|The 7 Cardinal Sins in Nutrition Communication
Sylvia Rowe MA and Nick
Volume 46 Number 6
Pages 276 - 280
Much has been written about nutrition communication, how it should be framed, targeted, structured, and worded for greatest effect. Relatively little has been written about possible pitfalls-errors in communicating that may lead to public confusion instead of understanding. In this article, the authors lay out, in their usual irreverent style, what may be regarded as the 7 greatest errors in nutrition communication, focusing primarily on the last of these, mistiming messages-especially delivering messages too late for them to be effective. Pointing out a gap between expectations of and actual consumer behavior, the article discusses the importance of understanding consumer psychology and of effectively timing communications-both nutrition and food safety messages-so that information is delivered when consumers are ready to receive and use it.
A Bit of Historical Context
To many dietitians and nutrition communicators, it must be a mystery how the public manages to ignore-or at least fail to recognize-sound nutrition advice. Misinformation, especially on the Web, is partly responsible for this perception gap-as a 2002 position paper for the American Dietetic Association points out:
Consumers are taking greater responsibility for self-care and are hungry for food and nutrition information, creating opportunities for nutrition misinformation, health fraud, and quackery to flourish.1
Since that report, misinformation and sometimes commercially motivated disinformation have proliferated on the Internet and have been dutifully initiated or documented by the traditional media. More than a few nutrition professionals regard nutrition misinformation as a form of health fraud and 1 practitioner argues that food faddism fuels the fraud. She asserts that food fads are based on 3 basic, widely circulated, false beliefs:
* Certain foods have special attributes that may cure disease.
* Certain foods should be removed from the diet because they are harmful.
* Certain foods have special health benefits.2
For reasons better explored by psychologists than nutritionists or communicators, there is a persistent belief-life philosophy even-that the above rules are true and apply to the food human beings eat.
Everything that has been said here so far should come as no surprise to the contemporary nutrition science community. What has been written about too insufficiently is how nutrition communications relate to misinformation. Actually, a fair amount has been written about the subject, especially in Nutrition Today, but in a continuing effort to combat misinformation, this article will explore what may well be the 7 deadly sins in nutrition communication-they will at least be among the deadliest sins!
Briefly, the most egregious communication mistakes one can commit, listed in no particular order, are as follows:
dishonesty (or, more bluntly, lying)-communicators who knowingly impart guidance not in accord with the current scientific consensus;
arrogance (disregarding the intelligence of the audience)-writers/presenters who address their readers/viewers with facile or unsupported assertions or talk down to their audience;
deceit (lack of transparency)-those who conceal their biases or financial backers so as to not handicap their credibility;
intransigence (failure to respect opposing views and opinions)-communicators who are dogmatic in their views, not sufficiently deferential to the possibility that future research may contradict their conclusions;
narcissism (failure to respect the current informational environment)-communicators who take no account of their audience's preconceptions and current beliefs;
irresponsibility (failure to take responsibility for how their messages are received)-writers/presenters who choose their words with little regard for their effect on the audience;
temporal obliviousness (the exercise of bad timing)-communicators who answer questions not yet asked, have no answers for questions that are being asked, or, worst, fail to anticipate in a timely fashion questions that ought to have been asked.
These communication sins are offered tongue-in-cheek; some are obvious, some are character flaws rather than communication flaws. But all of them have the effect of confusing and/or alienating the public, allowing consumers to distance themselves from the sound nutritional science being presented. Astute communicators can surely come up with a more detailed or comprehensive list of potential communication barriers. The 1 sin that seems to get the least respect when experts write on the subject is the last-in ways, the most crucial sin-bad timing.
"These communication 'sins'[horizontal ellipsis] all have the effect of confusing and/or alienating the public."
Timing Is Everything
A nutrition communicator normally might not even consider the importance of when a message is delivered-nutrition messages are eternal, are they not? They are not. Nutrition messages, even nutrition information in general, are time-bound; there is a time when the public's understanding will resonate to a given message and a time when there will be only confusion or worse. This truth would seem self-evident, but there are some good examples of messages whose time has failed to come. A recent HealthFocus report references a significant public health miscommunication regarding sodium intake:
An alarmingly low number of shoppers (29%) look for the sodium content consistently in each individual food they eat. But, even those consumers that monitor sodium do so intuitively, mostly by avoiding certain foods or categories, rather than by actually understanding their total daily sodium intake. One reason for this lack of diligence is likely that a large number of consumers, while concerned about sodium, are not concerned for health reasons, but rather for cosmetic and personal reasons. The perception among women that excess sodium causes water weight gain is a greater motivator for avoiding sodium than high blood pressure.3
In its latest national survey of consumers as to their beliefs about food and health, the International Food Information Council Foundation reports some significant nutrition disconnects.4 Despite the wide publicity given the current obesity epidemic,
* consumers say they are healthier but admit to making fewer dietary changes and are less physically active than reported just a year earlier.
* when asked to estimate the number of calories that should be consumed in an average day, one-third of Americans are unaware or unable to provide a response-only 1 in 10 estimates correctly; over half provide a response but estimate incorrectly.
