The purpose of this document is to reflect on our current practices and clarify implications for practice with respect to using a food neutral approach in the school setting.
Issue/ Background
Public Health Ontario (PHO) prepared and published (October 2024) an Evidence Brief “Food Neutrality or Food Bias and Impact in Children and Adolescents Aged 4-18 Years” (1). The Evidence Brief was prepared at the request of Ontario Dietitians in Public Health (ODPH). The brief aims to inform nutrition-based school health promotion by answering the following question: how does food neutral (or non-neutral/food bias) nutrition education messaging impact behaviours, physical health, and mental health in children and adolescents aged 4-18 years? The brief concludes that “there is a lack of evidence on the impact of food neutral approaches in interventions with school aged children and adolescents. There is no direct evidence that tests the impact of food neutral or food biased approaches on physical or mental health outcomes within the evidence published in the last 10 years” (1). The overall conclusion of the PHO evidence brief may raise questions about the current recommendations and messaging from ODPH regarding the use of neutral language.
Key Points
- The brief concludes there is no direct evidence on the impact of “food neutral” nutrition education messaging. This conclusion is based on a very specific research question and definition of “food neutral”. This lack of research is expected, given that the term “food neutrality” or “food neutral language” is a new term without a widely accepted definition. The absence of published literature does not invalidate the potential benefits of using food neutral language and/or approach but rather points to the fact that research is lagging behind practice.
- The brief did not uncover any research that demonstrates harm of using food neutral approaches when working with children and youth.
- If the research question was worded differently and/or used different terms to connote the same idea, the findings might have been quite different (i.e. nutrition education language that mitigates risk of eating disorders/reduces harm to relationship to food).
- The brief discusses available indirect evidence about food bias (e.g., labeling foods as “good” or “bad.”) and describes how such bias can lead to negative emotional impacts, like guilt and anxiety in children, contributing to unhealthy relationships with food. These findings point to potential harms of food biased approaches. Even if quantitative data are still lacking, these findings build support for food neutral language as its use may help remove the emotional burden attached to food choices and foster a positive relationship with food.
Provincial, Federal and Global Applications of a Food Neutral Approach
- A food neutral approach aligns with the Ontario Ministry of Education’s Curriculum – Health and Physical Education for Grades 1-8 and 9-12 (2,3):
- “Students bring their learning home to their families, and they have variable amounts of control over the food they eat at home and the food they bring to school. Teachers need to consider these realities and be aware of issues such as poverty, food allergies and sensitivities, eating disorders and weight preoccupation, and social and cultural practices in order to ensure that the learning is presented with sensitivity. Using a flexible and balanced approach and avoiding rigidity regarding food rules and guidelines can reduce potential triggers to body image and eating concerns. Sensitivity regarding weight and shape and personal values regarding “what is healthy” are important when considering instruction.”
- The concepts of using non-stigmatizing and non-judgemental approaches, including not labelling foods as good or bad, are being encouraged as an eating disorder prevention strategy in the school setting by the Eating Disorder Ontario Prevention program (4).
- Food neutral language is being used by dietitians in multiple Canadian provinces (5, 6, 7, 8, 9)
- Health Canada’s recently released Canada’s Food Guide – Toolkit for Educators has included a food neutral approach to classroom-based nutrition education activities. The toolkit guides educators to keep a non-judgmental attitude, and avoid labelling foods as good or bad, including in situations when children may show interest in, or bring up, highly processed foods during activities (10).
- The concepts of using neutral language are embedded in well-documented and respected approaches to eating and feeding, such as Satter Division of Responsibility in Feeding (sDOR) and Intuitive Eating (11, 12).
Recommendations for Public Health Practice
Despite the lack of published evidence regarding the terms food neutral/food neutrality, public health staff should continue to use non-judgmental, non-stigmatizing, and neutral approaches to food and nutrition in order to create positive relationships with food and minimize potential harms and unintended consequences.
References:
- Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evidence brief: food neutrality or food bias and impact in children and adolescents aged 4-18 years. Toronto, ON: King’s Printer for Ontario; 2024.
- The Ontario Public Service. The Ontario Curriculum Grades 1-8: Health and Physical Education [Internet]. 2019. Available from: https://www.edu.gov.on.ca/eng/curriculum/elementary/2019-health-physical-education-grades-1to8.pdf
- The Ontario Public Service. The Ontario Curriculum Grades 9 to 12: Health and Physical Education [Internet]. 2015. Available from: https://www.edu.gov.on.ca/eng/curriculum/secondary/health9to12.pdf
- Decision Making and Implementation Support Toolkit [Internet]. Eating Disorders Ontario Prevention . [cited 2024 Oct 29]. Available from: https://eatingdisordersontario.ca/wp-content/uploads/articulate/DMISToolkit/#/
- Alberta Health Services. Nutrition Bites [Internet]. Alberta Health Services; 2024 [cited 2024 May 30]. Available from: https://www.albertahealthservices.ca/nutrition/Page6457.aspx
- Navigating the Food Guide – Guiding Principles for Educators [Internet]. HealthySchools BC; 2024 [cited 2024 May 30]. Available from: https://healthyschoolsbc.ca/teach-food-first/guiding-principles/
- Remmer S. What is Food Neutrality, and Why is it Important for your Child? [Internet]. Sarah Remmer, RD. 2022 [cited 2024 Oct 29]. Available from: https://www.sarahremmer.com/what-is-food-neutrality-and-why-is-it-important-for-your-child/#diet
- Nova Scotia and Prince Edward Island. CELEBRATE Feeding. 2022 [cited 2024 Oct 29]. Available from: https://www.celebratefeeding.ca/
- The Nüton Team, Dairy Farmers of Canada’s Registered Dietitians. Nüton . Available from: https://nuton.ca/
- Canada H. Teaching Canada’s food guide [Internet]. Canada Food Guide. 2024 [cited 2024 Nov 4]. Available from: https://food-guide.canada.ca/en/toolkit-educators/
- Tribole E, Resch E. Intuitive Eating Studies [Internet]. The Original Intuitive Eating Pros. 2024 [cited 2024 Oct 29]. Available from: https://www.intuitiveeating.org/studies/
- Satter E. The Satter Eating Competence Model [Internet]. Ellyn Satter Institute. [cited 2024 Oct 29]. Available from: https://www.ellynsatterinstitute.org/satter-eating-competence-model/
