In September, this simple tweet went viral: "Please stop assigning food diaries to students. Please." Nearly 50,000 Twitter users liked the statement, many of whom shared their own experiences with the exercise.
Earlier that same month, Oona Hanson and Charlotte Markey wrote for the U.S. News & World Report that "food diaries are common nutrition assignments that pose a health risk to kids."
"It's a pattern familiar to anyone who treats adolescents with eating disorders: a well-intended nutrition lesson triggers an unhealthy relationship with food that spirals into mental illness," they wrote.
Usually kept over the course of a week or two, assigned food diaries ask students to track and record every single thing they consume, whether it be a juice box, gum or a rack of ribs. Ostensibly, this is to show the complete amount of food students consume on a weekly basis — which instructors can use to spark discussions about nutrition, food allergies and healthful choices.
However, when reached by email, Rebecca Firkser — who works as a writer, editor, recipe developer and food stylist — wrote that "if an assignment like this doesn't promote full-blown food obsession/disordered eating behavior, it would certainly encourage the notion that…food choices have morality, which lay the groundwork for the former. I can see this being just as dangerous to elementary-age kids (whose parents are being told to monitor their kids' weight) as to middle- and high-schoolers (battling body dysmorphia and diet culture as they are further exposed through media)."
Even students themselves have voiced concerns over this assignment. In 2017, Camille Caldera, who was then a student contributor for The Black and White at Walt Whitman High School in Bethesda, Md., wrote an opinion piece stating that "food tracking assignments cause students more harm than good."
Caldera noted that certain instructors would allow students who expressed discomfort with the assignment to opt out.
"However, not all affected students feel comfortable speaking to teachers about such a personal topic," she wrote. "Discussing the issue is often the hardest part, [an] anonymous sophomore girl said. She didn't feel comfortable asking to be excused from the assignment."
This begs the question, however: if there is already an established precedent of students needing to opt out of these assignments, for whatever reason, should this practice still be continued?
To better understand the history of food diaries and their continued use, despite evidence that they may be harmful to students' well-being, Salon Food spoke with Dr. Katherine Hill, a board-certified pediatrician who specializes in eating disorders, JD Ouellette, a Lived Experience Lead, and Megan Holt Hellner, a registered dietitian and the Head of Nutrition and Physical Activity Research at Equip. All three work with Equip, a virtual eating disorder treatment platform founded in 2019 "with a dream of making sure that everyone has access to evidence-based treatment for eating disorders."
This conversation has been edited lightly for clarity and length.
Salon: What is most concerning about this up-and-coming practice of assigning food diaries as "schoolwork" which is to be graded, i.e mandated assignments?
Hill: There is no denying that by and large, our society has an obsessive and dysfunctional relationship with food. As early as preschool, many schools teach kids to sort foods into "healthy" (or "good") foods and "unhealthy" (or "bad") foods. Assignments like these teach young children that food has moral value, which can lead to feelings of guilt and shame if they eat foods that fall into the "bad" category. And these feelings can create complicated relationships with food and body that can last a lifetime.
Ouellette: Food diaries fall into an area of education that I call "feelpinions"—things that we feel are just common sense, so we don't even bother to look for, or even conduct, research to see if what we believe is true or not. It "feels" like talking to kids explicitly about nutrition, good and bad foods, etc. and teaching them to count food groups and calories would lead to kids changing eating habits in a positive way. We don't have evidence that is true, and we have quite a bit of evidence it harms kids.
"Intuitive eating – that is listening to and trusting your own body's signals – is impossible if we "talk over" our body's signals with food rules that are arbitrary and generic, and food diaries are a step toward doing that."
Intuitive eating – that is listening to and trusting your own body's signals – is impossible if we "talk over" our body's signals with food rules that are arbitrary and generic, and food diaries are a step toward doing that.
A decade ago I was an educator with a daughter who had just developed anorexia, and someone who had never thought overly much about nutrition assignments as a teacher or parent. I began to look into what is happening in schools around nutrition education. One of the most fascinating things I learned was that Arkansas was the first state to begin doing anti-obesity education, and has "food diaries" assignments built into their state standards. Almost 20 years later, there's rising rates of both obesity and eating disorders. We have to rethink everything we currently do around nutrition and health education and that includes food diaries.
What are the most challenging aspects about an assignment of this nature? What is the projected 'takeaway' from such an assignment? Is it possibly doing any good?
