Anti-Diet Movements and Big Food: Real Talk from Expert Registered Dietitians

On April 3, 2024, the Washington Post published an article about the relationship between big food, anti-diet approaches, obesity, and Registered Dietitians (RDs). The authors claim that “anti-diet” RDs are discouraging weight loss efforts across the American public. They suggest this benefits Big Food’s profit margins and the RDs’ own wallets through sponsored post kickbacks. Unfortunately, the article relied more on sensationalism and fear mongering than on a balanced presentation of facts and evidence. We’re here to provide some real talk about anti-diet movements and big food, backed by research, and based on our extensive patient experience.

The Real Story

Let’s start with some definitions and context. 

What is Big Food?

“Big Food” refers to major food corporations in the United States, including companies like General Mills, Nestle, Kraft, Kellogg’s, Post, PepsiCo, and Coca-Cola. Many foods associated with these brands are processed or ultra-processed, often containing higher levels of sugar and salt. These ingredients can lead to negative health outcomes, like heart disease and diabetes, when consumed in excess.

However, current evidence shows that consuming these foods in moderation does not negatively impact most people’s health. Sodium and chloride, the minerals that make up table salt, are essential for our bodies to function. Avoiding or restricting certain foods outside of medical reasons–as one would do on a trendy diet–can increase the urge to binge or overeat, leading to frequent weight fluctuations and negative health outcomes.

Working toward a balanced eating pattern that includes whole grains, fruits, vegetables, protein, and yes, processed and even ultra-processed foods, can help repair your relationship with food. It can also reduce weight fluctuations and improve your overall health. More on this below!

Why is Big Food Controversial? And What Role Do RDs Play?

Big Food has historically prioritized profits over people, using food science and marketing to increase the public’s intake of their products. These companies have taken legal action against public health laws aimed at reducing sugar and salt intake to maintain their profit margins. They have even funded research studies that skew results to downplay the health impacts of certain ingredients.

Luckily, RDs are trained to independently evaluate foods and make informed recommendations for their patients and the public. RDs who provide evidence-based care are unlikely to recommend extremes in either direction, such as a strict diet of kale and tuna or a Twix and Cheetos only eating pattern. They critically assess scientific literature, focusing on rigorous studies to inform their recommendations. RDs also learn to identify who funds the research they review and assess for conflicts of interest.

What is the Anti-Diet Approach? Is It Beneficial or Harmful?

It’s unfortunate that the food industry “capitalized” on movements to address the pervasive shame and stigma around food and body. However, suggesting that dietitians cannot use these counseling approaches ethically is irresponsible at best and actively damaging to the mental and physical health of countless people at worst. The article’s limited exploration of how nutrition professionals implement these frameworks is alarming and misleading. Equally misleading is the interchangeable reference to “influencers” and “registered dietitians.” We aim to rectify these oversights for our community.

The terms and approaches cited in the article—Anti Diet, Intuitive Eating, Health at Every Size, and food freedom—are concepts and counseling frameworks. They center our relationship with food and body in conversations about health and wellness.

What is “food noise”, and how does it affect you?

Did you know that you have a relationship with food? This idea might seem abstract. A concrete example is the “food noise” often discussed with GLP1 Receptor Agonists like semaglutide and tirzepatide (Ozempic, Weygovy, Mounjaro, and Zepbound). “Food noise” refers to the ongoing internal monologue many of us experience around food. It includes thoughts about whether to eat, when to eat, and what to eat. For many, these thoughts become intrusive, occupying significant time and energy, and cannot be easily “turned off.”

GLP1-RAs address this by reducing hunger cues and altering dopamine signaling in the brain, which registers and seeks rewarding experiences. RDs often achieve similar results by exploring the context and content of a patient’s “food noise” and providing tools to shift their internal monologue. We leverage concepts from intuitive eating and anti-diet frameworks as part of this work. For countless patients, removing the shame and guilt around enjoying foods considered “bad” or “off limits” unlocks their ability to achieve a consistent, healthful eating pattern.

The Anti Diet Framework as a Viable Alternative

The Anti-Diet framework does not reject the evidence-based principles that underpin nutrition concepts. Instead, it rejects the culture that developed around them. It offers an alternative to the long-standing discourse that favors rigid rules and restrictions, which have not served many patients well. Years of restriction have left some people unable to identify and respond to their internal hunger cues. Black-and-white thinking about the “right” way to eat makes them more susceptible to extremes in behavior. Significant restriction of calories or certain foods for a period often leads to deviations from that strict routine.

