Dispelling nutrition myths, ranting, and occasionally, raving


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A dietitian’s take on the new Canadian Adult Obesity Clinical Practice Guidelines

Here are my thoughts on the new Canadian Adult Obesity Clinical Practice Guidelines (written as I read each chapter):

Reducing Weight Bias in Obesity Management, Practice and Policy

I was really pleased that they put this chapter first and I really didn’t find anything to object to in it. I was especially pleased to see the recommendation that weight not be a target for behaviour change, both on a population and individual level, and that other indicators be selected for assessing the effectiveness of population health interventions.

Epidemiology of Adult Obesity

This chapter discusses the prevalence of obesity in Canada among different age groups and changes in obesity rates over the past ten years. A definition for obesity is also finally provided:

Obesity is a chronic disease characterized by the presence of excessive and/or dysfunctional adipose tissue that impairs health and wellbeing. Obesity is a complex disease in both its etiology and pathophysiology.12 In epidemiological research, obesity is often determined using the body mass index (BMI), calculated as weight in kilograms divided by height in metres squared (kg/m2).

One thing that bothers me about this framing is the assumption that obesity is a disease in and of itself. I also don’t feel that enough emphasis was placed on the fact that BMI is not intended to be used at an individual level. This despite the fact that nearly every doctor (and many other healthcare professionals) uses it as such. There is disappointingly no mention of the significant limitations to BMI; i.e. that it is not appropriate to use with populations other than white adult men up to about the age of 50.

Essentially, what I get from this chapter is that “obesity” is a major “problem” in Canada but there is no real accurate way to measure it. So, call me crazy, but perhaps if there’s no good way to measure it “obesity” in and of itself is not a true disease or health concern. Perhaps instead, we should be focusing on tangible issues.

The Science of Obesity

A little bit more about BMI at the start of this chapter: “BMI is a fairly reliable anthropometric measurement to stratify obesity-related health risks at the population level.” I think this statement is debatable given the significant limitations of BMI. I truly think that we need to just let go of BMI altogether. Just throw it away. BMI is like the partner who constantly mistreats and gaslights you but because you’ve been together for so long you don’t want to “waste” all that time and energy you invested in the relationship so you stay with them even though that’s only going to prolong your misery. Just dump it already. Just because you don’t have a better option lined-up doesn’t mean you should forge ahead with this complete dumpster fire.

Then there’s this: “The increased availability of processed, affordable and effectively marketed food, abundance of sugar-sweetened beverages, economic growth, behavioural changes and rapid urbanization in low- and middle-income countries are some of the key drivers that promote overconsumption of food.” Sorry, what? Didn’t we just establish that “obesity” is complicated? And yet here we are boiling it down to people eating too much “junk” food. Sigh.

The chapter then goes on to discuss the biology and physiology of “obesity”. Even though previously establishing that BMI is only appropriate at a population level, there is still use of it for individual classification. There is also mention of a percentage of individuals “with obesity” who are metabolically healthy. Another problem, in my mind, of assuming “obesity” is a disease in and of itself. Essentially, you have people who have no health concerns but are labelling them as diseased solely on the basis of the size of their bodies. Didn’t we just talk about the harm of stigma? How is it not stigmatizing to say someone has a disease just because their body is classified as a certain size (based on a flawed measurement)? Why can’t we just focus on known health concerns (such as heart disease) and leave “obesity” out of the discussion entirely.

The chapter concludes by saying that, “Obesity, or excess adiposity, is the result of an imbalance between energy consumption and energy expenditure by an individual.” Boiling the “complex” “disease” of “obesity” (sorry for all the quotation marks!) down to eating more calories than you burn off which is an oversimplification and just further encourages the belief that fat people simply need to get more exercise, which I hope was not the intended message of the authors but nevertheless is what’s implied.

Prevention and Harm Reduction of Obesity (Clinical Prevention)

Don’t be fooled by the title of this chapter. It is not about reducing the harm caused by healthcare professionals when treating “obesity”. It is about preventing “obesity” in patients. I found this statement particularly alarming: “pregnancy and the postnatal period may be particularly important periods for targeted primary weight gain prevention.” People’s bodies go through HUGE changes during pregnancy, and postpartum and it’s NORMAL for bodies to be permanently altered by the process. There is already enough stress and pressure on someone during pregnancy and as a new parent. We absolutely do not need to be adding to the pressure during that time by shaming people for gaining too much weight during a pregnancy or pushing them to lose weight rapidly after giving birth.

