EVERYONE EATS! But Your Barber is Just Your Barber

If you were living in medieval times and needed medical attention, it is very possible that you would have gone to your barber. That’s right. The red, white and blue striping in the barbers pole originally signified blood, bandages, leaches and pain; announcing the fact that barbers were available to perform medical procedures like removing bladder obstructions, kidney stones and damaged teeth, lancing boils, amputating gangrenous limbs and of course bloodletting to treat wounds (applying leeches when the wounds were too tender or difficult to reach). In fact, barbers often displayed bowls of the blood in their windows to let passersby know that the procedure was available there.

Today, of course we know better. We go to doctors for medical procedures and dentists for problems with our teeth. And if we have emotional struggles that require attention we know to see a psychotherapist. I failed to mention that back in the day barbers were often called upon in this endeavor as well. Using a procedure called trepanning, they drilled a hole into the person’s head to let out the evil forces that caused mental illness and epilepsy.

Everyone Eats

As a nutrition professional for more than 25 years I have often wondered why is it that so many people, often without any specific training or experience (other than their own eating) feel qualified to counsel people on nutrition behaviors. And why is it that so many people who know to go to doctors, dentists and therapists for the appropriate issues are willing to take a different path when it comes to nutrition.

Almost twenty years ago, when we were raising our son, one of his favorite books was Everyone Poops. It was a funny, colorful way of educating kids about one of life’s messiest and most normal occurrences.

For some reason, as I was thinking about this nutrition conundrum the other day, my mind flitted back to this book. Perhaps the answer to the conundrum is that everyone eats! That’s right. Everyone eats! Everyone has an almost infinite set of personal experiences with food – everyday of their lives.

And some of these people, especially those who have been trained in the helping professions, want to impart the knowledge they have gained from these personal experiences with food to help others. Certainly makes sense. But...

Being Experienced at Eating is Not the Same as Being Qualified to Provide Nutrition Counsel

The idea that because someone has experience eating they are qualified to do nutrition counseling is curious to say the least. Think about it. If you have had experience owning a cat for many years – does that mean you are qualified to be a cat doctor? If you own a car for 10 years does that mean you are qualified to be an auto mechanic?

Few people would take their sick cat to anyone but a veterinarian and it is hard to imagine anyone bringing a broken-down car to their butcher. So, doesn’t it just make sense that if you need help with nutrition issues you would choose a trained nutrition professional?

When I ask this question, particularly of allied health professionals who are doing nutrition counseling, very often the response will be something like, “well many nutrition professionals are in the pocket of big food,” or “the nutrition professionals I have seen have not been helpful,” or “the nutrition professionals I have seen______." (fill in the blank)

With any profession, some practitioners will be more skilled than others and even more importantly not every professional in any profession will be helpful to every client. But if the first mechanic you go to is a crook or is just plain not helpful, most people do not respond by taking their car to their tailor or grabbing someone on the street and asking for help. They keep looking until they find a more honest, competent mechanic.

Somehow this thinking gets lost when it comes to eating and food – because I guess people figure that if someone is in a health-related field and/or has been eating long enough, they probably know what they are talking about. Everyone eats!

Helping Without Harming – More Difficult Than It Appears

Here is the rub. Humans have an amazingly complex relationship with food – one that transcends the nutrition information in a food label or the research on the physiological/health impact of individual foods. Different foods can have wildly different effects on different people, and a few missteps in imparting nutrition information and recommendations can cause significant problems for folks who are susceptible to eating disorders or whose food issues are tied up with emotional and other concerns.

Without having real training and experience with these intricacies, well-meaning people, including health professionals, can unwittingly do more harm than good when they “play” at being a nutrition professional.

If you are seeking nutrition help, and the person who is delivering it is a trained nutrition professional, you can make your decisions about their fit with your needs by seeing them a few times. If they do not have a significant history of nutrition training and experience (other than their own eating) you might want to consider the following red flags.

1. Recovering from an eating disorder – It is not unusual for people who are recovering from disordered eating or even more serious eating disorders to gravitate towards giving nutrition counsel and recommendations, whether they have any experience other than their own or not. While most are well-meaning, some can be almost evangelistic – like ex-smokers often tend to be. And while they may have inspiring and often heartbreaking stories of their long, painful, arduous journey with food; without significant training, they are not likely to be equipped to deal with the unique complexities of the human-food relationship. So what may have worked in their personal circumstance may in fact be triggering and harmful for others.
2. Moralizing About Food – Anytime the message focuses on good vs. bad, or healthy vs. unhealthy foods, or foods to eat and foods to avoid, consider raising your red flag. Food is just food. What is healthy for one person might not be for another, and all foods can fit in an overall healthy diet. As registered dietitian/nutritionist Rebecca Scritchfield says in her refreshing new book Body Kindness:

"Eat cake if you want cake and kale if you want kale, but don’t make it about anything more than it really is: just one of the many millions of food choices you are going to make in your lifetime. You’ll enjoy the cake and the kale much more when they aren’t tied to your worthiness."

