Dispelling nutrition myths, ranting, and occasionally, raving


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Why science is failing

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After my fellow dietitian Abby Langer wrote this article for Self, which I personally felt was quite considered and rather generous to the carnivore movement, I noticed a commonality among many of the people spewing abuse and vitriol (does an all-meat diet make you exceptionally angry?) toward her, and RDs in general. Any guesses? It was that many of them were engineers. I’m not sure what’s up with that. However, I can tell you that they are far more confident in their belief in the magic of the carnivore diet than I am in probably anything.

Then I was listening to StartUp podcast and something clicked. This season they’re following what’s called a “church plant” which is people trying to start new churches. On the last episode they were talking to a researcher who said that membership in all Christian churches in North America is declining, except for at evangelical churches. The reason for that? The certainty the evangelical church provides. Unlike other churches where there may be grey areas, things left up to interpretation, the evangelical church has definitive answers. And people like certainty. In religion and in nutrition.

You’ve probably heard the comparison of certain dietary beliefs to religious beliefs before. It’s nothing new. People attach their sense of self to a religious or dietary belief. They’re vegan, paleo, vegetarian, carnivore, catholic, or muslim. In the realm of diets, dietitians are agnostic. In the realm of medicine, Western doctors are agnostic. A great deal of the time, science is agnostic. We constantly question our beliefs and change them as new evidence comes to light. When someone asks is corn good for me we inwardly cringe because there are so many ways to answer that question and they all start with “it depends”. The carnivores are the evangelicals of the dietary world. They have all the answers with the utmost certainty. And how can someone who’s desperate to find a diet that will cure what ails them not be enticed by that confidence when faced with dietitians and doctors who are saying “let’s try this first and if that doesn’t work then we’ll try this” and on and on. We don’t offer a one-size-fits-all approach. We offer tailoring to help individuals find the way of eating that fits them best.

If you want certainty without evidence then you can find all the advice you want, and then some, from carnivorous engineers on twitter. If you’d rather have uncertainty and a little variety in your diet then find yourself a dietitian.


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So you don’t want the government in your kitchen

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According to Wikipedia, “A government is the system or group of people governing an organized community, often a state.[1] A government is like a clan with the purpose to govern the whole family or whole nation with powers of financial, military and civil laws. The main purpose of government is to seek the welfare of the civilians and to fulfill their need for the betterment of the nation.”

Canadians have a poor understanding of government. This comes as no surprise to me as I frequently see people complaining that the government should merely educate people about making healthy choices rather than introducing legislation that would make it easier for us to make healthy choices and/or harder to make unhealthy choices.  People want the government to stay out of their kitchens, shopping carts, restaurants, etc. This attitude shows a great deal of privilege, and ignorance.

To be able to afford to choose what we want to eat when we want to eat it is a measure of privilege. There are many people in Canada (and other countries) who don’t have that luxury. People who have no choice in what they eat, who can only afford or access limited options, people who go hungry.

Policies, subsidies, taxes (and tax breaks), legislation, and tariffs are all factors influenced by government that impact how much we pay for various products. Unlike something like a sugar-sweetened beverage tax, the consumer doesn’t directly see the effect of these factors on the price they pay at the cash register so they often don’t even realise just how much the government is influencing the cost of food. Also, there is a certain judgement value that comes with a tax like a SSB tax; taxes such as this are often referred to as “sin taxes”.

Yes, elected officials serve us and we essentially hire them to represent us in government. However, it’s also their job to “seek the welfare of the civilians”. So, what should the government do when our desires “I want to eat chips and drink pop for breakfast, lunch, and supper” are diametrically opposed to our welfare? It’s a tricky question. I certainly don’t want the government telling me what I can and can’t eat; and I’m a dietitian! I also know that education is not the (sole) answer.

Most people have a decent understanding of which foods they should be eating more of, and which they should be eating less of. Simply telling people to eat more vegetables and drink less pop is unlikely to result in any change in eating habits. I do think the government has a role to play in helping us to adopt healthier eating behaviours.

