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COMMENTARY Joan Gussow I would like to begin this paper with an anecdote, since I believe in the value of example in communication. Last week a student of mine took his doctoral oral examination. His study looked at the beliefs and behaviors of professional nutritionists regarding the safety and nutritiousness of the food supply. He found that the nutritionists he interviewed--most of whom were involved to some extent in pubic education--generally believed that the U.S. food supply is nutritious but were somewhat less certain about its safety. They also believed that ordinary people might have a very hard time selecting safe and nutritious foods without knowing a great deal more than they do now; in other words, the public needed nutrition education. The nutritionists themselves, however, turned out to be not very well informed about a number of consumer issues--food irradiation and aspartame, for example- that the public often wanted and perhaps needed to be educated about. In other words, these university-trained nutritionists felt that the food supply had reached such a level of complexity, and contained so many potentially unhealthy foods, that it was not at all easy for ordinary people to make the right food choices from it (or for practicing nutritionists to keep up with issues relevant to its safety and nutritiousness). Furthermore, these nutritionists believed that in the future the food supply would probably get worse, that is, would contain increasing numbers of unhealthy and questionably safe foods, but they felt that there wasn't very much they could do about this. The dissertation was very carefully and objectively written, and as a good educator, its author concluded 221
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that everyone, including nutritionists, needed to become more knowledgeable about the sources, the handling, and the ultimate quality of the food supply in order to make wise choices in the marketplace. One of the outside readers of the dissertation, however, an early childhood education specialist who chaired the oral exam, was obviously upset that the student had failed to sufficiently emphasize what the examiner took to be the obvious conclusion lurking in his results: that these nutritionists were caught in an ideological trap. They were, he pointed out, articulating the value of education, of individual knowledge, yet they could not adequately keep themselves informed about the changes in the food supply. Obviously, this observer said, these nutritionists are aware that information is economically and politically driven; they are aware that powerful disi'nforming forces are acting in the' domain they are concerned about, yet few of them had ever written a letter to a legislator about their'supply concerns, and none of them has testified or taken other direct political action. They were suffering, he said, from a severe case of personalism, clinging to their faith that more knowledge alone can change things. We nutrition educators have seen ourselves as a relatively powerless voice shouting into the wind of information that sells products, papers, magazines, and/or reputations--information that may or may not have consequences for eaters' nutritional status. Yet, these words of an observer outside the nutrition profession are a damning criticism of what it is nutrition educators think they are about. But to look at the food marketplace 'objectively is to be forced to acknowledge their truth. The politically and economically driven disinformation my colleague referred to comes, to begin with, from the food supply itself. Products with the life span of fruit flies (but whose ancestry is much less well studied) come and go from grocers' shelves; restaurants offer, on the one hand, spa cuisines for the already lean, while ordinarily hefty Americans are given the choice of full-fat toppings like bacon and cheese (or both) on already greasy hamburgers or are urged to partake of ham and cheese sandwiches on the once classy (and still greasy) croissant. 222
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In 1987, 25 new dinners appeared in grocers' freezer cabinets each month. A total of 1,031 new products--a majority of them food products--came onto the market in the month of May alone. Hundreds of these food products, as one observer wrote recently, ". . . boast of being sugar-free, caffeine-free, low in cholesterol, low in salt, low in preservatives and additives, high in carbohydrates, high in fiber, nutrients, vitamins and minerals" (Gayle, 1987~. Compound the confusion with products engineered to conform to the very latest laboratory findings on the possibly desirable composition of the food SUPP1Y: edible oils, for example, first made . . ~ high in polyunsaturates, then made high in monounsaturates, and finally made high in omega-3 fatty acids; fats and carbohydrates manipulated~to be nonabsorbable; and other substances still referred to as "foods" whose strongest selling point is that they have no nutritional value at all but taste "wild." Add to the confusion of commerce the confusion of science. Regular stories appear in the press, for example, reporting that prestigious researchers have decided fat is or is not implicated in breast cancer, or that less than one alcoholic beverage a week may increase a woman's risk of breast cancer although seven times as much may reduce a man's risk of heart disease. Readers must take with a grain of something other than salt the news that the dolphins dying on New Jersey shores have nothing to do with the safety of the fish caught in the waters off those same shores, or that the safety of the poultry supply has nothing to do with the pictures of someone's poultry floating in a soup of its own feces on the television program "60 Minutes." Put all this together and you have a recipe for a public that is truly dazed by food-related information that may or may not have health consequences. . As a missionary from one of the two cultures to the other, I assert that while we in education have, admittedly, not produced the science of teaching that our predecessors promised, we do know how to impart knowledge; and sometimes, under the right circumstances, we even know how to produce behavior change through education. I further assert that this general capacity can be applied to nutrition education, under the right 223
