Dietitians or Eco-worriers?

by Tracy Purbrick
Primary Care Dietitian

Never before has the very business of existence been so complicated. T’was a time when the prime considerations for purchasing food were cost, taste and for the more discerning customer, nutrition.

Nowadays the consumer (a term in itself wrought with guilt) is expected to ensure that they also buy food that is fair-trade, organic and green. The result is shopping aisle angst, or paralysis by analysis, as the ethically conscious wrestle with these impossibly conflicting demands. It now would appear that dietitians are being asked whether we too should join in the fray and incorporate environmental issues into our practice (Dietetics Today, July 2007).

Well, for those working on national agendas, the answer may well be yes, but with caveats (more on that later). But for the majority of us who work close up and personal with the disease stricken individual, the answer simply has to be no. To do so would in itself be unethical and quite frankly many of us haven’t got a clue what we’re talking about, including me.

To illustrate both points, we need to look no further than the hot topic of global warming. It firstly has to be acknowledged that this issue is by no means cut and dried. In fact, there are numerous eminent dissenters to the current climate change dogma; though like David Bellamy they remain in exile from ‘decent’ society. But even if we are avid believers in man’s (and not Mother Nature’s) hand in climate change, do we as dietitians have any more knowledge on reducing greenhouse gases than the next person?

As a profession we have experienced the horrors of watching certain media ‘nutritionists’ spout their own half baked notions on diet. We may even have dealt with the resultant faddy food fallout in clinics. For us to take on environmental issues, of which we know nothing more about than what we’ve read in the tabloids, is just as dangerous.

As acknowledged in ‘Dietetics Today', if we wade in and simplistically discourage food miles, we could actually churn out more green house gases. Ironic as it seems, due to the difference in farming methods from those practiced abroad, more locally purchased produce may be more carbon expensive. But even when local producers do manage to spare the odd emission, is that a worthy price for denying a living to families in the developing world?

Many farmers in Africa have actually converted from crops their locals would buy, in order to export to the fickle West. If shoppers now diverted their pennies elsewhere these third world farmers will be financially devastated. Even the neat notion that reducing packaging is always for the good, could be leading us up a less than green garden path. We forget that packaging used to portion up a product, can equal less food waste (as well as less food consumption) and reduce the carbon costs involved in storage. Uneducated, knee-jerk reactions, get warm, ‘glowy’, self satisfied feelings…. not results.

As for the ethics of spinning environmental concerns into consultations, this is fraught with conflicts of interest. Do I advise my patient to drink cola instead of a smoothies, or crisps instead of blueberries because they might possess smaller carbon footprints? Do I tell the fitness fanatic to slow down and chill out, as all that hyperventilation is further fuelling the miasma?

And do I convert all of my patients to vegans, to spare the world of flatulent dairy cattle and carbon intensive meat production, even at the risk of turning some of my patients into osteoporotic, apathetic anaemics*. And what of my Asian or African patients? Do I steer them away from okra and aubergines to broccoli and carrots instead? Or do I leave them alone and create a two tier system, whereby you can only eat such ‘exotica’ if it is part of your culinary heritage?

Assuming we could weigh up all of these issues and fathom how to save our patients whilst simultaneously saving the planet, I’d like to know how we’ll find the time. You cannot administer watered down, compromised dietary advice, without giving explanations and rationale. That’s one discussion the hard pressed NHS dietitian certainly doesn’t have time for.

At the end of the day, patients come to the dietitian to talk about what ails them, not the planet. I don’t want to be in a crisis over whether to advise someone to lose weight for the sake of their health, or to cling on to the blubber to save on their central heating! We can’t jump on a bandwagon, no matter how strongly we personally may feel on the topic or how trendy it is. We are qualified to do our job and we would risk undermining the patients trust in us.

While it may have been stated that dietetics doesn’t exist in a vacuum, if you are going to tell your patients the simple, honest to goodness truth about food, that is the way you need to operate. In reality, when a dietitian advises 5 a day, they don’t say; choose blueberries rather than blackberries; that nitty-gritty should be left to the individual’s choice and conscience.

And back to the role of dietitians in lobbying and that unfinished business of a caveat. Yes, by all means dietitians can do their part. But wouldn’t their skills be better used in upholding the nutritional end of any debate, to ensure that environmental concerns are balanced with health? Whilst many of us may prefer the pitter-patter of tinier carbon feet, our first allegiance should always be to their owner’s constitution. Otherwise, surely we are in the wrong profession.

* Let’s face it, whilst a vegan diet can be healthy, it requires a darned sight more effort to achieve, than most people are willing to invest.