Critical dietetics.

The following is an excerpt from Critical Dietetics: A Declaration, something I was lucky enough to witness being born early this summer.

…we acknowledge that food is more than the mere sum of its constituent nutrients. We recognize that human bodies in health and illness are complex and contextual. Moreover, we recognize that the knowledge that enables us to understand health is socially, culturally, historically, and environmentally constructed.

Dietetics and the field of nutrition, being relatively new fields, are only just coming, in some ways, to reflect critically on their own place in the world: the places where we have succeeded as well as the places where we have failed, and our responsibility to social justice via the currency of health promotion.

(And by health promotion I mean the ENTIRETY of health promotion, as laid out in the Ottawa Charter, linked above — not merely rhetorical social marketing campaigns that sometimes consist of little more than ableist, boot-strapping propaganda.)

Aside from certain progressive sub-fields, such as food security and the emerging criticism of food production systems, I feel like nutrition and dietetics have been missing an important intellectual cousin, so to speak, in the form of critical analysis — using the knowledge and techniques available to us through many other fields of inquiry, such as philosophy, humanities, literature, art, and identity studies — of our own practices, beliefs and intentions.

To me, critical dietetics includes questioning definitions of health as they currently stand; questioning top-down approaches that rely on the hierarchy of practitioner and patient; being willing to shine light on where, exactly, dietetics has failed its own practitioners as well as patients; discovering where cultural bias has informed dietetic practice and public health policy, often without being questioned or challenged.

I’m sure you can see how important this is in the light of fat acceptance and Health at Every Size.

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19 Comments

  1. Posted December 10, 2009 at 12:22 pm | Permalink

    So, if you had to guess, what percentage of dietitians and nutritionists would be on board with the Ottawa Charter? For instance, if I needed the advice of a nutritionist, what are the chances I would get someone with this kind of holistic view, as opposed to a traditionalist?

    Peace,
    Shannon

    • Posted December 10, 2009 at 12:27 pm | Permalink

      Well, supposedly, at least in Canada, they all are on board with the Ottawa Charter (though the Charter was written, I believe, more from a public policy perspective than an individual practice perspective.) How this informs actual practice, however, varies from individual to individual.

      The advice I give to most people who email me who need to see a dietitian who will take a more holistic (that is, mental + physical + social health approach), is to search for someone who is familiar with HAES.

      How do you find such people? Well, it’s not always easy, since there’s no official HAES specialty for RDs to tick off on their public profiles. An imperfect proxy for this is to look for RDs who work with eating disorders (as well as the particular health condition you’re interested in learning about.)

      Many eating disorder practitioners are familiar with, or even passionate about, HAES and allow it to inform other areas of their practice.

      • Posted December 10, 2009 at 1:20 pm | Permalink

        I would second your (far more knowledgeable :) ) recommendation of ED practitioners. The HAES nutritionists that I’ve found here in the Seattle area are, by and large, all ED specialists.

        I did manage to track them down with a web search for “health at every size” + city. That led me to another site, which led me to another site, and so forth.

  2. Mina
    Posted December 10, 2009 at 12:35 pm | Permalink

    “…we acknowledge that food is more than the mere sum of its constituent nutrients. We recognize that human bodies in health and illness are complex and contextual.”

    Had I heard that declaration, I would have given them a standing ovation.

  3. Posted December 10, 2009 at 12:45 pm | Permalink

    I’m starting to believe that much of what we are told is “ideal nutrition” is politically motivated. As various people in my life decide that x,y, and z are bad, and p,q, and r and good, some of this nutritional knowledge seems cultish almost. I’m starting to think that there really isn’t an ideal diet, and there’s a lot more flexibility in what is health promoting than I used to think. I’ve started to ask my friends who are starting inflexible eating, annoying things like “why should I eat that?” and “what makes you think that’s healthy?”, and “how is that supposed to help?”, and I get blank looks, or even worse, looks of horror because OBVIOUSLY everyone knows that if eating too much can be unhealthy, eating a little must be bad as well, and if eating some is healthy, eating outrageous amounts is even better. They tell me that food can cure all health problems and diseases, but if that’s true, why still the epilepsy, psoriasis? Fortunately, these folks are not dieticians, and I don’t see anyone coming to them for nutrition or other health advice anytime soon. As far as dieticians go, I’ve never dealt with any, but judging from much of the advice I see on-line, I won’t be looking for one anytime soon.

