Dispensing Nutritional Advice: Our Role and Boundaries as Behavior Analysts Specializing in Health and Fitness

By Laraine Winston, MS, LMHC, BCBA

As Behavior Analysts who work with clients with health and fitness related goals, we often target dietary behaviors. This is often a natural extension of our personal goals. Health and fitness enthusiasts can be very passionate, and hold very strong opinions about their own eating preferences, and Behavior Analysts are not immune. We’re used to speaking freely about our dietary beliefs and habits, and have every right to, as free speech is our guaranteed right. However, when we represent ourselves as experts, even for no charge, the relationship is different and we have ethical obligations.

The BACB Professional and Ethical Compliance Code for Behavior Analysts emphasizes the importance of practicing within our scope of expertise and demonstrated competence and our duty to consult with others when appropriate. Behavior analysts are experts in the behavior change process itself, not in specific nutritional or dietary practices.

In the US, only Registered Dietitians, Licensed Dietitians/Nutritionists or Licensed Physicians may legally prescribe diets, meal plans, or dietary supplements. Other professionals, including Certified Nutritionists, Certified Health Coaches, Certified Fitness Trainers, may educate, and in some cases counsel, (not treat or prescribe) in the areas of nutrition and diet. Examples include: use of the various tools and features of My Plate (The US Department of Agriculture official policies on nutrition); providing examples of healthy foods that meet those guidelines; talking about recommendations from authoritative sources such as the World Health Organization (WHO) and the National Institutes of Health (NIH); reviewing food journals, instruction on reading food labels; giving statistics on chronic disease and certain practices; and providing information on nutrients contained in foods. Some of these professionals recommend nutritional supplements or become “brand ambassadors”, but this is a risky practice that increases their liability insurance rates.

Behavior Analysts without any of the above credentials who deal with diet and nutrition fall into a bit of a gray area. Just as we might reference American Pediatric Association for readiness markers for toilet training, we can base dietary goals on MyPlate recommendations or similar widely accepted standards. Caution is advised, however, for those who stray closer to nutritional counseling or independent advice giving.

It’s important to know that a “clear, authoritative source”, is not the same thing as one study or even a group of studies that support any given conclusion. The food industry is fraught with biased and poorly designed studies that seem to support the conclusions of interested parties, along with legitimate research. Agencies like the WHO and the NIH weigh the fidelity of hundreds of studies on a single topic, and compare wide ranging (even opposing) conclusions, before updating their policies. Consumers are bombarded with contradictory information and vigorous marketing efforts so it’s especially important that Behavior Analysts avoid adding to confusion and misconceptions by referencing a small sample of the available data.

Regardless of any additional credentials and background, Behavior Analysts are urged to avoid the following pitfalls with respect to working with clients on dietary goals:

• Making broad generalizations or assumptions
  Example: Telling a client that it’s always better to eat several small meals during the course of a day than three larger meals. This may work for some people and may have been supported by some studies, but has also been contradicted and doesn’t rise to the level of a guideline from established authorities.
  Example: Telling a client that the reason he hasn’t lost weight is because he drinks soda. Although this might be the case, it’s an assumption if you’re not credentialed to assess the client’s health status.

• Using imprecise or misleading nutritional terminology
  Example: Telling a client to “avoid “carbs””. Carbohydrate is one of just three macronutrients that comprise all food, is likely the most misused term in nutrition, resulting in potentially harmful confusion and misconception. It is the primary macronutrient in whole fruits and vegetables, which MyPlate recommends as half of our daily caloric intake. MyPlate recommends that another roughly 25% of daily calories come from whole or refined grains, which contain both carbohydrate and protein. Avoiding carbs (eating mostly protein and fat) goes against accepted recommendations and can result in long term health problems. Many people use the term as short hand for “refined or processed foods” or use the term “bad carbs”. In our field, we know how incorrect language, such as using the term “reinforce” when a consequence is not actually increasing any behavior, can lead to problems. We also avoid labeling behaviors that are acceptable at low frequency as “bad” for obvious reasons. Even the terms “refined” and “processed”, while better than “carbs”, are still very loose. Grinding raw almonds to make a fresh nut butter is lightly processing them. The FDA encourages consumers to eat whole foods and to avoid “highly refined foods” (which it describes as having high levels of additives and concentrated/added sugars & fats). Ironically, many highly processed foods are touted as “low carb”. You can educate clients on the FDA recommendation to eat fewer highly refined foods and more whole foods, without recommending against an entire macronutrient.

• Allowing personal opinions or practices to influence work with the client
  Example: Discouraging a client from eating meat or dairy (within accepted guidelines) because you personally abstain from these food types. This pitfall is especially challenging for many, including the author of this article! Although we may adopt more restrictive eating practices personally and have solid reasons for doing so, we have to stay objective and client-centered when working with others.

• Sharing professional opinions one is not qualified to make
  Examples: Making statements like “although the MyPlate calculator put your daily weight loss calories at 1200, you need to take it down to 1000 so you can see results faster and stay motivated”, or “you’re probably having digestive issues that are preventing weight loss, so you should stay away from gluten”.

• Suggesting strategies that are restrictive, highly specific, contrary to guidelines, or not widely supported
  Examples: Unless otherwise qualified, making suggestions like “since you like sweets, drink a protein shake any time you get an urge to have something sweet”, “When you get hungry, eat just lettuce and carrots until dinner time”, “Don’t eat grains this week”, “let’s have you fast for two days a week”, or “your goal will be to make half of your calories protein”.Note: Many scientists make a good case that MyPlate, and other established authorities, are slow to accept valid current research conclusions and adjust their policies accordingly, but without further training or consultation, we are not in a position to personally evaluate all of the conflicting evidence when it comes to our clients and dispense independent recommendations.

Behavior Analysts have a vital role to play and much to contribute in the area of nutrition and diet. Responsible ABA practice includes acquiring additional knowledge and credentials, consulting with others when appropriate, avoiding common pitfalls, and using standard guidelines from authoritative sources. We can, and should, be an important part of the solution to large scale health problems that are currently plaguing our society. Go forth and change dietary behavior!

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