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O RIGINAL ARTICLE

C. F ISCHLER The nutritional cacophony may be detrimental to your health

PROGRESS IN NUTRITION Summary VOL . 13 , N. 3, 217-221, 2011 Contemporary societies live in a growing cacophony of health and nutri - tion news, advice, opinions, beliefs and recipes. This cacophony tends to TITOLO raise the level of anxiety, yet there is no evidence that it can bring about La cacofonia nutrizionale può significant health benefits. In the developed world, health policies have essere dannosa per la salute been governed more often than not by implicit assumptions which are discussed and criticized. The role of social and cultural dimensions in KEY WORDS and eating patterns is discussed and some novel directions for re - Health news coverage, policies, search are suggested. In particular, the paper hints at the need for com - prevention, comparative approach, parative approaches between similarly developed countries and the pos - Western diets, social cultural, sible positive role of social-cultural factors such as commensality or cer - eating patterns, time use, tain forms of it. commensality, , UK, US Riassunto PAROLE CHIAVE Le società contemporanee vivono in una cacofonia crescente di notizie, Copertura delle notizie sulla salute, consigli, opinioni, credenze e ricette sulla salute e sulla nutrizione. Ques - politiche, prevenzione, approccio ta cacofonia tende ad aumentare il livello di ansia ma non vi è alcuna comparativo, diete occidentali, prova che possa portare significativi vantaggi per la salute. Nel mondo cultura sociale, abitudini sviluppato le politiche sulla salute sono state regolate il più delle volte da alimentari, uso del tempo, assunzioni implicite che sono state discusse e criticate. In questo articolo commensalità, Francia, è stato discusso il ruolo della dimensione sociale e culturale nel cibo e Gran Bretagna, Stati Uniti nelle abitudini alimentari suggerendo alcune nuove direzioni per la ricer - ca. In particolare il lavoro allude alla necessità di approcci comparativi tra i paesi similarmente sviluppati e il possibile ruolo positivo di fattori socio-culturali come la commensalità o alcune sue forme.

Centre , CNRS/EHESS, , France We live in a nutritional cacopho - with the alarming title «Is sugar Address for correspondence: ny. As I write these words, today’s toxic?» . The content is even more Claude Fischler, PhD New York Times prints a long arti - alarming; according to the author, Directeur Centre Edgar Morin, CNRS/EHESS, cle by one of the most prominent in addition to making people fat, 22, rue d’Athènes 75009, Paris, France science writers in the English the substance also causes the E-mail: [email protected] speaking world, Gary Taubes, «metabolic syndrome» and, via in -

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sulin resistance, may well cause ing obese passers-by from their of - Dr. Aragon: «Oh, yes. Those are the cancer as well (1). Before even fice window. One asks the oth - charmed substances that some years reading the paper, I had heard on er: «Why is it that the more di - ago were thought to contain life-pre - the radio that, «according to a re - etary information we give them, serving properties.» cent study», coffee capsules for the fatter they get?» If indeed such Dr. Melik: «You mean there was no espresso machines may also cause is the case, where do the virtual deep fat? No steak or cream pies or... cancer because of the amount of “hidden calories ” in the dietary in - hot fudge?» furane they contain. The same formation come from? Dr. Aragon: «Those were thought to newspaper reporting the news is My answer would be that they be unhealthy... precisely the opposite also likely to carry ads for various probably come, mostly, from a set of what we now know to be true.» weight loss methods and a chain of implicit assumptions. Dr. Melik: «Incredible!» of restaurants or confectionery The first one could be phrased Comically improbable as this fic - stores, a story on possible causes «current scientific knowledge is tional situation may be, almost for obesity, advice to protect your forever». Under this assumption, equivalent stories can be found in children against the “epidemic” one looks at the past, particularly the not-so-distant, real, past. Take and any number of “recipes for the distant past, from the height margarine. For decades, American health” . of an apparently definitive superi - cardiologists have been prescribing As the great physician and de - ority. A hundred years ago, or their patients to replace butter bunker of medical myths Petr even only fifty, admittedly, scien - with soft margarine, for the sake Skrabanek once wrote, «People tists and physicians believed in of polyunsaturated fat. Then came who eat die» (2). From reading the theories that were later proven the study from Holland showing inextricable mesh of advice, warn - wrong. But this was the past. Now that the processing of soft mar - ings, scare stories, irreproducible we know… Yet the current state of garine actually involves a not-so- results, quack theories and serious knowledge rarely gets questioned friendly by-product: trans-fat. In science, advertising and PR that is in similar light. Seldom is the other words, cardiologists had the daily ration of anyone reading question asked: “What will scien - been strongly recommending that the news with a food and nutri - tists fifty years from now think their patients consume a substance tion biased eye, one would be led about the current theory”? In his that would eventually be indicted to believe that there actually are 1973 picture “Sleeper”, Woody as one of the worst nutritional cul - other options besides not eating Allen had his main character, one prits, one that Mayor Bloomberg (people who do not eat die, too, but Miles, experience a sort of Rip van of New York would actually ban usually quite a bit faster). The oth - Winkle experience in which he from the city’s restaurants a few er option, of course, being: pre - woke up from a long sleep in some years down the line… vention. remote future. The following dia - Similarly, at the end of the 19 th There is of course nothing wrong logue occurs over Miles’ head as century, Atwater and the most dis - with prevention, except when it is he awakes: tinguished MIT scholars in the based on false premises, shaky evi - Dr. Melik: (listing items Miles had emerging discipline of nutrition dence and underlying moralistic requested for breakfast) «... wheat thought they should reform the di - bias. I am reminded of a cartoon germ, organic honey, and... Tiger’s et of New England’s working class. showing two FDA experts watch - Milk.» They established the “New Eng -

