Causality, Attribution, and Diet Culture

Dietary Life RulesConsider these two competing headlines. In the Washington Post, Kate Cohen tells us “It’s time to cancel diet culture.” Then with a press release about new papers in Nature Medicine, researchers tell us “Most new Type 2 diabetes cases attributable to suboptimal diet.” It’s a fascinating mashup of causality, attribution, and diet culture.

On one hand, we have social commentary telling us that we should “shut up – about diets, about ‘guilty pleasures,’ about resolutions to eat ‘healthier.’” On the other hand, we have nutrition researchers telling us that bad diets bear the blame for the rising burden of chronic disease.

Should we resolve to eat healthier? Or fuhgeddaboudit?

Attribution and Causality

The research in Nature Medicine makes very clever use of attribution to suggest they have evidence for suboptimal diets causing type 2 diabetes around the world. In fact, they embed it in the title of their paper: “Incident type 2 diabetes attributable to suboptimal diet in 184 countries.”

If you look up attributable, Oxford will tell you it means “regarded as being caused by.” So you might say that the very title of this paper is an attribution of causality.

Yet, deep within their paper, the authors make it clear that they don’t have evidence for this, writing:

“Our modeling approach does not prove causation, and our findings should be considered as estimates of risk.”

This is a very advanced form of having one’s cake and eating it, too.


The other part of this mashup is another linguistic tool – the idiomatic boogeyman known as diet culture. This catchphrase serves to tell us that gurus of dietary perfection have taken themselves far too seriously. They have immersed us all in this diet culture that ruins our lives and will make our children sick and miserable. Cohen describes it as “ghastly and infuriating,” telling us to “cancel diet culture – if not for ourselves, for our kids.” She refers to advanced drugs for obesity and diabetes as an “injectable eating disorder.”

Separating Facts from Dogma

These two very different messages come at us with the volume cranked up to maximum.

On one hand, nutrition policy advocates say our diets are killing us and government inaction has given the world a preventable pandemic of diabetes. On the other hand we have fat activists saying the real problem is not an epidemic of diet-related diseases, it’s fat phobia.

The truth lies somewhere in between. Dire messaging about “sub-optimal diets” killing us and ruining the health of our children is not helpful. It does, in fact, promote weight-related stigma and bias. But at the same time, the rising health impact of obesity and diabetes is real and it too is causing great harm to many people. Nutrition is a factor, but neither nudging nor coercing people to consume a healthier diet has yet proven to fix the problem.

Turning down the volume on dogma might help. So, too, would a bit more curiosity about coping strategies that actually work.

Click here, here, and here for the papers with a slant toward optimal diets for global health. For Cohen’s resolution to cancel diet culture, click here.

Dietary Life Rules, woodcut by Utagawa Kunisada / WikiArt

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April 18, 2023