    I think critical thinking everywhere would be a good thing.

    • Posted December 10, 2009 at 1:01 pm | Permalink

      I’m starting to believe that much of what we are told is “ideal nutrition” is politically motivated.

      I think this is a really interesting line of thought, and quite possibly accurate.

      I struggle a lot with the analogy between food and medicine. Food, in certain instances, definitely can have effects that seem as potent or even miraculous as the effect of a drug. And, like drugs, not all foods have the same effects on different people.

      But I am stuck with the gut feeling that, despite certain similarities, food is not medicine, and it might be unhelpful for us to view it as such.

      Still working this one out, though. I reserve the right to totally change my mind :)

      • Posted December 10, 2009 at 6:15 pm | Permalink

        The dose makes the poison. – Paracelus

        We’ve known about the ‘little bit cures, whole lot kills’ effect in medicine for at the very least nearly 500 years now. The entire concept of overdose, intentional or not, is grounded in that knowledge.

        But the same understanding doesn’t seem to follow to things classified as food. We had a conversation on the possibility of tryptophan sedation effects in a family member right after Thanksgiving dinner, and it was like several at the table were having real issues thinking of dosing levels of food products.

        And I know I’ve heard ‘but you’d need to consume X [units] to get the effect’ statements in the It’s Good For You Now news reports about food health effects, but I’ve never heard anyone mention a ‘but if you eat more than Y [units], that chemical or something else in that food will cause problems’ statement attached, unless it was the ‘red wine is good for you, please drink responsibly’ thing.

  4. Charlotte Cooper
    Posted December 10, 2009 at 1:06 pm | Permalink

    Beautiful! Thanks for this.

  5. Posted December 10, 2009 at 1:13 pm | Permalink

    I am all conflicted about food but in weird ways I suspect. I actually had a bit of a breakdown the other day because I made whole wheat mac and cheese, hot dogs on whole wheat buns and frozen broccoli for dinner the other day. I made that meal because it was cheap and available. I tried my hardest to make it a nutritious meal and make it tasty for the kids. In the end I was depressed because I hate buying super cheap pork products because the animals aren’t treated well, industrial pork farms pollute, these weren’t locally grown veggies, there was only one veggie on the plate.

    I get that I am privileged to have concerns about not feeding my family well enough, without worrying (at least all the time) that I won’t be able to feed them at all. I have food security, I need to chill.

    I do think eating good for you (good for you the individual) food is key to health, but is it good for you the way a drug is; as a treatment? Or is it good for you in an optimizing your inherent health sort of way. I am totally wondering out loud here.

    • Posted December 10, 2009 at 1:32 pm | Permalink

      Those are really interesting questions you bring up, and I think your personal worries about the food you serve being “good enough” are shared by lots of us. I’ve certainly had those thoughts on more than one occasion.

      The way I’ve dealt with it, thus far, is considering things from a larger perspective. Frankly, I think the food system is messed up. I think it’s wrong that animals are treated poorly, that some subsidies exist that unbalance and undermine the way food production operates (don’t get me wrong, though — I do think some farm subsidies are necessary and good), and I think lack of sanitation and safe practices and exploitation of labourers are terrible things. I want to see all of these things fixed.

      However. In the same sense that individuals are often blamed for, and then burdened with fixing or compensating for, the systemic issues that exacerbate chronic disease (for example, having cities and neighbourhoods that are either too unsafe, or simply constructed to car-scale in such a way that makes it difficult or impossible for people to get natural forms of physical activity, like walking), I sense that making people feel guilty and ashamed and burdened, on an individual level, for problems that are truly policy-related and large systemic, is totally the wrong way to go about making change.

