How relevant are registered dietitians and their associations worldwide these days? That’s the question Cape Town consumer activist and Eategrity founder Sonia Mountford asks below of South African dietitians and their representative organisation, the Association for Dietetics in SA (ADSA).
Dieticians globally have long sought to appropriate to themselves a monopoly on diet and nutrition advice. It’s as if they’ve always believed their degrees confer a divine right to tell others what to eat and drink, and an omniscience by osmosis on optimum nutrition. Doctors have colluded by deferring to dietitians, and referring patients to them for weight loss, diabetes and other serious illness. In so doing, doctors have abrogated the responsibility the ancient Greek sage and father of modern medicine, Hippocrates, laid at their doorstep: to “let food be your medicine and medicine be your food”.
Government regulatory bodies globally, such as the Health Professions Council of South Africa (HPCSA), have effectively sanctioned dietitians’ stranglehold on dietary dogma and input into official dietary guidelines – guidelines still in place in SA, and shown to be without any scientific foundation whatsoever when they were unleashed on an unsuspecting public globally 40 years ago.
Then there’s the global phenomenon of ‘cosy relationships’ many dietitians and their associations have with the food and pharmaceutical industries, especially sugar, soft drink and cereal companies. In SA, experts say ADSA hasn’t helped its own cause with dogged adherence to the now thoroughly discredited diet-heart hypothesis, including the demonisation of saturated fat and the belief that low-carb, high-fat (LCHF, aka Banting) diets are a danger to the public, especially children, and that sugar and soft drinks can be part of healthy, ‘balanced’ diets – despite growing and compelling scientific evidence to the contrary.
The proof of the effects of all this is in the devastating “pudding”: rampaging epidemics of obesity, diabetes, heart disease and other so-called “non-communicable diseases” (NCDs), in SA and globally.
There are signs of changing times: doctors who realise it makes as much sense to ignore what their patients eat and drink as it does for organic farmers to ignore the state of the soil in which they grow food, and who acknowledge the well-documented link between diet and health; doctors who emulate the example of British NHS hospital doctor Elsa Draeger, an HIV and sexual health medicine specialist, who took to Twitter recently to say she has now “bypassed the dietitian”. Draegar and other doctors now routinely give weight loss and other vital health advice to patients even when it goes completely against conventional dietary “wisdom”.
Most of all, there is a bottom-up demand for change from ordinary people who are more educated and discerning about responsibility for their own health, and who question the legitimacy of nutrition advice from dietitians. Here, Mountford looks at why ADSA may be the reason registered dietitians have passed their sell-by date in SA, creating the need for a progressive alternative organisation to fill the vacuum. – Marika Sboros
By Sonia Mountford
Restricting the practice of nutrition to dietitians only is not in the public’s best interests, more so when the credibility of their representative body, the Association for Dietetics in South Africa (ADSA), is compromised due to their funding by Big Food.
Yet that is what the Health Professions Council of SA (HPCSA) at the behest of ADSA appears to support, by helping to press the mute button on all other dietary advice that ADSA disapproves of. (The HPCSA’s attempts to muzzle world-renowned scientist, medical doctor and University of Cape Town emeritus professor Tim Noakes at ADSA’s behest is just one glaring example.)
South Africa’s health professions community is in desperate need of a dose of integrity and needs to acknowledge the growing awareness globally of questionable “conventional” dietary advice due to Big Food influence.
In The Rise and Fall of Dietetics and of Nutrition Science, 4000 BCE-2000 CE, British epidemiologist Dr Geoffrey Cannon says nutrition science in its modern form dates from early to mid-19th century, and effectively created dietetics as a separate paramedical profession.
“The first generations of physiologists, biochemists and physicians who created nutrition science along the lines of the disciplines in which they were trained, believed they could change the world,” says Cannon.
“So they did, once governments and industry endorsed their ideas. The dimensions of nutrition narrowed but its scope widened. It became less a philosophy of life, more an instrument of state”.
Authority on dietary advice
Nutrition science has provided the means for dieticians to influence mainstream media dietary advice and contribute to the definition of a healthy diet for government dietary guidelines and policy.
As I previously questioned here and here, just how trustworthy and credible can this dietary advice be and should dietetic associations and their sponsors have input into national food guidelines?
ADSA seems to think there is no problem at all, and maintains that their “dietitians don’t dish up advice to please Big Food.”
ADSA seems to suffer from what I call “head in the sand” (HITS) syndrome: ADSA must be aware that the concerns raised over conflicts of interest by their Big Food sponsorships won’t go away by burying their heads in the sand. Denial of these conflicts of interest don’t afford the opportunity for reflection or critical policy changes for the better either.
This is the most concerning aspect of ADSA’s unwillingness to acknowledge the sponsorship concerns repeatedly raised. Along with their unwillingness for real dialogue, their arrogance in claiming dietary advice as their special preserve puts at risk progress towards real solutions to our obesity and the fight against non-communicable diseases (NCDs, such as obsesity, diabetes, heart disease and cancer).
A global phenomenon
Can South African citizens afford a stronghold on this type of dietary advice? Probably not. Are dieticians and in particular, ADSA in danger of becoming irrelevant if they don’t begin to take these conflicts of interest seriously? Very probably.
HITS syndrome is not unique to ADSA. It’s pretty much a global phenomenon.
