Is science communication about nutrition a mission impossible? (The Food Diaries, part two)

Science communication is a tricky business. How do we provide useful scientific advice on what people are better (off not) eating? Is the science on this even conclusive and how to communicate this without “mansplaining”, oversimplifying or alienating people with what we say?

Food in particular is a very hard topic to talk about in the context of trying to induce behavior change. Food is one of the most intrinsic things to our society – our culture evolved around food, many of our traditions are somehow connected to food and our eating habits. Which is why, trying to convey a message about food (even if factually correct) which might go even a little bit against what the person you talk with believes to be true is like taking a firm stance against who they are as part of their society.

In some cases however, science based food advice can be very relevant for public and individual health. Some types of campaigns have proven more effective than others and have much long-lasting effect than others. 

The two sides of the nutrition advice coin

Food fads

food diet fad nutrition science

Everyone eats.

Which is why, food fashion is such a lucrative business (almost as much as  food production itself).

Unfortunately, this means many people without any measurable knowledge in food and nutrition science are trying to sell audiences questionable or outright fraudulent food advice (and even products in some cases).

One common thing these individuals’ campaigns have (aside of being often completely unscientific) is that they worked. So what is it about food fads that catches like wildfire compared to standard nutrition advice? 

Here’s one nutritionist’s opinion on the most common diet fads (parts 1and 2).

Science-based nutrition advice

nutrition science degree

Admittedly, we as scientists and health professionals haven’t done the best of jobs to create accessible, understandable, actionable advice for people when it comes to food behavior. 

One of the main reasons for this is that science is not a clear-cut, yes-no matter. And statistics, uncertainties and natural variations in response to different food interventions do not translate well to popular messages. 

Also, dedicating most of our days to studying the science behind food and health leaves little time to develop all the other skills required to make a successful marketing campaign (which is what essentially the food-faddists are doing all day long, I presume).

While we blame physicians that they are not also including dietary advice for their patients along with their medication-based treatments, we often forget that most physicians are not even trained to do so (as this Journal of the American Medical Association Quick Uptake outlines). Even less frequently they are trained to take up outreach activities in their communities or give any type of media statements in a convincing and confident manner.

However, recent discoveries that personalized medicine and respectively, nutrition might be the right way forward to improving human well-being gives hope for science-based advice too.

Personalized nutrition

Why is current nutrition research non-personalized?

The so called “intervention studies” are currently the best way we can study and define the effect (and its size) when testing new drugs, dietary interventions or behavioral practices. Thanks to such trials, combined with fundamental research, we know a lot about how our bodies respond to different interventions (medical or nutritional). However, because clinical trials often involve hundreds and thousands of test subjects (this video explains why this is a good thing) they are perfect for detecting trend on population level, but not on individual. There might be smaller effects, which in the setting of the big study do not stand out from the overall “noise” in the data. Such effects could potentially influence the outcome for each individual (or a smaller group of individuals with specific common trait) and might be defined by a factor which does not define the whole population included in the original trial. So while very useful, we might be missing some important proverbial trees for the forest.

personalized medicine
Original image and more info you can find at the CrownBio Blog

What is personalized nutrition?

This is where the modern trend in both medicine, health and well-being is headed. By combining what we know from population studies with data on individual’s genetics, current conditions and lifestyle we can better understand the specific final outcome of an intervention. By doing so, we can then better tailor the intervention itself for the best possible benefit of each person. 

This whole approach, while still in early stages of development, might have another useful aspect, especially when we talk health advice and not necessarily treatment – people love the personal touch. The possibility to have “tailored” advice for each individual case could give an unprecedented power to the information you are trying to convey. 

It is no secret, that also from a marketing perspective, personalized advice is the way to go. If it weren’t the case, sales-based companies wouldn’t have been investing so much in complex algorithms which try to learn as much as possible about you to then suggest products which you happen to be convinced you want to buy.

personalized-nutrition
More on this you can find at the International Food Information Council Foundation

In light of my previous post , Obesity and diabetes – things you need to know (The Food Diaries, part one), personalized nutrition might be the key much more than successful science-based food outreach. It might be the right way to go about treating conditions like diabetes and obesity, which plague increasing numbers of the population from all ethnic, economic and social groups. Both conditions are so complex from metabolic perspective, and as some theories suggest, either can be the underlying reason for the other, that only a nearly case-by-case basis might be able to provide truly lasting positive results for people not affected by conventional treatments.

But until personalized nutrition is ready to live up to the challenge (newsflash – it is far from it yet), we still have the obligation to try and reach out the the different publics with useful, actionable, science-based advice on food and diets, and on that, there’s plenty of research done.

