How the Nutrition Field Became Toxic and What We Can Do About It

David Wiss, PhD, MS, RDN

What follows is a response to an esteemed colleague who requested statements from those who felt marginalized by the eating disorder community. It started with a paragraph and turned into an essay. Allow me to introduce myself… and thank you for letting me share 🙏🏼

My Background

My name is David Wiss. I am a 41-year-old White Jewish cishet male from Los Angeles, CA, and a product of the Los Angeles Unified School District. I recently completed a PhD from UCLA, giving me a prestigious title I worked hard for.

My father is a retired orthopedic surgeon who spent much of his early career in the county’s public health care system. Growing up, it was not unusual for him to get paged during a holiday or miss a baseball game to attend to someone who was shot, injured in a motor accident, or hurt on the job. My brother is 19 months older; we grew up close and competitive.

Needless to say, I represent the historically advantaged group. I grew up confident I would attend college and live a comfortable life. If I’m completely honest, I assumed I would be wildly successful, which, in many ways, I am.

Most people don’t know I have a dark addiction segment to my story, partly stemming from a legacy of alcoholism on my mom’s side. Middle school was rough, and I found drugs at a young age. My mother was a hippie in the late 1960s; I became a raver in the late ’90s. I love my mother deeply, who is currently living with dementia in memory care at age 72.

I got strung out on illegal drugs by the early 2000s, surviving the first wave of the opioid epidemic. During this time, there seemed to be an unlimited supply of 80 mg Oxycontin pills on the streets. I developed a severe substance use disorder, became a multiple convicted felon, and spent the better part of 2006 behind bars. I was exposed to racism and violence that was far more pronounced than I had experienced in middle and high school.

The last time I smoked crack was in the county jail in 2006, awaiting release to a non-profit Jewish treatment center in Culver City, CA (Beit T’shuvah), where I started my life over (age 24) with no college degree or clear path forward.

Social Disadvantage

In some ways, I represent one of the most marginalized groups in society: convicted felons with a history of life-threatening addiction. The statistics aren’t great for people with my background. I have faced structural disadvantages and have been denied several opportunities I deserved.

Due to years of internal work, I no longer need to share this information with everyone, but I occasionally have to disclose it. I’m in the mood for disclosure today. While my lived experience is valuable, it doesn’t define me, and I do not milk my story for praise.

Looking at me, you might see someone with many advantages in society, which in many ways is true. I own a home in West Los Angeles and run my own businesses. What is less obvious is that I suffer in silence as a person with multiple marginalized identities who looks like an oppressive force to some. I’ve even been told that I resemble someone’s perpetrator, which is hard for someone who has always tried to be an ally. In recent years, it has felt like my allyship is not even welcomed unless it looks a certain way.

I frequently challenge mainstream narratives, root for the underdog, and often stand up as the sole dissenting voice on matters of principle. I am not a “rebel” who insists on being different just to be different. I want to integrate into my community, professional field, the world, and beyond. I genuinely do 💜

Maybe it’s my adolescent adversity, but I have an antenna that alerts me to unsafety and disingenuous motives. I’ve learned to trust my instincts because the signals often guide me toward the truth, including the unpopular variety. When something is untrue, it often feels unsafe to me. Perhaps my challenges have become my assets.

Due to my past misdeeds and the gap in my resume, I struggled to find my place in the world. Recovery taught me to follow my intuition and led me to nutrition as a primary source of support in my healing journey. I was suddenly drawn to many plant foods that were never on my radar.

I grew up eating ultra-processed convenience foods, and by the time I hit “bottom,” I had multiple health challenges, many of which related to the foods I was eating (and probably more so to the range of health-promoting foods I was not).

Changing my eating patterns along with exercise, sleep, sunlight, intellectual curiosity, and altruism revolutionized my life. I chose to pursue nutrition as a career to help people during difficult transitions. I was drawn to nutrition for reasons that continue to be revealed 🙌🏼

My work in the field of nutrition has been extremely rewarding. However, along the path to becoming a registered dietitian nutritionist (RDN), my antenna signaled that the nutrition landscape was filled with injustices. The field has often felt unsafe with signs of corruption, agenda-pushing, narrative controlling, and profit motives. I‘ve frequently used my voice to raise awareness in an effort to elevate the consciousness in my profession.

Becoming a Registered Dietitian Nutritionist (RDN)

During my training to become an RDN, it was apparent (to me) that food industry interests tainted my education. Broadly, dietitians can be (unbeknownst) trained to support food industry interests, much like physicians can be trained to support pharmaceutical agendas. The difference is that there are strict rules about disclosing conflicts of interest in medicine, but such rules didn’t exist in nutrition when I was trained.

