From scientific studies and medical professionals to Instagram influencer ‘experts’, there is no shortage of nutrition and health information out there. But, the reality is the field of nutrition and dietetics is still new, and safe and effective health and diet advice implementation not only involves a great deal of trial and error but also some solid critical thinking skills, nuance, a ‘big picture’ perspective, and occasionally the ability to hold two opposing ideas at one time. It’s not the simple cause and effect model that we’ve always assumed.
After my intern Catie and I published our blog post on the Keto Diet, I was inspired to follow up with a post not about a specific diet, but instead a simple guide (keyword guide; not scripture), on how to determine if implementing a specific piece of health or diet advice is worth trying. While making shifts to your diet and movement patterns can be beneficial for a variety of reasons, just like surgery and medication, it comes with a series of potential side effects and risks.
Step 1. Identify the problem you are trying to manage or solve.
At some point over the last few decades, the field of nutrition, dietetics, and fitness took a turn from the realm of therapeutic and medicinal to “how to become smaller”. But it’s important to know that weight and body size in-and-of-itself is not a problem (the way our medical system and our society treats people in larger bodies is). So when you’re considering implementing health or diet advice, whether it be from your doctor or from your neighbor Karen’s grandson, ask yourself, what problem am I trying to solve with this intervention? If nothing comes up besides ‘I’m trying to solve the problem that is my body size (and all of the mental, emotional, and physical discomfort that comes along with that)’ I encourage you to seek the help of a Health at Every Size™ therapist or dietitian to start unpacking this thought.
If the goal is something more tangible like managing digestive discomfort or pain, high blood pressure or cholesterol, or diabetes, take a moment to take stock in what you’re hoping to get out of implementing this intervention. It could be anything from identifying foods that both taste and feel good to eat in order to dine out confidently, or manage blood sugar levels so you have the energy to start your business, play with your kids, or just live your life. In this first step, try your best to dig deeper to identify a non weight-centric goal.
Note: I understand that the concept that your body size is not a problem can bring up a lot of feelings of frustration, anger, and discomfort. Before you dismiss this idea, I encourage you to sit with these feelings and if needed, play a little game of ‘make believe’ to consider, what if this was true? How would this change how I treat my body and myself?
Step 2: Review the research.
Despite the amount of articles published everyday on nutrition and the amount of unsolicited diet advice we get from our cycling instructors and yoga teachers, again, there is really very little we know for sure about dietary interventions. Being able to view research studies from primary sources (such as medical journals vs. Self Magazine) is, I believe, an extremely important and useful skill. We’re going to teach you how to do that in an upcoming blog post. But sometimes reviewing the research means interrogating our neighbor Karen’s grandson when he about his experience with implementing a dietary intervention. He might be excited to talk about alllll of the benefits he’s experiencing, and if you’re someone who is suffering, taking his advice can sound really enticing. But before blindly going gluten free, review his sample size of 1, anecdotal study a little more closely. How long has he been doing this for? Are there any times he’s able to be flexible and eat gluten-filled foods? What else changed when he decided to eliminate gluten from his diet? Did he stop drinking beer, something he was drinking a lot of previously? Did he start eating more fruits and vegetables? Did is exercise patterns shift? What’s been the hardest part? Has he been able maintain his social relationships? Has he had any negative side effects? And, it’s also important to keep in mind this is just one person’s experience. For every person like Karen’s grandson, there is another person who experienced no changes to their mental or physical health, and another person who’s health suffered greatly. Talk to those people too!
Step 3. Get a second opinion.
Just like you would get a second opinion from another doctor on a risky surgery, it’s important to do the second opinion work for yourself. While in some cases a dietary intervention might be the way to go for disease or symptom management, there is a likely chance there are other options. For example, while consistent exercise can be a helpful way to manage your mood, so is going to regular therapy or counseling, or considering medical management for anxiety or depression. Make sure that you are presenting yourself with all options available to you before pigeon hole yourself into one course of treatment.
Step 4. Identify the costs and the risks.