      Again, don’t get me wrong — I like to see individuals feel empowered and intrinsically motivated (there’s that damn concept again!) to make choices in their daily lives that reflect their larger values (for instance, choosing to eat locally, or to be vegan, or to exercise despite barriers.)

      What I don’t like to see is the flipside of that supposed empowerment, which is BLAME.

      No one individual should ever feel they, personally, are responsible for compensating for the ills of the larger world by making truly burdensome changes to their personal lives.

      This is not to say people should “shirk personal responsibility” or blah blah blah. It IS to say that, often times, larger forces (government, business interests, whatever) enjoy passing the blame AND the responsibility to fix problems that they themselves caused and continue to perpetuate onto individuals who are already disadvantaged by those problems!

      So, to put it in less high-faluting terms, if you want to take a stand against shit that’s just not right in our food system by making changes to the way you eat — hell yeah. More power to you.

      But if you can’t, or simply don’t want to take on that project, that is absolutely your right, and you have no reason to feel guilty for that. It is not the responsibility of your groceries or your breakfast or your dinner to fix the fucking food system. It is the responsibility of people who have power in that system, and if you are concerned and want to get involved, you have lots of avenues of potential activism that needn’t affect your actual food choices.

      You can write letters to your representatives; you can write critically about business practices or advertising that you find offensive; you can call companies and tell them what you think.

      But you don’t have to feel guilty about buying and eating hotdogs. You can be mad that better-quality food is not available for cheaper, while also appreciating what you do have, enjoying it for what it is, and also looking forward to the day things change.

      I hope that makes sense. Something that really bothers me is when people feel ashamed of their food.

      You can want, and strive for, better foods to be available to everyone without having to take on that burden emotionally in the form of shame. Shame is a sign that blame and responsibility have been passed inappropriately onto your shoulders.

      Shame is not only unnecessary in these circumstances, but it can be actively harmful. Believing that the food you eat is subpar and dangerous can have a “nocebo” effect that actually can make you vulnerable to illness.

      We’d like to see some changes, yes, but bottom line: Food is food. And food is good.

      • Posted December 10, 2009 at 2:10 pm | Permalink

        Thank you Michelle, for not making me feel like an entitled whiner. I saw some photographs of civilian victims of the wars yesterday and now everything in my life feels so petty and horribly privileged. I feel so helpless and angry in the face of these types of institutional injustices. I tend to go into a shame/anger/depression spiral so profound, well… let me put it to you this way, I am an ardent environmentalist and I can’t bring myself to see “An Inconvenient Truth”.

        Eating minimally processed, sustainably grown, locally harvested foods aren’t just about me having my suburban panties in a bunch. I want all children everywhere to have a better quality of life. Yeah, cheap chocolate = child labor, dangerous back-breaking child labor. I can skip chocolate and we eat vegetarian many times per month but I just wish I could put food on the table and not have to worry about it every damn second. I agree, that can’t be good for my health either.

        I do what I can, when I can afford it, I get my veggies from a CSA, I eat vegetarian a lot, what meat we do consume tends to be along the lines of roast chicken one day, chicken/bean burritos the next day and chicken carcass soup the third day. I grow tomatoes and key limes in pots on my porch, and I vote for people who at least SAY they have my same ideals.

        unscrambled, bless you for taking on the medical system in any way at all. I have a had a few good doctors (and nurse practitioners) in my life, but far more unhelpful or even downright dangerous ones. Good on ya!

  6. Posted December 10, 2009 at 1:33 pm | Permalink

    Just commenting to say that I love love love love this site. I’m in medical school and I don’t spend a week without hearing the dog whistle blown about diabetes/fat/health in a way that blames fat people. No lie, someone within a small group discussion asked why we don’t just starve fat people (as in the famous starvation studies of the late 60’s), because people lost weight.

