Table 2.

Discussing diet and recognizing an individual’s life situation: Problematic practices in medical nutrition and recommendations for improvement

Avoid	Try this instead	Why?
Moralization of foods and food groups as “good” or “bad.” Example: “heart healthy fats,” “good carbs,” “bad fats”	Discuss the macro- and micronutrients found in various foods, their digestion, absorption, and metabolism/storage, and the impacts of any one nutrient deficiency or excess	Understanding nutritional needs is essential to making plans or recommendations for patients’ health A knowledge of foods’ nutritional content can help our patients meet their macro- and micronutrient needs in a variety of ways
Shaming or promoting certain types of food Examples: • Claiming organic produce or other expensive food items are necessary for health • Shaming or dismissing canned foods due to sodium content • Recommending or endorsing fad diets	If there is evidence that a food item promotes health better than a cheaper counterpart, share such evidence but acknowledge that not everyone has access to such foods Recognize the importance of shelf-stable products for certain individuals. Suggest strategies such as draining and rinsing canned foods to reduce sodium content Avoid promoting fad diets	Nutrition counseling must work within an individual’s life. If our guidance prioritizes perfection and shames what is accessible, we lose patients’ trust in our understanding of their circumstances and may cause patients to feel that healthy eating is not feasible We should promote health by maximizing the nutritional value available to any given patient Fad diets are usually not supported by robust evidence, may promote short-term, unsustainable changes, and may cause harm
Assuming everyone has equal access to and knowledge of how to prepare healthy meals Examples: • Ignoring the existence of food deserts, the ubiquity of ultraprocessed foods, and accessibility challenges many individuals face • Assuming patients have available cooking appliances and/or the time and ability to prepare their own meals	Proactively seek education on the role of social determinants of health in nutrition and disease Routinely discuss nutritional knowledge and current barriers to health with patients Prioritize practical and affordable nutrition approaches for patients Examples: • “What’s your understanding of how food choices can affect your health?” • “What gets in the way of eating a diet you consider to be ‘healthy’?” • Familiarize students with resources (e.g. local food programs, myplate.gov recipes) to provide actionable approaches	If a patient’s nutrition is harming their health, you must understand the barriers they face before providing guidance Sometimes our patients need education, other times being pointed towards a resource (i.e., food banks with fresh fruits and vegetables), and at other points directions on food preparation. Providing a “one-size-fits-all” approach to nutrition education can alienate patients and fall short of addressing their needs
Reducing food to its biological functions to the exclusion of the social and cultural aspects of eating Example: Marketing slogans like the USDA’s “Make every bite count” [52]	Discuss the environments and communities in which our patients eat Examples: • “Who does the cooking in your house?” • “Who do you eat with?” • “Outside of nutrition, when or why else do you find yourself eating?” Recognize the social and connecting nature of eating within a person’s life and community Examples: • Leaving space for consumption of celebratory foods such as cake at a wedding or birthday • Increased risk for malnutrition in disconnected older adults	Feeding behaviors serve various functions outside of nutrition for individuals and cultures. A deeper understanding of the why, with whom, and when people eat can help physicians support patients in their values and goals

Avoid

Try this instead

Why?

Moralization of foods and food groups as “good” or “bad.”

Example: “heart healthy fats,” “good carbs,” “bad fats”

Discuss the macro- and micronutrients found in various foods, their digestion, absorption, and metabolism/storage, and the impacts of any one nutrient deficiency or excess

Understanding nutritional needs is essential to making plans or recommendations for patients’ health

A knowledge of foods’ nutritional content can help our patients meet their macro- and micronutrient needs in a variety of ways

Shaming or promoting certain types of food

Examples:

• Claiming organic produce or other expensive food items are necessary for health

• Shaming or dismissing canned foods due to sodium content

• Recommending or endorsing fad diets

If there is evidence that a food item promotes health better than a cheaper counterpart, share such evidence but acknowledge that not everyone has access to such foods

Recognize the importance of shelf-stable products for certain individuals. Suggest strategies such as draining and rinsing canned foods to reduce sodium content

Avoid promoting fad diets

Nutrition counseling must work within an individual’s life. If our guidance prioritizes perfection and shames what is accessible, we lose patients’ trust in our understanding of their circumstances and may cause patients to feel that healthy eating is not feasible

We should promote health by maximizing the nutritional value available to any given patient

Fad diets are usually not supported by robust evidence, may promote short-term, unsustainable changes, and may cause harm

Assuming everyone has equal access to and knowledge of how to prepare healthy meals

Examples:

• Ignoring the existence of food deserts, the ubiquity of ultraprocessed foods, and accessibility challenges many individuals face

• Assuming patients have available cooking appliances and/or the time and ability to prepare their own meals

Proactively seek education on the role of social determinants of health in nutrition and disease

Routinely discuss nutritional knowledge and current barriers to health with patients

Prioritize practical and affordable nutrition approaches for patients

Examples:

• “What’s your understanding of how food choices can affect your health?”

• “What gets in the way of eating a diet you consider to be ‘healthy’?”

• Familiarize students with resources (e.g. local food programs, myplate.gov recipes) to provide actionable approaches

If a patient’s nutrition is harming their health, you must understand the barriers they face before providing guidance

Sometimes our patients need education, other times being pointed towards a resource (i.e., food banks with fresh fruits and vegetables), and at other points directions on food preparation. Providing a “one-size-fits-all” approach to nutrition education can alienate patients and fall short of addressing their needs

Reducing food to its biological functions to the exclusion of the social and cultural aspects of eating

Example: Marketing slogans like the USDA’s “Make every bite count” [52]

Discuss the environments and communities in which our patients eat

Examples:

• “Who does the cooking in your house?”

• “Who do you eat with?”

• “Outside of nutrition, when or why else do you find yourself eating?”

Recognize the social and connecting nature of eating within a person’s life and community

Examples:

• Leaving space for consumption of celebratory foods such as cake at a wedding or birthday

• Increased risk for malnutrition in disconnected older adults

Feeding behaviors serve various functions outside of nutrition for individuals and cultures. A deeper understanding of the why, with whom, and when people eat can help physicians support patients in their values and goals