The Obesity Epidemic and Nutrition

  • Government related guidelines and the problem of obesity

  • It is now anticipated that 42% of the US adult population will be obese by the year 2030

  • CMS announced that it will not reimburse registered dietitians to provide counseling for obesity any longer

There is an old saying for a failed plan that “we have been letting the fox guard the henhouse”.  Such is the case with the leadership in “nutrition”.  The “henhouse” has been our nutrition-related health, and the “fox” has been the dietetics profession.

Before I launch into the data supporting my point, I have to say that I deliberated for some time about writing this as it is somewhat of an assault against the behavior of another group of people.  This is something I do not like to do.  Several dietitians I know actually practice good clinical nutrition.  The profession in its larger bureaucracy has, however, gotten us very off course through their leadership (or the lack of it in a way that would make a difference).

I was struck by some information recently.  I saw a graphic about the relationship between government related guidelines and the problem of obesity that they are designed to “fix”.  Ideally there should be a declining obesity rate with progressive guidelines if these guidelines actually do what they are designed to do.  To the contrary, the relationship has been a progression of the problem with progressive guidelines to fix it.

If anyone struggles with the concept here, find a successful business person to explain it to you.  Somewhere along the line, “the plan” has to be measured against the “outcome”.   Take a look at the outcome:

The latest data projection released this week by the US Center for Disease Control shows that the problem is getting worse faster than even the most dramatic projects of a few years back.  It is now anticipated that 42% of the US adult population will be obese by the year 2030 (

The rub with the staggering rise in obesity rates is that it is the primary driving force behind the diabetes epidemic.  The remarkable correlation between the projections in diabetes increases and obesity increases is striking:

So how does all of this get back to the dietetics profession? Here is an interesting article (  It seems that Congressional investigation found that the American Dietetic Association (ADA) has been receiving $1 million a year in payments from pharmaceutical companies and an undisclosed amount from companies such as Coca-Cola, PepsiCo, and Hershey.  There is not much else someone could realistically call this except “conflict of interest”.

About the same time the Center for Medicare and Medicaid Services (CMS) announced that it will not reimburse registered dietitians to provide counseling for obesity any longer for the simple reason that there is no evidence that what they recommend works.  To the contrary, the evidence seems to suggest that it does the opposite.  This relates to the fact that ADA limits the scope of dietetic education and practice to USDA-approved recommendations.  The USDA recommendations have come under considerable criticism as they are overly influenced (inappropriately) by the largest single lobby in the Washington.  If you haven’t figured out who that is, the chart below will help.

Both groups (ADA and USDA) seem to be more industry friendly than concerned about outcome.  The USDA 2010 Dietary Guidelines “Independent Scientific Review Panel” consists of 7 registered dietitians of 8 total members.  Sounds like a family tree that does not branch enough!

Given all of this the ADA would seem to be in need of reform.  Their recent activities, however, have been to change their name to the Academy of Nutrition and Dietetics apparently to try to distance themselves from their record, and to lobby for laws throughout the US which would prohibit the providing of nutritional advice by anyone other than a dietitian.  Fortunately, no one else has seen the wisdom of that idea including here in Virginia where that bill came up without success in 2012 for the second time in 3 years.

If things are to change, what we do must change.  The champions of true change in nutrition that makes a meaningful positive change are clinical nutritionists and other like-minded providers.  Do some dietitians become good nutritionists in a functional sense?  The answer is yes, but not in large numbers and by no help from organized dietetics groups.  The only way things can change is to not stay the same!