British nutrition specialist and researcher Zoe Harcombe has questioned these conflicts of interest with The American Dietetic Association, Dieticians Association of Australia and British Dietetic Association (BDA) in depth in her book, The Obesity Epidemic: What caused it? How we can stop it?
She writes: “After a number of email exchanges, a BDA spokeswoman confirmed ‘we have been delighted to work with the Sugar Bureau…’.”
Michele Simon is a US public health lawyer specialising in legal strategies to counter corporate tactics that harm the public’s health , who has been researching and writing about the food industry and food politics since 1996.
She exposed these same conflicts of interest with the Academy of Nutrition and Dietetics (AND) in her report, AND now a word from our sponsors
In her latest report, Has the American Society for Nutrition Lost All Credibility? Simon castigates the American Society for Nutrition (ASN), the nation’s leading authority of nutrition scientists and researchers, for its cozy relationships with the likes of PepsiCo, Coca-Cola, Nestle, McDonalds, Monsanto, Mars, and the Sugar Association.
The above tweet by ADSA questioning dietary advice that goes against its own dogma can work both ways, including it own advice, but the association’s acute case of HITS syndrome seems to prevent them from seeing this.
It raises the question why ADSA regularly maintains that highly processed cereal bars can be part of an “active” kid’s diet and say that this advice is evidence-based science.
ADSA has said it stand by this advice “within the context of an ideal training diet for active children”.
This in itself creates concerns of legitimacy of the advice that ADSA provides and brings into question the science on which they are basing their advice. It contributes to growing concerns worldwide about outsides influences on dietitians’ advice.
Influence or Appeasement?
ADSA also insists that its members who take up positions within Big Food do so because it enables them to influence decision-making from within.
Former Yale University professor Kelly Brownell, now Dean of the Sanford School of Public Policy at Duke University, believes this position is “a trap”, based on her 30 years of experience in public health and policy. In a 2012 editorial in the joural PLOS (Public Library of Science) One, titled Thinking Forward: The Quicksand of Appeasing the Food Industry, she goes on to say: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry.”
The Silence is Deafening
If ADSA are serious about nutritional health then shouldn’t they be driving campaigns on the health risks of processed foods and nutrient-deficient cereals?
Many RDs don’t like what is being said about ADSA, but they don’t tell their organisation to drop associations and funding from Big Food, which places all dieticians in a bad light, particularly by defending it.
A reformist example: US dieticians who said enough is enough when their Academy of Nutrition and Dietetics (AND) made dietetics a ridiculed profession when they endorsed processed cheese Kraft Singles.
While Kraft claimed that the Academy had endorsed the product, the Academy “emphatically denied” the endorsement, saying instead that it was using the seal to “drive broader visibility to KidsEatRight.org”, a website the organisation created to be “a trusted educational resource for consumers”.
The Kraft story made headlines and resulted in a short segment on The Daily Show, with Jon Stewart saying that AND “is as much an Academy as [Kraft Singles] is cheese.”
Three RDs, Rachel Begun, Kate Geagan and Regan Jones drafted a Change.org petition calling for AND to “repeal the seal” on Kraft singles that received over 10,000 signatures in the first five days. With 11,947 supporters, mostly RD’s, on April 1, 2015 they thanked the Academy of Nutrition and Dietetics for their decision to terminate the Kids Eat Right initiative with Kraft.
Andy Bellatti, a US dietitian who believes the ties between Big Food and health organisations “pose significant conflicts of interest that ultimately damage the reputation of health professionals and inhibit important conversations about our food system and environment”, co-founded Dietitians for Professional Integrity with colleagues. The aim is to address the “very troublesome issue negatively impacting the credential we worked so hard to earn” .
It would be encouraging to see a similar group in SA formed by likeminded progressive dieticians with the same concerns, but RDs here seem mostly still to have an acute case of HITS syndrome
Certainly, food has become a complicated issue, and while scientific nutrition aims to simplify dietary knowledge, it does so without admitting that we just don’t know enough. When the US Department of Agriculture (USDA) published its first dietary recommendations nearly 40 years ago, specific vitamins and minerals had not even been discovered.
The study of soil and gut biomes is still in its infancy and holds promise for real understanding how our bodies work in relation to our food, and that to grow nutritionally rich food we need healthy soil.
“The problem with nutrient-by-nutrient nutrition science,” as New York University food and public health policy scientist Dr Marion Nestle has said, “is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.”
Academia has a place but not the right to push the mute button on any opposing views – particularly if we reflect just how broken our food system is and where we find ourselves after decades of official dietary advice.
How can anyone or any one-group claim to be an authority on dietary advice or nutrition?
A Climate of Fear
Instead there is a climate of fear, which leads to less transparency and less open dialogue when one group demands the monopoly on dietary advice in South Africa.
There needs to be greater dialogue among health professionals, and involvement of other stakeholders, such as consumer groups, food sovereignty groups, and nutritionists, and farmers who can influence the food supply, availability and how the food is grown.
Perhaps the greater question we should be asking is: What about our relationship with food? Do we know where our food comes from? How it is farmed, processed and delivered? What is the impact of how our food is produced on nutritional food security, environment, human rights, social justice and animal welfare?
While we all bury our heads in the sand, we can’t open up to honest conversations about food politics and the influence Big Food has on available food choices either.
A full version of this post appears on the Eategrity website
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