LAUSR

Ethical Considerations for Nutrition Counseling About Processed Food To the Editor We read with great interest the article “Processed Food: An Experiment that Failed.”1 We applaud efforts to bring attention to the public health effects of processed food. However, we are concerned that it misses the mark on 2 important issues related to families’ efforts to eat more healthfully. First, we were troubled by the following sentence: “Onethird of American mothers today don’t even know what real food is or how to cook,” a situation that renders them and their children “hostages to the processed food industry.”1 Such framing is concerning because it reinforces a problematic norm that mothers bear the primary responsibility for childhood obesity.2 Emphasizing the role of mothers in addressing childhood obesity makes sense from one perspective because US women are both more likely to shop for and prepare meals and to take children to the pediatrician than their male counterparts.3,4 Nevertheless, focusing solely on mothers represents a missed opportunity to enlist fathers and the broader society in promoting childhood nutrition and well-being.4 Relatedly, we must acknowledge the growing diversity of American families. In the 1960s, nearly three-quarters of American children lived in a family with 2 married parents in their first marriage. Today, less than half do so, one-quarter live with a single parent, and a growing number are in same-sex couple households. Recommendations and interventions for healthy eating should acknowledge and address changing household arrangements and their implications for children’s health. Second, when recommending dietary changes and designing interventions, we should recognize that families’ efforts to eat more healthfully can have economic, social, and psychological costs. Grocery shopping, meal planning, and cooking is time-consuming work. Some parents have unpredictable and inflexible work schedules, compromising their ability to plan ahead or find time to shop for and prepare healthy meals.5 Switching to healthier dietary practices can also have psychological and social costs because efforts to change dietary patterns can cause tension within families or can be difficult in unsupportive home and work environments.5 While these experiences are not universal, they are real. We must acknowledge the realities of families’ lived experiences if we are to develop effective and ethical approaches to encouraging children’s healthier eating. Simply reducing access to processed food does not address the real costs of healthier eating. We owe it to families to recognize these costs, develop interventions that minimize them, and foster broader responsibility for children’s healthy eating.