Dispelling nutrition myths, ranting, and occasionally, raving


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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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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.


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Canada’s not-so-innovative strategy to achieve healthy weights

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A few weeks ago, to little fanfare, the government of Canada announced an “Innovation Strategy” to achieve healthy weights in Canada. My coworker alerted me to it and got me going out on a rant on a Friday afternoon. Don’t get me wrong, there’s some good stuff in here: promoting active neighbourhoods to increase access to green spaces and encourage active transportation, promoting traditional foods, and early childhood interventions for priority populations. However, for the most part I was hugely underwhelmed by the strategy.

Most of the initiatives involved some form or other of food charity, such as expanding the community food centre model. While I appreciate the CFCs efforts to improve on the traditional food bank through the addition of cooking programs, gardens, and social inclusion, when it comes down to it, they’re still a charitable organization doing the work that our government should be doing. These programs also still put the onus on the individual to seek out and access the available services, rather than implementing programs that would be universally available. Also, I understand the desire to target people living on low incomes and experiencing food insecurity but I don’t believe that obesity and unhealthy lifestyles are something that only affect that population.

I know that it would be more complicated than throwing some money at some existing programs but I think that there are many things that the government could have chosen to do that would have a much greater impact on the health of Canadians. How about a national school lunch program? This would reach every child in school without stigma and would ensure that children had the nutrition needed to learn and grow. How about bringing back mandatory home economics or teaching food literacy in schools and supporting school gardens? Yes, I realize that the curriculum is under provincial jurisdiction but there must be some way to get this back in schools. That would ensure that all children learned food skills rather than just those attending limited classes. As we know, food skills are lacking across all income levels in Canada and are not just an issue for those living in poverty. How about subsidizing fresh vegetables and fruit making it easier for Canadians to afford these nutritious foods? I know that this one is working its way through government right now, but how about putting a ban on marketing to children? And not just “junk” food but all food as we know that children (and even teens, and let’s face it, adults) are ill-equipped to contend with the marketing abilities of the food industry (possibly more on this next week). How about increasing access to registered dietitians so that people who want to speak with a RD can do so? How about collaborating with doctors, farmers markets, and grocery stores to enable all physicians to “prescribe” vegetables and fruit? These initiatives would have far greater reach and impact than the ones selected by the government. It really makes me wonder who’s informing these decisions there and it enrages me that our governments continue to throw our money at piecemeal initiatives that are unlikely to make any significant long-term change in our health.


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Is a spoonful of sugar the way to get the vegetables to go down?

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When I saw this article: “Sugar, salt or sweeteners may be key to getting children to eat greens” last week in the Nutrition Resource Centre “News in Brief” email I knew that I had to read more. I mean, were the authors really suggesting that we should add sugar to veggies to get infants and toddlers to eat them? Or was this just a case of a misleading or misinterpreted press release? I found a copy of the full article: Mary Poppins was right: Adding small amounts of sugar or salt reduces the bitterness of vegetables and set about reading.

One thing that struck me right away was that this study was done with adults, no infants or toddlers, or children of any age were involved in the research. Adult participants were provided with puréed vegetables (broccoli, kale, and spinach) with varying concentrations of added sugar. They were asked to rate them on various attributes, and most importantly, they were asked to indicate whether or not they liked or disliked each sample. I was surprised that the conclusion would be drawn that adding sugar to green vegetables is a reasonable means to encourage infants to eat them (I’m saying infants because these were puréed veggies and as such are really only suitable for babies just starting to eat solid foods) based on ratings by adults. After all, adults have very different palates than infants and have very different relationships with food that have been shaped over decades. To me it seems inappropriate to conclude that because adults preferred sugar sweetened veggies that infants will as well. The authors themselves also state that, “It should be noted that infants and toddlers are also not merely small adults”. However, they also use the analogy of adults beginning coffee consumption with added sugar and gradually weaning off the sugar as justification for proposing adding sugar to vegetables when the World Health Organization, among many other bodies, is currently encouraging reduced consumption of added sugars.

The second thing I wondered about was precisely how much sugar was added to each serving of vegetables. The news article, and much of the journal article, references 1% and 2% concentrations but what did that translate to in teaspoons or grams? It sounds pretty innocuous, right? 1% or 2% is hardly anything. Well, in actuality the 1% was equivalent to the addition of 1/2 teaspoon per serving and the 2% was equivalent to 1 teaspoon per serving. Not an insignificant amount when you’re talking about toddlers who are generally only consuming a tablespoon or two of a food in a serving. Interestingly, the researchers asked parents how comfortable they would be offering their babies vegetables with added sugar in amounts of 8 calories, 16 calories, 1/2 teaspoon, or 1 teaspoon. The 8 calories = 1/2 teaspoon = 1% concentration. The 16 calories = 1 teaspoon = 2% concentration. Essentially asking: how can we frame this added sugar to make it more palatable to parents who are trying to feed their children healthy diets?

