Keywords

9.1 Society 5.0 and Nutrition

The Government of Japan established the “Science and Technology Basic Act” in 1995 (Heisei 7). The purpose of this law is to formulate a “Science and Technology Basic Plan” every four years in order to implement systematic and consistent science and technology policies from a long-term perspective. So far, the plan has been formulated for the first period (1996–2000) to through the fourth period (2011–2015), and science and technology policies have been promoted in accordance with these plans. The 5th Basic Plan was approved by the Cabinet on 22 January 2016, and science and technology policy is currently being pursued according to its contents. In this basic plan, Society 5.0 was proposed as the future vision of society.

Shouldn’t there be a 6th basic plan now in 2021.

9.1.1 Working Toward an Ideal Society

“Society 5.0 is a human-centered society that can develop economically while solving the problems of modern society through a system that closely integrates cyber space (virtual space) and physical space (real space).” In other words, it is an attempt to make the whole of social life convenient and comfortable by accumulating a huge amount of information emanating from real space into virtual space, analyzing this big data with artificial intelligence (AI), and feeding back the results of the analysis to people living in drop real space in various ways.

If we call hunting society, Society 1.0, then the agricultural society is called Society 2.0, the industrial society is called Society 3.0, the information society is called Society 4.0, and the future human-centered society is called Society 5. Specifically, Society 5.0 aims to create a society in which people and things are connected by the Internet of Things (IoT), and in which the necessary information is provided via robots and other means using artificial intelligence (AI) based on a variety of knowledge and information that exceeds human judgment. The idea is to use cutting-edge science and technology to solve the problems that our country is currently facing, such as the declining birth rate, ageing population, economic stagnation and environmental collapse.

9.1.2 Development of AI

The other day, when I called for a taxi from my home, instead of the voice of the receptionist as before, I got a robot voice replying, “Mr. Nakamura, If you would like a car delivered to your home, as usual, just hang up and please wait.” When I hung up the phone, the AI found the location of the nearest car, from the car navigation system and 10 min later, the car arrived as usual.

When he arrived, the driver said to me. “I’ve been dictated to by AI. eventually, they won’t need the office, and when they go automated, they won’t need us either.”

However, according to the driver’s story, the number of customers temporarily decreased because some people turned off the service when the voice from the robot was played. It seems that some customers look forward to the voice of the friendly receptionist. It’s going to take some time for it to be accepted by all.

AI and robotics are also becoming more prevalent in the field of nutrition. There are already “cooking robots” with arms that extend from both sides of the kitchen to follow instructions and cook. There are also apps on the market that allow you to take a picture of the food you are eating with your smartphone, and the AI will authenticate the picture, check your intake of food and dishes and calculate your nutritional intake. Furthermore, a method of evaluating the nutritional status by comparing this nutritional intake with the “Dietary Reference Intakes” and the reference amounts for dietary therapy is also about to be put into practical use.

AI will select the appropriate nutritional intake from the vast amount of guidance comments that have already been registered and convey them to the subject via a communication device. Such methods are now being put into practice.

I was once invited to the laboratory of a venture company. In front of a refrigerator, you answer questions from the refrigerator about your age, physique, health condition, physical condition, tastes, etc. The content of the conversation is analyzed by the AI built into the refrigerator, and a high-performance refrigerator is being developed that will propose a menu suitable for you, taking into consideration the condition of the ingredients stored in the refrigerator. It can also tell you how to cook and even tell you how to buy ingredients that are in short supply. The development of convenient cooking utensils and the spread of pre-prepared foods will continue, and a society in which consumers can easily access the meals they want is already in sight through the networking of local convenience stores, supermarkets, drugstores, restaurants, and cafeterias. Although the accuracy, validity, and effectiveness of these technologies are not yet certain, scientific innovation will certainly affect the work of dietitians and nutritionists.

9.2 AI and Robots Are Not the Ones to Fight

How should nutrition and diet professionals respond to these changes in society?

I believe that this is the key to the survival of the nutrition profession. The following is a list of issues that need to be considered.

9.2.1 Utilizing AI

First, the experts who will certainly be important in an AI and robot society are researchers and developers engaged in the development of such cutting-edge technologies. Some nutritional scientists and dietitians are already actively involved in the development of the AI-based devices and systems mentioned above. AI researchers and developers are expected to join nutrition experts, and nutritionists and dietitians specializing in AI and robotics will appear.

