January 2021 Issue
Shaping Better Nutrition Messages
By Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND
Today’s Dietitian
Vol. 23, No. 1, P. 36
Today’s Dietitian provides expert strategies for communicating effectively and setting the record straight about misleading claims.
While teaching a nutrition class to pregnant women, the dietitian advised them to eat a rainbow of fruits and vegetables. When these women reassembled as a group 30 days later, the RD was surprised by some of the responses she heard when she asked the participants about their experiences with eating the rainbow.
One woman reported saving money by not buying white onions since they didn’t seem to fit the criteria of a fruit or vegetable included in the colorful rainbow. Another woman said she bought purple grapes even though they were more expensive and not as tasty as the green ones. She already had green produce in her shopping cart, but nothing purple, she said. A third woman explained she purchased fruits and vegetables she had never tried before and was happy that her family found some new varieties they liked.
It was clear by the responses that the dietitian’s single directive had yielded many interpretations.
When it comes to getting nutrition messages across, it’s not enough for dietitians to be content experts. RDs need a variety of communications skills tailored to many different audiences, says Barbara Mayfield, MS, RDN, FAND, editor of Communicating Nutrition: The Authoritative Guide. All the nutrition knowledge and expertise in the world won’t help anyone if the knowledge isn’t communicated in a way the intended audience will interpret correctly and understand, Mayfield says.
What follows are strategies nutrition professionals can employ to improve the way they communicate nutrition messages, and ways to address misleading claims and incomplete messages about food and nutrition.
Know Your Audience
Your audience may be as small as one client sitting across from you in your office, or it may be thousands or millions of readers of your book or blog, or viewers of your YouTube channel. Effective communication is just that because it’s carefully designed for the audience. “We so often speak to ourselves,” Mayfield says.
Knowing whom you’re speaking to means understanding your audience’s priorities, backgrounds, problems, desires, and needs. Even in a TV segment, individuals in vast audiences viewing from home can resonate with some or all of the message, Mayfield notes.
To learn who your audience is, consider its culture, socioeconomic status, literacy level, health beliefs, living situation, cooking skills, health status, and more. Cultural differences may include sense of humor, gestures that are appropriate or inappropriate, gender biases, and other factors. All of these things influence the way individuals receive messages.
Words that describe food categories may be especially problematic for people with low health literacy or those with different cultural backgrounds, says New York–based Lorena Drago, MS, RDN, CDN, CDCES, an expert in diabetes and multicultural nutrition education. “Poultry and whole grains are examples of category words that need to be explained to ensure understanding,” she says. When talking about poultry, be clear by saying “poultry such as chicken and turkey,” and, when discussing whole grains, identify them by saying “whole grains such as brown rice, oats, and whole wheat bread,” Drago adds.
Be a Listener
“I love the expression, ‘You have two ears and one mouth for a reason,’” says Long Island, New York–based dietitian Bonnie Taub-Dix, MA, RDN, CDN, the award-winning author of Read It Before You Eat It, creator of the website and blog BetterThanDieting.com, and director and owner of BTD Nutrition Consultants, LLC, and @BTDMedia on Instagram.
Listening is the best way to learn about an audience’s needs and frame of reference, Taub-Dix says. When working one on one or in small groups, it’s important for dietitians to ask the right questions and clarify the clients’ understanding. And she says RDs should be careful to not make assumptions. For example, a dietitian may be counseling an individual with obesity who came to the visit to learn about diet for ulcerative colitis or gastroparesis. In this case, Taub-Dix urges dietitians to not assume the client wants or will be receptive to weight loss advice.
Know Yourself
Before dietitians can begin to understand how to communicate to their audiences, they must know themselves, says Jodi R. Pfarr, coauthor of The Urgency of Awareness. “Our personal identities and experiences give us certain perspectives,” she explains. “We all see and navigate the world differently because of our experiences. One experience isn’t better or worse [than another]. They’re just different.”
A key to connecting with an audience, she says, is understanding how our experiences have shaped us and being open to hearing about the perceptions and experiences of others.
Pfarr leads workshops to help individuals and organizations develop practices to help people with differing backgrounds and identities engage and communicate effectively. Participants explore the ways in which society typically normalizes one thing over another, such as right-handedness over left-handedness. Pfarr explains that most right-handed people don’t notice how society normalizes their experience because they’ve never had to think about it. Yet left-handed people know all too well that school desks, scissors, can openers, guitars, and much more aren’t made for them.
“If you’re part of a group that’s normalized, it can be difficult to recognize the benefits you have,” Pfarr says, adding that exploring one’s own experiences and the privileges they receive from having normalized identities will help RDs communicate with people who don’t share their identities.
Pfarr shares 10 examples of the 18 identity categories she includes in her workshop and book. In each example, the normalized group is listed first.