I’m not suggesting that Big Pharma and Big Food are inherently malicious. Our economic and political system (with lobbyists and special interest groups) allows them to dominate. Unscrupulous behind-the-scenes behavior permits Big Pharma and Big Food to collaborate in a system of financial gain and stockholder benefit based on the adage: “A sick society is a profitable society.”

My concerns about the food industry weren’t well-received during dietitian school. Most of my classmates didn’t seem to care about conflicts of interest. Most seemed to think the solution to the public health “problem” once referred to as the “obesity epidemic” was through education about calories and portion sizes, putting the onus on the individual. That approach never appealed to me.

Few of my teachers or classmates thought big industries were relevant to public health or eating disorder incidence. On the contrary, they were taught Big Food and Big Ag were the solutions. I learned about self-censoring my alternative viewpoints but always found it difficult to stay silent. Even from my seat, I’m stomping my feet to the rhythm of the ancient mysterious beat🪘

A handful of courageous dietitians put our careers on the line to form an advocacy group called Dietitians for Professional Integrity in 2013 (now disbanded). Our efforts improved ethics and disclosures in nutrition, but much progress remains.

It was apparent (to me) that the food world was ripe for exploitation, and the co-opting of RDNs was part of Big Food’s plan. In school, we were taught that we would be the go-to nutrition expert in the US and could work together on medical teams with high capacity for impact. Many RDNs felt disillusioned and disenfranchised when they discovered this was not always true. Sadly, many RDNs who were once colleagues have left the field entirely. I considered leaving numerous times but have stayed to forge a path and find other truth-seekers to trudge with🚶🏻‍♂️

My Career as a Dietitian

My career as an RDN has been rewarding and meaningful, participating in life-changing work in a private practice setting. Sadly, insurance rarely reimburses my clients. I founded Nutrition in Recovery ten years ago to provide nutrition education and counseling in mental health settings. We provide trauma- and eating disorder-informed care to mostly substance use disorder facilities. Most of my work is with complex co-occurring eating disorder clients who find it refreshing. I feel fortunate to be part of their recovery process.

Despite my misgivings about the food industry, I’ve come to learn the difference between individual and population health. While I have lofty public health goals related to nutrition reform, I also appreciate the need to find solutions for people in their current day and environment. Many need to make peace with food and their bodies. For some, that might mean eating fried chicken and cake with me at the grocery chain near my office. For others, that would not be my treatment recommendation. Multiple treatment models must coexist because nature is heterogeneous. Not all forms of disordered eating are the same.

I don’t support a single “food philosophy” and find it odd that my profession has silos that strongly favor a particular philosophy over another. The field has bias baked into it. Nutrition science can be opaque and easily spun to match different narratives. One can find evidence to support almost any philosophy (known as confirmation bias). Not surprisingly, much of nutrition science is funded by the food industry, which adds additional confusion due to publication bias.

Deviating from the Party Lines

Today, I view food and nutrition as unspoken tools of oppression in society. This comes from someone who has lived in institutions where people get stabbed over a honey bun, where we washed trays for hours in exchange for chocolate muffins, and committed crimes for bags of instant coffee to drink as thick as mud.

I also view weight stigma and diet culture as a tool of oppression. It is evident to many of us working in the field that weight is not simply a personal choice, BMI is racist, and most people seeking nutrition change gravitate toward fad diets. “Diet culture” generates enormous industries (with ties to Big Food and Big Pharma) with questionable beneficial impacts and often harmful consequences, including the onset of life-threatening eating disorders.

It has often been said: “If you want to know the truth, follow the money.”

Nutrition as a Social Justice Issue

I earned my doctorate at UCLA’s Fielding School of Public Health in the Community Health Sciences department. Shockingly, none of the department faculty were conducting mental health research at that time. Whenever I proposed topics related to eating disorders, nutrition for mental health, food addiction, ultra-processed foods, or nutrition for substance use disorder recovery, I was met with confusion and disapproval.

I was fortunate to minor in Health Psychology and collaborate with the epidemiology department for my dissertation: “Adverse Childhood Experiences and Mental Health Over the Life Course Among Men Who Have Sex With Men in Los Angeles.” Many are surprised that my doctoral research contained no nutrition variables.

I learned a great deal about the social determinants of health at UCLA. My doctoral program paralleled the timeline of the Trump administration, and my department was primarily focused on issues related to race and gender. I learned how societal structures reproduce inequities and how adversity gets “under the skin” to impact long-term health.

