Dispelling nutrition myths, ranting, and occasionally, raving


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What obesity and homosexuality have in common

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A couple of weeks ago I was listening to an episode of Radiolab on which they shared an episode of the short podcast series Unerased titled: Dr Davison and the Gay Cure. They were talking about the former perception of homosexuality as a disorder and the rise of conversion therapy. As I was listening what they were saying really struck a chord with me. I found myself thinking “this is exactly how people are going to think about weight loss counselling one day”.

On the podcast, they were saying, essentially, it doesn’t matter if people come to us wanting to change. What does it actually mean to help them? “The problem that these people are asking us to solve is a problem we created. That we labeled as a problem.” Even if we could effect certain changes, there is the more important question as to whether we should… It makes no difference how successful the treatment is, it is immoral.” And I was like “YES, this exact same thing could be said about weight loss treatment!”

This belief in relation to homosexuality was considered to be fringe and most people weren’t in support of it initially. This parallels the Health at Every Size/body diversity/weight acceptance movement. There is a lot of push-back from people in the medical community and the general public when it’s suggested that weight is not a condition that needs to be treated. Just as with the acceptance of homosexuality as a normal state, there were a few outspoken pioneers leading the movement and with time, it became more accepted by the mainstream. I feel that this is beginning to happen now with weight. More of us RDs who were always taught that “overweight” and “obesity” are unhealthy are coming to realize that people can be healthy at many different sizes.

Of course, there are still hold-outs and there is still conversion therapy happening in some places. Similarly, there will likely continue to be hold-outs who believe that only thin people can be healthy and that BMI is indicative of health. However, I’m hopeful that we’re reaching a turning point and that one day the medical community will agree that weight is not a “problem” and that weight loss treatments are unethical.


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Top 10 Holiday Survival Tips

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It’s that time of year when food is abundant, there is a seemingly never ending succession of holiday parties and events, all of which feature food. It’s also that time of year when you start to see a proliferation of articles about the average weight gain over the holidays and how you can save yourself from looking like the poor unfortunate headless woman in the photo by preloading your purse with celery sticks and doing 20 burpees every time you take a drink of rum and eggnog. This is not one of those lists.

The holidays should be fun. A time to connect with family and friends, have a reprieve from work, and yes, even eat delicious baked goods. If the holidays for you are a time to feel full of chocolate and regret, a time filled with anxiety about all of the “bad” food you’re going to be faced with, then these 10 tips should help get you through the holiday season without guilt.

  1. Stop imbuing food with moral value. There are no good or bad foods and you are not good or bad for eating certain foods.
  2. Don’t feel guilty for enjoying delicious foods or for eating food for reasons other than hunger.
  3. Don’t confuse the number on the scale with your personal worth or a measure of your health. Consider not weighing yourself.
  4. Ignore or call-out people who make judgemental comments about what you are (or aren’t) eating. Try to focus on your internal cues when deciding whether or not to eat or what to eat. It’s nobody else’s business what you put on your plate.
  5. Don’t let food-pushers pressure you into eating things you don’t want to eat. Conversely, if you’re someone who tends to show their love by pushing food on people please consider that someone declining your offer of food is not a reflection of their feelings toward you. Try just putting food out and not pressuring anyone to eat it.
  6. Don’t make a New Year’s resolution to lose weight/eat healthy/go on a diet.
  7. Wear clothes that make you comfortable and happy.
  8. Remember to nourish your body. Yes, it’s okay to eat cookies and chocolate but you won’t feel at your best if you’re eating these foods exclusively.
  9. Don’t read (other) articles about “surviving” the holidays.
  10. If you’re struggling with body acceptance, don’t feel like you have to go through it alone. Find a Registered Dietitian who specializes in a HAES or weight-neutral approach.


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What does “healthy” look like?

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A little while ago I wrote about the importance of representation and how the health care industry is failing at it. Of course, it’s not quite as simple as saying “we’re going to use more diverse images in our marketing and materials”. Most organizations don’t take their own photos. Instead, most use stock photography sites from which staff select images. It’s not just health care that has a problem, it’s all media, and it’s the sites from which we source our images.

So many of the images I come across on the stock photo site we use at work are problematic. I’m not going to name the site because it really doesn’t matter which one it is, they’re all the same. Search the word “healthy” and you’ll likely come up with a lot of smiling, slim, glowing, youthful white people outdoors wearing athletic clothing or eating salad. Of course there might be one older person, a black person, and a “normal” (i.e. not model thin) person in the mix but these are the exceptions that prove the rule. Fitness returns more of the same, minus the salad shots. On the other hand, when you search “fat” you come back with a bunch of headless torsos clutching their bellies, larger people drooling over fries, large people looking miserable, and a few “good” fat people engaging in physical activity – again, the exceptions that prove the rule. Then there’s the images of “healthy choices” in which the ubiquitous glowing youthful white woman is weighing a doughnut in one hand and an apple in the other as if this is all that healthy eating is about. Or how about the images of large women kicking “junk food” solidly away? How virtuous. Or the woman literally taking a pair of scissors to her stomach? Horrifying.

