Making Sense of the Contradiction: Nutrition matters, body size doesn’t, and the food system needs fixing

As a dietitian, I was trained in a weight-centric, calorie counting approach. Many of us were. I was taught how to help people lose weight by exercising more, eating less and eating the ‘right’ foods. I thought my job would be to teach people about a balanced diet and how to improve their health through nutrition. And I do DO that.

But it became apparent pretty rapidly after I started working as a dietitian, that this model (calories in, calories out) is not the whole story. So many of my clients wanted to care for their health through nutrition and movement, and yet, so often it seemed impossible.

There seemed to be a great disconnect between what people wanted and what they could actually accomplish.

In addition, many of my clients did everything ‘right’, and their weight still did not change. In fact, for many people, doing the ‘right’ things led to a more difficult relationship with food, or even weight gain over time. No one had taught me what to do when someone is scared of having chocolate in the house or hates their body or cannot sense when they are hungry or done eating.

And then there were my clients who had a BMI (body mass index) that they considered too high and they felt (and were told) they had to lose weight, but by all markers, THEY WERE HEALTHY, which begs the question of why on earth they were being told to lose weight. Who died and made BMI the god of all things health-related?

It all started to feel senseless – this focus on weight, BMI, and calories. Particularly in a world where some of my clients were struggling to feed themselves at all.

Thankfully I was part of an excellent team of dietitians who taught me about Health at Every Size^TM (HAES), the problems with BMI and dieting, the benefits of intuitive eating, and the power of a weight-neutral approach.

I learned so much about how BMI is harmful at best and racist and sexist at worst. I learned about how body respect can change our mental and physical health. I learned that dieting itself is often the problem, leading to disordered eating, long term weight gain, and disconnecting people from their bodies and autonomy. I learned how intuitive eating can help someone who has spent a lifetime frustrated with food and their body learn to trust their body and enjoy food.

In addition, I attended a grad school program that shed light on injustices built into the food system and how those injustices, in turn, impact our health and ability to care for our bodies. Systems play a powerful role in shaping individual behavior and daily choices.

And yet, somewhere along the way, I started feeling like I had swung too far in the other direction, as if nothing about nutrition mattered at all.

To be clear, this is NOT (for the most part) the message in these spaces. HAES, body positivity, intuitive eating, and the food justice movement are powerful frameworks that MUST be incorporated into how dietitians and all medical providers practice.

But somewhere in there, I forgot about the baby in the bathwater and threw it all out the window. The message that was loudest for me became that all foods are the same and teaching balanced nutrition is just a bunch of rules that are unhelpful.

I had to stand in front of a mirror and ask myself why I am a dietitian if my primary message is – do whatever you want, it’s all fine.

I came to understand that the idea of ‘balanced nutrition’ was tied up so closely to body size and dieting (and has been since the origins of the field of dietetics) that in my efforts to reshape my understanding of body size and dieting, I lost my sense of the role that nutrition can have in our physical well-being.

So I want to spend a few minutes untying this messaging.

The reality is that many things are true at once:

• You can eat whatever you want AND also sometimes how we eat makes us feel like sh*t.
• Caring for our bodies through food and movement can be life-giving AND also it’s not the only thing that affects our health. Our environment, genetics, and social circumstances matter
• Eating broccoli versus a cookie is not a matter of virtue, value, or inherent worth. We all know how much sleep matters for our health, but no one thinks you are a bad person if you don’t get enough sleep. In fact, I have heard the narrative that you are somehow more virtuous if you can skimp on sleep for the sake of work. Unpack that one for me.
• You can optimize your health with nutrition and movement AND you might care more about other things. Our time is limited. You get to pick what you spend your time on. Again, this is not a matter of morality, only preference.
• Body size does not indicate health or worth AND, oh wait – no, this is true full stop. Let me say it again – BODY SIZE DOES NOT INDICATE HEALTH OR WORTH. Am I yelling? I feel like I am yelling. I think I should be yelling. Most people do not seem to understand this. Our cultural obsession with body size as a measure of health is one of the most harmful narratives we have adopted. Oh, and it stems from the days of slavery and trying to work our way into heaven. Didn’t know you were linking to that, did you?

And did you know that research shows that kids who have a positive relationship with their body (aka don’t feel like they need to shrink it or are the wrong size), are more likely to exercise and eat well and are less likely to have disordered eating or engage in self-harm.

So, if we taught all kids regardless of body size to embrace and care for their bodies without any emphasis on body size, we would be in a much better place.

Basically, even IF body size is a problem, we are better off pretending that it is NOT. Our physical and mental health would thank us.

We must untie nutrition and movement from body size. That could be the single most important thing we can do for the health of kids and adults alike.