Secondly, expectations are rising for dietitians and nutritionists who can use AI and robots to provide nutritional guidance so that nutrition and diet can be practiced in a way that is easy to understand and enjoyable for the target person or target group. In other words, nutrition improvement can be practiced more reliably using cutting-edge technology, and dietitian is a profession that can provide nutritional guidance with even better results than currently. In order to improve nutrition successfully, it is of primary importance to provide nutrition guidance based on scientific evidence. AI has the ability to analyze a large amount of scientific data, identify problems, and tell us how to solve them. However, just being taught how to improve nutrition does not mean that your nutritional status will improve. It is necessary that the subject actually makes a behavioral change in accordance with the solution and that this is carried out in a sustained manner, so that new eating habits are formed. New eating habits involve the ability to make appropriate choices of foods, dishes and menus, and to repeat healthy eating behaviors without the need for specific awareness or knowledge. Brushing your teeth every morning is something that you have learned to do as part of your health routine, not something that you do consciously each time you remember to brush your teeth.

9.2.2 Strengths and Weaknesses of AI

If the features of AI are used in several families to ensure improved nutrition, the task can be carried out efficiently and effectively. For example, AI is good at comprehensively analyzing problems and telling us solutions based on subject interviews, diet and nutrition surveys, clinical examinations etc. However, the actual behavioral change by the subject requires nutritional guidance based on a comprehensive assessment of the individual’s outlook on life, lifestyle, family environment, learning ability, personality and past habits. Moreover, a relationship of trust is necessary between the subject and the instructor, and very few people can be expected to decide to change the lifestyle they have developed over the years because of advice given by AI, no matter how scientifically good it is.

AI and robots also have the problem of not being able to proactively find issues and problems on their own compared to humans. Furthermore, they cannot follow the flow of the conversation or read between the lines, and are inflexible and stubborn. Moreover, many people cannot develop emotional sympathy with AI (Table 9.1).

Table 9.1 Characteristics of AI and robots
Full size table

In this way, knowing the problems and weaknesses of the latest technology, while taking advantage of them to further enhance their own expertise, is crucial for the survival of future professionals. I believe that surviving as a professional while maintaining a certain social status in today’s ever-developing society requires not only the universal values of the profession and the professional ability of the individual, but also the courage and wisdom to evolve and adapt ourselves to changes in society. Charles Darwin, who advocated the theory of evolution, left behind the wise words, “In the world of living things, it is not the strongest that survives, nor the cleverest that survives. Those whose changes happen to be adapted to their environment survive”.

Players of shogi (Japanese chess) have already stopped fighting against AI. This is because they have realized that humans can no longer win. However, by practicing with AI, young chess players have become stronger and able to beat their seniors, which made the competition between humans more interesting and made the chess world more exciting. When locomotives and cars were born, they were often made to compete with track athletes and horse-drawn carriages. Today, however, there are no runners competing with sports cars, and each competes separately to make society more enjoyable. In other words, the direction of nutrition in the future is to think of AI and robots as a tool to enhance our own expertise, and to enhance our expertise in Society 5.

9.3 Teaching Nutrition to Create Behavior Change

Whatever the society, a universal value of the nutrition profession is for people to feel that they can trust the dietitian or nutritionist and look forward to meeting and talking with them. The true purpose of teaching nutrition is not simply to share one’s expertise in nutrition with people. Computers and AI have already taught us how to spread nutritional knowledge, and the streets are full of information, including false stories. Therefore, it can be said that the acquisition of knowledge and skills to cause behavioral change is an essential matter for dietitians and nutritionists.

9.3.1 Behavior Change Theory

Since there are several models of behavior change theory, we have organized them in terms of nutrition guidance.

  1. 1.

    Stimulus control method

Since behavior is changed by stimuli, this is a method to increase good stimuli and decrease bad stimuli. For example, when we have to get exercise, we increase visual stimulation by putting our favorite walking shoes by the door, and when we have to eat less, we try to control stimulation by avoiding passing a noodle shop on the way home.

  1. 2.

    Reaction disturbance and habit antagonism method

For strong temptations to negative behaviors, we teach coping strategies that prevent the behavior from occurring. For example, when a person wants to “eat anyway,” we instruct him or her be patient for 5 min and then go outside for a walk or do something he or she likes (response interference method).

If the patient is unable to do this, we can instruct the patient to eat low-calorie salads, seaweed, or non-sugar sweeteners (habit-antagonism method).

  1. 3.

    Behavioral substitution method

This is a way to replace unhealthy behaviors with healthy behaviors. For example, if a person has a habit of drinking alcohol or bingeing on sweets to relieve stress, they can transform it into a new healthy behavior, such as taking a weekend trip or getting involved in sports.

  1. 4.

    Operant enhancement method

This is a method of setting behavioral goals and providing positive stimulation. It is similar to the method of feeding animals and making them learn tricks. In the case of humans, for example, if a person loses 5 kg in 6 months, they set a goal to go out with friends, go shopping, or receive a present, and then carry out the goal.

  1. 5.