Being the only White cishet male in my cohort positioned me as a symbol of the oppressive force. I perceived this in subtle and not-so-subtle ways. I recall being accused of only caring about the opioid crisis because it affected White people, which is untrue. I didn’t share my personal struggles until the third year after many assumptions had been made about me.

During this time, the eating disorder field took a turn toward activism. It was a period of anger from marginalized groups and a chance to speak out against unjust forces and raise collective consciousness in this country. It was also a time when the political divide created an abnormally loud “us vs. them” distinction, which led to what is now called “cancel culture.”

Cancel Culture in the Eating Disorder Field

The eating disorder field (predominantly composed of White cis-women) created some powerful waves to cancel diet culture and raise awareness about the need for weight-inclusive and gender-affirming health care. I am proud to participate in this movement through my clinical practice and scholarly pursuits, discussing the role of weight stigma as a cause and consequence of addiction-like eating.

During this period of social division, I witnessed a strong campsite culture (also referred to as tribalism) forming in the nutrition space, spearheaded by timely advocacy efforts by eating disorder professionals. While the intentions were good and the message was needed, I watched the “Anti-Diet” community become toxic online. Hurt people hurt people, and marginalized groups marginalize groups 🥹

One way to summarize the split is the diet vs. non-diet divide. I have always identified as “non-diet” because I don’t encourage counting calories, fixed meal plans, or weighed-and-measured amounts of food (unless clinically appropriate). I don’t endorse the “exchange system,” which was once the mainstay in most eating disorder treatment settings, but I’m happy to use it with someone who feels supported by that approach.

Meanwhile, the definition of diet culture has continued to expand. Any nutritional approach that doesn’t include cookies, cake, chips, and ice cream has become “diet culture.” Any voice that challenges food industry tactics is touting diet culture. Anyone who wants to lose weight is participating in diet culture. Anyone who believes food addiction is real is perpetuating diet culture. These conversations demand you “pick a side” and wave your flag.

It has created a culture of inauthenticity. Like the political divide, there are social pressures to align with a specific camp, leaving no room to play the middle. This phenomenon, known as groupthink, has swept through the nutrition field in recent years. My antenna continues to signal because our patients suffer the most from this clinician divide.

While most of us can identify diet culture as problematic, the question becomes: where does all the dieting stem from in the first place? A recent longitudinal study showed that among adolescents, food addiction predicted dietary restraint, but dietary restraint did not predict food addiction 🤔

Topics related to ultra-processed foods and associated food addiction have been canceled in the eating disorder field. This is partly because many people with restrictive eating disorders can present with perceived food addiction. Improperly endorsing food addiction (false positive) can perpetuate restriction, a core feature of eating disorders. The data cannot be reconciled without an open and inquisitive scientific mind.

For example, our 2020 paper described the need to view food addiction in the context of eating disorders and the limitations of the food addiction construct. Instead of pretending food addiction doesn’t exist, I continue to invite the difficult conversations that many others prefer to avoid. My personal recovery journey taught me how to lean into discomfort. I invite you to lean in.

I was once asked to present about the complicated intersection between substance use disorders, food addictions, and eating disorders at the local eating disorder chapter meeting. I learned that some group leaders were firmly against it, and my proposal was rejected.

There were moments when I thought I had to abandon my research interests to remain in the eating disorder field. While I have witnessed many colleagues captured by the bandwagon effect, I have continued to rely on my intuition (and the PubMed alerts I get each week) to guide me. My father taught me about the need for new thoughts to challenge old thoughts and for new data to challenge old data.

Finding My Tribe

I’ve had difficulty finding like-minded colleagues who embrace dialectics in dietetics and invite nuance into nutrition. I have found some folks, and the connections feel deep. I do the type of work that most eating disorder dietitians do, but I also include a functional medicine component when it is clinically appropriate.

Unlike many of my colleagues, I think there are solutions to cases of eating disorders that involve conversations around ultra-processed foods, the neurobiology of reward, gut health, and the inflammatory cascade. This is particularly true when there are trauma histories, co-occurring substance use disorders, or persistent depressive symptoms.

Food can be profound, and not all calories are created equal. These conversations can be had from a food-positive, body-neutral, and non-diet perspective. Not all eating disorders have the same biological underpinnings, and we desperately need more discernment and nuance in the food space. Are you here for it?

