Self Reports of Virtue in Nutrition

In an editorial for JAMA this week, Frank Hu and Walter Willett tell us they have a clear view of the future for nutrition research. We’ve broken the bonds of biochemistry, animal models, and feeding studies. Biomarkers are nice, but at best they can only complement – not replace – dietary self reports. Thanks to nutritional epidemiology, we pretty much know the basic elements of a healthy diet.

The real challenge ahead, they say, will be to make people change their eating habits. It will be hard. It will take more than one thing to do it. But with soda taxes, regulations, financial incentives, and new environments at school and work, all will be well.

A Fly in the Ointment: Diverse Views About Food Choices

Writing in the Journal of Medical Ethics, Timothy Martin Wilkinson offers a distinctly different view. Trying to regulate how people eat for the sake of health equity, he says, would be premature at the very least.

He asks, how can it be a good thing to limit the options of people already harmed by social and economic disadvantages? They already suffer from limited options. Justifying that approach requires an assumption that these people can’t choose wisely for themselves. He says:

Some may think that if the conclusion is that we should have no regulations without really solid research, it is just the same old delaying tactic as used by tobacco and alcohol firms and climate change deniers.

The enemies of public health unreasonably insist on certainty when we already have good grounds to act. But we do not yet have good grounds for preventive regulations in the case of badly off adults. For the reasons set out, preventive regulations could worsen the position of the worst off on the most plausible criterion of their welfare, and there are some grounds to believe it would.

Attaching Stigma to Nutrition

Furthermore, presuming to choose for people with lower status has other consequences. Writing in Social Science and Medicine, Priya Fielding-Singh explains that adolescents now see healthy eating as a mark of financial privilege and moral superiority.

“Beliefs about healthy eating,” she says, “serve as a powerful medium for adolescents to mark and moralize socioeconomic groups, and each other.”

Will the Future of Nutrition Look Like the Past?

Will large datasets of dietary self-reports lead the way to the future? Hu and Willett see biomarkers, omics, and personalized nutrition as having serious limitations. They say “high expectations need to be tempered.” Turning to randomized controlled studies is “a simplistic response” to questions about causality. What we need for addressing obesity is a shift away from biomedical thinking toward a socioecological model. So they say.

But all that sounds like more of same to us. And the same old song hasn’t brought much progress on obesity. In fact, it’s brought us bias, stigma, and despair for many people living with it.

Click here for the commentary by Hu and Willett, here for the paper by Wilkinson, and here for the paper by Fielding-Singh.

Man and Woman Sharing a Meal, sketch by Vincent van Gogh / WikiArt

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November 4, 2018