The Erosion of Trust in Professionals, aka That Time My Gynecologist Gave Me Dietary Advice While Looking at my Cervix

Jen Campbell went on an amazing rant in the Weight Loss Without Restriction Facebook group last week. She was on fire about nutritional misinformation being shared in a group, with the poster using the fact that the misinformation was from a medical professional to give credence to their dietary philosophy. The rant was a real act of beauty. Unfortunately, I can’t link the video here, since it’s not available on Youtube.⁽¹⁾ However, let me give you some choice excerpts:

“I think what pisses me off the most. . . is when doctors get involved and are sending people down rabbit holes. I think it pisses me off more when doctors do it, rather than wellness influencers or different gurus are, because of the abuse of power. And the natural trust that a lot of us have for doctors, and the trust that ends up being eroded over time from people that we should be able to trust.”

Jen and Annie go on to offer advice on how to talk about nutrition with your doctor, and how to assess if the advice they are giving you is best for you. One of the many reasons I have so much trust in Jen and Annie, and the work they do in Balance 365 (aside from rants like this) is that they always put nutritional advice in a larger context. They want to know if it’s the best advice for you not just for your physical health, not just for reducing body fat (if that’s your goal), but what emotional toll would those changes take? What is the financial impact? How does it fit in with the rest of your life? These are important, meaningful questions that lead to sustainability of dietary changes and acknowledge the whole health of someone, not just a fattist/sizeist assumption that if it leads to weight loss, it must be good.

And I’m all in on Jen’s point about the erosion of trust in professionals that is a natural consequence of this sort of snake oil. It’s one of my biggest beefs with the diet, fitness, and wellness space, too. We need to know who we can trust, and the world has plenty of people with letters after their names taking advantage of public trust to sell quick fixes. Rampant unethical advice from people abusing their positions of power is not inevitable–we live in systems that allow it to happen. We have chosen to not create checks to that power, so the average American can’t tell the difference between a registered dietician (which requires a degree, internship hours and accreditation by passing exams) and a nutritionist (which does not)^.(2) And so, when the advice doesn’t work, or gets counteracted by some new information, or does harm, it is natural to hold it against medicine as a practice rather than a few unethical individuals. We’ve been given no meaningful and reliable way to discern the difference between them.

Like a lot of women, particularly women with obesity (and, from what I understand it’s even worse for members of the BIPOC community), I have had my fair share of medical professionals offering me unwanted dietary advice. Unfortunately, I’ve since learned that even as a now smaller-bodied person, the unqualified dietary advice doesn’t go away when we are smaller. They may not be trying to help me lose fat⁽³⁾, but they are still trying to solve perceived problems that I am not there to have solved. The most recent example of this was about 6 months before my hysterectomy.

Imagine this, as the gynecologist is examining my vagina and cervix, me strapped into stirrups on an exam table, gonads facing the open air, she casually mentions that she saw I had immune disorders on my chart. “You know, if you want to talk to me about it later, I have some dietary recommendations for you. Have you heard of [fill in some pop-culture book about gluten intolerances here]?”

I was furious. Can you imagine a more vulnerable situation in which to interject unrequested advice? And while I have lived with my immune disorders for decades now, they carry with them real life-threatening and trauma-inducing potential. I, and people like me with challenging chronic illnesses, are especially vulnerable to wanting to believe hope-giving misinformation. And besides, I was there to treat painful fibroids. It was completely out of her scope of practice to offer me dietary advice, and certainly to offer advice about a condition I was not there to receive treatment for! I could not change physicians quickly enough.

Beyond the harms this sort of misinformation causes the individual, erosion of trust in professionals is pernicious, and it endangers the health of our democracies. Look at what well-placed lies have allowed to happen here in the United States in our COVID-19 response. I believe it possible we could have nearly eradicated the disease within our borders by this point, if more of us simply had trust in our systems and medicine and everyone who safely could be vaccinated did so. I understand that the distrust in medicine and other positions of authority in our communities of color is deeper and based in long histories of trauma. I am deeply sympathetic to this distrust, and members of those communities are not the target of my ire. I’m mostly looking at my fellow White Americans, who have allowed themselves to follow the advice of politicians who are lying to them to maintain power and control rather than to trust the medical professionals who are telling them the truth. The Republican Party has succeeded in weaponizing this distrust in professionals, and there’s no evidence that they will back off any time soon.

Distrust, once formed, can be difficult to reverse. And it feels to me that it can spread like a contagion, from one form of authority to another. It only takes two points to make a line, and our minds are well-designed to identify simple patterns. There are health, fitness and wellness professionals we can trust. We can learn from them and develop a deeper understanding of ourselves and what works within our unique circumstances. I share Jen’s outrage that the voices of these quality professionals are drowned out so frequently by folks with less integrity, abusing their positions of power to gain influence and profits.

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⁽¹⁾ _{If you are a woman or female-identified, you can request to join the group, and then search the old posts. The video is from a live video Q&A given last Thursday, July 8th.}

⁽²⁾ _{Jen is Canadian, and I admit, I don’t know how Canada does in identifying their true medical professionals and the folks that I think of as providing “culturally-specific medicine.” I put chiropractic, naturopaths, cupping, Chinese herbalists, and all sorts of other non-scientific practices in this basket. Not to say that it doesn’t work or doesn’t have a place in society, but rather to identify that some of its efficacy is derived from culturally-specific ways of identifying illness. Illness is not only a physical experience but a psycho-social-cultural one. And of course, I recognize that science and “Western” medicine is a cultural construct, too, but it’s also, at its best, repeatable and verifiable, and I think that appropriately puts it on a rung above these other treatments, which may require a certain amount of buy-in to create the desired effects.}

⁽³⁾ _{Then there was the GP who mentioned I was “only a few pounds below the maximum for the ‘normal weight range’ for my height,” and I might want to keep an eye on that. Ugh. Yeah. So, I didn’t see him again, either.}