Summary

Question 1:

  

Many respondents indicated that they go back and forth on this particular issue. Those who were supportive of implementing taxes on “less than healthy” food items indicated that such measures are justified primarily due to the fact that many chronic diseases have a link to nutrition, and the care for such conditions increases health care costs for all of us. Sammy brought up that other countries have implemented taxation systems and have had beneficial outcomes; however, Vivian pointed out that the U.S. might find it difficult to follow suit because of our prime opposition to government control over our freedom of choice. Many of those who were in support of taxation also pointed out that the products would still be available for consumer purchase, they would just be more expensive, which is similar to cigarettes and tanning. Susan indicated that no matter how the categorization of healthy versus unhealthy goes about, RDs should be on the forefront providing input so as to make our voices heard as the go-to food and nutrition experts.

Many of those who were against taxation discussed the importance of consumer choice and intervention by education; as opposed to intervention by way of “punishing” those who choose to produce and/or consume foods that are deemed as unhealthy. Also as Vivian pointed out, some American cities have tried to implement restrictions on less than healthy food items with moderate to no success (e.g. New York City repealing its large soda ban). Indeed, freedom of choice is tough subject to tackle. Another sticking point for opponents of a “fat tax” was the criteria for classifying what could count as “healthy” versus “unhealthy.” Jennifer pointed out that it would be incredibly complex and nearly unrealistic to implement a “fat tax” because of the difficulty in determining what would constitute healthy versus unhealthy. Others agreed with this standpoint. Abby and Amanda pointed out that nutrition is not “black and white,” and Amanda also brought up an interesting perspective about nutrition being such a young science. She brought up emerging research, and conflicting research studies. Is saturated fat unhealthy? Or, in the words of supplemental article #3 is there “no significant evidence that dietary saturated fat is associated with increased risk for CHD or CVD.” Which side would the decisions makers take? This is a very interesting perspective.  In addition, Charity brought up the implications of a tax system on the food stamp program, which she mentions would have to also undergo some changes to ensure that food stamps could provide families with enough nutritious food.

Caroline also brought up an interesting point that multi-billion dollar corporations would barely take a hit, while smaller companies would be the one with the tax burden bringing down their profit margins. Gina brought up that, “in the end the small companies with single or few product lines end up paying the price…making the taxation or subsidization a more significant determinant for their success.” Carly brought up that taxation might harm our economy,” which we obviously wouldn’t want, while Desiray indicated that big businesses could also simply raise the prices of all of their items (healthy and unhealthy) to make up for the extra taxes they have to pay. She brought up that if this were the case, we would all pay the price, not just those producing/purchasing unhealthy food items. Janelle also brought up an interesting point about which profession (e.g. RDs, food scientists, government) would be responsible for deciding the items to be taxed, and Brady was certain that even if taxes were imposed manufacturers would find a way to “fudge” the line.

As for subsidies, many agreed that it might be time for government subsidies to shift away from corn and soy. As Gina pointed out, subsidies to the corn and soy industries causes such ingredients to be quite common in available foods.  As Jeanne pointed out, if we were to shift the money away from the corn and soy industry, the prevalence of those ingredients in our food supply may decrease. As Tina brought up, the shift in subsidies could be transferred over to other produce that, as many respondents pointed out, is claimed to be “too expensive” by a large number of consumers.  As Sophie pointed out, if fruits and vegetables were subsidized, they would be available at a cheaper price to consumers, and consumers would have less evidence to support their notion that fruits and vegetables are too expensive. This could be of benefit because, as Janelle pointed out, a primary emphasis of our careers should be to educate our clients on choosing nutrient dense foods such as fruits and vegetables. If such foods are cheaper, regular consumption may be easier for consumers to swallow (pun intended).

Question 2:

Many pointed out that one of the biggest things we, as future dietitians, can do is to teach consumers to vote with the almighty dollar. As many have pointed out, if companies begin to lose business because consumers are purchasing different items from other manufacturers, that may spur change faster than anything else. Money makes the world go around, and corporate America is no exception. Also as many pointed out, in order for consumers to vote with the almighty dollar, they must first be educated on how to make healthier choices at the grocery store. Many brought up reading food labels as a great place to start. If we can teach consumers how to read food labels, they can make more informed decisions and put their money towards healthier products. Tina and Janelle also brought up how grocery store dietitians can make a difference, as they can provide hands-on education with consumers right in the store. Consumers can be taught how to effectively shop for healthful food items and can also be taught other simple tips such as how to navigate the store (e.g. outside perimeter). However, Charity brought up that some grocery store RDs might use their position to promote fad products. Carrie brought up that we could also influence change by educating consumers about their rights as consumers, such as figuring out where their food is coming from.