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circumstances. I am merely questioning here whether anything nutrition educators are supposed to do is likely to produce the right circumstances. Having said that, I suggest that those who wish to know where nutrition education research is going should look at the American Dietetic Association's September 1987 journal supplement "The Leading Edge in Nutrition Education: Research Enhancing Practice. n There is very poor funding for nutrition education research, and the profession has embarked on a desperate struggle to quantify in order to justify funding. Even though it is generally agreed that much of what we need to know requires qualitative methods--in-depth interviews, participant-observer approaches--it is recognized that such studies do not get funded. There is beginning to be funding for community intervention studies, but since nutrition educators have had little to no opportunity to develop a track record in such projects, they are seldom even in the running to be project directors. As for the education of nutrition educators, a document entitled "The Academic Preparation of the Nutrition Education Specialist" has been generated by a committee made up of representatives from the Society for Nutrition Education, the American Home Economics Association, the American Dietetic Association, and the Faculties of Graduate Programs in Public Health Nutrition. The document describes the competencies of those who consider themselves specialists in nutrition education (it is available from the Society for Nutrition Education, Oakland, California). To learn who has been training such people, a questionnaire was sent out to the institutions who had helped generate the list of competencies. They were asked whether they, in fact, trained people who met these criteria. A rather wide range of programs were surveyed: nutrition and nutrition science, public health nutrition, foods and nutrition, home economics, animal science, and human development. The response was excellent, and 16 institutions said they provided such training. Although professionals trained to mastery in the identified competencies would have both the scientific knowledge and the process skills needed to transmit 224
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nutrition knowledge to the public, in an educative enviro Dent, the listed knowledge and skills may not be sufficient, as I suggested earlier, to enable nutrition educators to operate effectively in the present disinformative milieu. Therefore, I would like to suggest some of the other things that nutrition educators need to know and do if they are to have the remotest chance of being effective. This should by no means be looked upon as a complete list. First, nutrition educators need to know much more than they do now about why people spontaneously change their eating habits when they are not subjecting themselves to intentional nutrition education. Mostly we study how effective we are with people who, in a sense, volunteer to get educated. We need to collect data that will allow us to understand how and why free-living individuals, floating in the tide of information and misinformation - that floods their environment, start to eat better. Second, nutrition educators must be trained to be politically as well as scientifically sophisticated. Recently, Barth Eide and I defined a nutrition educator as "one who helps people of whatever social, economic, political circumstance to meet their need for nutritious food, n with the implication that at least part of the training of nutrition educators must teach them to seek out the real causes of poverty and hunger around the world and to act effectively against causes rather than ineffectually against consequences. Third, nutrition educators need to be taught how to conceptualize, to make connections, and to understand the differences between facts and judgments. They must learn to be capable of dealing with ambiguities, to accept that for some issues there are no simple right answers but only choices that are often best made within a context wider than that commonly subsumed under the term nutrition. Such breadth of vision will make them vividly aware that all education is inevitably value-laden and cannot possibly be otherwise, because it is impossible to teach everything about a topic and decisions about what to leave in and what to leave out reflect the educators' values. 225
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Should a nutrition lesson about a winter strawberry teach that it contains only 5 calories without teaching that 435 calories are expended flying it from California to New York? Should we consider as successful weight loss programs in which pounds are shed because clients are compliant, even though the world outside those programs demands noncompliance--the self-esteem and stubbornness to fight off the culture's blandishments to eat? Nutrition educators are always teaching more than they intend to, and they must be trained to become conscious of the broadest implications of what they do. Finally, nutrition educators must learn to cope with scientists, and vice versa. I have said elsewhere that I wishtwe could get scientists to forcefully remind . . reporters of the modesty of their own results; but since that seems unlikely, I wish that, at a minimum, researchers would get in touch with a nutrition educator who is not tied to their particular vision of reality before they go public with their results and let that educator place their results in a context that will make sense to the average eater. Campbell pointed out in a recent paper that the unwarranted explicitness of dietary recommendations has helped create marketplace confusion (Campbell and O'Connor, 1988~. The facts are not good enough to permit us to quibble honestly over 5 percentage points of fat calories or 5 grams of fiber. Nor will such distinctions matter to the eating public. The public needs to 'tee told that nutritionists agree about the need for a lower fat and higher fiber diet containing an abundance of fruits, vegetables, and whole grains. What are educators supposed to do about interviews like the one on the "MacNeil/Lehrer News Hour" in late 1987 in which a well-known scientist was quoted as saying that contaminated water from Silicon Valley wells was safer than broccoli, potatoes, or tomatoes. Unless such remarks are very carefully put into context, they are not helpful to those trying to teach people to eat more fruits and vegetables. Nutrition educators should not have to expend time and energy combatting misinterpretations or overgeneralizations that forethought could have avoided. 226
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REFERENCES Campbell, T.C., and T. O'Connor. 1988. Scientific evidence and explicit health claims in food advertisements. J. Nutr. Ed. 20:87-92. Gayle, M.E. 1987. Applying futures' research to nutrition education. Pp. S78-S80 in M.E. Lewis, ed. The Loading Edge in Nutrition Education. Proceedings of the National Conference on Nutrition Education Research. J. Am. Diet. Assn. 87~9~:S1-S82, Suppl. Sept. 1987. 227
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