By Marika Sboros
It’s no real surprise that Big Food loves the Dietitians Association of Australia (DAA). DAA has quietly carved out close to a monopoly for its members on giving dietary advice to the public.
It regularly dishes up messages that feed Big Food’s interests and product sales. Critics say that it makes sense, then, that processed food and drink industries happily pay oodles of boodle to keep that monopoly going and messages flowing. They say that DAA’s self-regulated status makes it even more attractive to those interests. It means that DAA can pretty much do as it pleases and it does.
Yet there’s a downside to DAA’s cosy relationship with food industries. British obesity researcher Dr Zoë Harcombe has called it “sleeping with the enemy”. In a critique of conflicts of interest in her groundbreaking book, The Obesity Epidemic, What Caused it? How Can We Stop It?, she looks at the consequences. Harcombe was referring to the US dietetics fraternity. She could have been talking about DAA. In Part 3 of this series, Foodmed.net looks at why critics say that DAA may bitterly regret getting into bed with Big Food.
Uniquely Down Under, dietitians don’t fall under the Australian Health Practitioner Regulation Agency (AHPRA)’s jurisdiction. That’s because the government decided that dietitians pose “low-risk” to the public. However, DAA itself undermines that position regularly with attacks on specific diets as “dangerous”. In particular, it presents low-carb and Paleo diets as dangerous fads despite compelling evidence to the contrary.
Those messages align perfectly with the Australian government’s Guide to Healthy Eating. (Note the prominence given to grains, legumes and low-fat foods.) Consequently, critics say it should be renamed the Australian Guide to Unhealthy Eating. (UK nutrition specialist Michael Joseph created a low-carb version for balance. Scroll down below.)
Those messages put a big smile on food industry faces, including Big Sugar. All benefit massively from the Guide.
However, those messages undermine DAA’s credibility as a source of evidence-based nutrition information. That’s because DAA effectively suppresses or ignores effective, safe and cheap therapies to treat and prevent obesity, diabetes, heart disease and other serious diseases.
Recent research by scientists at Queensland University of Technology looked at industry influence on the country’s dietary guidelines. It suggested that nutrition professionals have “allowed” the industry to have more influence than it should.
One problem, critics say, is that Australian dietetics is a profession that has a medical effect but no medical regulation of standards such as AHPRA’s. DAA’s long-serving CEO Claire Hewat has said that DAA’s self-regulation is as good as, if not better than, that which AHPRA offers.
Critics say that if doctors behaved like some DAA dietitians – practising while taking money from industry – AHPRA would sanction them in a flash.
Of course, it’s also true that DAA is not completely unregulated. It must still answer to Australia’s national and state-based consumer laws. Consequently, these place DAA on the same legal footing as food industry corporations.
There’s also nothing in the country’s Corporations Act that says that DAA must operate in the best interests of Australia’s health – or even its members’ interests. Those are “discretionary decisions for DAA”, says a legal analyst. In other words, DAA is the only one who can slap itself on the wrist for not operating in those interests.
However, it’s complicated business assessing in whose interests DAA most often acts. One reason is its different member groups with vastly different interests. These include:
- Private practitioners;
- Government health workers;
- Celebrity practitioners, who some critics unkindly call media “tarts”;
- Practitioners with health foods/supplements on the side;
- Dietitians contracted/employed by food industry or drug companies;
- Dietitians employed by other not-for-profit organisations, many of which have ties to food or drug companies;
- Academics with careers, reputations and funding sources to protect so that they can do research.
The first two have less interest in pushing industry lines and more in the health of patients – or should have. For the rest, when DAA acts in Big Food’s interests, it acts in those members’ interests as well.
Critics say that to do that effectively, Hewat has created a fiefdom, which a weak board facilitates. One weapon that maintains that fiefdom is the Accredited Practising Dietitian (APD) certification process, which DAA created. This allows dietitians to use the title APD to register as a Medicare Provider. As well, their clients can qualify for government-funded Medicare rebates for APD services.
In this way, DAA has carved out a monopoly of sorts for its members, with ongoing industry collaboration. DAA readily admits that Nestlé is the country’s largest employers of APDs.
A DAA poster even describes APDs as “the only university-qualified experts who give advice on food and nutrition”. That statement didn’t go down well with the many other university qualified experts on food and nutrition.
However, the reality is that it is difficult for dietitians to run a viable private practice without an APD registration. It also means that at the stroke of a pen, DAA’s Board – and Hewat – can remove APD status from errant dietitians.
This usually leads to a dramatic decline in their business, as happened to one dietitian. (More on that in the final part of this series.) Thus, those are powerful incentives to dietitians not to cross DAA – and Hewat.
Retired Danish cardiologist Dr Torben Glud is one of many doctors globally who disagrees with dietitians having any sort of monopoly on dietary advice. Doctors must speak to their patients about diet, says Glud, who is also an internal medicine specialist.
Both doctors and dietitians should have updated, evidence-based nutrition guidelines, he says. As well, food and drug industries should have “no influence on education and training of doctors and dietitians”. The problem is that food industry still “heavily influences” the education of dietitians, Glud says.