I’ve written about it before, but it bears mentioning again that we as a society (and especially as healthcare professionals) do people, especially women, a huge disservice by promoting the message that we should remain one weight throughout adulthood. It is actually normal and perfectly healthy to gain weight as we age, particularly during menopause, and this weight may actually be protective against illness in older adults.

One more thing that I am horrified by in this chapter is the suggestion of encouraging adolescents to self-weigh in an effort to prevent obesity. This is a recipe for creating eating disorders. We should not be pushing this narrative of measuring self-worth on a scale to youth. Rather we should be promoting self-confidence and encouraging them to embrace and respect differences in body shapes and sizes. Promote healthy choices to youth, not bathroom scales.

Enabling Participation in Activities of Daily Living for People Living with Obesity

This chapter is all about how doctors should provide advice to patients classified as having “obesity” on how to perform activities of daily living, cleaning skin folds, and avoiding falls. Which I find a little presumptuous and cringeworthy. I know that I would be offended if a doctor told me, unprompted, how to wash my own body.

The authors even state: “There are significant gaps in knowledge about what it is like to live with obesity in the context of participating in day to day activities including self-care, leisure and life roles.” Here’s a novel idea: how about we allow patients to state their concerns to their doctors and then let doctors provide solicited advice.

Assessment of People Living with Obesity

All the recommendations for healthcare providers in this section (save for one) are graded level D. I don’t know about others, but I am not comfortable moving forward with such low quality evidence.

I appreciate the author’s emphasis on avoiding stigmatizing patients. However, I question whether it is possible to do this when labelling individuals as having a disease on the basis of the size of their bodies. Also, I once again question the recommendation that healthcare providers assess BMI when it was earlier established that this is not an appropriate measure on an individual basis. Do we really want to continue to use a deeply flawed tool just because we don’t have something better? Perhaps we should focus on actual lab work and patient concerns rather than something we know is potentially harmful.

The Role of Mental Health in Obesity Management 

I do think that it’s vitally important to discuss mental health when we’re discussing “obesity”. However, I’m disappointed that this chapter implies that people classified as having “obesity” may have binge eating disorder. It is possible for people with larger bodies to suffer from anorexia and bulimia, and really all types of eating disorders. They are not the sole domain of people with smaller bodies and failure to recognize this increases the risk of harm. I would have also liked to see more connection between this chapter and the chapter on weight stigma. Many of the ill-effects of “obesity” may actually be attributable to weight stigma.

Medical Nutrition Therapy in Obesity Management

I don’t have much to say about this chapter. I might also just be getting tired of reading. I appreciate that the authors state that there is little evidence of calorie restricted diets being beneficial and mentioning that dietitians can provide support for patients.

Physical Activity in Obesity Management

I’m actually surprised that there is supposedly high quality evidence to support exercise for achieving “reductions in abdominal visceral fat” (Grade A!) and losing small amounts of weight and maintaining weight loss (Grade B). The vast majority of research that I’ve seen has shown that exercise is not effective at producing long-term weight loss in most people. Of course, the authors of this chapter also state that physical activity can be helpful in managing a number of health conditions and is beneficial even when not accompanied by weight loss. This is the messaging that I think is best. We should be focussing on being physically active for overall well-being. Otherwise people see it as “work” and a means to an end and it all too often is abandoned.

Weight Management over the Reproductive Years for Adult Women Living with Obesity 

I wasn’t going to bother with the remaining sections (and this is out of order) because they address management of “obesity” and I feel like it’s kind of pointless for me to pass judgement on them when I’ve already established that I don’t believe “obesity” is a disease to be treated. However, as a relatively new mom I couldn’t resist taking a peek at the chapter on reproductive years. And I had a bit of a wtf moment when I read the following: “Primary care providers should offer behaviour change interventions, including both nutrition and physical activity, to adult women with obesity who are considering a pregnancy (Level 3, Grade C),7,8 who are pregnant (Level 2a, Grade B)915 and who are postpartum (Level 1a, Grade A)16 in order to achieve weight targets.” I mean, given that we’ve already determined that these are ineffective means for achieving weight loss why would they be recommended for that purpose? Also, can we please stop obsessing over women’s weight?? Why isn’t there a chapter on managing men’s weight through the reproductive years? Fuck the patriarchy.

