Years ago, I had written a blog post on what I considered the “4 Foundations of Healthy Eating”. At the time, I considered those foundations the starting point of “good nutrition,” and used them in various ways in my practice. Since then, my views on health, eating, and nutrition have changed, and so I thought that it was time for a refresh.

These foundations and the pyramid image are inspired by Satter’s Hierarchy of Food Needs, which is in turn inspired by Maslow’s Hierarchy of Needs, which is in turn inspired/stolen from Blackfoot ideas.

Why is “Healthy” in Quotation Marks?

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The perfectionism in the statement makes health inaccessible to most, if not all, people.

By putting quotations around the word “healthy,” my hope is to invite people to define the word in their own way that makes it more accessible to them, if attaining health is one of their goals. For example, the Association for Size Diversity and Health (ASDAH) describes health as “exist[ing] on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living.”

Although I would guess that most people reading a dietitian’s website are probably looking to improve their health through food and nutrition, it’s important to note that it doesn’t have to be a goal for everyone—health is not a moral imperative.

The 4 Foundations in Detail

1. Food Security and Clean Water Supply

It would seem obvious that in order to eat “healthfully,” you would need to “have physical and economic access to sufficient safe and nutritious food” and clean water. However, you may be surprised by how even some public health groups seem to want to jump past this foundation and recommend certain types of foods over others when people aren’t getting enough food and fluids in the first place.

By placing food security and access to safe and clean drinking water at the base of the pyramid, I hope to underscore that “healthy” eating is not just about food or individual behaviour, but also about systemic concerns. The lack of a safe, clean water supply is an ongoing issue for many First Nations within Canada’s borders.

Additionally, the importance of fluid intake is sometimes ignored when we talk about nutrition. You may have heard before that while we can survive weeks without food, we can only survive days without water. Our bodies are ~70% water, and so adequate fluid intake (whether it’s through water, other beverages, or even fluid-containing foods like fruits and vegetables) is important to ensure all the biological functions in our body run smoothly.

2. Regular Eating

Eating regularly throughout the day helps to give your body the fuel that it needs to get through the day, and maximizes your chances that your nutrition needs are met. Though there has been an increase in research on the potential benefits of intermittent fasting over the past few years, most of it is short-term and often doesn’t consider the longer-term psychological effects of food and calorie restriction.

I struggled with the wording of this foundation, as I know “regular” is often regarded as a synonym of “normal” (though I do appreciate Ellyn Satter’s definition of “normal eating“.) I also know that the word “regular” can imply eating at the same times/intervals throughout the day, though that is not the expectation.

What about “eating according to hunger cues”? While that works very well for some and is aligned with intuitive eating, it’s not accessible to all—responding to hunger cues may not be available for people for a number of reasons, including neurodivergence, GI surgery, a long history of dieting, or simply the way that a person’s day is structured.

In practice, for those who are just starting, or getting back to eating more regularly, I often recommend planning to eat in regular intervals at first, and using those times as external cues to check in on your internal cues. With time, experimentation, and practice, you may find what “regular eating” looks like for you.

3. Variety of Food Choices

Eating a variety of foods again maximizes your chances of meeting your nutrition needs, and in some cases, many of the nutrients can “work together” to improve health and well-being. Furthermore, meals that provide a variety of colours, flavours, and textures can help increase satisfaction.

While I’m trying to shed the stereotypical dietitian adage of “choosing at least 3 of 4 food groups at every meal” some people do find planning to include a vegetable/fruit, grain/starch, and protein-rich food or a combination of the three macronutrients (carbohydrates, protein, and fat) helpful guidelines when thinking about what variety can look like from a nutritional perspective.

4. Individual Needs

Though this foundation is at the very tiny, tip-top of the pyramid, it is doing a lot of heavy lifting. In addition to “health needs”, this section encompasses needs and desires based on culture, preferences, lifestyle, and so on. Similar to the “instrumental foods” level of Satter’s Hierarchy of Food Needs, there is a tendency to focus on this section when we talk about nutrition, but without building a solid foundation in the other sections of the pyramid, it makes it more difficult to ensure that individual needs are met.

Why is the pyramid curved at the bottom?

A pie chart with a section resembling the '4 Foundations of Healthy Eating' pyramid highlighted. Text reads: 'Nutrition is just one of many factors influencing health  營養只是健康的决定因素之一' Smaller text on the lower left corner reads 'Not to Scale 不按比例'

The unique shape of the pyramid is to highlight that nutrition is just one piece of the larger health “pie”. It’s important to note that the image above is not to scale (my Canva skills are limited 😅); nutrition might be an even smaller contributor to our health than what is depicted. Factors outside of individual control, such as social determinants of health and genetics, often have a far greater influence on health than individual behaviour.

What are your thoughts on these 4 Foundations of “Healthy” Eating? Is there anything that you would add or take away? Please share your thoughts in the comments below.

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