Hill: In middle and high school, a common assignment is for students to track their nutritional intake for a few days. For some, these assignments can lead to obsessive calorie counting and restrictive eating, both risk factors for developing an eating disorder. Furthermore, teachers may also critique or grade students' dietary recalls, which can be problematic. For instance, teachers might point out if a student has exceeded an average person's daily limits of calories or fat grams, or if they didn't consume enough fresh produce. Every person is different in what their own individual body needs, and a growing, active male athlete, for instance, might have double the nutritional requirement of an average adult. And not every child (and their family) has access to foods like fresh produce, so it's not fair to grade students on factors they can't control; we know food insecurity is also an independent risk factor for eating disorders.
Ouellette: The projected takeaway is if we get kids to look at what they are eating in a day, where they are not following "the rules," and where they can change their diet to mimic current thinking on food groups, good and bad food, amount of fruit and veg, etcetera, these children will be healthier in both childhood and life.
Challenges to this practice, in addition to the absence of robust evidence-based support for food diaries that also look at unintended consequences, start with the fact that this is a judgmental and often shame-based assignment.
Kids are largely eating food that is available to them. Children rarely set the budget for a family's food or are responsible for stocking the refrigerator and pantry. So if their food diary is judged to be lacking, that is an inherent judgment of what the grownups in their life provide for them. Do we want to set up a dynamic where kids feel obligated to tell their families they are parenting them "wrong"? Do we want to promote the idea their family is failing them by not providing food diary A+-worthy meals and snacks?
It's also important to accept that bodies and appetites both come in different sizes. We don't expect everyone of the same height to wear the same size shoe, so why would we think it would be all the same for weight or appetite or intake? How is it even possible for a teacher, who is usually not also a medical doctor or registered dietitian, to appropriately judge and grade a child's intake as healthy or not for them personally?
I don't see a benefit to these assignments as they stand now. Again, I think we need to have robust research for an intervention rather than assuming it works. It's highly problematic that we would seek to solve a societal issue involving matters of food policy, economics, social justice, food apartheid, etc. by framing it as individual choices, particularly with children.
What is the history of food diaries? Were they an invention of nutritionists/dietitians to monitor food allergies, food intake, weight loss or gain, etc.?
Hellner: Food diaries (or journals) are instruments for assessment of one's nutrition, and have been common practice for many decades. Ancel Keys, author of the well known Minnesota Starvation Experiment which took place in the 1940s, had his study participants complete food diaries. Registered dietitians use them to assess adequacy of one's diet, to identify nutrients of concern, food sensitivities/intolerances and maladaptive eating behaviors. Additionally, they're often used as a tool to help an individual become more mindful of their eating behaviors and relationship with food. The objective of keeping a food journal will shift based upon patient needs. A patient seeking help for hypertension, for instance, may be asked to complete a food journal to assess their sodium intake, while the aim for someone struggling with binge eating disorder may be to identify patterns that are reinforcing binge urges.
Students are often given an assignment to keep food journals as part of nutrition or health programming in school settings. However, while well intended, educators simply don't have the training to give feedback in a way that is sound, safe, appropriate and helpful. Children and young adults are relentlessly subjected to feedback around weight and shape from diet culture, media, and peers, and are particularly vulnerable to struggles with food and body image. Food diaries, when used with intention and care – and with guidance from a trained professional – can be a helpful way to help one gain insight and shift away from dysfunctional behaviors. We discourage educators from engaging in this practice with students given the potential for doing harm.
Ouellette: Food diaries do have usefulness for folks figuring out migraine triggers, allergies, etc. and it's important to highlight it as part of a medical intervention with trained professionals like MDs and dietitians. There is a long history of using food diaries to aid weight loss, and the evidence does show they are effective, at least in the short term, for adults who use them. We cannot discuss that piece of things without also being clear research shows long term weight loss is not achievable for most people, and also affirming the most common outcome of dieting is higher weight down the line. Food diaries to support restrictive eating is common in those with eating disorders and that speaks to the risk of introducing them to children. Food diaries can also be a positive resource for those in eating disorder treatment as a way to ensure adequate intake is happening. When we are treating children and adolescents, it's the parent's responsibility to ensure their children are receiving enough food intake.
Do you find that this practice would be most concerning for a particular age group?
Ouellette: Eating disorders are happening in children as young as five, so this practice is concerning at every age level. This process is teaching children to ignore their own body's hunger cues rather than teaching them to listen to them. We are also endorsing that food is only fuel, rather than acknowledging food is an important component of culture, community and love.
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What are ways to shatter the harmful mentality that links morality and "goodness" with certain foods, diets, ingredients, etcetera?