I firmly believe that RDNs, as medical practitioners, have been marginalized. Dietitians are underpaid compared to other healthcare professionals with similar training. Many are tasked with educating people who have limited access to nutrient-dense foods. Dietitians often rely on resources and educational materials created with food industry interests. Unfortunately, many dietitians are not trained to critically audit scientific literature or conduct independent research.

Many eating disorder dietitians inadvertently represent a voice for Big Food, actively advocating foods made for profit rather than health. The philosophy that “all foods fit” is the industry’s ultimate goal because it exonerates them from producer responsibilities. I’m usually met with resistance and disapproval when exploring these challenging big-picture topics with my colleagues. Dialectical ways of thinking are becoming increasingly uncommon in the nutrition space 🤯

I do receive messages from colleagues who appreciate non-binary thinking about nutrition and health. However, in the eating disorder community, these conversations are usually offline. I’ve had colleagues quietly express interest in my public health views but wouldn’t want others to know. I’ve also had colleagues sever ties with me because I published papers on food addiction that challenged their professional beliefs.

The ethos in much of my field (and in today’s political climate) is that either you’re with us and all the way with us, or you’re against us, and we are, therefore, against you (i.e., you are canceled). Meanwhile, science should always be about data and ongoing dialogue, not necessarily consensus.

Because I continue to discuss the importance of food quality for gut health and mental well-being, does that mean I’m not welcome in the eating disorder field? Or is it because I don’t quite fit into the box? That box seems to be getting smaller and smaller during a time that desperately craves expansion and diversity 💗

As someone who will not abandon his core values in favor of group conformity, I have felt marginalized by the eating disorder treatment community. Whether or not being a White cishet male has played a role is not the point- just a detail I couldn’t ignore. I know other advocates for people with various addictions who feel the same way 🫶🏼

What matters is that I’m still here. I have continued to treat a range of individuals with eating disorders, publish papers, and attend conferences and events. I love my work and continue to learn and grow. I’m excited about the future of my field and probably need more patience. Change takes time. I’m certainly here for it.

I’ve been collecting data in my private practice for nearly three years and look forward to analyzing and submitting it for publication. Even though I’ve experienced brief moments of embarrassment related to my RDN credential, I’m proud to be a dietitian and pioneer in the “Nutrition for Mental Health” revolution, connected to the growing fields of nutritional psychology and nutritional psychiatry.

Summary

I understand some aspects of marginalization and stigmatization. Other aspects I will never fully grasp. I know what it’s like to be treated differently based on characteristics that cannot be changed and how painful that can feel. The discrimination I’ve faced from being a multiple convicted felon doesn’t sting anymore. It’s in my past- I’ve taken full responsibility for it.

Meanwhile, the microdiscrim from the eating disorder field has necessitated real endurance on my part. Most dietitians would move their specialty elsewhere or conform to whatever accepted group narratives perpetuate the status quo. I will continue to stand tall in my own brand of dignity. It feels right (most of the time), and I know my clients are grateful. I know that someone reading this is grateful, too 🙏🏼

I can’t wait to share the Wise Mind Nutrition app with a novel (and free) food log with the treatment and recovery communities. It contains a daily program that promotes dialectical thinking and builds empowered eaters along their journey to improve mental health using food and lifestyle medicine. It’s part of the solution to the toxic tribalism that has made the field of nutrition feel like an unsafe place. It’s designed to make you feel safe in your nutritional identity. Join the movement 🧠

People can often recover from most forms of disordered eating with the help of a good RDN and treatment team. The life-changing work we do can also be done without succumbing to the financial agendas of the food and pharmaceutical companies. The agenda should include personal, familial, and community health- across levels of body, mind, and spirit.

Throughout history, the encouragement of groups to target one another has been a tool of tyrants. It can be seen from Washington DC to mass incarceration in California. And now, in the nutrition sphere, people are pitted against themselves and, therefore, cannot mobilize against the less-discussed systemic inequities. I’m ready to see some tangible change in the spirit of truth, accessibility, and organic egg yolks with that deep orange carotenoid pigment 🙌🏼

This conversation about the nutrition landscape isn’t black and white and isn’t about right or wrong. We shouldn’t have to pick a side. There is plenty of room for social justice movements to exist simultaneously and synergize. If eating disorder professionals teach our clients to have less rigid and more flexible thinking patterns, I hope we can do the same.

Even though I‘ve felt out of place, I’m not leaving. My path is clear, but it appears long and sometimes feels cold. Feel free to walk with me in pursuit of warmth, truth, resilience, and sustainable recovery. Together, we can accomplish what we can never accomplish alone!

Onward 🌱