Response to Washington Post “Anti-Diet” Culture Article
Last week the Washington Post published a controversial article entitled “As obesity rises, Big Food and dietitians push ‘anti-diet’ advice.” The article describes the anti-diet culture and shares that dietitians are involved in working with food companies to promote sugary foods, to the detriment of the health of their followers.
In this blog post, I am going to address what the authors got right… and what they got wrong.
First, the authors claim that a popular Instagram dietitian can be seen promoting General Mills and their sugary cereals. A quick glance at her Instagram account shows that she was promoting cereal for breakfast, however, she was promoting Cheerios Oat Crunch served with almonds, blueberries and bananas on top. The nutrition break down of Cheerios Oat Crunch per serving is 220 calories, 4 grams of fiber and 15 grams of added sugar. Plus, other vitamins and minerals. High in sugar? Yes, but other health benefits like fiber and for a quick breakfast certainly a decent option.
The Washington Post also calls out research funded by General Mills touting the benefits of having cereal for breakfast. Did General Mills fund research on breakfast cereals? Yes… BUT this research was published in a peer-reviewed journal, meaning experts in the field reviewed the methods, results, conclusions and funding before allowing it to be published. AND the research was a systematic review. That means they compiled the results of many different studies (not funded by General Mills) to reach their results and conclusions. So, in reality, General Mills had nothing to do with the hands on research.
Besides, cereal can be a perfectly healthy option for breakfast or snacks. I recommend patients to look for a cereal that has at least 3 grams of fiber and less than 10 grams of added sugar. And if you can pair it with fruit and nuts like the Instagram dietitian, even better!
Next, the Post talks about healthy at every size (HAES) and intuitive eating. Let me explain what those things are. First, HAES was an initiative started to bring awareness and education to fat shaming in our society and in the healthcare system. There is some proof to this, members of the healthcare team (nurses, doctors, even dietitians!) can shame people for their weight and may even provide less quality care to individuals with a higher BMI, thinking it is their fault that they have health issues due to their higher weight.
However, in recent years HAES and anti-diet supporters have been proclaiming that their approach, which includes a focus on a person’s overall health versus a number on a scale, is better for the patient’s health outcomes. First, I would argue that if you are a good dietitian, you don’t have patients focus on the scale, even if the goal is weight loss. Talking about how a patient feels better, can do more activities, lowering their cholesterol, etc are much better for long term motivation than the number on the scale. And also… the data doesn’t agree with the HAES approach. We evaluated the HAES approach in a recent systematic review and found no improvement in weight (no surprise HAES approach isn’t supposed to change weight), blood sugars, cholesterol or even quality of life (which HAES folks argue that their approach does improve). So to a certain extent, the Post did get this one right.
What about intuitive eating? I call this mindful eating when I work with patients. It means that instead of mindlessly eating when you are grabbing for something to eat you check-in with yourself and see if you are really hungry or are you just eating because you are bored, stressed, sad, etc. If they answer is one of the latter, go find something else to do. If you are truly hungry, eat something!
Intuitive eating also talks about being in tune with your cravings, for example, when you crave something sweet, eat something sweet. I tell my patients when they are craving something sweet and they check in and determine it is because they are truly hungry to try eating fruit first. Nine times out of ten, this will satisfy their sweet tooth. And if they have the fruit and still want that cookie the tenth time, I tell them it is OK to have it once awhile.
Some folks have taken this too far and tell patients to check in with hunger but then to eat whatever they want when they are hungry (one view of anti-diet approach). This can lead to weight gain and other issues. So the Post half got this right.
Then the Post attacked ice cream and highlighted an Instagram dietitian promoting it. Ice cream is high in calories but it also provides some protein, calcium, vitamin D and magnesium. Should you eat ice cream everyday? No… but everything in moderation. Enjoying it once and awhile is totally fine.
Lastly, the Post discusses weight cycling. This is where people lose weight, gain it back, lose it again, etc. Studies have found this is extremely detrimental to our health, worse than if you just kept the weight on all along. This is where HAES people say their approach works, better to stay heavy than to weight cycle. But in reality, what is really needed is for people to not only have support losing weight, but to continue with that support to maintain that weight loss. That means working with a dietitian long-term once you have met your weight loss goal. You should have appointments every 3 months to make sure you are staying on track. So, I guess I’ll give the Post this one.
Overall, I like to think all dietitians are anti-diet dietitians. We don’t want some crazy diet plan that people can follow for a month, lose weight, and then go back to their bad habits. We want a lifestyle change of healthy eating that people ENJOY and can follow long-term for the best health outcomes.
What do you think? Comment and share!
