Diet Plans and the ‘Cult of Expertise’

One of the questions most frequently asked about our Weight Management programme is:

• Will it enable me to write diet plans?

The short answer is no. In terms of the interventions within the programme, we discourage dieting and the writing of ‘diet plans’.

It’s a legitimate question though which requires unpacking.

First up, there are a series of reflective questions we need to ask ourselves. Why do we:

• Feel the need to tell others what to do?
• Assign value to ‘prescribing’ solutions for others?
• Aspire to be ‘experts’ and have our expertise recognised by others?

Underlying these questions is a fundamental assumption – people struggle because they lack the knowledge of what to do. ‘They’ need to be told…by people with ‘expertise’.

But when it comes to knowledge of nutrition, how valid is this assumption?

Try asking the following question to a random selection of people:

• To lose weight, what should you eat more or less of?

With relative ease, most people will identify that they should eat:

• Less fast- and junk-foods including sugary drinks.
• More fruit and vegetables.

Yet our National Health Survey clearly indicates that this is not what most of us are doing.

So, if our dietary behaviours are being shaped by factors other than ‘knowledge of what to eat’, then how are interventions oriented on ‘telling people what to eat’ going to be effective?

Quite simply, they can’t be. For any intervention to work, it must accurately identify and address the actual problem.

In this article we intend to do just that. We’ll discuss:

• Diet plans – what are they and who do they benefit?
• If diet plans aren’t the solution, then what’s the problem?
• The cult of ‘the expert’.
• What interventions need to include to actually change behaviour.

Diet plans – what are they, who do they benefit?

Diets (for example, the Paleo Diet), refer to a specific course or way of eating which ‘dieters’ must restrict themselves. Most commonly, people ‘diet’ to lose weight.

Diets aren’t tailored to individuals. They usually require people to make major changes to the way they eat to comply with the diet. Those who design diets have no relationship with or understanding of those attempting to undertake the diet.

In contrast, diet plans are (ideally) tailored to an individual’s goals, health status, weight, and lifestyle. They act as a prescription of what to eat (and drink), how much, and when.

Diet plans can be prepared for and tailored to individuals as well as groups such as:

• Elite level sports teams.
• People in assisted living (e.g., retirement villages).
• People with long-term nutrition or digestive system disorders such as irritable bowel syndrome or a nutrient allergy.

Without doubt, effective, nutritionally balanced diet plans will benefit such individuals and groups.

In the examples above, for the diet plan to be effective the planner must have a significant understanding of:

• Dietetics (application of the science of nutrition to human health and disease).

In summary, those with specific dietary needs relating to elite level performance or health/medical conditions may benefit from diet plans; if those plans are designed by someone who specialises in dietetics.

This makes diet plans the domain of dietitians or nutritionists.

However, outside of those with very specific dietary needs, the question I’m interested in is:

• Will diet plans benefit the general population – especially those who want to lose weight and improve their health?

Answering this question requires us to get to the root of the problem – why do so many kiwis struggle with their weight?

If diet plans aren’t the solution – what’s the problem?

Despite phenomenal growth in the global diet industry we keep getting bigger. In NZ, almost 70% of adults and 20% of children now classify as overweight or obese.

Do diets fail because they’re not tailored to individuals? Would tailored diet plans prescribed by dietetic experts make any meaningful difference to these statistics?

Diet plans may be more nutritionally balanced than most popular diets. But they suffer from the same flawed assumption; people struggle with their weight because they don’t know what to eat more or less of.

The ‘solution’ to this flawed assumption is telling people what to eat. The more ‘expert’ the teller, the better the solution. Or so the rationale goes.

However, because the problem isn’t a lack of knowledge, the ‘solution’ is anything but helpful.

In our Weight Management programme we take a deep dive into understanding the problem.

We reveal that our weight issues are caused by a multitude of interrelated factors including:

Human biology:

• The human gut is made of elastic, smooth muscle which encourages us to overeat. Overtime, we’ve become very efficient at converting this excess into bodyfat.

Our need to feel ‘full’ enabled us to take full advantage of limited resources when food was scarce. This biological reality backfires on us now that food is abundant.

Psychology:

• The anticipation of and consumption of food triggers the release of key neurotransmitters (dopamine, serotonin, endorphins) in the brain. These neurotransmitters are associated with our feelings of pleasure, reward, pain relief and positive mood.

Quite simply, eating makes us feel good! The rewards associated with eating drive us to eat.

This ‘drive’ encouraged us to search for food when it was scarce. Again, this reality is far less beneficial now that food is easy to access and available almost everywhere.

The food environment:

• Modern, ultra-processed foods have large quantities of sugar and fat added to make them even more pleasurable to consume.
• The exhaustive promotion of junk and fast-food triggers their consumption by getting the dopamine juices flowing. It incentivises us to eat to attain the reward that we know is coming.

Increasingly, ultra-processed food is being recognised for its addictive qualities. In a short period of time, such foods have become the default (most available, affordable, accessible) for many.

Society:

• We use food to celebrate and commiserate – seldom do such events and circumstances revolve around healthier foods.

Modern society celebrates the accomplishments of the individual. It encourages us to isolate ourselves to seek personal advancement. For many, the pleasure gained through regular, supportive interaction with others is limited or non-existent. Food provides a pleasurable escape from the unpleasant realities of modern life.

Considering all of these factors, ask yourself – how are any of them addressed by a diet plan?

Now before we discuss what ‘effective’ interventions include, we need to consider why ‘telling others what to do’ is a problem.

What’s ‘the cult of expertise’ – why is it a problem?

Here’s a scenario to ponder.

