind set in the health care field involves smart and educated professionals telling everyone else how they should eat. Patients and consumers get tired of being ignored, dismissed and patronized. Dr Katz notes all the ways others are unable to acknowledge that one dietary approach doesn’t work for everyone, but I hope he calls out the USDA Dietary Guidelines, My Plate, The Obesity Algorithm, and other health care directives with equal force. Too many food guides do not address the needs of individuals and contribute to poor health more than anyone wants to admit. I’m not surprised Dr. Katz gets attacked from vegans, Paleo enthusiasts, and other narrow and prescriptive dietary advocates — especially folks living their own fixed mind set existence. They are screaming to be heard.
All of us in health care and public health arena need to stop pretending that there is one right way to eat. We need to listen with genuine curiosity and learn from our patients about their experiences before we can begin to support their journey. The goal should be figuring out an approach to food that works for them, not engaging in a power struggle determining who is right. Maybe we need to rethink our approach to public health nutrition and figure out how to make sophisticated nutrition support available to the everyone. Here are my top three suggestions:
- Recognize that the randomized clinical trial does very little to address the personal experience of any one person. Research is important, but clinicians and researchers alike need to pay more attention to the range and not just the point of statistical significance.
- Figure out a way to provide adequate nutrition support for every person from a qualified nutrition professional. What could be more important that teaching people how to feed their health from someone who specializes in the science of food and nutrition– and the tricky task of integrating knowledge with behavior. Conventional diet therapy fall short. Following a prescriptive diet or an an obesity algorithm that is more about diagnosis and directives for treatment is not the same as working with a client to bridge the gap between knowledge and behavior.
- Reimburse qualified nutritionists and dietitians for nutrition services for all appropriate diagnoses, including obesity. It is absurd to think the majority of primary care doctors–or obesity medicine specialists– are the most cost effective practitioners to adequately counsel clients regarding something as complex as weight management.
Lastly, we need to figure out who will pay for these services, unless we are happy with the status quo. Will it be worth it? I invite some brilliant economist to calculate the percentage of our GNP derived from the manufacture of highly processed food, pollution and waste from industrialized farming, chemical contamination, increasing stress of the workplace, and other factors that contribute to poor metabolic health? Add that number to all the money we throw at so called “health care” that mostly treats disease. Can’t wait to find out how those dollars compare to the cost for appropriate nutrition support. Let me know.