In terms of education, rather than simply promoting messages and plastering billboards telling us what foods to eat (or to limit) or putting calories on menus (ahem), the government should be making food literacy a mandatory component of the curriculum in schools. Children should be learning where food comes from, how to prepare it, how to read nutrition facts panels and ingredient lists, and how to find credible nutrition information in a sea of goop.

Beyond education, the government should be looking at the factors that influence our food choices. The most commonly cited of these factors are: access, affordability, time, and personal preference. A little brainstorming about these:

  • Access: there could be legislation about where fast food outlets can be located and ensuring there are grocery stores, markets, or convenience stores stocking nutritious foods to serve all communities. Many grocery stores are now offering delivery options; perhaps the government could support these initiatives.
  • Affordability: while it’s a bit of a myth that healthy eating has to be expensive, there can be more of an up-front cost to purchasing food for a healthy meal than there is to buy a burger and fries. In addition to creating policies and subsidies that would make healthier foods such as fresh produce more affordable, the government could also look to the creation of affordable housing, better transit systems, and basic income guarantees (BIG) so that people have more money in their pockets for nutritious food.
  • Time: part of the food literacy education in schools would serve to show people that it is possible to make a quick, healthy, and tasty meal. In addition to this, the government could pass legislation around work hours so that more people could have flexibility in their days and more time to prepare food. BIG would also support this as it would provide value for labour in the home. If our society put more value on food preparation and family meal times then as individuals we would be more likely to put in the time to cook and eat together.
  • Personal preference: this is a little trickier for the government to address. However, given the other measures, I think that an increase in appreciation for nutritious food would follow. If parents have more time and money and access to nutritious food, then they’d be more likely to choose these foods. Particularly if they’ve had exposure to these foods from a younger age through things such as food literacy education in schools.

The government is already in your kitchen, in your shopping cart, in restaurants, on the farm, in the grocery store. No one is saying that the government should ban the consumption of pop, or any other food. Rather than removing personal choice, legislation can serve to give more choice to those who are currently limited by their circumstances, and make it easier for all of us to make healthier choices.


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A smile doesn’t hide your weight bias

 

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I completed an online course on weight bias and stigma for healthcare professionals last week. There was quite a bit that was good but there were a couple of things that rubbed me the wrong way.

If you’re not already aware Obesity Canada states that, “weight bias refers to negative attitudes and views about obesity and about people with obesity. Weight stigma refers to social stereotypes and misconceptions about obesity. These social stereotypes and misconceptions include beliefs that  people with obesity are lazy, awkward, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline or self-control.” 

Weight bias and stigma can cause significant harm to fat people. In fact, they likely cause more damage to people than carrying extra weight itself does.

The course I took was very good about making this clear and provided the facts as well as showing how harmful weight bias can be to patients. However, there was a video with some experts that I felt undermined the message. Here are the quotes that bothered me:

“If weight loss was easy we wouldn’t have the current obesity epidemic that we have.” – Director of Research and Anti-Stigma Initiatives at the Yale Rudd Center

“People think that for someone who’s overweight all they need to lose weight is some self-control and trying harder to eat less and exercise more. If that only worked we wouldn’t have the problem that we have today. The causes of obesity are very complex…” – Director of Research and School Programs at the Yale Rudd Center

The Yale Rudd Center is well-regarded for their work in reducing weight stigma and both of these individuals quoted above are prominent in the field. At first glance what they’ve said seems innocuous. However, the fact that this was a course intended to combat weight stigma, the experts are saying that obesity is an “epidemic” and a “problem” runs counter to the message they’re trying to convey. It just goes to show how deeply ingrained weight bias is when the very experts trying to counter it are inadvertently perpetuating it. When you say that obesity is a problem then you are saying that fat people are a problem. And I don’t see how that’s not stigmatizing.

The other problem I had with the course were the case scenario videos they shared. There would be one video where staff and medical professionals were rude and unprofessional to patients regarding their weight. Then they would show a video that was intended to show a positive interaction. Really the only differences in the “good” videos were that the healthcare professional was all smiles and asked the patient if they could talk about their weight before advising behaviour change under the guise of promoting healthy behaviours rather than telling them directly to lose weight. To me, the message was the same, it was “you need to lose weight” delivered with a smile rather than scorn. There was still no looking at overall health to determine if weight loss was actually warranted, there was still no consideration of other causes of the presenting ailments, and there was still no recognition that simply telling people to eat healthier and move more (especially without first determining what their current lifestyle is like) is not an effective way to get people to lose weight.