Obesity Management and Indigenous Peoples

As a white person, I am uncomfortable commenting on this chapter. I don’t know the backgrounds of the authors but I hope that they are Indigenous. I was pleased to see the recommendation that healthcare providers educate themselves about Indigenous cultures. Also, that they recognize that health inequities exist. However, I’m question why this particular population was singled out and the discussion about Indigenous Peoples being disempowered felt a little condescending. I don’t think that we, as healthcare providers (or humans in general) should be making assumptions about people. Perhaps it would have been better to put a discussion about systemic oppression up-front with weight bias as there are many people who have been harmed by our white patriarchal systems. Perhaps it would be better to listen to patients about their experiences and concerns rather than making assumptions not matter how well-intended.

Final thoughts (aka TL;DR):

I get that the authors have devoted careers to working on treating and preventing obesity so it must be incredibly difficult to let that go. But we need to stop and ask who it’s serving to pathologize obesity, and as well-meaning as it may be if it is not actually causing more harm than good. We need to stop talking about “obesity” altogether and start focussing our time and energy on creating healthy supportive environments and systems. Let’s get a national school food policy, let’s dismantle the patriarchy, let’s implement a universal basic income, let’s eliminate poverty, let’s teach food literacy in schools, let’s create walkable communities, let’s encourage work-life balance.


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Is mom the TA for calling out her sister for buying her daughter a food scale?

I don’t have much to blog about lately. All of my usual sources of inspiration have been dominated by covid-19 for the past few months. My life revolves around my baby and we don’t go anywhere. I can’t even glean inspiration from the grocery store because I haven’t been there in over 10 weeks (11 weeks? I’ve lost count). I pretty much only check Twitter now to read posts from AITA (am I the asshole?) and Reddit relationships because it’s otherwise just an unending torrent of horror and frustration. So, I’ve now reached the stage of social isolation where I start to write about AITA posts. The one above really stuck with me.

Obviously the mom is TA (the asshole), as is the aunt. I started out on the mom’s side. Of course I would be super pissed if I had a teenaged daughter and someone bought her a food scale so that she can weigh everything she’s eating. And I 100% love the messaging that she can be healthy regardless of body size, not tying self-worth up with what her body looks like, and engaging in physical activities that she enjoys, not as a means to lose weight. However, I think both the mom and the aunt are giving the poor girl messages that are likely to lead to an unhealthy relationship with food and her body.

In the comments the mother says that she only cooks three kinds of vegetables, and only sometimes, because no one in their family likes vegetables. She states that they’re healthy but her comments indicate that the household engages in very little physical activity and doesn’t eat a balanced diet. She seems to be under the misguided impression that just because she’s preparing meals at home that they are de facto nutritious. Obviously, if she’s not including vegetables or fruit at every meal then they are nutritionally lacking (the current recommendation from Health Canada is to make half your plate vegetables and fruit). She also seems to think that vigorous exercise is unhealthy as she expressed concern that her daughter was sweating and out of breath from her home workouts. The current physical activity guidelines for children and youth (ages 5-17) start with a recommendation to “sweat” by accumulating at least 60 minutes of moderate to vigorous activity a day.

I think it’s extremely sad that the mother would discourage her daughter from engaging in physical activity and prevent her from eating a healthy diet. Let’s not let the aunt off the hook either though. Given the mother’s strange perception of what’s healthy and unhealthy I’m not sure that we can trust her assessment that the aunt has an unhealthy relationship with food and exercise. Whether she does or not, it was completely inappropriate for her to provide a 14 year old child with a scale to portion her food. Teenagers are growing rapidly and need sufficient calories and nutrients to support this growth. In addition, if she is weighing her food, the daughter is not learning to trust her own hunger and satiety cues. Teaching her that food is something to be restricted to attain a certain body size is only going to lead to longterm hang-ups when it comes to food.