One could easily conclude from the International Food Information Council research that this is not a good time to be delivering caloric energy-balance messages to consumers.
The US Department of Agriculture's Center for Nutrition Policy and Promotion this past summer offered another example of timing's influence on message delivery. It abandoned the personalized food pyramid approach to dietary guidance in favor of a simpler icon: the plate of food.5 For years, communicators attempted, largely in vain, to explain how a pyramid shape related to healthy food choices-it might have been the wrong geometric shape to influence consumer decisions, but it was certainly the wrong time to deliver such messages. With the public choosing larger and larger plates of food, as made evident by their increasing girth, it may be the right time now to construct guidance around a plate. "MyPlate" delivers guidance not only for choosing foods but also for choosing portions, and although a new government recommendation is entitled "Balancing Calories," the message is a much simpler: "enjoy your food, but eat less."6 It may never have been the right time for calories-in/calories-out messages. Timeliness is the thing-the right message delivered at the right time-or communication fails. In the words of Jimmy Jones' classic 50s pop hit:
Who in the world would've ever known
What Columbus could do,
If Queen Isabella hadn't hocked her jewels
But she had timin'[horizontal ellipsis]
ticka, ticka, ticka[horizontal ellipsis] good timin!7
"Timeliness is the thing-the right message delivered at the right time-or communication fails."
Nutrition communicators-and, for that matter, science communicators in general-are tempted to believe that a scientific "fact" (such as "energy balance implies calories consumed must equal calories expended") will be accepted by the public so long as it is explained correctly and providing that the public is capable of understanding that fact. Recent expert thinking about risk communication supports a different analysis; consumers do not receive information in a vacuum but in the context of their extremely complex life experiences, complete with belief systems, ideologies, and emotions.8 Their nutrition choices and decisions may thus seem to be irrational, but they are actually "beyond rational." That is 1 major reason why the timing of a nutrition message is important. As the Hartman Group puts it, referring to the perception versus reality of consumer behavior:
Consumers, when asked, will most often stress the dramatic impact events, such as the rising price of gasoline or food, have on their lives; yet, the reality is that these singular events will not in and of themselves cause consumers to behave differently.9
The belief that "consumers care about scientifically proven product effectiveness" Hartman calls a myth.
Criticality of Timeliness
Given the increasing velocity of communication in the Internet age, timing is no longer an option in public/press relations-delivery of reliable information must be as nearly instantaneous as possible or it will be supplanted by some other form of "knowledge." Nutrition and food scientists, used to releasing research results in the standard scientific journals, will be surprised to see media headlines and blog sites applying their own spin to the information before it has even been published in print. Their studies will be competing for public attention with non-peer-reviewed research and, worse, with a myriad of Web sites of widely varying credibility, delivering content to consumers.
The most critical issue in guiding the messages designed to reach the public is timeliness. Hence, we see the rise of online scientific journals, publishing on the Internet weeks and months ahead of their print counterparts. Sometimes, even they may be too slow to control nutrition messages reaching consumers. The ultimate goal is instantaneity-eliminating any gap between arriving at a valid conclusion or crafting a public health message and delivering that information to the public, globally, over the Internet.
Food safety risk communicators have learned this lesson all too well-or certainly ought to have learned it! During last spring's Escherichia coli outbreak in Germany, there were serious international political repercussions from the initial reports linking the pathogen to lettuce, tomatoes, and cucumbers, linked variously to produce from Spain, Holland, Portugal, and Italy, before it was finally concluded and announced that the outbreak originated from bean sprouts grown in Germany. One official described the faulty reports as a "communications disaster."10 It was almost a replay of the American experience in 2006, when a pair of produce-related E. coli outbreaks was initially reported as the result of imported produce-tomatoes, peppers, green onions-before finally being traced to US-grown spinach and iceberg lettuce.11 By any standard, the communication in all these instances was flawed and wound up provoking consumer confusion if not outright alarm.
These incidents raise an important point: timeliness, although critical, is a 2-edged sword. Mindful that the public needed information quickly in the above-cited food safety outbreaks, communicators rushed to deliver the best available information. Unfortunately, what was available at any given time was not necessarily accurate, and in the cases cited, early information was in fact inaccurate. The rush to judgment, while appropriately informed and transparent, led to public confusion. So there is a corollary to the recommendation to disseminate information as fast as humanly possible: be fast, but be accurate-not an easy assignment.
Researchers winding up their studies and preparing to submit them to peer review in print journals need to be especially aware of timing issues; organizations or groups with a special interest in the subject matter will be anxious to disseminate the findings with their own unique spin on the interpretation, before publication. Similarly, the news media have no interest in delaying their reports until findings have been peer reviewed. At most, they will report interpreted research conclusions as preliminary and then repeat the stories weeks or months later when the findings have finally been peer reviewed. By that time, the public will have received the messages from someone other than the scientists.
