I Have Mixed Feelings About Evidence-Based Practice and Here's Why

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We can’t put all of our eggs in the “evidence-based practice” basket. While evidenced-based practice is helpful and great and important, it is also limited. So many folks are not represented by the body of research that currently exists, and this is just one of MANY examples of how our world is not inclusive.

One way to quickly get a glimpse of some of the limitations of research is to look at the population studied/the identifiers of the participants of a study or the research. The population studied is who the results of the research can truly be applicable to (and even then the findings and recommendations based on the research may not always be practical).

So who is mostly represented in the research…white, able-bodied, cis-gender, neurotypical, etc. Sure there has been some efforts made in expanding representation but when looking at the amount of diversity relative to the entire body of research it is pretty minimal.

Another aspect to keep in mind is that a lot of research is conducted under very restricted and controlled conditions, which is not usually representative of the complexities and intersections of our lives. Randomized control trials are considered the “gold standard” (ie. the “best”) in research (or at least this is what I was taught and conditioned to believe), but I have a hard time accepting it to be the gold standard anymore. Maybe in some instances it is, but not in all.

With hearing this, I understand the tendency to just want to reject all research that exists or has ever existed. And just how understanding the limitations of research can be helpful, utilizing the research when it’s applicable can also be helpful. What I am saying is that we have to be really mindful of the evidence we may be utilizing and when it may or may not be useful, and that we need to continue to push for more inclusion, diversity and representation of all in the research.

Here is another question that may come up when thinking about the limitations of research…..what about all of those fad diets and such that are often based on anecdotal research or no formal research at all? Wouldn’t what I’m saying apply in this situation too? Good question! To help us figure this out, here are some questions to ask when looking at the fad diets [research]...if any of the answers to these questions are ‘Yes’, that is a helpful sign that this fad diet or diet trend will likely do more harm than good in the long run. 

  • Is it body shaming? Is it telling you/folks their body is wrong or a problem? Examples of this include any talks of shrinking your body size or changing your body composition [ultimately to try to conform to oppressive societal standards] 

  • Is it bashing foods? Does it put foods into any type of “good”/“bad” categories. This includes (but is not limited to) labeling food as “healthy”/“unhealthy”, “clean”/“dirty”, categorizing foods (and the allowance of each) by a point system, etc.?

  • Is it perpetuating the harmful idea that a person has to “earn” their food intake or “burn” it off?

  • Is it marketing exercise/physical activity/movement as a way to manage one’s weight/body size [which may be disguised as getting “fit”]? 

  • Is it ignorant of the fact that food is more than fuel (ie. that it’s also for pleasure and for connection with others, for example)? 

  • Does it perpetuate the idea that you are a better person for pursuing “good” health, losing weight, etc? 

  • Is it ignorant of the fact that access (which includes socioeconomic status) is a significant factor in health status? Is it ignorant of the privilege one must have in order to be able to follow their diet plan, lifestyle change, etc? 

  • Does it perpetrate the message that pursuit of “good” health is mainly a matter of self-control and willpower, and that those who don’t pursue good health are lazy or less than?

Again, if any of the answers to these questions are yes then there is a really good chance that diet (“lifestyle”, “wellness plan” or whatever it’s being called at the time you’re reading this blog post) will perpetuate shame and guilt about your body, eating patterns and health rather than be helpful.

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Particularly if you were conditioned to believe that evidence-based practice is the end-all-be-all, I know that being critical of evidence-based care might be hard to grasp, accept or come to terms with. It’s ok if there are feelings, especially anger, disbelief or annoyance, that are coming up for you as you are reading this. If that is happening, I would invite you to be gentle and compassionate with yourself and curious. And maybe now, or at another time, reflect [non-judgmentally] on why you might be feelings this way. It can be hard to question or second-guess what we’ve been taught or know. And it’s also important to do so when there is a chance that what we believe could be negatively impacting lives by excluding them.

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