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land Kitchen”, inspired from Ger - decisions or choices; 4. obstacles to and relationships. Eating is not man “people’s kitchens”. The idea success in this respect are igno - just individual behavior; it also was to improve the blue collars’ di - rance, commercial pressures, lob - consists of social practices and rit - et using the latest findings of the bies, advertising. As a conse - uals. In short, eating is determined new nutrition. New England’s quence, solutions seem obvious: not just by individual rational working class was to be shown communicate to individuals about choice but also, and to a large de - how to cook cheaper cuts of beef good nutrition, improve their gree, by culture, which operates, as into slowly simmered stews. For knowledge, which in turn will lead it were, as an implicit script. Typi - laborers, the New England them to behavioral change. cally, when asked by anthropolo - Kitchen recommended, in the light The problem with these assump - gists why they do something the of the time’s nutritional knowl - tions and the actions and policies way they do it, people’s answer is: edge, high calorie content, hence they inspired is that they simply “We’ve always done it this way”. fatty cuts of meat and little if any don’t work. As the former chair - A third implicit assumption is that vegetables: as vitamins were not man of WHO’s task force on obe - of the existence of something typ - known, they seemed to offer noth - sity recently stated, “Recent rigor - ically referred to as “modern ing but undigestible fiber and wa - ous analyses show that individual - Western diet” and often associated ter… The New England Kitchen ized advice to reduce intake and with the nutritional transition. failed to attract much interest from take more exercise is an exception - The following quote, in my view, the “New England working class” ally poor way of ensuring that a illustrates the implicit assumption: – in fact a patchwork of ethnic population does not gain weight. «The cultures of societies are underes - groups from various parts of Eu - The unrelenting epidemic reflects timated determinants of their popu - rope not particularly keen on four the presence of a “toxic environ - lation health and well-being. This is or five-hour stews. Considering ment” where the need for physical as true of modern Western culture, what we currently know (or be - activity has almost been eliminat - including its defining qualities of lieve) about fiber and saturated fat, ed by cars, mechanical aids at materialism and individualism, as it their reluctance might have been work and in the home, TV and is of other cultures. […] materialism for the better… (3). Scientific computers, etc.” (4). and individualism are detrimental truths are, and should be seen as, The reason interventions based on to health and well-being through biodegradable. the assumptions do not work is their impact on psychosocial factors The second implicit assumption is that humans do not just eat ac - such as personal control and social actually a set of assumptions and it cording to individual “informed support» (5). has governed most of choice” and “preference”. They are On the one hand, the author com - policy and intervention in the last subject to beliefs (religious or oth - plains that «cultures of societies» decades. When poor nutrition is er), usage, to tradition and socially (note the plural) are «underesti - diagnosed, it is (implicitly or ex - determined eating patterns. They mated determinants»; on the oth - plicitly) assumed that, 1. the cause eat, not nutrients and calories, but er, he goes on to refer to “modern is the individual’s poor behavior; 2. , dishes, meals and they do Western culture” in the singular, as eating behavior is the net sum of so in specific places, at specific if cultural diversity were the exclu - individual choices; 3. the solution times and with specific people sive feature of “non Western” soci - is to help individuals make better with whom they have interactions eties. Yet evidence is there may be

