Let's talk about ~that~ Washington Post article...
What people get wrong about anti-diet culture, intuitive eating, and the dietetics profession at large
If you follow me on Instagram, you might have already seen that I posted a few thoughts about a Washington Post article published a couple weeks ago titled “As obesity rises, Big Food and dietitians push ‘anti-diet’ advice.” (I feel morally opposed to linking the actual article itself as I don’t want to give it more clicks; read at your own peril.) Upon further reflection, though, I felt that the topic deserved a more thorough discussion.
Let’s begin with Jaye, whose story opens the article:
Jaye Rochon struggled to lose weight for years. But she felt as if a burden had lifted when she discovered YouTube influencers advocating “health at every size” — urging her to stop dieting and start listening to her “mental hunger.”
She stopped avoiding favorite foods such as cupcakes and Nutella. “They made me feel like I was safe eating whatever the hell I wanted,” said Rochon, 51, a video editor in Wausau, Wis. In two months, she regained 50 pounds. As her weight neared 300 pounds, she began to worry about her health.
The article goes on to discuss how dietitians “are building lucrative followings by co-opting anti-diet messages,” citing an investigation into 68 dietitians with at least 10,000 followers and observing that “[m]ost of the influencers who used anti-diet language also were paid to promote products from food, beverage and supplement companies.” What the Post is aiming to do here is 1) reduce the credibility of registered dietitians (especially those who identify as anti-diet or non-diet RDs) and claim that we generally don’t know what we’re doing, and 2) paint registered dietitians as profit-hungry shills who advertise ideas like “food freedom” just to prey on vulnerable people, all while getting paid off by “Big Food”.
I’m not going to talk too much about this second point, at least in this post, but just know that the group of dietitians that the reporters analyzed makes up 0.6% of the roughly 112,000 dietitians that are currently registered by the Commission on Dietetic Registration, and that the average annual salary nationwide for RDs is $69,680.
On the point of credibility, though, I think we can read this article through a different lens. I view this article as actually underscoring the dire need for dietitians to work one-on-one with patients to help them heal their relationships with food while also working towards their health goals.
Jaye’s story is one of a woman who, desperate to fix her relationship with food and stop the cycle of dieting, saw a message online that resonated with her and then ran with it. Yet it’s not surprising at all that Jaye’s attempt to follow anti-diet principles failed her, because it’s sort of akin to running a marathon without any training. Had she sought out the help of an RD specifically trained in these principles, the outcome likely would have been different.
And let me be clear: I don’t blame Jaye at all. Nutrition can be confusing, and I do think dietitians need to be careful about the way they message these ideas online, especially when a 30-second TikTok will never be able to communicate the type of nuance that’s needed in these discussions. But that’s all the more reason to, again, work with RDs to actually learn what anti-diet principles mean and how to put them into practice.
So what does anti-diet actually mean?
“Anti-diet,” “intuitive eating,” “food freedom,” and “Health At Every Size” are all discussed (and at times, conflated) in the WaPo article, but I’m going to focus on intuitive eating (IE). That’s because the principles of IE, like “Reject the diet mentality,” “Honor your hunger,” and “Respect your body” encompass many of these aforementioned concepts.
Intuitive Eating has actually been around for quite some time, though, as the Post points out, it’s become increasingly popular in recent years. Founded by two dietitians, Elyse Resch and Evelyn Tribole, IE is based on the belief that we are all born with hunger and fullness cues that guide us in when, how much, and what to eat. By tapping into these innate cues, we’re able to meet both our biological and psychological needs.
What the Post (conveniently) left out is that, for many of us, these cues become distorted and dysregulated over time, often because of chronic dieting — but also because we live in a modern world in which busy schedules, stress, and illness force us to stop trusting our bodies.
Think of it this way: imagine a rickety bridge that spans across a deep chasm. On one side of the chasm is chronic dieting. On the other side lies intuitive eating. If you try to cross that bridge without any guardrails, you’re likely to fall into the canyon below.
Working with a dietitian allows for those guardrails to be in place. I work primarily with patients with eating disorders. I also work with many patients who may not have eating disorders but nevertheless have poor awareness of their own hunger and fullness cues. When we start to work together, I don’t throw intuitive eating at them immediately, or even after several sessions. Instead, we find ways to “bridge” the gap between their current relationship to food and a more intuitive one using more structured ways of eating. These are the guardrails on the bridge, and they are there to ensure that my patients are getting an adequate balance of micro- and macronutrients based on their body’s individual needs. (And, by the way, that’s another reason to work with an RD: we provide individualized medical nutrition therapy according to a a patient’s specific needs and health goals, which is impossible and actually unethical to provide on social media.)