1. Right-handed vs left-handed
2. Male vs female or intersex
3. Middle class to upper class vs underclass, working poor, or impoverished
4. White vs of color
5. Formally educated vs informally educated
6. Employed vs unemployed or underemployed
7. Christianity vs all other religions and no religious identification
8. Married vs single, partnered but unmarried, divorced, or widowed
9. Able-bodied vs persons with physical disability
10. Formal English vs informal English or a language other than English
Pfarr asks readers and workshop participants to acknowledge their own identities and explore the benefits they experience when they’re part of a normalized group. Consider that those who aren’t in the normalized group may feel discriminated against and accustomed to having their voices go unheard.
The next step for dietitians is to use this newfound knowledge to be inclusive in their nutrition messaging. A female dietitian who’s married and middle class who has never lived in poverty may need to use extra effort to understand the needs and circumstances of a single mom who’s underclass and informally educated. The client’s primary focus may be to get the family fed, whereas the meal’s nutritional value may be more important to someone who expects food to always be available.
Pfarr urges professionals to avoid making assumptions about someone’s access to healthful food, the time they have to buy and prepare meals, and the energy available for planning and preparing balanced meals. In addition, she says not to assume your priorities are their priorities. People of lower socioeconomic status and other nonnormalized groups often have more immediate threats than disease prevention.
“To help people make diet changes, it’s important to show that you understand their lives,” Pfarr says. For example, emphasizing that good nutrition can help a person better care for children and elders is likely to be more effective for the client struggling to pay bills than saying good nutrition can help prevent heart disease later in life.
Be Inclusive
If hosting a food demonstration in an upscale grocery store, RDs may assume their audience has a well-equipped kitchen. Using a garlic press, hand juicer, and other small kitchen tools is fitting. But if the dietitian is hosting the demo on a morning television show, he or she will reach more people by choosing words and examples that are more inclusive, Mayfield says. For instance, they should use a generic brand of canned tomatoes or empty the tomatoes into a glass dish to avoid showing the brand name. And if they use a garlic press and hand juicer, they should include tips on how to crush garlic or squeeze juice from a lemon without those tools.
Developing a TV segment is especially challenging, Taub-Dix says, because dietitians have only one opportunity to get their message across. “Dietitians on TV need to be clear, concise, and inclusive because they don’t get a second chance to explain themselves,” she says.
Misunderstood Messages
As part of employing strategies to effectively communicate nutrition messages, dietitians must learn how to address misleading claims or incomplete messages about food and nutrition that often prevent individuals from getting all the nutrients they need to live a healthful life. And this often starts in the supermarket.
An example of an incomplete message is to shop only the perimeter of the store. Taub-Dix agrees that “the perimeter of the store carries treasures such as produce; protein-rich foods like meat, fish, and poultry; and a variety of milks, but that doesn’t mean consumers shouldn’t also make the most of the middle aisles, where they’ll find beans, nuts, and pasta, to name a few.”
Yet, many shoppers hear this nutrition sound bite and assume the center aisles of the supermarket contain only unhealthful foods. A clearer message identifies wholesome choices in various parts of the supermarket.
The following messages are what experts identify as potentially misleading or off-putting to consumers:
• Avoid sweetened beverages. Drago discourages dietitians from using this general message. She urges RDs to be more specific by saying something such as, “This means not drinking sodas like cola and ginger ale, [presweetened] iced teas, and fruit drinks. Diet sodas are OK to drink.”
• Eat a rainbow of fruits and vegetables. While this message is meant to conjure up a colorful image that encourages consumers to eat a wide variety of fruits and vegetables, it turns off many struggling with food access.
“Some people are going to hear that and think it’s a pretty uppity statement,” Pfarr says, noting that many people live where there’s no rainbow of fruits and vegetables available. It’s better to encourage individuals, readers, and listeners to “eat as many types and colors of fruits and vegetables as you can and have available,” she explains.
A second concern with this message is that many take the rainbow concept literally and choose to avoid white and brown produce such as bananas, onions, mushrooms, and cauliflower.
• Eat whole grains. Consumers often interpret this message to mean that refined grains are bad and shouldn’t be eaten. “Avoiding cereals and other refined grains that are fortified with folic acid can be dangerous for women of childbearing age,” says Yanni Papanikolaou, MPH, a nutrition research scientist with Nutritional Strategies, Inc, in Toronto, Ontario, Canada. “Since the mandatory fortification of certain grains in 1998 by the FDA, we have seen a significant decline in babies born with neural tube defects. Researchers have found that since folic acid fortification, approximately 1,300 babies are born each year without a neural tube defect who might otherwise have been affected.”
Papanikolaou’s own modeling research using US National Health and Nutrition Examination Survey data shows that eliminating enriched and fortified grains from the diet would increase the number of adults falling short of the folate recommendation from an already disappointing 28 million to 111 million. “Think twice about eliminating cereals from your diet if you are thinking of having a baby,” he says.
• Don’t waste food. This tidbit has the tendency to support overeating, warns Sharon Palmer, MSFS, RDN, an author and plant-based nutrition and sustainability expert based in Ojai, California, known as The Plant-Powered Dietitian. “Not wasting food is a really great cause to reduce the environmental impact related to our food system, but exceeding your energy needs is actually a form of food waste,” she says.