    Cognitive behavioral therapy

This is a method of transformation that makes the person aware of inappropriate health behaviors and practices, and moves them to more rational thinking and behavior. For example, if an obese person has a habit of unwillingly eating sweet every day, he or she may say, “How weak-willed I am! I shouldn’t have eaten that. It’s pathetic. I just can’t do it.” For those who are hopeless and believe that they can’t do it at all, following process is a way to change them so that they can think and act positively.

  1. â‘ 

    Life without sweets would be boring.

  2. ②

    Is there a cake that is low energy and tastes good?

  3. ③

    Yes, I’ll make my own homemade cake with vegetables.

  4. â‘Ł

    This is a great way to get fiber, vitamins, and minerals.

  5. ⑤

    It’s fun to make something yourself

  6. â‘Ą

    It’s fun to have a lot of variety, so I do it over and over again.

  1. 6.

    Self-monitoring method

This is a method in which the subject records his or her words, actions, thoughts, and moods on a memo sheet (worksheet) and evaluates them. It is important to judge the subject’s motivation, knowledge, learning ability, environment, etc. comprehensively to determine which method is suitable.

  1. 7.

    Behavior changes stage model

This is a model derived from research on smoking cessation in the early 1980s. It suggests that people go through five stages to change their behavior: “indifference stage,” “interest stage,” “preparation stage,” “implementation stage,” and “maintenance stage”. This method is a way of working through each stage, keeping track of achievements and problems, in order to get as far as possible at each stage.

  1. 8.

    Nudge theory

Nudge means to prod someone lightly with an elbow for attention or as a signal, and nudge theory is “a method of helping people to voluntarily make better choices for themselves”. It is a strategy based on behavioral economics that provides “a form of presenting choices” in a casual way. For example, rather than prohibiting or restricting the purchase or consumption of unhealthy foods, it aims to create an environment in which people can easily choose the “right food behavior”.

For example, in supermarkets, healthy foods are displayed at eye level, shopping carts are separate with a string in the middle to create a dedicated space for fruits and vegetables, small sizes of alcoholic and high-sugar beverages are easily available, and a variety of low-sodium foods are displayed. In other words, it is a way to make people change their eating behavior to the right one and make it a habit with little awareness through modest guidance and warning.

9.4 Nutritional Guidance That Is More in Line with People, Which AI and Robots Cannot Do

What kind of nutritional guidance by registered dietitians can never be done by AI or robots? How can we become the kind of dietitian who makes people enjoy consultations and willing to go see the dietitian again?

I think that the key to overcoming AI and robotics lies in this area. AI-based nutritional counseling software has already been developed, but the comments made by AI are patterned, so users get bored after a few consultations.

I had the same problem when I started teaching nutrition in the hospital. The first time or two, patients would come in and then not continue. What kind of nutritional guidance should I provide? At that time, however, there were no textbooks or reference books on nutrition counseling for individuals. The purpose of nutritional guidance was to teach the subject proper nutrition in an easy-to-understand manner, specifically, the correct selection of foods, how to prepare menus, and guidance on cooking techniques. However, the more nutritional guidance was given, the more it became clear that it was difficult to improve the dietary habits of the subjects and to change their eating habits simply by teaching them the information and techniques described in textbooks.

In particular, I realized that I was completely powerless to help patients with anorexia, which at that time was developing as a harmful effect of extreme dieting. The patients had more nutritional knowledge and a stronger will than others, and they could practice with certainty, but they were suffering from malnutrition. In other words, it was impossible to correct their behavior with knowledge alone, because their biased knowledge had amplified into beliefs, which resulted in abnormal eating behavior. Concerned about this, I consulted Pr. Michiko Fukazawa, who was also a pioneer for medical caseworkers at St. Marianna University Hospital. Caseworkers are professionals who provide consultation and assistance to people with mental, physical, and social problems, and they possess advanced counseling skills based on psychology. On her advice, I read a book on counseling and thought about applying these techniques to nutritional guidance. In the end, I realized that the important thing in nutritional guidance is to build a trusting relationship with the patient.

Knowing that the words of a reliable dietitian can have considerable power to change the lifestyle of patients. I have organized the points for building a reliable nutrition consultation into eight items based on a series of difficult consultation cases. I think that it is necessary for registered dietitians to acquire such skills in order to live in the society 5.0

9.4.1 Nutrition Counseling Skills That Registered Dietitians Should Acquire

  1. â‘ 

    Listening closely

The first 10–15 min of a nutritional consultation should be devoted to listening to the patient. Listening to the patient is not just listening to what they have to say, but it is also listening hard and making it easy for them to talk by saying things like, “I see,” or “Is that so?” There are patients who are satisfied with being listened to. However, no matter how much I listen, there are patients who do not want to speak and do not start to talk.

For example, there was a patient with anorexia who came to the Nutrition Consultation Room from Sendai. At first, he did not speak at all and was remarkably thin, so we admitted him to the hospital. We walked in silence along the corridor to the ward, and when we arrived at the ward, I casually asked him what he liked.