The same thing can happen with any nutrition or food safety message. If journalists or bloggers or twitter users have already spread a message of their own-for instance, that the only sure way to lose weight is by avoiding carbohydrates or fats or high/low glycemic index foods-it will be extraordinarily difficult to supplant that message with one that has been carefully worked out by dietitians. If the Internet is already buzzing with an alleged cause of a food safety outbreak, it will be extraordinarily difficult for the Food and Drug Administration or European Food Safety Authority or food scientists in general to supplant that buzz with a carefully worked-out message of their own. It will be too late.
Unfortunately, there is some bad news for scientists hoping to correct this state of affairs: the nature of nutrition or food science is that it must proceed methodically, not hastily. It is, in general, in the nature of careful, thoughtful communicators that they choose their messages carefully, not rushing into the fray recklessly. It is also in the nature of bloggers, tweeters, Web site "auteurs," and mass media reporters that they choose their messages speedily, necessarily without regard for sober facts. The unfortunate state of current affairs is that whoever gets there first has the most influence on the message or its interpretation.
"The unfortunate state of current affairs is that whoever gets there first has the most influence on the message or its interpretation."
Fortunately, this seemingly grim circumstance also affords a great opportunity for nutrition communicators. If they observe the guidelines for timely messaging, by being early in framing a message or early to respond to misinformation, they can truly shape the public dialogue and get truthful, scientific communications back on track. The key is not so much that overused term proactivity as timeliness.
Given that it is largely peer review that helps to ensure that a research conclusion is accurate or at least as accurate as possible, improved timeliness implies that the speed of peer review must be increased. Possibly a pre-peer-reviewed preview of nutrition research could be offered-by the actual researchers or by the publishing journal-in the interest of earliest possible dissemination. A practice similar to that is currently being tried by a number of prestigious scientific journals, including Nutrition Today: "published online ahead of print."12,13
The best remedy for missed communication opportunities is for nutrition communicators, researchers, and others interested in facts and good context to be vigilant as to the timing of messages, being neither recklessly hasty nor too late. Bearing in mind that the best nutrition counsel is virtually worthless if it falls on deaf ears, the following best practices is a necessary but insufficient condition for good communications. Delivering the word may be a little like what a good vintner does to ensure public acceptance: using a metaphor-good messaging is like fine wine-it is as Orson Welles put it in his fondly remembered 1980 commercial for a California wine maker, promising the public to "sell no wine before its time."14
1. Wansink B. ADA Position Statement: Food and Nutrition Misinformation. http://www.adajournal.org/article/S0002-8223(06)00202-1/fulltext . Accessed November 9, 2011. [Context Link]
2. Pacheco G. Deciphering Nutrition Misinformation. http://docs.schoolnutrition.org/meetingsandevents/anc2009/files/presentations/monday/ANC2009_Deciphering_Nutrition_Misinformation.pdf . Accessed July 2, 2011. [Context Link]
3. Health Focus International. HealthFocus Study Reveals Information Gap Regarding Sodium Intake. January 2010. http://eon.businesswire.com/portal/site/eon/permalink/?ndmViewId=news_view&newsId=20100114005980&newsLang=en . Accessed July 5, 2011. [Context Link]
4. International Food Information Council Foundation. 2011 Food & Health Survey. June 2011. http://www.foodinsight.org/Resources/Detail.aspx?topic=2011_Food_Health_Survey_Consumer_Attitudes_Toward_Food_Safety_Nutrition_Health . Accessed July 4, 2011. [Context Link]
5. USDA, Center for Nutrition Policy and Promotion. MyPlate. http://www.cnpp.usda.gov/MyPlate.htm . Accessed July 4, 2011. [Context Link]
6. Center for Nutrition Policy and Promotion. Dietary Guidelines 2010, Selected Messages for Consumers. http://www.ChooseMyPlate.gov/downloads/MyPlate/SelectedMessages.pdf . Accessed July 4, 2011. [Context Link]
7. Tobias-Ballard. Good Timin. Cub Records 9067, 1960. [Context Link]
8. Morgan MG, Bischhoff B, Bostrom A. Risk Communication: A Mental Models Approach. Cambridge, UK: Cambridge University Press; 2002. [Context Link]
9. Hartman Group. Understanding Consumer Behavior in Tough Times. May 2008. http://www.hartman-group.com/hartbeat/understanding-consumer-behavior-in-tough-times . Accessed July 5, 2011. [Context Link]
10. Forbrig J. A battered Germany recovers from E. coli outbreak. Los Angeles Times. June 2011. http://articles.latimes.com/2011/jun/11/world/sc-fg-germany-ecoli-20110611 . Accessed July 6, 2011. [Context Link]
11. Wikipedia. 2006 North American E. coli outbreak. http://en.wikipedia.org/wiki/2006_North_American_E._coli_outbreak . Accessed July 6, 2011. [Context Link]
12. Nutrition Today, Articles "published ahead-of-print." http://journals.lww.com/nutritiontodayonline/toc/publishahead . Accessed July 8, 2011. [Context Link]
13. American Journal of Clinical Nutrition. Articles "first published online." http://www.ajcn.org/content/early/recent . Accessed July 8, 2011. [Context Link]
14. Welles O. YouTube video. Edited Paul Masson Television Commercial. http://www.youtube.com/watch?v=bpj0t2ozPWY . Accessed July 12, 2011. [Context Link]