In addition, we must broaden the conversation around nutrition and movement beyond individual responsibility. Because even when people want to care for their health, the systems we live in often make this incredibly difficult.

To bring this all together, here is what I am coming to understand. Our American approach to health does not work. The American approach includes making people obsessed with body size and food, dieting as the answer, and emphasizing individual responsibility to eat well and exercise. This ‘pull yourself up by the bootstraps’ approach only works for a select few. Usually, people with plenty of money.

Essentially, you need to have a certain amount of income, resources, time, and energy to combat the status quo. This status quo is a sedentary, busy, cooking-averse society. Many of us drive everywhere, feel too busy to cook, or were never taught how. Many of our jobs and daily tasks take so much time and attention that there is little room for much else.

Status quo matters. We know that if being an organ donor is the default when someone renews their driver’s license, then many more people become organ donors (reference). We are not suddenly more altruistic if organ donation is the default, it is just easier to go with the status quo. For many reasons.

We need to think about our food system and movement through the lens of the default if we care about our health and well-being.

And to be clear, as I mentioned earlier, environment, medical care, and social circumstances greatly impact our health as well, but because I am a dietitian, my ideas are focused on food and movement.

In addition, we can learn from other cultures when they do things differently than us, but we also need our solutions to be uniquely American.

Here are a few of my ideas for changing our status quo to improve our ability to move regularly and eat foods that nourish us:

Community dining halls for the neighborhood for all income levels: A number of churches in my county offer free community meals; however, I often have the sense (perhaps a misinformed sense) that these meals are meant for people who are struggling to make ends meet. This creates a stigma around these meals.

I envision something without stigma. I envision a community dining hall in each neighborhood where everyone of all incomes comes together to eat. The food would be delicious, satisfying, and nutritious. It would be a place to socialize with people who live close by. Everyone would contribute/take turns in whatever capacity they have. The entire neighborhood would benefit.

Busy families who do not have time to cook could grab a quick meal. People who are isolated would have a place to socialize and contribute to their community. The community would be more connected and we would be able to socialize with those who are different from us. And, of course, we would be fed. Well fed.

Quick, easy, cheap, balanced food options: I envision a small diner or food stand on every corner where food is simple, balanced, delicious and readily available for very little money. I have seen examples of this in other countries. People can grab breakfast on their way to work or pop in for lunch during the work-day. It wouldn’t break the bank and options would be tasty and nutritious.

Cooking classes for all ages: This would start in elementary school and continue through middle, high school, and college. Feeding ourselves and those around us is a fundamental human skill that many people do not have. We need to teach this. I find that when my clients can cook, they have greater ability to care for their health.

Subsidized CSA’s (Community Supported Agriculture): In my twenties, I learned how to cook a wider variety of vegetables when I signed up for a CSA box that included vegetables that I was not familiar with such as Swiss chard and kohlrabi. Plus, it was fun and I always had vegetables on hand. But CSA’s can be expensive. Subsidizing this is a win for the consumer and the farmer. And the community because it keeps money in the local economy.

Communities designed for movement: We need our housing and towns to take into account our ability to walk, bike, and run around outside safely. This means having beautiful common spaces like parks, sidewalks, wider roads for biking, and towns/communities designed to allow people to get everything they need locally. We can do this, but we need to be intentional.

Cities like Paris have made this a priority. It likely has downsides and expenses, but it is something we must consider if we care for our mental and physical health. We could do this in a uniquely American way because we are an innovative, hard-working bunch. I know we could.

Work places that prioritize balance: In addition to working, we need to have time to make food, to move our bodies, to socialize, and to care for our families, amongst many things. Back in the 1930’s, it was thought that we would have a 3-day work week by now. Sometimes it feels like technology has simply increased our ability to work more at all hours and in all places and to do more, faster. And to be constantly distracted. Technology should work for us, not the other way around. We need more societal conversation around this.

Food policies that benefit the consumer and the farmer: There is a lot that could be said here, but so often food policies benefit the bottom line of the food industry. We need to stop this. And yes, it is complicated and nuanced. But the goal should still be policies that benefit the consumer and local economies.

There are many other ideas worthy of being discussed as well. I am highlighting just a few.

You might be thinking, I agree. We have things a bit upside down and backwards when it comes to food and nutrition – what do I do?

We all have our work to do. I would encourage you to think about this through the lens of your own life and your passions. What matters the most to you? What is available to you?

If each of us chooses just one way to engage – whether it’s how we shop, cook, vote, or connect – change becomes possible.

And once again I am talking out of two sides of my mouth because our default system matters and yet, how we as individuals spend our time, our money, and what we think about the world matters too.

Here are a few things that I and the team at Eat Well Collective are doing to impact the food system and to push back on the status quo: