Dispelling nutrition myths, ranting, and occasionally, raving


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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.


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Call in the food police, we’ve got another unruly body

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I feel the need to expand on something I touched on in my post last week. It’s related to people judging dietitians on the basis of our weight. My previous post mainly discussed why it’s inappropriate to judge anyone’s professional abilities, including dietitians, on the basis of their perceived size. However, I think this all too common judgement also speaks to the lack of understanding of what we do.

There’s a common (mis)perception that dietitians are all weight loss counsellors. As a result, if we don’t have that elusive “perfect body” people think that we suck at our jobs. After all, what else do we do other than police the food people put into their mouths. If we can’t control the food going into our own mouths, how on earth can we possibly control the food going into the mouths of all the other owners of “unruly” bodies. While some dietitians certainly do work in weight management, even those dietitians are not actually food police. The majority of dietitians don’t work in weight management. Curious what a dietitian actually does, check out this old post.

It is not part of my job to control my body so that it fits your perceived notion of healthy and fit. Whether or not I am large has no bearing on my knowledge of nutrition. It does not impede my ability to calculate a tube feed, modify a recipe, expound on celiac disease, or help someone with diabetes manage their blood sugar. Just as being small and having no knowledge of nutrition does not automatically imbue me with the capacity to do these things. As with any profession, the size of a dietitian is not a reflection of their knowledge, experience, or capability.

Dietitians do So Much More than help people lose weight. Despite the impression that our name gives, we are not all about putting people on diets. For many of us, aside from medically necessary diets (for example in the case of allergy sufferers or those with celiac disease) “diet” is a four letter word. We’re not all on a mission to rein in unruly bodies and create a world populated solely by thin bodies. When we do work in positions of counsel we usually aim to help people to gain greater compassion for, and appreciation of their own bodies. To help people view food as a source of pleasure rather than an enemy out to destroy our hard-fought-for chiselled physiques.


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Being thin is not a qualification for providing nutrition advice

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Last week a bunch of crossfitters and meatatarians got all worked up because the former president of the Academy of Nutrition and Dietetics (the US organization representing registered nutrition professionals) released a video that essentially warned RDs to watch for people without appropriate credentials providing nutrition advice. Some people evidently felt that she was unworthy to issue such a warning as she did not fit their limited definition of an acceptable body size. There are so many things wrong with this assertion that I don’t even know where to begin.

First, I happen to agree with Beseler (the RD in the video). As I’ve argued in the past, dietitians are regulated healthcare professionals which means that we have to complete a number of requirements to maintain our licencing. Being licenced also means that the public has added protection and recourse in the event that we do provide advice that causes harm. Would the video have more credence if it came from someone slimmer? Let me remind you that being young thin and pretty are not qualifications to provide nutrition advice.

Second, just as being young thin and pretty aren’t qualifications to provide nutrition advice, nor is being old large and unattractive a sign that someone is not qualified to provide nutrition advice. An individual’s appearance is not a reflection of their expertise. Personally, I wouldn’t want to receive nutrition advice from someone who judges others based purely on their size.

Third, I can’t tell from the video what size Beseler is anyway. Her size should be irrelevant anyway. Attacking her based on her weight is bullying. The narrow perception of what bodies are acceptable also shows the narrow-mindedness of the attackers. It also shows the pervasiveness of weight bias in our society. That people are more willing to accept advice from someone who has no nutrition education simply because they fit a thin ideal over someone who is highly credentialed but may not have that “perfect” physique is a sad reflection of our ingrained fear of fat.

Healthy bodies come in all different shapes and sizes. Your worth is not related to your size.