Overall, I felt that the message of the importance of not perpetuating weight bias was lost when all the healthcare professionals were still delivering the message to their patients that they should lose weight. And yes, some people can benefit from losing some weight, but this should be determined with appropriate assessment and then weight management options need to be appropriately discussed with the patient. Simply telling someone, on the basis of their BMI, to eat less and move more with a smile is not helpful.

If you do happen to know of a good online weight bias course please let me know as I’m still looking!


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If you’re cheating on your diet, then you should probably break-up with it

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Yes, the above post is undoubtedly very cute. Using emojis is a fun way to make your point. However, I would argue that if you are struggling with your weight that you should actually reverse the suggestion by Dr Nadolsky.

I’m not saying, eat unhealthy food all day every day. I’m saying, take some of those “treat” foods from the weekend and enjoy them whenever you feel like it. Something more along these lines:

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If you’re struggling with your weight and you’re eating super healthy through the week and then you “undo” all your hard work by eating a bunch of crap on the weekend your problem is not the weekend. Your problem is the week. If your workweek diet is very restrictive and doesn’t allow room for treats, or carbs, or entire food groups, then it’s not a sustainable way of eating. If you feel deprived during the week, then it’s not a sustainable way of eating. If you can’t continue to eat the way you eat during the week through the weekend, then it’s not a sustainable way of eating. If your diet through the week is devoid of pleasure, then it’s not a sustainable way of eating. If you’re cheating on your diet whether it be for one day a week, or all weekend, then you should probably break-up with it.

Regardless of your weight, your diet should be one that you enjoy. That provides you with nourishment and pleasure. You should be able to enjoy your food every damn day of the week.


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Representation matters and the health care industry is failing miserably at it

Source: UConn Rudd Center for Food Policy & Obesity.

In relation to my recent posts about how a dietitian’s weight is not indicative of their professional capability, I’ve been thinking a lot about weight bias. Specifically, I’ve been thinking about how we portray (or don’t portray, as the case may be) people who are considered to be overweight or obese.

At work, I often find myself advocating for more diversity in our images of people. But by that I always mean “maybe we should include images of some people who aren’t young and white”. It actually kind of blows my mind that every time a draft comes back from a graphic designer that EVERYONE is youthful and white. Anyway… That’s not what I wanted to write about today. It’s the fact that they are also ALWAYS thin. I get it, we’re in the business of promoting health and what would you picture if I asked you to picture someone healthy. You’d probably envision someone who’s trim, youthful, smiling. The fact of the matter is though that health comes in all shapes and sizes.

Representation matters. If you don’t see yourself in an organization’s images, or a magazine’s, or in the media, you’re not likely to relate to the messages they’re sharing. I’m not talking about showing pictures of headless obese bodies when we’re talking about obesity, as a matter of fact, I’d rather we all just stopped talking about obesity altogether but that’s another rant. I’m talking about when we choose an image for a campaign for oral health, or a social media post about sexual health, or a banner promoting your services. Whatever the case may be. Think about it, with more than half the population falling into the category of overweight, our healthy living (and really ALL promotional) messages are missing out on a huge proportion of the population. If we truly want to promote healthy lifestyles for all then we need to include everyone in our messages. Don’t make it about weight though. Weight loss should not be the message. The message should be that everyone, regardless of size, age, ability, or race is deserving of good health and can enjoy a healthy active lifestyle. That everyone is deserving of health care services. That regardless of size, your voice should be heard. It really stuck with me how in Hunger, Roxanne Gay wrote about becoming more invisible the larger her body became. This is not how things should be. Your worth should not be inversely proportionate to your weight.

If you want to start including more positive non-stereotypical images of people with obesity in your work, check out Obesity Canada’s image bank or Yale Rudd Centre’s image gallery.