Currently browsing posts about: Personal-responsibility

III.  Personalized, as opposed to Public Health, Nutrition

Stephanie Rogus, a former doctoral studentt in my NYU department, and Peter Lurie, director of the Center for Science in the Public Interest, have a new paper out: Personalized nutrition: aligning science, regulation, and marketing. Health Affairs Scholar, Volume 2, Issue 9, September 2024, qxae107, https://doi.org/10.1093/haschl/qxae107

Proponents of personalized nutrition assert that population-based approaches to dietary recommendations have had limited impact because they have failed to take interindividual differences into account. Proponents argue that increasing or reducing consumption of particular foods in response to the results of a survey or diagnostic test allows for the development of more personalized and, it is argued, more effective recommendations.

Their paper does not deal with the flaws in individualized approached to nutritional health—“precision” nutrition: the cost, the difficulty, the lack of support, the inability to reach those who most need support, etc.  Instead, it focuses on the commercialization of personalized nutrition:

regulatory gaps have led to market growth of products with unknown efficacy that are making bold, and possibly unsubstantiated, claims. As personalized nutrition products and related treatments continue to enter the market without regulation, unreliable products may cause consumers financial, psychological, and physical harm. Stronger regulation will help engender trust in these products among consumers and ensure their safety and effectiveness.

Hard to argue with that.  Glad they wrote it.

I’m getting caught up on my journal reading and just ran across an editorial from The Lancet, January 21.  It takes on the UK government’s “personal responsibility” approach to health promotion based on the idea that

gently ‘nudging’ people to change their unhealthy behaviours was the key to public health.

Even the UK government has to admit that the nudge approach isn’t working.  Now it is telling physicians in the National Health Service (NHS) to nag:

use every contact with patients and the public to help them maintain and improve their physical and mental health and wellbeing.

The Lancet asks:

Is this a realistic, sensible, and effective recommendation? We would say not.

Effective, evidenced-based public health measures do not include nudging people into healthy behaviours or getting NHS staff to lecture patients on healthy lifestyles.

They include measures such as raising taxes on cigarettes, alcohol, fatty foods, and sugary drinks, reducing junk food and drink advertising to children, and restricting hours on sale of alcoholic drinks….Focusing on other approaches is foolish.

The nudge and nag approaches need one thing: the firm elbow.

USDA economists have just produced a theoretical study proposing – surprise! – that knowledge of nutrition is not sufficient to change dietary behavior. What they call “immediate visceral factors” (i.e. hunger, food in front of you, large portions) overpower “cognitive dietary information.” They don’t put it this way, but that’s why personal responsibility doesn’t work. You have to change the food environment to make it easier to make better choices. It’s nice to have some evidence….