Hill: Instead of categorizing foods as good or bad, it can be helpful to take an "all foods fit" approach, where no food is deemed off-limits and no food is given a moral value. For example, in a school assignment with 2 categories of "healthy" or "unhealthy", a student might classify kale as "good" and ice cream as "bad". And while we probably shouldn't eat ice cream with every meal, on a hot summer day, for example, going out for ice cream can be a wonderful treat. Ice cream also has lots of nutrients, like carbs, fats, and proteins, that our bodies can use as fuel. We shouldn't teach children that they should feel shame or guilt when enjoying a treat like ice cream now and then. And in fact, there are potential negative health consequences of eating too much kale as well! Instead of kale being "good" and ice cream being "bad", it's better to think of kale and ice cream as both having a role in a healthy, varied diet, and perhaps thinking instead in terms of "sometimes foods" and "everyday foods".
"Another reason food diaries can be problematic in young people is that children and even adolescents tend to think more concretely than adults."
Another reason food diaries can be problematic in young people is that children and even adolescents tend to think more concretely than adults. I've had many young patients take away from school assignments messages like: "sugar is bad and if I eat sugar I'll get diabetes", and the next thing you know they are avoiding all sugar and rapidly losing weight. Or they've watched a documentary about the food industry and decided to abruptly cut out all animal products. For some kids, this might be fine, but for others, a restrictive diet can be a trigger for a dangerous eating disorder.
Ouellette: It is a process to unlearn all of the "feelpinions" that have guided us and become embedded in our culture. I think acknowledging what we have been doing doesn't work is a start. Dive into learning about intuitive eating—not through a diet/weight control lens, but through a return-to-trust-of-our-amazing bodies lens. If you have concerns about specific ingredients in our food supply, tackle those at a system level.
Make a commitment not to moralize food, or the food anyone is eating. It's not a measure of anyone's worth or health or anything else. Eating organic or "clean" generally has more to do with someone's disposable income than their "superior" approach to their diet. There is no food or ingredient as scary as being scared of food.
What are the cultural and socioeconomic factors that might play into this, such as "food swamps," less access to fresh produce, etcetera?
Hill: There are many barriers that could prevent people from creating the kind of food diary that would be deemed "healthy."
Food diaries as school assignments can illuminate how varied access to fresh food can be. Economic barriers to health food are incredibly common: the USDA estimates that 23 million people, including 6 million children, live in food deserts, meaning that access to grocery stores, farmers markets, and other sources of "health" foods is severely limited. Food swamps, too, restrict meal options to fast-food restaurants, corner stores, and other outlets with a limited selection of highly processed items. When students simply don't have the ability to access foods like fresh produce, forcing them to monitor and track their daily food intake quickly becomes an inequitable and unfair assignment. And beyond that, food insecurity and economic barriers to food are both risk factors for eating disorders, and they should be addressed on a systemic level, rather than called out as a failing on the students' part.
Cultural factors can also prevent the creation of an outwardly "healthy" food diary. We know that every culture's food looks different from others – certain cuisines might heavily favor ingredients like vegetables or proteins, while others might leverage techniques including frying or marinating. As a result, it's useful to understand how different cultural attitudes toward food can impact a child's ability to eat what their teachers would consider a "healthy" diet.
Ouellette: We always need to be attuned to the fact that not every student in a classroom comes from a family with an ample budget for the fresh fruit and vegetables a food diary theoretically wants to see. Parents may rely on convenience foods due to budgetary or logistical necessity. They may live in an area impacted by food apartheid—a compounding issue in relation to food diaries. One system is telling you that you cannot be healthy or good without meeting arbitrary food rules, and another system has made sure you don't even have realistic access to the foods you are "supposed" to eat. This is not a recipe for success.
Thank you for your insight! Any final notes?
Ouellette: I think a lot of school assignments around food, nutrition, movement and exercise would benefit from adults putting themselves in the shoes of the children doing them. How would you feel if someone told you your parents don't buy the "right" food? How would you feel if you were told you need to play outdoors for X hours a day, but your school has barely any recess and your neighborhood isn't safe or suited for outdoor play? How would you feel if you were in a large meeting and someone asked you to calculate your weight on the moon and wrote them all on the board? How would you feel if the school was telling you to eat two vegetables and a fruit for lunch, but the only way you get much playtime is to shove a bologna sandwich in your mouth and run off to the playground?
There is a lot we could do to positively impact the health and wellbeing of our students that is our adult responsibility to change—and that doesn't start with grading them on things largely out of their control.