Then one word: “Tennis.”

“Right, well, I’ll see you at the tennis courts over there tomorrow morning”

At 7:30 in the morning he showed up at the tennis court. After a few rallies, we sat down on the bench and gradually began to talk. It is important to keep in mind that it is not easy to initiate an honest conversation with a person.

  1. ②

    Parroting

Parroting is a method of repeating the words spoken by the patient. For example, when a patient complains that he cannot stop to take sweets, you should return the parrot as follows.

“I see. You can’t help but indulge in sweet things, can you. I sometimes do that, too”

If I repeat the same thing that the patient complained about, he will think that the registered dietitian understands his worry and suffering, and the distance between patient and registered dietitian will be reduced.

  1. ③

    Sometimes organize the story

Patients talk one-sidedly about their thoughts and feelings, regardless of the context of the conversation. The order of the conversation and the relationship between the patient and others may become incoherent, so it is important to organize, order, and confirm the conversation from time to time before proceeding to the next conversation.

“So, this is what you are trying to say, Mr./Ms. ○○.” And then, we move forward by organizing the conversation and confirming it. In this way, it is possible to delve into the actual situation of the person’s dietary habits and find out the points that need to be improved.

  1. â‘Ł

    Respect for silence

It is important to maintain silence from time to time during the dialogue. For example, when, a patient tells you something he or she has never told anyone before, respect the silence. Then say something like. :

“Yes, this is a difficult subject, so you can take your time and think before you talk about it.”

Then, when so me story after the silence, put the words such as the following.

“It must have been hard for you, and I’m so glad you told me about it.”

“You’ve made a difficult decision”

  1. ⑤

    The improvement target is one or two feasible steps

From a professional point of view, many problems exist for patients. However, in general, people remember only one or two words that they hear from others. If we are told too many things, such as “follow this and that,” we are left with the impression that dietary therapy is difficult, and we lose the goal of what exactly should be improved by next time. If patients can’t do anything, they don’t feel like going to the consultation room.

For example, if there are five items that need to be improved, I will make a plan to improve them one by one over the course of five consultations. I narrow down the items to be improved to one or two before the next visit, and at the end of the consultation, I speak clearly so as to leave a lasting impression.

“Remember, until next time, alcohol only twice a week.”

In addition, it is effective to set improvement targets based on a consensus system.

“I’d like to set a goal of losing two kilos of weight by next month, would you like that?”

“No, I will be so busy with work and eating out this month that it’s impossible for me to lose 2 kg.”

“Okay, so you think you can do about a kilo first?”

“I think I can manage one kilo.”

“So let’s say we both agree to lose one kilogram.”

Thus, if goals are set in a collegial manner, patients will be highly motivated.

  1. â‘Ą

    Always find the results

The key to sustaining nutrition counseling is to find results of nutrition counseling that can be seen.

“Mr./Ms.○○, what’s changed in a month?”

“Nothing, my blood pressure’s not dropping. My blood sugar’s not dropping.”

“The weight has come down, hasn’t it?”

“No, my weight hasn’t changed.”

“How are you feeling?”

“Nothing has changed.”

“So let’s measure your body fat, shall we? …We’ve seen a slight drop since the last.”

“What? My body fat gone down?”

As you can see from this conversation, when you come back to the office, you should find at least one thing that has improved. When you find something, praise the effort and explain the significance of the result. This is because the biggest reason why patients cannot continue is that they cannot see any results.

  1. ⑦

    Become an attractive person

The registered dietitian herself should strive to be an attractive person who is interested in sports, arts, and even culture on a regular basis. That person should be a professional who has a lot to talk about, who enjoys conversation, and who wants to hear a story again. Nutrition coaching is not selling an item of value; it is selling intangible words and attitudes. People are willing to pay for meaningful words from an attractive and trustworthy person, but they are not willing to pay for someone who is the opposite, and they will not want to see them again.

  1. ⑧

    Nutrition counseling that is attentive to patients’ thoughts

Nutritional guidance does not mean showing off one’s own nutritional knowledge and skills in front of others. When I was young, I once observed a group of senior nutrition instructors. There were many types of nutrition instructors: those who talked about their knowledge in a one-sided manner, those who drew chemical symbols of nutrients with pride, those who talked about difficult topics using technical terms, and those who boasted about past cases.

What is important is that we should aim to be able to provide nutritional guidance that is based on scientific evidence and attentive to the subject’s body and mind, so that a person can live a full and meaningful life for as long as possible, no matter what disease or disability they may have. In this way, nutritional guidance will become enjoyable and interesting for patients, and something they want to receive again and again. AI and robots are excellent sidekicks for such nutritional counseling, but they cannot play the leading role.