Both the mother and the aunt are pushing their own agendas on this girl. If they truly had her best interests at heart they would support her efforts to eat a healthier diet and to safely engage in physical activity. Ideally, the mother would lead by example by role modelling a positive relationship with food, physical activity, and her body, but if she can’t bring herself to eat a green vegetable, the very least she can do is to provide them to her daughter as she’s asking.


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Dietitian confessions: starting my baby on solid foods

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I haven’t written in a little while because it feels like a nutrition blog is so irrelevant when we’re in the midst of a pandemic. I also don’t want to write about anything related to the covid because self-care for me right now means not overwhelming myself with pandemic-related info. But, maybe you’re like me and you’re trying to avoid too much virtual exposure to covid-19 and you’d welcome a break with a little nutrition confessional. So, I’m here today to share with you my experience starting my baby on solid foods.

As a dietitian I’ve learned all about starting infants on solid foods. As a dietitian who works in public health I’ve even taught classes on the subject. As a lover of cooking and eating I was feeling pretty confident and excited about introducing my nugget to new flavours after six months of only ever consuming breast milk and formula. The first stumble in my plan was the fact that she wasn’t ready to start solid foods at six months.

If you’re aware of current pediatric recommendations, it’s advised that babies be fed only breast milk or formula until six months of age. I dutifully waited all that time, but babies don’t all mature at the same rate. Something that never came up when I learned about introducing solids was baby’s age versus their adjusted age. My baby was born a month early and this meant that even though she was six months old, developmentally she was more like five months. I ended up having to give her a couple of extra weeks before she was interested in and able to eat solids.

Another current recommendation is to start babies on iron-rich foods and once they’re consuming them regularly then you can introduce other foods. These foods include: meats, egg yolk, beans, lentils, and fortified baby cereal. I was confident that I was going to feed my baby whole foods, that fortified cereal was an old-school first food. Ha ha ha. My baby had other ideas. She was uninterested in my concoction of puréed chickpeas mixed with pumped milk. She was displeased with puréed hardboiled egg. And she was absolutely appalled by the jarred chicken baby food I bought in a desperate attempt to get her to eat something from that list of iron-rich foods (see photo above). Honestly, I couldn’t blame her – have you ever tried chicken baby food?? Finally, I abandoned my smug plan and fed her some iron-fortified baby oat cereal which she ate but with little enthusiasm. I made her strained green peas, which were a pain in the ass to make and which she rejected. I moved on to offering her some foods that weren’t iron-rich (gasp) but were possibly more palatable: banana (acceptable), avocado (no thank you), and sweet potato (could not get enough). I managed to get some iron in her through a combination of mixing these foods with baby cereal or with sweet potato.

I had also envisioned making her baby food myself, after all, she should quickly advance from purées to soft whole foods according to everything I’d read. It turns out that it’s pretty much impossible to get super small quantities of food smooth in my food processor. It also turns out that she wasn’t ready to try different textures for nearly two months. So, I bought ready made baby food packets from the grocery store and supplemented with baby cereal and easy to purée foods like sweet potato, butternut squash, and banana. This was an easier way for me to introduce a variety of new foods to her without ending up with a freezer full of puréed food.

She’s now advanced to consuming a mix of commercial baby food, homemade baby food (like tiny baby pancakes and muffins) and modified foods that we’re eating like puréed dal or mashed pasta. Despite what many people believe, babies don’t have to eat bland food. Yes, it’s great to let them taste unadulterated foods so that they experience the different flavours of whole foods but they can also handle herbs and spices and these are also important flavours to expose them to.

If you’re a new parent starting your baby out on solids there can be a lot of pressure to do this in a certain way. I see so many blogs with these elaborate baby meals and that’s awesome if you have time and money and your baby is interested in these foods but you are not failing as a parent if you’re feeding your baby infant cereal or food from a jar or squeeze pouch. As long as your baby is experiencing new flavours, and then new textures, then you’re doing just fine.