Some respondents were more in favor of large-scale efforts such as lobbying than others. Haley pointed out that RDs would be wise to set aside a couple of days each year to lobby or contact legislation. Jennifer brought up that voices heard in unison are much more powerful than individual voices for change. The Academy of Nutrition and Dietetics, which is the “worlds largest organization of food and nutrition professionals,” may provide such a platform for RDs to organize and be heard on a large-scale level. Brady had a great idea regarding using social media to influence change, and many agreed that using social media might be an effective way to get the word out on topics with the food industry. Gina brought up the Better Business Bureau (BBB) and their work with ensuring ethics in the marketplace, so that “buyers and sellers trust each other.” She mentioned the need for unbiased third parties to be involved in the process of judging whether or not changes have actually been made. Such use of unbiased sources would create accountability from food companies and would do more to eliminate the possibility of them just reporting positive information in self-reported surveys. Carly brought up finding out which companies have made false claims and holding them accountable by reporting them into government agencies and/or by bringing this to the attention of consumers.

Sammy brought up the Kraft Cheese situation and posted a link for dietitians for professional integrity, which is a way that we can influence change right here, right now and Vivian discussed that it’s not only corporate food manufacturers should be held accountable, but also fast food and other restaurants as well.  Everyone had fantastic ideas for change, and it seems like many are interested in doing more to try and ensure integrity and honesty in corporate America.

Question 3:

The responses for this question were largely similar among all participants. The vast majority of respondents brought up the concepts of showing clients what they “should” be doing, as opposed to what they “shouldn’t” be doing. Tina brought up that she finds clients to be more receptive when they are told what they can do and they become turned off when they are told what they can’t do. Caroline brought up that if we stop focusing on the “shouldn't,” RDs might be able to shake off the “food police” label—which is a very good thing! Along these same lines of should versus shouldn't, Gina brought up that she had read a book over break entitled “Intuitive Eating,” and that the book indicated that restriction makes us desire things more. As Gina indicated, if we focus on the “should” (“Try a vegetable stir fry, make a fruit smoothie!”), we can take the focus off of the unhealthy items. It’s all about positivity.

Another very common theme was that of portion control/moderation whereby dietitians should focus on the big picture and not demonize any one particular nutrient (such as saturated fat) as the sole cause of anything. Sammy started the conversation by bringing up the “should versus shouldn’t,” and also brought up that we will just have to take a “wait and see” type approach with saturated fat research. Janelle brought up that that some foods that are considered to be part of a nutritiously balanced diet do, in fact, contain saturated fat. Vivian also discussed this concept. As they both stated, it is important that we do not demonize saturated fat, as it may cause our patients to be scared of such foods (i.e. dairy and meat), which contain many vital nutrients.  Many (e.g. Brady, Sammy) also brought up the concept of staying away from labeling foods “good” or “bad,” and as Emma stated: “the focus should be on correct portion sizes and overall health.” Agreeing with Emma, Janelle stated, “we really need to focus on teaching consumers about moderation, balance, proper portion sizes…” Possibly the coolest line, Desiray stated, “Instead of having the people focus on eating kale and chia everything, we should focus on getting them to crave moderation,” and Carly indicated that “As RDs and future RDs we need to focus on teaching our clients moderation rather than good food/bad foods causing disease.” Overall, respondents really focused on the concept of moderation and also focused on the importance of using “should” versus “shouldn’t.”