This is not to say that folks can’t try to adopt IE or other anti-diet principles on their own, and I’m sure there are plenty of people who have done so successfully. The Intuitive Eating book and workbook are awesome resources to start with if you’re interested. Again, though, if you at all are struggling with your relationship with food in any way, I recommend not doing it on your own.
But back to the article at hand!
Another issue I have with the way the article was written is that it struggles to capture the nuances of “food freedom.” The article suggests that food freedom means “eating whatever the hell” you want; Rochon notes she believed “[y]our relationship with food would just get magically healed, if you just ate the doughnuts and ate the cookies and weren’t afraid of what you were eating.” Many people mistakenly believe that food freedom means eating whatever you want, when you want, in whatever quantities you want. This mindset is a glaring misrepresentation of what food freedom actually means.
Food freedom means that food and eating do not exist as a significant source of stress or anxiety in your day-to-day life. It means taking away the power that food has over your emotions and feelings. When anti-diet RDs say “allow all foods” or “all foods fit,” what we mean is that, if we give ourselves permission to eat all foods, we actually take away the power those foods have over us. It moves us toward a neutral relationship towards food.
This concept also gets muddled when folks hear anti-diet or IE-aligned dietitians say things like “there are no good and bad foods.” Again, the Post seems to take this to mean that these dietitians believe all foods are the same and that eating a bowl of ice cream is the same as eating a bowl of broccoli. This, again, is a misinterpretation.
Of course, foods have different nutritional profiles and properties, and some foods are more nutritious than others. What anti-diet messaging, “food freedom” and intuitive eating do say is that we as human beings aren’t bad (or lazy, or weak, or guilty) if we eat a bowl of ice cream. These frameworks remove morality from food. That doesn’t mean we can’t make choices around food that are health-informed, but it does mean that whether we choose the ice cream or the broccoli, we deserve to feel morally neutral about either option.
The shame game
Food being morally neutral reminds me of another point: I’ve found it interesting to dissect how shame and guilt are so interwoven into the way our culture thinks about food, eating, and health. Even just observing the language we use around food and eating — saying we’re “bad” for eating a particular food, or calling a day without food rules a “cheat day” — demonstrates our society’s belief that eating healthily, and being healthy in general, is some kind of moral obligation.
All you need to do is read the comments on the very article we’re currently picking apart discussing to observe how quickly we pass judgment on people who engage in what we deem to be unhealthy eating behaviors. Yet I encourage you to think about the following situations that increase health risk but that we typically don’t shame others for engaging in:
Not wearing sunscreen
Riding a bike without a helmet
Drinking alcohol, even just socially (alcohol is a toxin, unfortunately…!)
My intention with these examples is not to shame those who engage in these behaviors (and in fact, I have done all of these myself at one point or another — sorry Mom!). Rather, it’s to call attention to the types of behaviors we place moral value on. When held up to the mirror, it’s quite obvious that actions that are connected to fatness (eating gluttonously, not exercising) are viewed as inherently more shameful than other risky behaviors that aren’t directly related to appearance or body size.
There’s much more that I could discuss, including a burgeoning body of research that demonstrates that intuitive eating is positively associated with several health biomarkers, like improved glycemic control and improved blood lipids. Or how increasing health-promoting behaviors like eating fruits and vegetables improves health biomarkers regardless of BMI. Or how BMI is made up. But that’ll all be for another day.
At the end of the day, it’s unfortunate that articles like this one continue to sow mistrust in dietitians and other healthcare professionals, especially at a time when health misinformation, particularly from online health and wellness influencers, is rampant. Unlike RDs and other credentialed providers, influencers have no professional code of ethics they must follow or license that can be taken away, and therefore face no repercussions for providing potentially harmful information. Which makes it all the more frustrating to RDs that articles like these are published.
TLDR: if you struggle with your relationship with food but are interested in the non-diet or IE approach, please see a dietitian. RDs are here to help you work towards food freedom and intuitive eating while also helping you work towards any specific health goals that you might have: more stable blood sugar, lower cholesterol, fewer GI symptoms, better energy, you name it. The two are not mutually exclusive, as the WaPo article might want you to believe.