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.

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加工食品营养咨询的伦理考虑

向编辑提供有关加工食品的营养咨询的伦理考虑 我们怀着极大的兴趣阅读了“加工食品：失败的实验”一文。1 我们赞赏为引起人们对加工食品对公共健康影响的关注而做出的努力。然而，我们担心它在与家庭努力吃得更健康有关的两个重要问题上没有达到目标。首先，我们被下面这句话困扰：“今天有三分之一的美国母亲甚至不知道什么是真正的食物或如何烹饪”，这种情况使她们和她们的孩子“沦为加工食品行业的人质。”1 这样的框架令人担忧，因为它强化了一个有问题的规范，即母亲对儿童肥胖负主要责任。2 从一个角度来看，强调母亲在解决儿童肥胖问题中的作用是有道理的，因为与男性同行相比，美国女性更有可能购买和准备饭菜，也更有可能带孩子去看儿科医生。 3,4 然而，仅关注母亲代表错失了让父亲和更广泛的社会参与促进儿童营养和福祉的机会。4 与此相关，我们必须承认美国家庭日益多样化。在 1960 年代，近四分之三的美国儿童在他们的第一次婚姻中生活在两个已婚父母的家庭中。今天，只有不到一半这样做，四分之一与单亲生活在一起，越来越多的人生活在同性夫妇家庭中。健康饮食的建议和干预措施应承认并解决不断变化的家庭安排及其对儿童健康的影响。其次，在推荐饮食改变和设计干预措施时，我们应该认识到，家庭为更健康饮食所做的努力可能会产生经济、社会和心理成本。杂货店购物、膳食计划和烹饪是一项耗时的工作。一些父母的工作时间表不可预测且不灵活，这会影响他们提前计划或抽出时间购买和准备健康膳食的能力。 5 改用更健康的饮食习惯也会产生心理和社会成本，因为改变饮食模式的努力会导致家庭内部紧张或者在不支持的家庭和工作环境中可能会很困难。 5 虽然这些经历并不普遍，他们是真实的。如果我们要制定有效和合乎道德的方法来鼓励儿童更健康的饮食，我们就必须承认家庭生活经历的现实。简单地减少加工食品的获取并不能解决更健康饮食的实际成本。我们应该让家庭认识到这些成本，制定干预措施以最大限度地减少这些成本，并培养对儿童健康饮食的更广泛责任。