Systemic regulation of dietary advice
The history of dietary advice shows wild swings. This is even embedded in popular understanding: many people will tell you that today’s advice to eat a particular food will be next year’s advice not to eat it. It would not be an exaggeration to call this a hysterical pattern. A succession of crazy ideas. For this to be a useful observation does not depend on the truth or the accuracy of any particular advice, it simply describes a pattern of wild swings between many extremes.
To describe this pattern in terms of viability is revealing. In the short term, the latest dietary advice is compelling reading, precisely because there is an expectation that it will overturn the tired old rules or what to eat. When Nina Teicholz in Big Fat Surprise describes the origins of the “Mediterranean diet” she notes how the prominent Harvard researchers finally get to eat food that tastes of something, rather than bland American pap. In idyllic settings, too! So, in the short term there is a market for changed advice that keep the diet industry in business.
In the medium term, this picture is more confused. We are now seeing the wave of long term conditions due to wrong dietary advice killing vast numbers of people: more than any war. And the diet industry is impotent against these trends. The current wave of global regulation of food was kicked off by panics in the 1970’s. Middle-aged men who were otherwise at the top of the world’s power structures were being killed by heart attacks. Obviously children’s diets needed regulating!
Everyone can see obesity levels rising inexorably. There is quite literally no hiding it. Everyone has been told that people must take personal responsibility for eating too much. The notion that dietary advice might set people up to fail again and again and again in controlling their weight is just around the corner. The credibility of the diet industry is lower and lower: it is thought to be like the fashion industry, thriving on change for its own sake. Are you keeping up?
In this blog post we want to use ideas from the Viable Systems Model to look at how there could be a different diet industry, one that was actually helpful to people’s health rather than killing them. And clearly that is not a matter of the advice itself but of the nature of system connections. That is the fundamental systems insight: it is not the things that are connected but the relationships between them that count.[1]
Let’s return briefly to hysteria. Hysteria is a thing of crowds: it works on fear and mass emotion.[2] The world epidemics of long term conditions and the all too visible, stubborn rise of obesity are generating fear. That is why regulation (interference) started, and the search for viability means that it will have to be controlled. Of course, hysteria is itself an illness of sorts and mental health is a major dimension of the social and cultural vortex we have created.
Feedback loops
The question of the overarching feedback loop cannot be avoided. Over a period of years the health of the population needs to inform the dietary advice itself. Increasingly we can’t see the population as monolithic.[3] We do need to distinguish men and women, affluent and poor, young and old, cultural food patterns, and, and.
The second overarching loop needs to evaluate the food environment. What food is sold, what claims are made about it and what is the health advice on the packaging. Since all marketing of that nature is thoroughly evaluated for its effect on buying behaviour, there is already a commercially funded information source about what people are being persuaded to buy.
Thirdly, we need to accept that teachable moments for consumers occur when people are ill or in enough of a crisis to approach health professionals. What health professionals say in these circumstances, in terms of advice but also of blame and the allocation of responsibility for future action, is a big issue. Health professionals are among the worst at accepting that they cause illness and death directly, despite mountains of evidence that this is so. Very little can happen while health professionals do not accept the evidence in front of their eyes. [4]
If these three aspects of the overarching feedback loop are properly collated and correlated they can be fed back both into the governance process of the system and also into the design of the various projects working on the system internally.
The environment of dietary advice
The dietary advice system sits in a world where big food uses all it resources to get consumers addicted to their products, and we mean literal addiction. And it sits in a world where big pharma colludes in this process to create a market for pharmaceutical “solutions” to the ill health produced by food addictions.
Because of the hysteria we noted in the introduction there is a huge market for non-solutions, for miracle diets, misleading approaches, deliberate corruption of the science, the very worst journalism by the most ignorant journalists, and glossy marketing of death.
Is this environment a factor in the overall issue? Of course it is, and it is outside the governance of the system we are interested in. The credibility of the governance of the system and of its particular interventions rests on how it handles the corruption of the environment. This is a much higher standard of credibility than normally demanded of systems in public life. It is like raising a flag to be shot at. Everyone in the wider environment with an interest in food can be expected to pit their own credibility against the governance mechanisms.
The present situation is that a very large minority of people interested in reforming their diet/lifestyle are using social media connections to circumvent official advice. So there are massive information and influence flows outside the officially acknowledged communication channels. These are not understood inside the present food advice system precisely because there is no listening and monitoring going on. The overarching loops in the previous section are nowhere implemented at all.
Common interests
There are companies that are getting diet results. I am thinking of Virta in the US that has great results reversing their patients’ diabetes. And I am thinking of Diet Doctor in Europe. These are basically online services with proper medical teams and properly individualised advice and treatment with a common resource of general information and things like recipes and menu plans.
Then there are particular GPs like David Unwin and medical consultants like Aseem Malhotra and Gary Fettke. These people have both their own patients in conventional settings and a global presence as speakers and advisers.