Palmer recommends dietitians offer specific examples to common messages to facilitate learning. For example, she suggests reminding audiences to store leftovers, share food with others, and buy only the amount they need.
• Avoid processed foods. “Processed foods are certainly misunderstood,” says Dana Angelo White, MS, RD, ATC, a nutrition consultant, certified athletic trainer, and author of several cookbooks, based in Fairfield, Connecticut. “People seem to be programmed to think all processed foods are bad but most likely can’t indicate how or why. Jumping to the conclusion that all processed foods should be avoided might mean you are missing out on some healthful and convenient foods—and the nutrients they offer. Frozen fruits and veggies, canned tuna, cheese, and nut butter all undergo various types of processing but are foods everyone can benefit from eating. On top of being delicious, these processed foods are often affordable and easy to prepare.”
Instead of categorizing foods as processed or unprocessed, dietitians can teach consumers how to assess the nutrient value of foods through label reading. Furthermore, Pfarr warns that telling rushed or overwhelmed people or those living in poverty to avoid processed foods may make them feel as if they’re being dismissed or blamed for their choices. They may conclude that the dietitian simply doesn’t understand their life circumstances and has little to offer them.
• All carbs turn into sugar. “It’s very frustrating to continue to see carbs demonized,” White says. “Everyone from older adults to college students seem to believe that the goal should be eating as few carbs as possible. While this may lead some to cut excessively large portions of pasta or encourage skipping a morning donut, they are also shunning whole grains, potatoes, and fruit, which hurts their energy levels, fiber intake, and more.”
A clearer message is to choose wholesome carb-rich foods such as fruits, oats, and lentils over others such as candy and donuts.
• Eat plant-based. This directive is quite ambiguous. According to the International Food Information Council (IFIC) Foundation’s 2019 Food & Health Survey, approximately one-third of respondents believe a plant-based diet to be 100% vegan, and another 20% believe a plant-based diet is vegetarian. Comparatively, only slightly less than 40% believe a plant-based diet includes animal products, yet plant-based frequently is used to describe a diet that includes more plant than animal products.1
In a separate IFIC survey conducted in December 2019, when comparing the Nutrition Facts labels and ingredients lists for a plant-based meat alternative with 100% ground beef, 40% of respondents viewed the plant-based meat alternative as more healthful even though it was higher in calories, saturated fat, and sodium, and lower in protein per serving and contained more than a dozen ingredients compared with beef’s single ingredient.2
Kris Sollid, IFIC’s senior director of nutrition communications, says this conclusion may stem from a perception that plant-based foods in general are superior to animal-based foods. Or perhaps the long list of micronutrients voluntarily identified on the Nutrition Facts panel of the plant-based meat alternative skewed respondents’ views. It’s worth noting that the beef was higher in cholesterol and lower in fiber.
Palmer is concerned that the message to eat plant-based may ignore the need to carefully select wholesome foods. “There are plenty of junk foods that are plant-based,” she says, “such as soda, chips, and candy. A recent study found that the quality of a plant-based diet is more important than just eating plant-based. A poor-quality plant-based diet was linked to no benefit compared with an average diet, but a high-quality plant-based diet was linked to significant benefits.”
Sollid notes that because there’s no commonly accepted definition of a plant-based diet, confusion likely will continue. By taking the time to examine their messages, social biases, and possible misinterpretations, dietitians can help their audiences understand and act on sound nutrition advice.
— Jill Weisenberger, MS, RDN, CDCES, CHWC, FAND, is the author of four books, including Prediabetes: A Complete Guide. She is a freelance writer and a nutrition and diabetes consultant to the food industry. She feels fortunate to have been a participant in one of Jodi Pfarr’s workshops during a partially sponsored conference.
References
1. International Food Information Council Foundation. 2019 Food & Health Survey. https://foodinsight.org/wp-content/uploads/2019/05/IFIC-Foundation-2019-Food-and-Health-Report-FINAL.pdf#page=30. Published 2019.
2. International Food Information Council. A consumer survey on plant alternatives to meat. https://foodinsight.org/wp-content/uploads/2020/01/IFIC-Plant-Alternative-to-Animal-Meat-Survey.pdf. Published 2020.
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Do Your Research
In addition to spending time with your intended audience and asking probing, nonjudgmental questions, Barbara Mayfield, MS, RDN, FAND, and Melissa Joy Dobbins, MS, RDN, CDCES, say dietitians can learn about the people with whom they want to communicate in several ways, such as the following:
• Review free resources on the website of aha! Process, Inc (ahaprocess.com) to learn about living in poverty.
• Survey your group before a speaking engagement or before developing educational materials.
• Conduct a focus group.
• Before a media interview, ask your contact about audience demographics and concerns.
• Survey your podcast or blog audience to learn about their professions, interests, gender, and more.
• Test your message with a few people who are similar to your target audience. Ask what the message means to them and whether it resonates. Revise and retest your message.
• Pay attention to listener and reader feedback and speaker evaluations.
— JW