Thread by @ahhite

Hmm. While I think it is true that diet is the fundamental key to good health (w/o adequate essential nutrition, you're sunk), I actually do think that saying "diet doesn't fix everything" might be a good public health message if it were taken up seriously. 1/

Hear me out.

https://twitter.com/AmandaZZ100/status/1183385832058687493

The creation of the 1977 Dietary Goals & 1980 Dietary Guidelines emerged from & amplified a seismic shift in how we think about public health.

Prior to this, "public health" had (mostly) been about clean air & water, feeding the hungry, safe cars, buildings, streets, etc. 2/

It even included access to health care. The 1960s & early 1970s included bipartisan support to create a national health insurance plan. Protecting "the health of the public" was considered to be the responsibility of governments & corporations.

Then came "healthism." 3/

"Healthism" is a term coined by Robert Crawford--in 1980 (no coincidence). Healthism = the belief that protection of health is the responsibility of the individual & "responsible citizenship" = pursing health by following rules about "eating right" & other lifestyle matters. 4/

1977 DGs/1980 DGAs provided those rules & from that point on, diet (& other rules for "living right") really was supposed to "fix" everything.

Gov & corp need no longer worry about access to healthcare, ensuring safe environments (beyond basic regs), providing living wages- 5/

things would go a VERY LONG way to improving the health of the public.

We KNOW health & SES are closely linked. We see this even in dietary studies that are supposed to prove that health & DIET are closely linked. 6/

We even have a name for it, "the healthy user" bias. But what we fail to add is that "the healthy user" is much more likely to be white, well-educated & from an upper income bracket than not.

Unfortunately, public health experts - and others - often take this to mean that 7/

those who are NOT white, well-educated & from an upper income bracket just don't care about their health the way they should & we have to help them by "making the healthy choice, the easy choice."

And, now proponents of LCHF diets are about to join the fray. 8/

Advocating for a LCHF dietary pattern to be added to the DGA does NOTHING to change any of the above.

It simply adds another way that we can blame people for their own poor health: "We gave them a LCHF diet to follow & they didn't. It is their own fault they are sick!" 9/

This disregards ALL OF THE OTHER THINGS that can lead to poor health outcomes that cannot be "fixed" by diet: genetics, epigenetics, childhood trauma, poverty, exposure to environmental toxins, lack of access to health care, etc. etc. etc. 10/

So, yeah, maybe a public health message that says "Diet doesn't fix everything" would focus public health experts on fixing some of the things that do matter: environments, educational systems, economic inequalities, institutionalized discrimination, etc. etc. 11/

And maybe it would focus some of our LCHF experts on advocacy more productive than asking for a LCHF dietary pattern to be added to the DGA - and have them advocate for things like:
12/

--mandating healthcare providers are taught about using LCHF diets for diseases where benefit is proven
--requiring that insurance companies only reimburse for diabetes education that offers the option of LCHF
13/

--mandating Medicare/Medicaid-reimbursed diabetes education programs offer this option

There is so much more we can do besides dumping responsibility back on individuals for knowing/following gov nutrition advice.

And we could start with "diet doesn't fix everything."

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