Friday, January 20, 2012

The Fallacy of Moderation

What does moderation really mean?
 Moderation is a word that has been used quite often when describing healthy eating and drinking patterns. Webster's Collegiate Dictionary defines moderation as avoidance of extremes or tending toward average. What does this really mean when we are talking about food? Does it mean one cookie a day or one less cookie than we usually eat? Perhaps it means that we don't eat the whole cookie jar? Does it mean once a day, once a week, once a month or once a year? The problem is that it can mean anything that we want it to mean. This isn't good enough when we are talking about promoting healthy eating behaviors. To say "all things in moderation" to me seems like an excuse to maintain the status quo, which arguably is average.

Paula Deen announced this week that she has had type 2 diabetes for the past three years. Her announcement mentioned very little about following healthy dietary habits. Rather, she stated that she has always been a advocate for moderation (there's that word again). Deen's recipes are not known for being healthy and it must be extremely embarrassing for her to have developed a disease that has a strong tie to dietary factors. Regardless of the cause of diabetes, diet and exercise are integral for its management. They are much too important to be passed off by the use of a non-specific word such as moderation. Deen's announcement this week motivated me to write this blog post, but this post is not about her.

The food industry loves the term moderation for the very reason that it is non-specific. Hershey's has created the Moderation Nation to help consumers find balance in their lives. Part of their message is that 100 calories a day of chocolate can fit into your balanced diet. That's fine, if you do not need to lose weight, but about one third of American adults are obese. George Blackburn, MD, PhD, Chief of the Nutritional/Metabolism Laboratory, and Director of the Center for the Study of Nutrition Medicine, which are affiliated with the Beth Israel Deaconess Medical Center in Boston, Massachusetts, reports that for a vast majority of obese Americans, as little as 200 calories a day prevents them from losing the 20-30 pounds necessary to gain significant health benefits(1). That is less than a small package of M&M's (240 calories). Often, that 100 calorie treat becomes a 200 or 300 calorie "nibble" especially when the whole package contains more than 100 calories. The concept of moderation keeps consumers buying products, which is the primary concern of major food manufacturers and restaurants. In the case of Deen's Savannah, GA restaurant, it keeps the line of patrons circling the block waiting to be seated. Moderation promotes sales and keeps the customers coming through the door.

Last month the marketing research group NPD discovered that Americans are following MyPlate guidelines only 2% of the time. That translates to seven days out of the year! That surely is not moderation and I would argue that the message of moderation is not working. MyPlate promotes such a simple concept and advises Americans to consume half of their plate from fruits and vegetables. It doesn't get much easier than that!

So what can we do that is better? The National Heart, Lung and Blood Institute in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases developed the WeCan Program to teach children and families how to choose healthier diets and exercise more. This program uses the Stoplight Approach to teach which foods should be eaten every day (green light), which foods should be eaten in smaller quantities and less often (yellow light) and which foods should rarely be eaten (red light). Another way to define this approach uses the words "Go, Slow, and Whoa." These three simple words convey more meaning than the word moderation and help to underscore that not all foods can be eaten regularly in moderation if you are trying to lose weight. This approach can be used to teach adults how to better control their food intake too and shows great promise in some area weight management programs.

Stoplight symbols have been added to packaged foods in some European countries to help consumers choose healthier diets. It's doubtful that food manufacturers would allow such a system in the United States because many food products would be labeled yellow or red which could potentially negatively impact sales. You can understand why manufacturers prefer the use of the term "moderation" when it comes to promoting healthier diet habits.

Smart phone users can benefit from using the Fooducate application which independently grades thousands of grocery food items and provides a stoplight color code and letter grade to help consumers make appropriate food choices. The app also discusses the reason for the grade so that you can better understand what makes a food more or less healthy.

I encourage you to make a pertinent comment on this post. I will send a copy of The Little Black Book of Foodspiration by Yvette Quantz, RD, CSSD, LD to the first 20 people who leave a comment. If you are one of the twenty, please email me at info@rochesternutrition with you name and address.