Think about this as creating your own “side effects may include” voice over. While nothing is 100% guarantee, diet and health advice is given out so readily that it feels like it is. When considering to making a shift to your eating or exercise habits weighing the costs is an essential, if not the most essential, step. Last week when we published our post about the Keto Diet, there were a few people who came in hot talking about their ‘positively life changing’ experience with this diet. There were also a lot more people who came out to say that this diet lead to an eating disorder, hospitalization, extreme exhaustion, and depression. No one experience is “right”, but it would be irresponsible, and for me as a clinician, unethical to recommend a diet knowing that there are so many costs and risks attached to it. This is where a good old fashioned cost/benefit or pro/con list comes in handy. Pull out a pen and paper and weigh the financial, physiological, psychological, social, and emotional costs to implementing this advice. And the great thing about this list, is that it’s unique to YOU, not Karen’s grandson.
Returning to the gluten example. One of the costs, for me, of giving up gluten is feeling a heightened sense of frustration or overall lack of ease (and ease and simplicity is something I really value) when I go home to my mom’s house to make homemade lasagna. Or no longer being able to go to my favorite pizza place for a delicious dinner. Cooking and enjoying a meal together as a family and pizza dates out are something I really enjoy, and I know giving up gluten would not only make navigating those social situations more difficult than I desire, it would also mean eliminating experiences in my life that are joyful. From a financial standpoint, if I wanted to still be able to enjoy the gluten-free variety of my favorite foods, this would increase my food costs and impact my budget. And for me, someone without celiac, I know there is also no research to show that this dietary change would be physiological beneficial, even if it is physiologically low risk.
Now sometimes the answer is clear. If you have a peanut allergy, there might be costs to giving up peanuts but the benefit (like, not going into anaphylactic shock) is very clear. If you’re a person suffering from a food allergy or celiac disease, making this type of pro/con list might be a waste of time ;).
Step 5. Be open to making adjustments.
Once you’ve sorted out your pro/con list, if you decide to move forward with implementing a particular piece of dietary advice, make sure to go into your decision being open to making adjustments as needed, just like you do with any decision in life (starting a new job, relationship, medication…). One of the risks of making any dietary or exercise changes is an unnecessary preoccupation with food and body (go ahead and add that to your list above if you haven’t already!) and an all-or-nothing thinking pattern around food. This can lead to an ongoing restrict/binge cycle or a full-blown eating disorder. Again, this is not always the case, but it is a potential risk. The very act of practicing flexibility around eating and exercise can automatically dissipate some of these risks. Usually this simply means listening to your body and honoring it’s needs. It also means prioritizing your values and what you want out of life.
Instead of ending on a theoretical note, let’s make sense of all of this with a concrete example.
Let’s use the example of using toothpaste. Toothpaste was actually made popular by an advertising executive, not a dentist or oral hygiene expert. And at the time of it’s invention, there were no scientific studies to back up it’s effectiveness for fighting plaque or preventing cavities (in fact, I think there is still little research on the subject!). But, the country embraced toothpaste with open arms and now brushing our teeth is a daily health habit we do without question. The pros (having minty fresh breath, superficially brighter teeth, and preventing cavities) usually outweigh the cons (cost of toothpaste and toothbrushes, time spent in the AM and PM brushing). I don’t know about you, but it’s something I’ve been able to practice flexibility around, buying less expensive toothpaste if needed, or accidentally forgetting to brush before bed. If that happens it doesn’t feel awesome, but it doesn’t ruin my day. Overall it’s an easy habit to keep up with and it makes me feel good!
As an anti-diet dietitian I feel like I spend a lot of my time debating if dieting “works”. But I’m starting to realize that I don’t care if it “works”. I care if it’s ethical, I care if it’s humane, and I care if it’s moving us as a society down a path towards health equity. When we look at dietary interventions through this lens the conversation automatically becomes much more nuanced, and health can no longer be measured by pounds lost or sizes dropped. My hope is that this guide allows you to look at your own choices around diet and health in a way that feels more nuanced and more specific to YOU. I also hope it allows you to feel flexible around your choices, and to know if something isn’t working for you, you have permission to change without guilt or shame or having to explain yourself to your friends, family, or strangers on the internet. And because as a dietitian in a helping role, I am super biased, I highly recommend working with a Health at Every Size™ physician, dietitian, and/or therapist to help you implement any changes to your diet or lifestyle.
Is there anything you would add to this guide? I’d love to hear your comments!