Susan indicated that saturated fat is usually a good starting point for educating clients, as we do not want to overwhelm them at first. We can focus on one dietary factor, and go from there. Susan also indicated that she believes that a heart healthy diet education may not be possible in a condensed inpatient education window and that long-term follow-up is warranted. I agreed with this statement and brought up cardiac rehab classes as a great way to follow-up. Many also agreed that no matter what the research says about saturated fat and CVD, heart disease is definitely a multifactorial condition and many things come into play. As Jenn stated, “Typically the onset of disease is caused by more than one risk factor, and a single nutrient is very unlikely to be solely responsible for the development for heart disease, or any medical diagnosis for that matter.” Haley indicated that she believes there are multiple factors that contribute to heat disease and that everything (e.g. genetics, activity) needs to be taken seriously. Sophie had similar feelings and stated, “I believe there are many factors to heart disease that we need to be aware of.” Caroline indicated that it is “second nature for Americans to demonize one problem as the cause of an issue, but it is a synergy of risk factors that generate heart disease” and emphasized the importance of focusing on all of the potential risk factors, Abby brought up that it may be unfair to blame heart disease on saturated fat only. Brady brought up that he believes physical activity (or the lack thereof) to be the biggest risk factor, and Jeanne agreed.

As for the more current research with saturated fat, all respondents indicated that the two supplemental articles were not enough to convince them that saturated fat may not be as clearly linked to heart disease as is commonly thought. As Caroline stated, “ I do not think we have enough evidence to clear the association of saturated fat to heart disease. I think further research needs to be done.” Many (e.g. Emma, Gina, Desiray, Janelle) agreed with this standpoint about the need for more research. Brady indicated that he would feel silly telling patients that saturated fat is a “bad” fat but also that he would need to see very large-scale controlled trials to become convinced that the association between saturated fat and CVD is null, while Charity indicated, “a few research articles is never enough to convince me. I need more data!” As Sammy brought up, we will have to stay tuned with the saturated fat research. Abby pointed out that it will be interesting to see if future studies can provide enough evidence to change what is readily accepted regarding saturated fat and its association with CVD, she also pointed out that “the field of nutrition is constantly evolving…” Amanda brought up a great point that, “it will be interesting to see how this subject evolves over the course of our career as dietitians. I’m sure it will not be the first area of nutrition where we will see changes.”

Indeed, we will just have to wait and see what future research has in store.

Recommendations for practice:

The responses indicate that taxation and/or subsidies may or may not be justified; however, no matter what the future holds with taxation/subsidies, respondents generally agreed that it is our job to educate consumers about healthy food options so that they can make more informed food choices for themselves and their families. As such, RDs should make a conscious effort to ensure that clients understand basic tactics such as label reading and the importance of a balanced lifestyle with a firm emphasis on moderation. If we empower our clients with knowledge, they can vote with their dollar. Such shifts in food purchasing may inspire food manufacturers to change their formulations or to make healthier alternatives if they think that is what consumers want. Additionally, RDs should make an attempt to debunk the notion that healthful foods such as fruits and vegetables are “too expensive” by providing suggestions for making the dollar go further. Such strategies could include: buying in season, shopping at discounted retailers (e.g. Aldi’s), and/or buying frozen or canned options. Another idea would be to emphasize the possibility of using a community garden and/or starting a garden (community or personal) to provide produce during the warmer months. In the end, it is our job to empower clients to make healthful lifestyle change. We can provide knowledge and do our best to influence policy (e.g. taxation), but we need clients to step up to the plate and do their part too.

Additionally, some mentioned that it is important that RDs take time out of their year to get out and make their voices heard through advocacy/lobbying. We are the “nation’s largest group of food and nutrition professionals,” so it is important that we find time to stand tall for what we believe in (healthy lifestyles). We are not always heard individually, but if we stand together, we may be able to trigger change. The responses to last question focusing on saturated fat indicated that the research is not yet sufficient to change best practice recommendations of limiting saturated fat intake along with other healthful lifestyle changes. While many indicated that saturated fat shouldn’t be considered “bad,” more must be done to prove that Americans shouldn’t make simple changes to limit their consumption of saturated fats (e.g. choosing fruits and vegetables over processed foods). Many also brought up the absolute importance of focusing on the “bigger picture” rather than just demonizing one particular thing, as the onset of chronic disease is multifactorial. Another common theme was focusing on what people “should” do versus what they “shouldn’t” do so as to create a more positive education session (nobody likes to be told what NOT to do!) As such, (and as pointed out above) RDs should preach a healthy, balanced lifestyle with moderation as a guiding principle. We are not there to tell people how to live their lives (“Don’t DO THAT!”), but rather we are there to help to guide them on a healthy lifestyle journey. RDs should demonstrate empathy with clients and focus on positive lifestyle changes without focusing on any one particular thing; it's all about balance!