There are charities, but this is more complicated and I can’t get my head around it. There seems to be a world of difference between for instance Diabetes UK and diabetes.co.uk. The first seems to be fully in the pocket of people funding wrong advice and the latter seems to have a large body of diabetics providing peer support, and a low carb programme.
Any advice system worth its name would be working on understanding the common interests between these initiatives, and of course all the others. This is where the pool of evidence of actual change in real people’s lives will come from. It will enable advice and the effect of advice to be understood over time.
The difference between these initiatives and the current sources of official advice is instructive. Official advice is supposed to be evidence based. That means expensive trials and statistical inference. The fact that the evidence is actually complete rubbish doesn’t stop officials[5] refusing to change the advice for lack of evidence that they won’t fund the collection of. How strange it is that all the information being generated daily about what works and what doesn’t has no way of being heard in the citadel of Public Health.
The coordination and mutual enhancement of working projects is the very stuff of real governance. What should be happening is precisely the studies with sensitivity to local situations, the sharing of experience, the travel grants, the building of experience and expertise. But not based on failed theories and discredited evidence, fully open to what wants to emerge.
The funding of clinical research trials should of course be used to explore the emerging patterns, meanings and theories of this governance work. It should absolutely not be used as it is at present to try and shore up failed and botched theories in order to protect egos and the establishment of public health.
A contradiction
There is a contradiction at the heart of this piece. We have said that there is hysterical change at the heart of public perceptions of dietary advice. And we have also said that public health is stuck in a bunker and never changes. On the face of it, public health being seemingly immune to the hysteria might look sensible. No change in the face of random change.
Food regulation in the seventies really started with an irrational but widespread fear of saturated fats. Today’s version of that same fear is the vegan craze. It is this central thread that the food industry has exploited, because it pushes people towards their profit centres of long shelf-life processed carbohydrate foods. The hysteria seems to be froth around a lie. I am in Berlin this week and searching an upmarket supermarket for, for instance, full fat yoghourt, is a real challenge. Everything is low fat. And the latest research says that dairy fat is protective of human health especially in children and young people. Contemporaneously, food programmes in US schools are starting to mandate low fat milk!
We are in the same place as those idiotic and corrupted Harvard researchers being blandished by real food in the Mediterranean. Only some of the flavours they were treated to were real, and ours are supplied by the food processing industry to make increasingly bland (if not actually disgusting) food taste of something. Look at the ingredient list of the Impossible Burger. Maybe the most important governance move would be to start to outlaw all that technology that turns rubbish into food that seems palatable. It is, of course, fat that gives food its taste[6], and there is a rock-solid evolutionary reason for that!
Our contradiction looks as if it is pointing to a system invariant. No matter what happens and what the evidence is, saturated fat/red meat is the problem. This looks like big food and big pharma corruption of the bodies that set dietary advice, of public health bodies and the WHO. So the big task of governance would be to escape the web of deceit and false science that has been spun over fifty years. Becoming aware of this web is only a first step. What it means to raise a flag for people to fire at is the next step.
The incredibly well-funded EAT/Lancet study into saving the planet by telling us what to eat has just received a bloody nose with the withdrawal of WHO approval. (The study finds that we should eat miniscule amounts of meat in a basically plant based diet. A wide range of other experts have documented the nutrient deficiencies in the recommended diet.) And they are pushing in India for Indian children to be vegetarian. So governance has to cope with very glossy PR, plausible public interest positioning and lots of funding pushing very hard for goals that will destroy health. The RSA Food and Farming Commission, who we have complained about before, welcomed EAT/Lancet with open arms.
In the field of climate change there was a similar campaign of misinformation and attempts to discredit key research and researchers. Climate change has had to contend with the might of big oil, and what is changing the balance of power is a successful global campaign to get institutions to disinvest from oil companies. We have had campaigns about the bad behaviour of the likes of Nestle promoting formula milk in the third world, but we are still a million miles from people disinvesting from Kellogg’s because they are wrecking the health of our children.
That is the scale of the governance challenge.
[1] A colleague recently recounted that the chief thing about an eco-system is the connections and relationships, as if that were somehow different from other systems…
[2] It’s a positive feedback loop that escalates until it collapses for other reasons.
[3] Few things generalize. We often note that the world is not flat, for all that official advice and so-called science treats it as such.
[4] For amusement, you could ask your dentist about the mercury contained in fillings, whether it stays put and inert or leeches out into the body and causes ill-health. The answers may vary on whether the dentist’s practice still uses such ‘silver’ amalgam fillings.
[5] You know who you are, Alison Tedstone, National Director with responsibility of diet, nutrition, and obesity in the Health and Wellbeing Directorate of Public Health England…
[6] That and seasoning, by which we mean the chef’s meaning of salt and pepper. One of the chief things that makes restaurant food tastier is that they’re less stingy with the salt than we are at home…