Some dietitians are trying to distance themselves from DAA’s industry links. For example, Fiona Willer launched the Society for Australian Independent Dietitian-Nutritionists (AIDNs) in early December 2016. The initiative includes a registry of “independent” nutrition professionals.
Willer is careful not to antagonise DAA or Hewat. She calls herself a “proud DAA” member and says that AIDNs’ work complements rather than competes with DAA.
Of course, DAA is not alone in facing ongoing criticism over food-industry links. The British Dietitians Assocation (BDA) is similarly conflicted. Medical journalist Jerome Burne wrote about BDA’s conflicts in Cuddly dietitians in cosy embrace of industry fat cats.
“Quite simply, the industry is running rings round the dietitians,” says Burne. It’s the reason that years of trying to get meaningful changes that would significantly improve the nation’s health have achieved little.
“Declarations of interest by individual researchers are obviously important,” Burne says. “However, once you get on some board or committee you probably shouldn’t have any commercial links at all.”
In South Africa, the Association for Dietetics in SA (ADSA) is under similar ongoing scrutiny. Consumer activist Sonia Mountford asked blunt questions: Can you trust dietitians who are in bed with Big Food? and Why Does Big Food Love Dietitians Quite So Much?
New Zealand registered dietitian Dr Caryn Zinn says that all dietetics organisations globally have been or are in bed with food industries.
“Many of these organisations may not have fully realised how compromising the relationship is,” Zinn says. At least, not until critics turned on the heat and applied close scrutiny.
She also believes that DAA is working towards more “whole food” sponsorship. For evidence, she cites the Egg Council, avocado and almond boards, and Meat & Livestock Australia that are now DAA sponsors.
Zinn gave evidence at the trial of South African scientist Prof Tim Noakes in October 2016 for his views on LCHF diets to treat obesity, diabetes and heart disease. Click here to read why Noakes has chosen to go on trial.
Zinn told the hearing that it is unethical for dietitians who know about LCHF not to advise it to patients.
US dietitian Andy Bellatti is co-founder of Dietitians for Professional Integrity, which advocates for responsible, ethical sponsorship within the Academy of Nutrition and Dietetics. He dismisses DAA’s “change from within” argument for corporate partnerships.
“It’s a well-documented food-industry tactic to promote products through seemingly objective experts – usually doctors, nutritionists, and dietitians,” says Bellatti. “Research demonstrates time and again that financial conflicts of interest often result in biases that tend to favour the sponsor.”
Bellatti says that producers of seemingly unhealthy products, such as corn chips or sweetened yogurts, take a “nutritionism approach”.
“They employ nutrition experts to highlight one aspect of the produce, such as fibre in corn chips or the calcium in yogurt,” he says. This deflects attention from legitimate health concerns about added sugars or high levels of processing.
Researchers have said for years that food companies’ involvement with dietitians’ groups is not altruistic. They say that companies use these professionals to add a veneer of respectability to their products.
It’s called “health washing”, “health by association” or the “halo effect”. Researchers say it’s a dirty activity aimed at increasing sales and profit margins. They say that Coca-Cola has taken health washing to new heights with “astroturfing”. That’s the term for creating an impression of widespread grassroots support for a policy, individual, or product, where little such support exists.
Bellatti says that most international dietitian associations believe that sitting at the table with industry is the most effective way to bring about change. History, however, shows otherwise.
“Usually, sitting at the table with industry means that industry sets the table, chooses the menu and leaves the health organisation with the bill – and its reputation in tatters,” he says.
“It makes more sense to sit at the table with entities who have the same goals. At the end of the day, a company that makes most profit selling soda simply does not prioritise public health in the same way a nutrition organisation does – or should.”
The current paradigm – of dietitians’ groups in bed with Big Food – exists because it has become the norm, Bellatti says.This is not about conspiracy theories or “evil people”, he says. Rather, it is the sociopolitical reality.
“The food industry actively battles public health policy with its lobbyists and deep pockets. Why would a health organisation think that an industry that spends millions of dollars obstructing nutrition labeling and regulations on marketing to children is a suitable partner?”
Dietitians undergo significant schooling and training to receive their credential. Society needs to acknowledge and respect that, he says It’s also true that most doctors get few hours of nutrition in their curriculums.
Consequently, dietitians need to keep an eye out for other well-trained, well-educated health professionals as partners.
“Chefs, health coaches, and other health professionals bring skill sets and perspectives that can help support and supplement the work that dietitians do,” Bellatti says.
Click here to read: WHY SO MANY DIETITIANS HAVE ‘HITS’ SYNDROME
State University of New York cellular biology professor Richard Feinman says that health agencies are supported by all kinds of funding sources.
Feinman believes that DAA’s unscientific opinions and poor understanding “do not appear to be due to corruption”. Rather, these may fall under Hanlon’s Razor rule:
“One should not invoke malice until one has excluded stupidity.”
Thus, whether it’s undue influence or stupidity, it may not be a wise consumer decision to follow “DAA’s way” when pursuing dietary and medical health goals.
- Coming up in Part 4: The perils of crossing DAA – and CEO, Claire Hewat
- Part 1: Is DAA really in bed with Big Food?
- Part 2: DAA talking heads: time for new conversation?
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- Foodmed.net submitted questions in lengthy emailed correspondence with DAA’s national office last year. DAA cut off contact in December 2016.