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Cooking in the time of COVID19

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Image from Cook Smarts

Since you’re all (hopefully) joining me in social-isolation (I’ve been practicing for a while being on mat leave) I thought I’d compile some useful websites for pantry recipes and meal planning.

Also, while it’s good to have enough food at home to see you through two weeks, please be considerate when you’re shopping and don’t buy more than you need. There are many people who can’t afford to stock-up and/or don’t have facilities to store piles of food.

With that out of the way, I’m a big fan of Budget Bytes and she’s compiled a list of 15 pantry recipes. She has lots of other recipes on her website too that are affordable and require very few perishable ingredients. And for more affordable recipes you might want to check out Jack Monroe’s (aka The Bootstrap Cook) website. Smitten Kitchen’s blog and cookbooks are a couple of my favourite recipe resources. She’s also got a section for pantry recipes on her website. Another great source of simple, affordable recipes is Leanne Brown’s free pdf cookbook: Good & Cheap.

Why not take advantage of being home to try a new baking recipe? Personally, I’m planning on tackling croissants. Sally’s Baking Addiction has compiled a list of 36+ fun home baking projects for everyone who’s holed up at home.

If you’re new to meal planning, UnlockFood.ca has a list of 7 steps for quick and easy meal planning and if you scroll down to the bottom there are a bunch of additional meal planning tools.

This is just a short list I threw together off the top of my head to get you started. If you know of additional websites please share in the comments. Also, if you decide to undertake a baking project send me a pic!


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Why this dietitian hates Nutrition Month

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It’s March and that means it’s Nutrition Month. The time of year when dietitians post a whole bunch of the same social media messages that were created by Dietitians of Canada and a whole bunch of people probably mute the hashtag “NutritionMonth2020” to stop the onslaught. And I have to confess, even as a dietitian, that impulse is strong. But, the bombardment of generic healthy eating messages aside, there’s another reason why I hate Nutrition Month and that’s the fact that it’s more of a vehicle for Big Food to promote their products than it is an opportunity for dietitians to promote nutrition and our profession.

Every year Dietitians of Canada releases a suite of Nutrition Month tools and resources. And every year I find myself feeling frustrated by the obvious bias they exhibit for their sponsors. Let’s see if you can guess the two sponsors this year just by the recipes in their free recipe booklet: Hearty Manitoba Vegetable Soup, Avocado and Fruit Salad with Basil and Honey, Proudly Canadian Beet and Barley Salad, Roasted Cauliflower Farro and Avocado Salad, Avocado and Tuna Salad Sandwich, Easy Red Lentil Dhal, Grilled Vegetable Bean and Avocado Tacos, Mexican Squash and Bean Salad, Super Easy Chicken Parm, Chewy Ginger Pecan Cookies, Peach Strawberry and Almond Muesli, Yoghurt Bark. To help you out a little, I’ve bolded the recipes that were supplied by the sponsors. One is obvious: Avocados from Mexico. The other may be a little trickier: Dairy Farmers of Canada.

Dietitians are supposed to be an unbiased, evidence-based source of nutrition information and yet how can we expect people to believe that when a national dietetic organization accepts sponsorship from food companies and exhibits clear preference for those foods as a result?

Don’t get me wrong, I love avocados as much as a Millennial and I consume plenty of dairy products. However, both of these foods are problematic and should probably not be so heavily promoted by Dietitians of Canada. There are ethical concerns about both avocados and dairy (e.g. methane gas, land use, animal welfare). In addition, these are both fairly high-ticket grocery items, at least in Canada. A single avocado often goes for $1.99 at my local grocery store while a modest block of cheese is at least $7.99. Considering that about one in eight households in Canada is food insecure is it really appropriate for DC to be promoting such costly items as part of national Nutrition Month? I mean, considering that an annual DC membership costs $496 and DC has roughly 6000 members, surely to goodness they could develop a few recipes on their own, or even have members submit them so that they didn’t have to resort to corporate sponsorship.

All this to say, I hate Nutrition Month. Nutrition Month could be great. Dietitians of Canada has a fantastic opportunity to promote nutrition, dietitians, and all that we do. However, as it stands, Nutrition Month does nothing more than to undermine our credibility as nutrition professionals.