In this framework of “good” or “bad” foods, there is no template for integrating “taboo” items into a balanced eating pattern. What follows is that most people experience dysregulated eating behavior and a regression in previously established healthy habits. We sometimes call this a binge/restrict cycle, or yo-yo dieting. In these cases, skilled registered dietitians use principles of Intuitive Eating or Anti Diet frameworks to help patients create a neutral internal monologue and a more flexible approach to feeding themselves.

Scientific literature and the combined experience of 70+ RDs on the Culina Health team support using education, empowerment, and patient buy-in for positive health benefits. They prioritize these over using shame, guilt, and fear as behavior change motivators.

What the Research Says About Balanced Eating Patterns

Chavkin and his colleagues also failed to convey that these approaches can be used alongside education on balanced eating patterns and nutrition recommendations for preventing and managing chronic disease. This includes nutrition therapy for the conditions the authors purport to be so concerned about like diabetes, and heart disease. The Scientific Report of the 2020 Dietary Guidelines Committee backs the use of an overall healthy eating pattern that limits, but does not necessarily exclude, nutrients like saturated fat, sodium and added sugar.

This is an unfiltered literature review by experts in the field before government agencies and special interest lobbies get their say. Nutrition guidelines from medical organizations like the American Diabetes Association, American Heart Association and the American College of Cardiology echo this idea, supporting eating patterns that limit, but do not necessarily exclude, the “nutrients of concern” we tend to find in highly processed foods.

How We Work With Patients To Develop Balanced Eating Patterns

It is factually true that our patients can enjoy some of their favorite baked goods or packaged snacks while eating in a way that is associated with decreased risk of heart disease, kidney disease, diabetes, Alzheimer’s disease, and certain cancers. When patients are able to assess their food choices objectively, without a cloud of judgment and fear hanging over them, they often do a better job of striking the right balance. Ironically, this article embodies the sensationalized media coverage of nutrition news that creates more barriers to the health behaviors it is presumably trying to promote.

Using an anti-diet approach is in no way an endorsement of the food industry’s current practices. Registered dietitians are simply trying to help patients optimize their health in our current food environment. We do not live in a research study, or the ivory tower of academia. We live in the real world. Here, in the real world, there is sugar sweetened cereal. There are foods that bring us joy, foods that connect us to our culture and our loved ones and our childhood – some of these foods are nutrient dense; some feature sugar and palm oil and a host of other ingredients you wouldn’t find in a home kitchen. Shunning the approaches that allow our patients to integrate all of these foods into a sustainable healthy eating pattern here in the real world would be short sighted indeed. 

What About Weight?

This article shows lack of insight by insinuating that we cannot discuss health behaviors without discussing weight. The conversation about the role of weight and weight management in health promotion is not as one-sided as it once was. There is too much evidence on the impact of internalized weight stigma on mental and physical health to ignore. At the same time, we are starting to see papers illuminating the ways in which health behaviors confer benefits independent of promoting weight loss.

This is an admittedly controversial topic that warrants its own write up. For now, suffice to say that weight is not a positive motivator for many patients, and those patients are able to achieve the most consistency with health behaviors when they shift focus away from the scale. Mounting evidence supports weight neutral approaches to nutrition care as non-inferior to structured weight loss programs – meaning we can use them when needed without putting anyone’s health on the line.

Big Food and Registered Dietitian Influencers

So is Big Food Capitalizing on the Anti-Diet Approach?

Of course! Based on the above, it should not be surprising that Big Food would see the potential financial benefit of leaning into the anti-diet approach and developing partnerships with influencer RDs in order to sell their products. Industry is the original influencer afterall. Big Food has also increased their production of lower added sugar and lower sodium foods because of demand. They go where the money is. Does that reduce the value of an anti-diet approach? No. 

But is Your RD Receiving Kickbacks from Big Food at the Expense of Your Health?

Probably not. Firstly, the majority of RDs are not influencers. 

It is critical to point out that the authors reviewed social media posts from a mere 68 RDs for their analysis. This represents 0.06% of the field based on the Academy of Nutrition and Dietetics registry statistics indicating that there are roughly 112,000 Registered Dietitians in practice. Furthermore, the article cited that 10 RDs promoted General Mills cereals, which is representative of 0.009% of the field. As for RDs who attend FNCE? About 7% of the field attends each year. That is all to say the authors were not thorough in their analysis and failed to include the majority of RDs working in the field in their article. If they had, perhaps they would have told a very different story–one of hard-working clinicians focused on improving the lives of their patients; not just creating sponsored content posts and waiting for their kickbacks to roll in. 