All these images do is serve to reinforce the popular beliefs that we hold around body size, health, and personal responsibility. To reinforce the stigma against larger bodies and the false assumption that smaller bodies are always healthy bodies and the result of healthy personal choices. It takes a lot of effort and consideration for people to choose images from these stock photo sites that don’t contribute to stereotypes. It’s worth that extra effort though to show that all bodies are good bodies and that your organization is for everyone, not just people who look a certain way.


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Response to: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight?

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Someone I follow on twitter recently shared this blog post: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight? by another dietitian, Janet Helm. In the post she mused about dietitians promoting themselves as “non-diet” and what this might say about other dietitians. She agreed with many points made by dietitians, quoted in RD/writer Cara Rosenbloom’s recent excellent piece for the Washington Post about non-diet dietitians, but seemed unwilling to go so far as to embrace the philosophy herself. She ended her post with the following questions: “Can’t we all get along? Can’t intuitive eating and body positivity coexist with losing weight?  Why must we line up on two sides?  Why the conflict?” I’m going to do my best to respond to these questions.

First, I too have asked that same question: “Can’t we all get along?” at times. Remember craisingate? Personally, I don’t think that as dietitians we have to agree on everything. It’s okay for us to have different perspectives and approaches. Also, in the case of diet vs non-diet, I don’t see it as an issue of getting along. Maybe I’m blissfully unaware, but I haven’t seen any “non-diet” dietitians attacking other dietitians for promoting weight management. I don’t see dietitians referring to themselves as “non-diet” as lining up on an opposing side or creating conflict. Rather, I see this identification as a way for dietitians to let prospective clients know that they do not promote weight loss as a goal. In a profession which so many believe our sole mission is to help people lose weight I think that it’s necessary for RDs who do not promote weight loss diets to make this clear up-front. I don’t believe the intent is to pass judgement on other dietitians who haven’t embraced the same approach, or to create a professional divide. However, I can see how a dietitian who has built a career around weight management counselling might see this new-ish movement as a personal judgement.

My friend Cheryl Strachan, aka “Sweet Spot RD” wrote an excellent blog post last week (while I was mulling over how best to respond to Janet’s post): Why I can’t help you lose weight. This heartfelt post explained why she would no longer work with clients on weight loss. Providing the current evidence on weight loss and health and the struggle she went through to reach this position. Rather than having me regurgitate all of the evidence here, I recommend you take a few minutes to go read it and then come back.

Done? Okay, great. So you’ll note that Cheryl mentions that when she studied nutrition in 2003 it was accepted without question that weight management was a significant part of being a dietitian. I can tell you that it was the same when I went back to uni to study nutrition in 2006. I’m not sure if things have changed since then. I suspect that they haven’t, at least not completely. It takes time for institutions and society to change. As a dietitian who has worked in weight management in the past I too have struggled to fully embrace health at every size. I understand why a fellow dietitian would ask: Can’t intuitive eating and body positivity coexist with losing weight? It’s an incredibly tough question and the answer is nuanced and it may not be the same for everyone.

I do believe that intuitive eating and body positivity can peacefully coexist with weight loss. However, I think that this can only be the case when weight loss is not the ultimate goal. For me, body positivity is appreciating your body as it currently exists and continuing to appreciate it if you gain weight or lose weight. It’s about treating yourself with respect and compassion and providing your body and mind with the nourishment they need. If you are doing these things with the clandestine goal of losing weight then you are doing yourself a disservice. That being said, it’s okay to want to lose weight. We live in a society that has conditioned us from a very young age to believe that being thin is important. It’s unrealistic to except this engrained belief to vanish overnight. It takes time to relearn to listen to your body and to treat it with respect when you’ve been viewing it as the enemy, a captor, keeping the real you the thin you hidden away. So, no, body positivity and weight loss can’t coexist but yes, body positivity and weight loss can coexist.

I think that as time goes on and nutrition programs update their curriculums, as old-school dietitians are more exposed to evidence regarding the harms of weight bias and weight loss diets, and the hold-outs retire, that things will change. After all, as dietitians we are supposed to provide evidence-based best practice and the evidence against weight loss diets is mounting. Eventually there will be no non-diet dietitians because that will be the approach we all take.


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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!