Ani has struggled with her weight for years; she’s tried multiple diets and weight-loss programmes. A similar pattern keeps repeating; she quickly regains lost weight once the diet or programme finishes.

Ani has approached the following practitioners for help:

• Leo the Personal Trainer tells Ani to do the Paleo Diet. ‘It replicates the way humans used to eat before obesity was a problem’.
• Doctor Davina tells Ani to take pills that will stop her digestive system from absorbing fat.
• Alternative Therapist Mike tells her to undergo a course of hypnotherapy to reduce food cravings.
• Jackie the Dietitian tells her to follow a structured, nutritionally balanced, calorie-controlled diet plan.

Each of these ‘experts’ may genuinely believe in what they’ve told Ani to do.

Unfortunately, none of them have developed any expertise in ‘Ani’.

If they valued Ani, they’d discover that:

• To reduce her risk of heart attack, Ani is actively reducing her meat consumption, which runs counter to the Paleo diet.
• The side effect of the diet pills (an oily discharge from ‘the posterior’) isn’t acceptable to Ani.
• Due to a traumatic experience earlier in life, Ani is terrified of hypnotherapy.
• Ani doesn’t have the time to prepare separate meals for her and her kids, as the diet plan requires.

So, what’s the likely outcome of this scenario?

Nothing changes for Ani. The ‘solutions’ she’s been presented with aren’t realistic. Another failure will likely result in her feeling even worse about herself than she already does.

However, the practitioners will get to demonstrate their superior knowledge and expertise. Their ego’s will get a nice stroking. And when Ani inevitably fails to implement their solutions, they’ll be able to assign blame accordingly:

‘If only she tried a little harder and was more committed…’

Unfortunately, scenarios similar to this play out all too often.

We’ve developed an unhealthy reliance on, and unchallenged acceptance of ‘experts’. Experts are deemed to have superior knowledge that should be accepted and adhered to, without question.

When it comes to helping people change their eating behaviours this is a major problem.

As humans, we’re all unique. Hence, the factors that influence our weight affect us differently. As practitioners, we have to accept that knowing what causes excessive weight, and possible interventions, is only part of solving the problem.

Successful interventions are collaborative; they depend on the combined expertise of practitioner and client. One’s expertise is not superior or inferior to the other. They’re different, yet equally important.

Only the client knows what:

• Has/hasn’t worked in the past and why,
• Stressors exist in their life and how they are dealt or not dealt with,
• Changes are practical, impractical, possible, or impossible,
• Support they need to overcome obstacles and ‘bad days’,
• ‘Their’ life currently looks like.

The traditional model of ‘helping’ views the client as ‘the problem’. Hence, ‘they’ need to be told what to do. ‘They’ need to follow the direction of people with superior expertise.

Such models don’t understand that clients hold the keys to their own success. A ‘person-centred’ practitioner helps their clients to find those keys and develop the skills and confidence to use them.

So, if knowledge of nutrition isn’t the problem (it isn’t), and if the practitioners role is to help people change their behaviour (it is) then the important question is…

What do interventions need to include to be successful?

To lose weight and keep it off, diets and diet plans make the same flawed assumption:

• The essence of the problem is a lack of nutritional knowledge.

Underlying this assumption is a fundamentally naïve belief:

• Behaviours can be changed by telling people what to do.

This isn’t the case.

Behaviours are wired into the neural structure of our brains through repetition. The more we repeat a behaviour the more automatic it becomes. Overtime, unhealthy eating behaviours repeat largely on autopilot.

Once prompted through advertising, hunger or simply proximity to food, we eat. The pleasure of eating reinforces the act, strengthening the neural pathways to make subsequent acts more automatic.

The essence of our weight problem is behavioural, not nutritional. As such, interventions must be behavioural in nature – first and foremost.

Straight away, this changes the nature of the client-practitioner relationship. Behavioural interventions cannot be authoritarian where one party dictates actions to the other.

Client and practitioner must work together to:

• Understand the context within which unhealthy eating behaviours occur and what influences those behaviours.
• Identify and implement strategies to modify existing behaviours to make them healthier and pleasurable enough to be sustained.
• Reduce exposure to the cues or triggers that prompt unhealthy behaviours.
• Identify non-food-related physical activities to engage in that provide a source of pleasure and reward.
• Build networks that provide a consistent source of positive, non-judgemental support.
• Actively learn from and build on factors that help the process of change, whilst eradicating factors that hinder change.

In short, this is the intervention and approach to working with clients that we present in our Weight Management programme.

With regard to helping the general public achieve sustainable weight loss, it trumps ‘diet plans’ all-day, every-day.

Diet Plans – A Final Word

Whether in our personal or professional lives we tend to be surrounded by ‘experts’. People who, usually without being asked, revel in ‘telling us what we should do’.

Seldom is the advice or ‘solution’ presented by these experts of any value. The reason for this is simple – it’s little more than their spin on what they’d do if they were us. As if we’re all the same, living identical realities, which we aren’t.

Hence, any sentence that starts with ‘If I were you, I’d do…’ or ‘You should…’ is one to be wary of.

A solution presented without a significant understanding of the problem is just background noise. Its purpose is little other than pandering to the ego of the teller.

In many regards diet plans are effectively noise. They’re a simple solution in desperate search of a problem because they solve very little. Just like their cousin – the diet.

Our weight issues aren’t simple. They can’t be solved with simple…’If I were you…’ or ‘Just do X’. They require genuine expertise – a thorough understanding of the problem and a realisation that when it comes to behaviour change, sustainable solutions can only eventuate from a collaborative process.