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common features in Western, de - France seems to have particular cally, Americans express more at - veloped societies but there is no attachment to mealtime and com - tachment to individual extensive such thing as one modern West - mensality. Of all the developed choice than any of the other sam - ern culture. In order to support countries, France has experienced ples in the five-country survey this statement, I can refer to vari - the least decline in time spent eat - (12). ous data. ing (8). Empirical data show that Cultural diversity is no less of a First, differential epidemiological meal patterns in France, unlike reality among developed nations data themselves are often over - several other neighboring coun - than it is in developing countries. looked when a “hot” topic such as tries, have kept their diachronic This diversity should indeed be obesity is discussed. It is somehow three course structure in spite of taken into consideration, as well as taken for granted that whatever overall simplification. Commen - socioeconomic differentiation happens in the United States is sality, reflected in part by strictly within countries – a major factor bound to reach the rest of the kept mealtimes, is perceived by re - in the distribution of health and world, particularly the Western spondents to surveys as one of the illness in general, of obesity in world in the following years if not keys of “eating well” (9). The na - particular. Rather than blindly months. Thus the spread of obesi - tional time use surveys of France spreading alarm over the “obesity ty in the US is offered as self-ex - and the UK show that, on any giv - epidemic” around the corner, one planatory evidence for “contagion” en day, at 12.30, 54.1% of the should delve into the differences, in the developed world. Yet there French are eating; a similar peak if any, and the specific features of exist considerable differences be - occurs in the UK at 1.10 PM but the local culture that might help tween prevalences in the “West - only 17.6% are eating (10). The explain them – thus possibly help - ern” world, let alone the developed French are not just eating at the ing preventing the “contagion”. non-Western countries such as same time; they are also eating Public health policies have long Japan. France, in particular, is a lunch and dinner together with been aimed at individuals, urging case in point, with the lowest commensals in about 80% of the them to change their behavior and prevalence of obesity in Europe, cases (11). make “rational, healthy choices”. low prevalence of overweight, yet This comes in strong contrast This may have produced more ad - unusually high rate of under - with trends observed in other, verse than positive results. Med - weight (mostly women) (6). A similarly developed, countries in icalization and individualization of very recent review and analysis of which food intakes are more scat - food and eating by both the in - survey data globally available since tered during the day and individu - dustry (health and nutrition the 1980s shows that, in that peri - alized. Our own comparative data claims) and public health (guide - od, France experienced the least show that French, Italian, Swiss lines for “the people” aimed at in - increase in obesity rates among af - samples are more concerned with dividual behavior, food pyramids, fluent countries (7). quality produce, tradition and etc.), both echoed and amplified These epidemiological specific happy experiences of social eating, by the media, lead to a “nutritional features coincide with clearcut while American and British sam - cacophony” and various degrees of cultural peculiarities, which might ples manifest both attachment to, anxiety associated with question - well have some degree of relevance and anxiety over, free and respon - able diets, eating disorders and no in this respect. sible individual choice (12). Typi - reduction in the prevalence of

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obesity. If anything, the US case eating in plethoric societies may Données Sociales - La Société suggests the opposite seems to be carry more liabilities than benefits Française. Paris: INSEE, 2006. 7. Finucane MM, et al . National, region - true. Actual behavior is generally while there may be long unsus - al, and global trends in body-mass in - not effectively modified in those pected benefits associated with the dex since 1980: systematic analysis of categories of the population in sharing of food in the common health examination surveys and epi - which improvement is most meal. demiological studies with 960 coun - try-years and 9·1 million participants. sought. As we have seen, historical The Lancet 2011; February 4. evidence shows that, all things 8. OECD. Society At A Glance. In : considered, this might be for the References OECD Social Indicators. Paris: Or - better, as progress in scientific ganization for Economic Co-operation and Development (OECD), 2009. knowledge often reveals that suc - 1. Taubes G. Is Sugar Toxic? The New York Times Sunday Magazine, April 9. Lahlou S. Penser Manger. Paris: PUF, cess might have done more harm 17, MM47, 2011. 1998. than good). Most campaigns and 2. Skrabanek P. L’alimentation entre enfer 10. de Saint Pol T. Le dîner des Français: public policies so far have been et salut. In Manger Magique, edited by un synchronisme alimentaire qui se maintient. Economie et Statistique based on implicit assumptions that C. Fischler. Paris: Autrement, 1994: 169-178. 2006; 400: 45-69. were wrong, in particular that eat - 3. Levenstein H. Revolution at the table. 11. Poulain JP , Romon M, Barbes P, Jean - ing is just another form of individ - The transformation of the american di - neau S, Tibère L. Evolution du modèle ual, private consumption. In most et. New York: Oxford University Press, alimentaire français et impact sur la if not all societies on the planet, 1988. corpulence - Les dimensions sociales 4. James W , Philip T. Developing national de l’obésité - Alimentation hors repas eating is done in a social context. obesity prevention policies: an interna - et corpulence. Paris: Ministère de la The procurement, distribution and tional perspective. Obésité 2007; 2 (1): Recherche - Programme Nutrialis- sharing of food and the social reg - 122-32. RARE, 2003. ulation thereof are the basis for 5. Eckersley R. Is Modern Western Cul - 12. Fischler C , Masson E. Manger - ture a Health Hazard? Int J Epidemiol Français, Européens et Américains much of social organization in hu - 2006; 35: 252-8. face à l’alimentation. Paris: Odile Ja - man societies. Individualization 6. de Saint Pol T. Corps et appartenance cob, 2008. and, as it were, privatization of sociale: la corpulence en Europe. In

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