But what if my RD IS an influencer? 

You’re probably fine. Here’s why: 

RDs are trained to assess food products and are bound to a code of ethics that prevents them from making harmful recommendations. Helping support the public in achieving a more neutral relationship with food after decades of “eat this, not that,” “low fat,” “high fat,” “no fat” is not a harmful recommendation.  If an RD seems to be pushing for a specific food brand or supplement and is unable to discuss alternatives, that may be a red flag. Otherwise, recommending specific food products that align patients’ physical and mental health needs is part of our job.

What if I follow RD influencers because I enjoy their content?

Great! Enjoy their recipes and recs if they align with your goals! As with all things on the internet, proceed with caution and avoid taking generalized health recommendations. If you are thinking about making dietary changes, it is best to implement these modifications with the support of an experienced clinician – even a vegan or keto diet can go sideways if your sole source of information is an internet influencer. 

Concerned about which RDs are popping up on your socials? A Culina Health RD can help you determine who deserves a spot on your feed. 

If we are going to discuss industry affiliations, it bears mentioning that one author of the article in question penned a book for the Lose It! phone application, selling their weight loss method. So a journalist railing against registered dietitians for receiving personalized boxes of cheerios (which, by the way, is a whole grain cereal with minimal added sugar) has himself profited from the $10 billion diet and wellness industry. An industry which is in large part responsible for the tortured relationship with food we now see in many patients. Of note, the book recommends strict calorie counting, which is not an evidence based approach for long-term sustainable weight loss.

The Bottom Line

To the authors of the Washington Post article and any interviewed:

We invite you to come and speak with us if you would like to ask any follow up questions, or experience quality nutrition care first hand (your first sessions are on the house).

To our patients:

Please rest assured that your wellbeing is the driving factor in everything that we do. You have trusted us with your health, and we don’t take that lightly. You can continue to expect compassionate, evidence based care from us.

To our Registered Dietitians:

We see your tireless commitment to your patients, and the genuine joy you feel when they are successful. We see the effort you put into staying updated on current evidence to ensure your recommendations are safe and effective. It’s a true honor to work with you.

To everyone else in our community, and anyone who has made it this far:

When a large segment of nutrition professionals who discuss eating behaviors with people day in and day out tell you we need to re-think the public discourse on food and nutrition – please hear us. Engage us in dialogue if you have questions. Everything we do is to help people live life to its well-nourished, delicious best.

About the Authors

Elizabeth Tallerico, MS, RDN, CDN, LDN

Elizabeth Tallerico is the VP of Clinical Care Delivery and Research at Culina Health, specializing in GI disorders, sustainable weight loss, disordered eating, maternal health, pre-diabetes management, cancer prevention, and nutrition for longevity. She is deeply passionate about empowering dietitians to take their place on the frontline of healthcare, and advocates for diversity in the field, reducing barriers to entry for registered dietitians in underrepresented groups.

Elizabeth received her Master’s degree in Clinical Nutrition from New York University and completed her clinical training at Montefiore Medical Center in the Bronx. Prior to her work at Culina Health, she served as inpatient dietitian at Montefiore and worked as a research assistant at Roswell Park Cancer Institute in Buffalo, New York. She has appeared as a featured speaker at Montefiore Medical Center and New York University, and regularly leads professional development programs in nutrition.

Melissa Alazraki, MS, RDN, CDCES

Melissa Alazraki is the Director of Clinical Care Delivery at Culina Health, and a certified diabetes care and education specialist. Her primary specialties are diabetes and heart disease. She approaches nutrition from a weight-neutral perspective and works to help patients better understand their bodies, navigate health obstacles, and find ways to meet nutrition goals in a realistic way that centers their quality of life and enjoyment of food. Melissa is a passionate advocate for patient empowerment, an approach that centers the agency and dignity of each person in their healthcare journey. 

Melissa completed her MS in Clinical Nutrition at New York University. Prior to her work at Culina Health, she worked in acute and ambulatory care at New York Presbyterian Hospital and NYU Langone Health. She has spoken at conferences held by NYU Langone, the American Heart Association, and the Juvenile Diabetes Research Foundation, among others. She has also been a nutrition expert in media outlets like Healthline, Sirius Radio, and more.