What is normal eating? Part 1
I’m writing this because nearly every day someone finds my blog by typing the question ‘how can I eat normally?’ into a search engine. This is, to me, equal parts sad and inspiring.
We’ll start with a definition: Medical Nutrition Therapy (MNT), which is what a clinical dietitian practices to address a specific disease or condition, using a therapeutic diet. The diet is designed to positively change the biomarkers of the disease at hand, like blood sugar in diabetic patients. Therapeutic diets come in all varieties — from simple, heart-healthy diets based on the Food Guide for people with high cholesterol, to lengthy, bizarre lists of foods that must be avoided for kidney disease.
Most popular diet advice for people looking to lose weight or ‘eat healthy’ offers some version of a therapeutic diet — which was originally intended to help manage a specific disease. The problem with this is: if you don’t have a disease, there’s no evidence that a therapeutic diet is good for you. You’re better off focusing on normal eating.
Unfortunately, the concept of normal eating itself has become perverted, as many concepts from MNT have managed to infiltrate those ho-hum nutrition guidelines intended for “normal, healthy” people. The Food Guide has become more rule-bound as it focuses on preventing chronic disease in people who aren’t even sick. We are exhorted to limit energy, fat, sugar, and salt, and even to count calories as part of a normal eating. Worse still, the US Food Guide emphasizes the importance of achieving and maintaining a “healthy weight” based on BMI guidelines that do not match the actual mortality stats. At least one dietitian, Ellyn Satter, has criticized the Food Guide for being unrealistic in its complexity of restrictions, and for promoting restrained eating.
And for all that — it doesn’t even work.
According to Satter, “only a third of today’s consumers score an average of 70 or above on the 100-point Healthy Eating Index, and only 20%…are able to consume their five-a-day of fruits and vegetables. Weight loss…continues to be key to nutrition policy, even though long-term efficacy of weight maintenance is poor.”
Not only doesn’t it work — it’s insulting.
Satter reports that, in response to an ADA-commissioned survey, “Forty percent of survey participants said they were tired of being told what to eat.”
What is the answer then? Instead of restrictive guidelines and negative-sounding messages about food, Satter recommends “eating competence,” which is what we’ll look at next. But I’ll give you a hint: normal, healthy eating may have more to do with meeting people where they are than worshiping at the altar of perfect nutrition.
Filed under: dietetics, eating, health at every size, nutrition | 6 Comments
Great post – I always wondered when food started being medicine and not, you know, FOOD. As a species somehow we’ve been managing to feed ourselves just fine for thousands of years – I wonder why NOW it’s suddenly become a problem?
Hahaha, good question! And I agree — for specific diseases, yeah, sometimes food can be tweaked for therapeutic, even drug-like effects. But it’s not as if there are no negative consequences of this on the quality of life or mental state of the patient, even if the disease responds well to the nutrition intervention. It’s just plain hard for people to be on a therapeutic diet, even if their lives depend on it.
So why must we all try to be on what is, essentially, a therapeutic diet? Why can’t we just, um, eat?
I can’t wait to read more. Last night I found myself in tears because I only had XX% fat for the day but a certain magazine told me that to be not depressed I had to have XX% fat but I was already over the calorie count that a certain website told me was healthy . . . and I thought, I am losing my mind trying to be healthy.
Sarah, I think you’re definitely not alone. And, honestly, I kind of think magazines are absolutely the worst place to read nutrition advice!
This is exactly why I started my blog. People don’t listen to doctors or scientists, they listen to each other and follow the eating patterns of their friends and family more often. We should all eat to live a healthy, full, and satisfied life.