The American medical establishment is fixated on a narrow definition of “healthy food.”
A Filipina woman recently came to see me for dietitian services after she was told by her primary care provider that she needed to “eat healthier.” She was told if she didn’t make adjustments to her diet, she’d be at risk of developing a chronic disease. Understandably, she was concerned.
A quick look at her lab results revealed that she was in no imminent danger; her blood sugar, cholesterol, and blood pressure were all within healthy limits. And after a conversation about her food choices, I discovered that she was happy and following a well-balanced pattern of eating, usually a mix of protein, fats, and carbs seasoned with vegetables and herbs. She loved savory breakfasts — often a combination of well-seasoned garlicky rice served with fish — and her lunches and dinners were built around plates similar to Arroz Caldo (a richly-flavored ginger and garlic soup, either sour, tangy, or spicy).
These are all nutritious ingredients and mindfully prepped meals. So, I wondered, what was the problem?
I quickly realized the issue was not her eating habits, it was that she relied on dishes, ingredients, and cooking styles that were unfamiliar to her white doctor.
The real “problem” to unpack is the American medical establishment’s fixation on weaponizing health from an Anglo-centric, data-poor understanding of nutrition, or what I like to call “wellness washing.”
Google the phrase “healthy food,” and the screen will populate with brightly colored fruits, (usually berries), cruciferous vegetables (think broccoli and cauliflower), nuts, seeds, and beans. I won’t argue that these aren’t all nutrient-rich and objectively healthy ingredients. However, they only represent one version of health, and this version is steeped in whiteness. Likewise, the current Dietary Guidelines for Americans, which play a crucial role in shaping nutrition policy and subsequently get conveyed as recommendations to the public (and are reflected in those Google search results you see), are influenced by a federal committee composed primarily of white, independent experts in nutrition and public health.
Not only do these experts form a homogenous group, but the data sets they rely on are also lacking nuance and effective ways to extrapolate meaningful data from diverse populations.
A significant portion of the data they use comes from the National Health and Nutrition Examination Surveys (NHANES). At the inception of the study (1971-1974), this data was largely gathered from white participants.
The longest-running study of the relationship between dietary factors and chronic disease is the Framingham Heart Study, which is used to inform health recommendations and features predominantly white, middle-class participants. Since 1951, the Framingham study has generated over 2,000 journal articles and retains a central place in the creation of public health nutrition policy recommendations for all Americans.
The major health entities in the U.S. are acknowledging that there is a problem with using non-representative data sets to develop guidelines for the whole U.S. population. To make up for the lack of representation in the first two NHANES surveys, for the third (1988-1994) they included a larger study population of 40,000 people, which did include Black and Mexican Americans. In subsequent bi-annual surveys, NHANES oversampled marginalized populations including African American, Asian American, and Latinx persons, among other groups, in an effort to produce more reliable statistics.
But it’s no longer sufficient to notice and acknowledge that the study design isn’t inclusive of marginalized populations. Radical shifts need to happen, ones that will allow for the gathering of meaningful data that are representative of diverse populations.
Health and nutrition guidelines that don’t consider all Americans push historically marginalized groups further to the sidelines. The majority of the studies that are used to develop these guidelines pull from data that studies white middle-aged men, and while it’s valid and important information, it’s not at all inclusive of anyone that is not white, male, or middle-aged. Okra from the Caribbean or Berbere from East Africa are excellent ingredients that deserve a place alongside olive oil and berries on the lists of “best foods to eat for health.”
Xenophobia is real, and the foods of many Americans — like Ital Stew, a Jamaican vegetable stew seasoned with ginger, garlic, hot peppers, and herbs — are blocked from entering a health canon that heralds steamed vegetables, grilled animal protein, and brown rice as the prescription for health. Everyone deserves a seat at the table, and recognizing not just the delicious flavors, but also the nourishment of so many different food traditions is one crucial step to a more equitable future.
Maya Feller, MS, RD, CDN, of Brooklyn-based Maya Feller Nutrition, is a nationally recognized registered dietitian nutritionist. She received her master’s of science in clinical nutrition at New York University. Maya shares her approachable, real-food-based solutions through regular speaking engagements, writing in local and national publications, and as a nutrition expert on Good Morning America. Her cookbook, EATING FROM OUR ROOTS, was recently published by Rodale Books, an imprint of Random House Publishing Group, a division of Penguin Random House LLC.