One of the most common examples of this issue is the oft repeated saying – “you are what you eat.” Aside from the obvious shaming of people’s food choices (remember it is often difficult for people to separate feelings about food from feelings about self), this statement is scientifically indefensible. We know that individual health behaviors account for only about 25% of the health disparities across our population, and eating is only one such behavior. A much more accurate statement might be “you are where you live,” because if you travel the 12 miles from Downtown Washington DC to the suburbs of Maryland, life expectancy increases by about 20 years!

3. Fear mongering: Gloom and Doom - If a presentation starts out with a list of diseases that you will get or avoid if you change what you eat, or promises of a longer life expectancy if you make those changes, your red flag should be flying. Here is a recent example from a nutrition health coaching organization introducing their training:

"1.6 billion adults worldwide are obese and 366 million have diabetes. We spend trillions on healthcare and are still getting sicker and our life expectancies are getting lower."

Yes, I know this is traditionally how we have approached trying to get people to be healthier. But scaring people is simply not an effective approach for achieving sustained change. In fact, being anxious all the time is decidedly bad for your health. And the huge problems with our health care system have much more to do with the system itself than with individual people’s health behaviors anyway.

4. Check Our Privilege - If you hear a health professional bragging about how, even with their frenetic schedule they manage to get up at 4 am to run on a treadmill and make a kale smoothie, you probably want to reach for the red flag. Yes, it might be nice if we all had the time and resources to eat only locally-sourced, organic foods that we pick and prepare ourselves each day – but this is simply not feasible for the vast majority of people in this country or on this planet. For those of us for whom it is feasible, we need to be sure to check our privilege before we risk making other people feel bad about the reality that for them it is simply not. And if anyone follows up with “it is really no more expensive or time consuming to eat that way,” well I have some swamp land just south of where I live that I would be happy to show you!

5. Behavioral Gimmicks – Beware of approaches aimed at controlling your food intake. No, drinking a lot of water before a meal will not help you lose weight. The best rule to follow here is, if it seems a bit silly, or too good to be true, it probably is. Other questionable recommendations in this genre include eating off smaller plates, estimating the percentage of different kinds of foods that should make up each plate, putting down your fork for a specified amount of time in-between bites, and so on.

One of the most instructive recommendations of this type actually comes from Tom Rath who has done such great work with Gallup. His recommendation for guiding people about what and how to order when they are eating out:

“The first person to announce what he or she is ordering sets the anchor for the entire group. If the first-person ordering chooses a healthy option, it puts a little pressure on everyone else to do the same.”

Aside from the fact that this suggestion treats adults as if they were small children at best, who’s to say what is healthy or unhealthy for any particular individual, and what on earth happened to Gallup’s usual focus on autonomy? So often, when the topic is food, autonomy seems to take a back seat to whatever the presenter’s preferences happen to be.

Why is this example so instructive? Tom Rath is internationally respected as a researcher, author, and filmmaker, sometimes referred to as a “lifestyle expert.” He has struggled with serious health issues of his own and he has used Gallup’s incredible data to help people focus in on what is most important for their health. All good. But as we will see in #6 below, this may not be enough.

6. Nutrition Researchers vs. Nutrition Experts - The 6th and last red flag is reserved for nutrition researchers and journalists. It may apply to scientists like Tom Rath, but even more specifically to folks like Gary Taubes, Nina Teicholz, Michael Pollan and a whole slew of medical doctors who study the nutrition literature. These are all very smart people and good researchers and we can certainly learn from their hard work. But, in terms of working with individual human beings on their relationships with food, the academic study of nutrition research only gets you so far. Do these experts work “in the trenches” every day with people who are struggling with food? Do they have the background and practical experience for how to apply the nutrition research (much of which is biased by spuriously significant associations) to the larger context and complexities of people’s lives?

How do they balance the latest science with the idea that the purpose of food – at its core - is to; a) provide the fuel we need to live our lives, and b) offer an opportunity to experience satisfaction and pleasure. When food becomes THE FOCUS of our lives it makes our lives more limited and too much focus on food science can become counterproductive in daily life. “Healthy eating” is more than just simply about WHAT we eat. It has to do with why, when, how, and where we invest our energy as well!

Take Home

So, where does that leave us? There are good reasons why you see a doctor when you are sick and a psychotherapist when you are troubled, and why you take your car to a mechanic when it is not working properly and your sick cat to a veterinarian. So the next time you are struggling with your relationship with food, why not consider going to a nutrition professional for help?

And at the workplace, instead of offering nutrition and weight loss programs that focus on restriction of one or another food group, or lists of foods that are good and bad, or behavioral gimmicks to externally control your eating, how about offering instead programs that help people make peace with their bodies and their food and teach people how to eat mindfully? 

And, of course, if you need a haircut – your barber is the person to see!

Dr. Jon Robison - www.salveopartners.com - [email protected]