Despite the general conclusion that adding sugar to vegetables may encourage young children to eat them, even the ratings by adults were not overwhelmingly improved by the added sugar. For broccoli and kale purées both 1% and 2% sugar increased overall liking. For spinach the 2% sugar (but not the 1%) increased overall liking. For broccoli and spinach the sugar increased the ratings of liking from disliked to liked. However, for kale, even at the highest sugar level ratings never rose above the midpoint (i.e. neither like nor dislike). So, these adults did not like any of the green vegetables to begin with (at least not in puréed form) but after adding higher quantities of sugar they liked the spinach, and even with the smaller quantity of added sugar they liked the broccoli. But neither amount of sugar was enough to get them to like the kale. Would babies have different initial reactions to these vegetables? Would the addition of sugar cause them to change these reactions? I don’t know and I don’t think anyone can say based on the results of this study alone.

Just for fun, I took a look at the funding sources for the study after I finished reading it. Can you guess what one of the funding organizations was? If you guess the Sugar Association you’d be correct. I think this explains a lot because honestly I was a bit baffled as to why anyone would be looking into adding sugar to get babies to eat vegetables and why such tenuous conclusions would be drawn and publicized based on the actual findings. But who other than the Sugar Association would think that we need to encourage babies to eat more sugar?

I think a better analogy than the sugar sweetened coffee for this research would be the argument that chocolate milk is a good way to get kids to drink milk or that baking apples into a pie is a good way to encourage fruit consumption. In some ways it’s even worse because infants are at the mercy of their caregivers when it comes to what foods are offered to them and encouraging a preference for only sweet foods at such a young impressionable age could have long lasting implications for their food choices and health throughout their lives.

 


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The Food Guide needs to rise above dietary dogma

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A while ago I remember reading an article by some doctors about how the updated Canada’s Food Guide should be promoting a low-carb, high-fat (LCHF) diet. Then last week there was another article about a “prominent Ontario doctor” who asserts that the new Food Guide is being based on “very bad science”. And I’m just so frustrated that doctors, who we all know receive minimal nutrition education, are getting so much press for their self-serving misinformed opinions.

First of all, these doctors all serve to benefit if their particular dietary dogma is promoted. The doctors pushing the LCHF agenda make a living by putting people on this diet. The doctor who said the new Food Guide is based on “very bad science” and should instead contain specific diet recommendations (e.g. low-fat, DASH, LCHF) has received money from the Dairy Farmers of Canada in the past (and as we know, they are highly opposed to the potential shift from the current Food Guide food groupings).

Secondly, they seem to have a poor grasp of population health and the purpose of a national food guide. When we’re talking about population health we’re talking about improving the health of the entire population. We are not trying to address specific medical concerns of illnesses. We’re also not trying to put the entire country on a weight loss diet, which seems to be the perspective that these physicians are taking. Similar to the daily recommended intakes for vitamins and minerals, which are based on the average amount that a healthy person requires each day, the food guide is intended to promote a healthy dietary pattern for most healthy Canadians. Obviously we are all different and our needs and optimal diets will vary, hence the fact that this is called a guide. It’s not a prescriptive diet, it’s one size fits most with some personal tweaking, not one size fits all straight off the rack. It’s not meant to address every, or actually any, disease states. That’s why we have dietitians and doctors and primary healthcare to help individuals with specific health concerns. It’s meant to promote a healthy pattern of eating among as much of the population as possible. It’s not at all, “picking a specific dietary plan for all Canadians is the wrong approach and that, like all clinical processes, treatment should be considered based on individual patient needs” as the doctor in the second article said. It’s providing general guidance on healthy food choices for those who aren’t in need of clinical treatment.

The narrow focus on clinical care and treatment in the realm of healthcare does a disservice to us all. As does the medicalization of eating. In order to promote health and wellness in our communities and country we need to move back upstream and start preventing the need for many doctor visits, hospital stays, and medications. That sort of thing is achieved through population-based measures that address the social determinants of health and general guidelines such as Canada’s Food Guide.