1. Blackburn, GL and Waltman, GA. Expanding the Limits of Treatment-New Strategic Initiatives. J Am Diet Assoc. 2005;105:S131-S135.


  1. Nice post Carol. I agree that "moderation" is too vague a term to have meaning for a lot of people (though I will admit I'd be quite disappointed if I did have to cut out my semi-regular square of dark chocolate!).

    As an RD teaching nutrition classes in a public school system, I like using the "go, slow, whoa" approach. However, I often find that kids, adolescents, and even parents tend to group some "whoa" items in the go or slow categories. Even with education, I have arguments and rationalizations that Ben & Jerrys should still be okay to eat more frequently, because "after all, it has some calcium."

    Making unhealthy choices in the name of "moderation", rationalizing poor diet choices as being healthier than they really are....sometimes, I think we brush off unhealthy habits rather than taking a serious look at how our habits affect our health.

  2. When I first started as a dietitian and was teaching a weight loss class, I found myself preaching moderation. After a few classes, I realized that I know what moderation is for me and what moderation should be for others, but that's not how my class sees it. Now, the moderation discussion is more about how distorted their image of moderation is (most of the time, it's the one less cookie approach) and how to get that image of moderation in check (along with the image of what a true portion is). I like the "Go, Slow, Whoa" approach and am going to investigate using it for my upcoming approach.

  3. The root of the problem seems to go much deeper than just the fact that many are quick to say, "Everything in moderation." Not only is there no definition of what moderation is but so very many people have little to no understanding of how big a role nutrition can and does play in a person's overall health. I've even heard people with the letters M.D. behind their name say, "O that doesn't make any difference," in reference to someone asking about nutrition.

    Most physicians will admit there's a link between weight, overeating, and one's health but too many of them don't think it matters how you get to a healthy weight or if a healthy weight person eats junk all.the.time. Until or unless there's a problem that they know (like Celiac or Crohn's) is linked to diet or when they want someone with high blood pressure to lower salt intake... or diabetics... otherwise far too many people are just told, "It doesn't matter." I even had one physician tell me that my patient was a peasant woman and I shouldn't bother to teach her anything because she wouldn't make any changes and I was wasting my time. *sigh*

    It seems that not only does our educational system fail to provide good nutrition to a large majority of students but it fails to educate them on why a diet high in fruits and veggies is good for them, the benefits and possible consequences of not eating well. Further, medical school seems woefully lacking in this area as well.

    Thanks for trying to help get the word out.

  4. I could not agree more. I cannot stand the word moderation as it has no meaning, especially not in the standard American diet. Sorry, I really don't believe that broccoli and snickers have an equal, moderate place in the diet. I think moderation has helped turn food into an excuse, especially for dieters. I'm not saying that we can't enjoy yummy foods every now and then, but using the "everything in moderation" excuse gets us nowhere, especially for individuals trying to lose weight.

    I think the most frustrating thing about the Paula situation is that she didn't take any responsibility. Of course she is not a doctor or a RD but to say she has always preached moderation is ridiculous. I understand that for business reasons, she would never admit that her dietary choices and recipes have a large impact on her recent diagnosis. It's too bad- that would be more of a empowered statement than cashing in.

  5. My favorite saying about ... Everything in moderation ... is ...

    The notion that it’s O.K. to eat everything in moderation is just an excuse to eat whatever you want.

  6. Moderation is a general term that is only helpful when combined with some sense of knowledge. If we eat alot of fatty foods, but each in that ok? How about if we eat varied foods, all in moderation, but each one lacking critical nutrients? I think the idea is here that it's ok to eat things from the "bad" groups in moderation if we are getting the needed nutrients, calories, and vitamins in total amounts. Fat in moderation...and yes, even a snickers or cookie in moderation when compared to out caloric intake and daily allowances is fine. The problem is that people aren't sometimes educated on what their daily intake should moderation is a quite relative term. For more diet foods there are plenty of sources in this blog and on the web to become educated and I think that's what should be pushed in lieu of moderation.