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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
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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.
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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
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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
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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.
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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.
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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.
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Representative terms from entire chapter:
nutrition education
