In public health, we spend a lot of time talking about food, and unfortunately, making value judgements about various foods and ways of eating. We often focus on trying to influence individual behaviors, rather than improving the social determinants of health (SDOH) for community and population health.

Even when we are working on “improving access to food” for people who have limited resources, we are mostly focused on foods we have deemed appropriate, thus making it really about influencing individual behavior. For example, policy that allows the use of food subsidies or benefits at farmers’ markets is a beneficial expansion of the program, but still limits food options to those deemed “appropriate” by policymakers (i.e., the fresh produce from farmers). Having an allowed list of foods that can be purchased using benefits from the Women, Infants, and Children (WIC) program is similarly restrictive and driven by moralistic judgments about what kind of food people “should” be eating. In contrast, a basic minimum income policy allows people the autonomy to choose how to distribute their resources for themselves, which might include having enough money for shelter, transportation, healthcare, education, and food. These SDOH are correlated with health outcomes, and involve so much more than just what we eat.  

There are multiple challenges to talking about food in neutral and factual ways, which respect individual and cultural values, and take SDOH into consideration.

Definitions – Often, the words we use to describe food are vague, but we use them as if they are specific. Two examples are “healthy food” and “ultra-processed food.”  One could say that a healthy food is one that “improves a person’s health”- for example, by providing necessary nutrients. But there are many aspects to health, and food plays many roles in our lives. While we are generally referring to nutrition and physical health when we are talking about food, our emotional, social and financial health can also be impacted for better or worse. For example, we can also consider the positive health impacts of being comfortable and relaxed about food choices (rather than stressing about dietary minutia), enjoying a meal with friends and family (rather than skipping a social event due to what will be served), or having the financial resources to access foods for fuel and enjoyment (rather than struggling to put food on the table). 

Similarly, while there are official definitions of “ultra-processed,” trying to apply them to specific foods or meals often reveals more questions than answers.  Research attempting to connect higher consumption of “ultra-processed” foods (UPFs) to various health issues often fails to control for SDOH, such as poverty and its associated stigma. Definitions of UPFs are also inconsistent in research, making it hard to get a clear picture of the impacts.  (See for example, Gibney (2018) and Maintenance Phase “Ultra-Processed Foods” episode.)  If we want the public to avoid eating processed foods (however they are defined), then we need to create a context (related to adequate resources of time, money, knowledge, and desire) that allows people to plan for, purchase, and prepare more whole, unprocessed foods. Our society is not currently organized so that most people are able to do this, and not everyone enjoys the process.

Another term that raises definition issues is “food addiction.” While each individual gets to name their own feelings about certain foods (for example, feeling out of control), pathologizing eating behaviors, especially as applied to others, is problematic. If we take a more nuanced look with a weight-inclusive lens, we discover that bingeing or feeling out of control with food is often an outcome of food restriction. Food restriction can be intentional (dieting and dietary restraint) or unintentional (food insecurity, lack of structure, and work/home demands). “Food noise,” often used as an indicator of “food addiction,” is often actually the hunger that stems from restriction. One could argue that “food noise” is helpful for planning what and when to eat throughout the day and week. This article from the Center for Body Trust goes into this in detail and provides more resources: Re-evaluating “Food Addiction”.

Social and Cultural Values – The field of dietetics and much of our public health approach to food are based on Euro-centric and white supremacy values and perspectives on foods. While many dietitians and others are moving away from a weight-centric practice, there is still often a focus on breaking down food into its nutritional components, often stripping it of cultural, emotional, or social values (called nutritionism). Traditional foods or ways of preparing them can come from ethnic identities, geographic connections, or families and communities.  Labeling certain foods as unhealthy or “bad for you” disrespects these traditions and is a method of shaming, which is definitely not health enhancing. 

Individual Needs – When we make general recommendations about food – “people should eat this,” or “should not eat that” – we are also usually making assumptions about an individual’s health status, nutritional needs, cultural norms, financial and time resources, activity levels, past history with disordered eating, and more.  When our recommendations include judgements about food, such as “eat these good/clean/healthy foods,” this translates easily to judgements about the people who eat “bad/junk/unhealthy foods,” whether we intend it or not. This also applies to labeling ways of preparing food as “good” or “bad.” In order to do our work in a trauma-informed way, we should not be making specific food recommendations unless we know the above background information for a person, such as would be gathered in a thorough intake with a Registered Dietitian or Nutritionist. Just because something “worked” for one person (however they are defining that), doesn’t mean that it will necessarily have the same impact on others. “Influencers” often become popular with their anecdotal stories, rather than scientific evidence, which can cause harm, or at a minimum, be a waste of money.