    For real.

    So this is one of my sanity checks, and I thank you for it.

    • Posted December 10, 2009 at 2:22 pm | Permalink

      Thank you, and I feel you. Being in school for dietetics is sometimes (though, surprisingly, a lot less than I thought it would be) similar to what you describe. But I am so glad there are other students coming into healthcare fields who will make change.

      I also hope you read one of my very best IRL friend’s blog at http://haesmed.blogspot.com/ – she’s also in med school and attempting to deal with it from a HAES perspective.

      She doesn’t update often, but when she does it’s totally worth it.

      • Posted December 10, 2009 at 5:28 pm | Permalink

        Oh I TOTALLY read that blog. It has already made a difference for me.

        Though, really, I just get stared at a lot. Never mind when I try to bring any kind of intersectional analysis to the conversation. Plus I’m a bunch older than my fellow nerdlets? Oy. Luckily, I live across town from the school, am happily partnered, and have a bunch of friends that have NO THANG to do with this, so my sanity is still intact.

        Another sample conversation, this in my epidemiology class:

        Prof: talking about the obesity epidemic, yadda yadda….

        Me: “In order for something to be an epidemic, doesn’t it have to be a disease?”

        Prof: Obesity isn’t a disease?

        Me: No it isn’t.

        Prof: (look of who is this lizard in front of me)

        Me: Never mind, it’s tangential to the conversation.

        That’s the other thing. I need to get better at patiently explaining. It’ll come in time. I suppose.

        • Posted December 10, 2009 at 7:52 pm | Permalink

          Hahahahha. I am also older (I’m 30) and have background interests that have less to do with chemistry and biology, and more to do with humanities, art, and political activism. Soo…yeah. That makes for an interesting combo when you’re surrounded (mostly) by people who are more interested in memorizing the steps of glycolysis than talking about the social implications of public health campaigns, and the philosophy of science behind it.

          Not to diss glycolysis, either — it’s just two different ways of thinking.

  7. Posted December 14, 2009 at 1:08 pm | Permalink

    Amen! This is so well put. I am in school to become a registered dietitian and the lack of critical thinking is driving me bonkers. It’s so hard for me to sit in classes where I’m the fattest person there and everyone is talking about those poor sad fat people who are all killing themselves slowly… and my peers aren’t being taught to think critically or put the data into a larger context. I can’t wait to get through my RD training and internship so that I can have some degree of independence of thought and action in my own career (if I’m lucky enough to not work in a huge bureaucratic agency where I’m forced to toe [tow?] the ADA line)

  8. Jacqui Gingras
    Posted February 13, 2010 at 11:43 am | Permalink

    Michelle and Other Subversive Souls,
    Thank you for taking up this discussion of criticality. I believe that our future depends on whether we can embrace not knowing. Too much certainty is killing the health professions or rather, killing others’ trust in the health professions.
    We are going to start a journal called Critical Dietetics so keep your ideas flowing – and your poetry!

    Despite having to change the name of the declaration (now just simply called Critical Dietetics: A Declaration), we are growing with new adventures on the horizon. We need lots of support to share the message that another way of thinking, knowing, and being in dietetics and other health care professions is possible.

    j

    • Posted February 13, 2010 at 11:56 am | Permalink

      I am very excited, Jacqui. You all have done an amazing thing in bringing this forward to a wider audience. I’m hoping this will result in a bit of a renaissance of critical analysis in the health professions as a whole!

      And I totally agree about the certainty thing. Because “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Science never can know anything for certain. Because that’s not how belief on the basis of proof works.

      But we seem to have come to the mistaken conclusion that *pretending* we know for certain will bolster our authority somehow. And when the public finds out that that certainty doesn’t exist, and that those “experts” and “authorities” are just humans, fumbling around trying to figure things out like everyone else, they feel justifiably betrayed.

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