Gaps in a "registered" education

When I published my broadside yesterday about registered dietitians, I said that it reflected views I’d held for a while but that they’d boiled over in the past little while. The flash point  was the show Dr. Oz did last week on food addiction in which he had two “experts,” Keri Gans and Dr. Neal Barnard.

If I’d included only Dr. Barnard in that sentence, I would not have needed the quote marks.

You may know that I’ve already commented once on the show and that I thought it had many encouraging parts for advocates of recovery from food addiction. But my writing yesterday showed me I had more to say.

The downer was Gans, who argued the “con” position forcefully, if uninformedly, from the start: “First of all,” she said, “as a registered dietitian, I base everything of my opinions on science, and right now, the studies aren’t conclusive. They don’t point in the direction of saying, ‘you can be addicted to food.’”

Actually, they do point in that direction, loudly and repeatedly: A team led by Ashley Gearhardt at Yale used a questionnaire to identify food addicts and scans of brain activity to confirm its efficacy. Sounds pretty science-y to me!

That study builds on dozens of food-addiction studies in rats, including Paul Kenny’s and Paul Johnson’s work at Scripps Florida, Bart Hoebel’s and Nicole Avena’s research on sugar addiction at Princeton, and Serge Ahmed’s work at the University of Bordeaux in France. There are dozens of such studies, literally.

Her very next sentence made clear she didn’t understand her terms either, which is perhaps understandable for a laywoman, but not for Gans, whose dietetic expertise is “registered,” who has a nutrition practice in Manhattan, and who is author of “The Small Change Diet”: “If you think about it, we need food for survival. How can you be addicted to something your body needs?”

Well, sort of, but “food addiction” doesn’t refer to all foods for all eaters, any more than alcohol addiction applies to all drinkers. The biochemistry in some people reacts more strongly to some food substances than others, and sometimes in dangerously unhealthy ways. Among the easy examples are shellfish and peanuts, which most people can enjoy but some will experience anaphylaxis, a life-threatening allergic reaction.

The biochemical reactions I’m referring to, most often to refined foods, are not as dramatic, but when they lead to physical cravings — which lead to overeating, which leads to obesity — they are also life-threatening, if on a longer timeline. In my case, I weighed 365 pounds at age 34; was my life not threatened by what and how I was eating?

I don’t claim that that one-paragraph rendition of my story “proves” food addiction. My point is that some people react to some foods differently than others do, just as two people can drink alcohol and have dramatically different reactions.

So OK, the term “food addiction” is ineffective, or even misleading, and casual skeptics can be forgiven if they don’t get that. But Gans said on air that she’s treated “hundreds and hundreds” of people. Did she never notice that some people go back to the same substances time and again, despite wanting change enough that they paid to engage her services, and who no doubt had tried many other stratagems as well?

Gans blamed emotions solely for overeating, and I agree that emotions can trigger both eating and overeating. But how is that proof that food addiction isn’t also at work? Why do some people who eat emotionally just eat it a little and then get back to normal, while others eat more at each sitting, have more sittings, and need milder and milder triggers to start again — until they don’t need any trigger at all? Why must emotional eating and food-addictive eating be mutual exclusive?

Any time you can’t fathom food addiction, just substitute alcohol as the substance of no choice: People drink over emotions too — a celebratory beer, or drowning one’s sorrow — but some drink for a night or two and others end up in the gutter.

Gans’s “solution” is simplistic: “So many people, it goes back to fond memories ... their grandmother making them mashed potatoes [for example]. These foods that just felt really good to them. And as they’ve gotten older, they haven’t really learned other behaviors how to feel good about things, so they use food to replace it.”

So, she just needs to teach her clients up, right? Just a little learning about “how to feel good about things,” and that’ll do it? Gee, why didn’t any of the 145 million Americans who are obese or overweight ever think of that?

As I said, Gans cited her treatment of hundreds and hundreds of clients. The more useful figure would be her success rate; that’s what’s going to establish her credibility with me. My assumption, just using common sense, is that she’s doing about as well as everyone else.

We know that the vast majority of dieters fail to lose weight or fail to keep it off. I don’t know how long the registered-dietitian designation has been around, but the American Dietetic Association was founded in 1917, so it was past a half-century old by the time the nation’s waistline began to balloon in the 1970s, and its reactions to the obesity crisis in the 40 years since appear not to have helped much.

If Gans were doing a lot better with clients than that trend, I feel confident she’d be letting everyone know, and the world would be beating a path to her door. 


Note: I offered Gans a chance to reply to this post before I published it, but she has not replied.

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