Twenty-Five

Years in Dietetics: A Critical Reflection

by Yael Joffe, RD, PhD

I have waited 25 years to write this article. Despite forays into alternative careers, I have returned time and time again to my initial passion for nutrition. With great fortune, 15 years ago, I fell into the field of nutrigenomics and I have remained there ever since. Yet I have always had a level of discomfort with my chosen profession, never feeling entirely proud to define myself as a dietician. It is only in the last few years that I have understood what that may be about. Ignited by the writings of Michael Pollen, Marion Nestle, and Raj Patel, I have come to understand that there is something wrong in the way nutrition is being researched, advocated, and practiced.

Gyorgy Scrinis defines the ideology of nutritionism as a nutritionally reductive approach whereby nutrition is understood as nutrients rather than as food.^1,2 For the past century, nutritionism has been the ruling ideology of nutrition and dietetics. It is the ideology of the food industry, regulatory bodies, health institutions, and professional training. There is a great need for a new nutrition ideology, a new way of seeing and knowing about food, nutrition, health, and conditions such as obesity. I believe that studying the interactions between food, nature and society will provide a new way of seeing and knowing food and health.

Nutrition and dietetic professionals throughout the world have been trained in the current ideology of nutritionism. Food is taught, spoken about, and practiced in a biomedical model, with little consideration of the social, environmental, political, and economic relationships that govern food production and consumption. Dietetic and nutrition associations (and many dietitians and nutritionists) have unashamedly collaborated with the food industry for sponsorship and income, although there are hopeful signs that this is changing.

I have unwittingly been a part of nutritionism in my work, looking at nutrition primarily through genetic interactions and biochemical pathways. As my perspective expands, I now feel like the mother in the Incredibles movie, with one of my elastic arms stretched out to encompass the very important nutritional biochemistry and nutrigenomics (diet and genetics) and the other arm encompassing the social and environmental interaction with food.

Recently, I came across the Giessen Declaration and the New Nutrition Science Project. The Giessen Declaration was established from a meeting held in 2005 under the auspices of the president of the University of Giessen in Germany, the president of the International Union of Nutritional Sciences, and the president of the World Health Policy Forum. Some of the best nutrition scientists in the world were present. “This Declaration emphasized that the most relevant and urgent work to be done by professionals working in nutrition science and in food and nutrition policy is in its three biological, social and environmental dimensions all together.”³ The declaration led to the establishment of the New Nutrition Science Project. These nutrition scientists proposed that nutrition science “retain its current ‘classical’ identity as a biological science, within a broader and integrated conceptual framework, and will also be confirmed as a social and environmental science. As such it will be concerned with personal and population health, and with planetary health – the welfare and future.”⁴

Nutrition science has made giant strides in the last century. But the human population continues to increase, and the global climate is changing, with vast implications. Our science has been good in specific ways, but has ignored and overlooked planetary welfare and thus the basic determinants of human health and well-being. We must now ensure that the practice of our science supports sustainable ecosystems and healthy environments.⁵ (<This quote could be in a sidebar>)

The New Nutrition Science Project puts forth the idea of “wholesome nutrition” as the most suitable way to eat and drink.⁶ Wholesome nutrition consists mostly of foods of plant origin that have been processed as little as possible but as much as necessary. Fresh foods beneficial to health are prepared as tasty meals. The main foods to be eaten are fruits, vegetables, whole-grain products, legumes, and nuts, as well as dairy products. If desired, small amounts of meat, fish, and eggs may be included. About half of the amount of foods eaten in this approach fresh raw foods (fruits, salads, nuts). In addition to the health interactions of food and nutrition, social, ecological and economical aspects of food consumption are taken into account to achieve sustainability. This means, among other things, a preference for organic and seasonal food produced locally. The packaging of food should be environmentally benign. If foods from abroad are consumed, they should originate from fair trading.

There is no doubt in my mind that what the New Nutrition Project proposed in 2005 is what is missing from the way nutrition is currently taught and practiced within academia and mainstream medicine. But there are many questions that arise for me. Why were no dietitians included in the Giessen Meeting? Why did they not have a voice? What has happened to the working agenda defined in 2005? Why did it take me 10 years to find it? Why was it not embraced by the nutrition and dietetic profession as the way to move forward?

Despite my general disappointment with the way dietetics has been taught and managed in the past, there are many signs that things are changing:

• Functional medicine and functional nutrition are providing health professionals with a different paradigm to work within, a more effective way to treat the patient in entirety.

• The USA-based Academy of Nutrition and Dietetics has committed itself to looking at how it has done things in the past 100 years, including its sponsorship policy. Sonja L. Connor, president of the Academy of Nutrition and Dietetics, is looking for a new way to move forward. “We can re-engineer ourselves as an organization and a profession, moving to the forefront in implementing systems that improve health and well-being.”

• The Nutrition Academy has two outstanding dietetic practice groups (DPG) that do excellent work and reflect my own interests within this field: the Hunger and Environmental Nutrition DPG, and the Dietitians in Integrative and Functional Medicine DPG.

• The progressive nutrition and dietetic curriculum offered by universities such as New York University and the University of Vermont has shown a different way of teaching and knowing nutrition and dietetics by including biological, social, and environmental nutrition.

• The recently published Qatar Dietary Guidelines are distinct from others around the world; they include both the social and environmental dimensions of nutrition and reflect the wholesome nutrition described above. Similarly, in the Mediterranean diet pyramid, biodiversity, seasonality, traditional, local, and eco-friendly products are included. They also recommend culinary activities (cooking), regular physical activity, adequate rest, and conviviality.⁷

Most importantly, I continue to encounter many outstanding individual dietitians working for change, dieticians who have made the effort to gain more knowledge, and to challenge the profession to be better and do better than they have been doing. I look very much forward to another 25 years as our profession unfolds.

Notes

1. Scrinis G. Sorry, marge. Meanjin. 2002;61(4);108.

2. Scrinis G. On the ideology of nutritionism. Gastronomica. 2008;8(1):39–48.

2005;8(6a), 766–772.

3. Cannon G, Leitzmann C. The new nutrition science project. Public Health Nutr. 2005;8(6a):673–694.

4. Beauman C, Cannon G, Elmadfa I, et al. The principles, definition and dimensions of the new nutrition science. Public Health Nutr. 2005;8(6a):695–698.

5. Wahlqvist ML. The new nutrition science: sustainability and development. Public Health Nutr. 2005;8(6a):766–772.

6. Leitzmann C, Cannon G. Dimensions, domains and principles of the new nutrition science. Public Health Nutr. 2005;8(6a):787–794.

7. Bach-Faig A, Berry EM, Lairon D, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274–2284. doi:10.1017/S1368980011002515.