Individual versus Population Views: Diet Recommendations
Arno Motulsky, geneticist and co-chair of the 1980s National Research Council Diet-Health Committee, once opined to the committee: “There is no more an average diet than there is an average person. It won’t be long before we will be able to identify individuals with particular susceptibilities and make recommendations tailored to their defect. Then we will no longer have to bludgeon the whole population with dietary recommendations.” (personal communication: NRC Diet-Health Committee, 1987)
This insight emerged, heartfelt from the chair, despite weeks of palaver about the powerful cultural influences and public health aspects of habitual diets, peoples’ food choices, and chronic disease risk, which was the presumed focus and purpose of the Council’s Diet and Health Report. The committee had made an exhaustive review of the population evidence and held hours of discussion on the familial, community, and wider cultural determinants of eating patterns and their relation to population risk of chronic diseases.
Nevertheless, after two years discussions about population-wide phenomena, the committee co-chairs, Motulsky and Dewitt Goodman, Columbia University investigator, restricted the committee’s final recommendations to those for individuals; patients only; with no goals or recommendations for diet and health for the population as a whole.
A classic academic view of recommendations for the general population is that “we need more research” to be certain. In fact, certainty rarely comes, especially about effects on health of environment and behavior. The greatest need for the public health in such ever-present conditions of incomplete knowledge is sound advice for all, based on expert synthesis of the best available evidence.
As Mark Hegsted, consultant to the Council, remarked: “The individual approach to dietary recommendations is an abnegation of medical responsibility!” (Henry Blackburn)
Committee on Diet and Health. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press.