A moderate view on fat restriction for young children.
As dietetics professionals, rather than debating dietary prescriptions, we must make our priority evaluating whether those prescriptions can be reasonably and consistently translated into food selection and eating patterns. This is nothing new to us. We have long advised physicians about the practicality of diet prescriptions and often recommended that prescriptions be moderated. In my view, we are at our finest when we are advocates for people and their relationships with food rather than arbiters of diets. Rather than emphasizing what people should eat, we must emphasize what is possible and reasonable for them to eat. In my experience, the gap between knowing and doing will continue as long as the knowing is unrealistic. Clinical experience makes it clear that if a diet prescription is unrealistic, it will not do any good. In attempting to apply unrealistic dietary prescriptions, we do not help people. We just make them into dietary cripples. It has been extraordinarily difficult to lighten up on the particular diet prescription of the US Dietary Guidelines. Given the emphasis on preventive nutritional care and the urgency with which the messages are delivered, I and many other dietetics professionals believe our are hands tied: We must go along with the US Dietary Guidelines. If we relax our efforts to persuade people to eat in accordance with the prescription, we have been led to believe we will do them irreparable harm. The data do not support such a threat, either for children or for adults. There is enough inconsistency in the evidence linking dietary fat and heart disease to make prevention a hope, not a guarantee. Before we apply the formulas we love so well (yes, I love them too), we must consider what our attempts to apply a formula will do to people's eating attitudes and behaviors and to the feeding relationships between adults and children. People manage to feed themselves and their children, and they eat the way they do for reasons that grow out of their cultural traditions, preferences, and practicalities. Sweeping changes carry the risk of undermining serviceable foodways, so it is reasonable to recommend such changes only on an individual basis and, for the public, on the basis of compelling evidence. No such evidence exists. Because the scientific evidence for the connection between childhood diet and heart disease is debatable, it is legitimate for us to be advocates for children by recommending doing less, rather than more. "Less" in my view, does not mean doing nothing at all. It means helping families enjoy food and optimize normal eating patterns, rather than attempting to achieve a particular prescription for dietary fat.
Satter
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Ellyn Satter Associates, Madison, WI 53711-3062, USA.
D000328:Adult; D001161:Arteriosclerosis / Q000178:diet therapy / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D018752:Diet, Fat-Restricted / Q000009:adverse effects / Q000523:psychology / Q000592:standards*; D005195:Family Relations; D005247:Feeding Behavior / Q000523:psychology*; D005522:Food Services; D006801:Humans; D018673:Nutrition Policy; D014481:United States