Advice on how to advise on nutrition (and science in general)

Arguably, one of the first and most important aspects of giving and accepting someone’s advice is trust.  If the person you are advising does not trust you, they will not care at all for your advice however grounded in science it might be.

This year, in the American Journal of Clinical Nutrition, Cutberto Garza and his colleagues published a long review outlining different strategies on how to earn and keep the trust of your specific public so you can convey evidence-based messages and hope they stick. The publication is of my favorite kind – open access so even if you are not working in a scientific institution of any sort, you can read the whole work here. But to summarize some of the main points very shortly, here’s a list of what you can find in it:

1. Scientific literacy and public trust

If we don’t teach the members of society how to understand and appreciate the scientific method we cannot expect them to take critical look on our outreach efforts. Such literacy education goes beyond the individuals who have aptitude for science. It extends to every single individual in order to allow them to basically understand accessible scientific results, allowing them to function and somewhat judge on the importance and relevance of an information piece for their well-being.  

statistics science comics
https://xkcd.com/925/

Personalized nutrition advice as a complement to obesity and diabetes treatment

2. Conflict of Interest and objectivity

This being a very complex mine-field of legal terms, it boils down to the fact that unless each one of us is clear and transparent about all our potentially conflicting interests we cannot expect others to be so, nor to hold the trust of society. And this spans much further than just financial gain, which is the most commonly discussed type of conflict of interest blamed to affect objectivity. It is easier said than done (like removing all our biases), but we have the ethical duty to commit our entire objectivity to the current problem in the interest of the patient/consumer/member of society only

conflict of interest
You can be doing two different things with integrity, but rarely at the same time.

3. Achieving highest standards of rigor and reproducibility

publication pressure science
From "A personal tale of scientific misconduct" by L SCHNEIDER

As recently as 2014, concern was raised about the “reproducibility crisis” in science. In fact, this put the doubt on the wrong spot – scientific method, while the main culprit for the publication of wrong results and conclusions, and fraudulent studies was much more complex. The unbearable burden to publish more frequently than results are reasonably produced, and in higher impact factor journals to have the chance to “stay in the game” was imposed on scientists by funding agencies and the multi-million $ industry of scientific publishing houses. While it is natural that science is a competitive field like any other innovation activity, the focus was wrongly placed for decades on the “how much can you publish” rather than “how good are your results”. Returning to the ethical origins of the scientific endeavor is an ultimate step towards regaining the trust of the public.

4. Equity

The ability of scientists and practitioners alike to move away from behaviors which relate the biases I referred to earlier, is a main paint point and reason for societal mistrust in the information shared from those respective parties.

“Socio-economic status remains a highly significant source of inequity in public health and clinical nutrition and of public mistrust in the nutrition research enterprise. Nutrient deficiencies, avoidable inequalities in availability or access to healthy foods, and nutrition-related chronic diseases are disproportionality concentrated in economically disadvantaged communities and are usually associated with poor health outcomes” (from the same American Journal of Clinical Nutrition article).

5. Independent audits of adherence

Science is a self-correcting activity – scientific experiments constantly question and revise existing knowledge and reformulate proof with the newest available evidence. 

If we as scientists are willing to subject our own behavior to such audit, then we will have stronger trust between ourselves and society at large will trust our results more. The peer-reviewed publication process is one such audit, recent straying away due to publication pressure aside. Freedom of patents on scientific discoveries, fair ethical training and examination of our experimental set-ups could go a long way towards regaining the public trust in scientists.

The conclusion is simple, the way forward - not so much

Outreach with evidence-based nutrition advice is vital for public health and individual well-being. It is one of the key way we can push back on misinformation which can hurt or kill people. It is also not easy, nor there is a silver bullet for how to do it right.

On the bright side of this complexity, is all the flexibility that comes with it. Not having one single right way to communicate about food and nutrition science, means you have the choice between many different media and ways of doing it, all of which can be fitted best to your personality to get to that genuine sweet spot. Because no matter how much you know, how well you are positioned to talk to people about their eating habits and diets, and how much they seem to trust you, if you are not being honest about who you are and how it all ties to you personally, it won’t last.

If you are a nutrition scientist on the fence of venturing into the science communication field, Gregor Miller and his team have a very compelling article as to why you should definitely do it. It is also completely free to read and you can find it here.

science communication nutrition food
The bottom line as to why you should consider communicating about science (especially in food and nutrition). Cartoon by Tom Dunne

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