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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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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Doctors giving nutrition advice probably shouldn’t reference Pete Evans

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I saw this article last week and had mixed feelings about it. I know that we were all supposed to read it and be horrified that a doctor was reprimanded for giving patients nutrition advice. After all, shouldn’t doctors be doing more to help patients manage their health through lifestyle changes? But… there’s so much that this article doesn’t tell us.

Just to start by clearing the air, obviously you all know that I’m a dietitian. Of course I’m going to feel a little defensive of my profession. The orthopaedic surgeon in question was undermining recommendations given by dietitians at the hospital where he worked. All because he had studied some nutrition on his own. Can you even imagine the outrage that would occur if the tables were turned and a dietitian undermined advice given by a doctor?! I’m certain that the RD would lose her (or his) licence, not just be given a slap on the wrist and told to stop working outside the scope of their practice.

Everyone think that they’re experts in nutrition simply because they eat (yes that’s hyperbole, please don’t send me your #notalleaters comments). So many people believe that doctors are all knowing. Unfortunately, it would seem that some doctors fall prey to this mode of thought as well. Doctors specialize. A doctor who works in oncology is going to have an entirely different knowledge-base and skill set from a doctor who works in neurosurgery. Doctors should not be expected to know everything. Yes, family doctors should be better equipped to provide nutrition advice but an orthopaedic surgeon should defer to the dietitians on-staff. It takes an incredibly high level of self regard to believe that you are more of an expert in a field in which you did a little self-study than a regulated health professional who studied the subject for over four years, is immersed in it on the job, and who must complete on-going education to maintain their credentials.

There’s some amazing irony in the article as well. The author references a television episode with the doctor in question and celebrity chef Pete Evans. For those who are unaware, Evans is a notorious charlatan and has faced entirely warranted criticism for promoting unsafe infant diets amongst other questionable nutrition practices. A few paragraphs down, the author goes on to say:

In addition there are numerous unqualified “gurus” giving advice about what we should and should not be eating. Surely it is preferable to have a doctor giving nutrition advice rather than unqualified individuals, many of whom have a product or program to sell.

Um HELLO??? Pete Evans is the epitome of the unqualified guru with a product to sell. Just prior to this statement, the author even admitted that the majority of doctors receive very little formal nutrition education. So, no. It’s not preferable to have a wholly unqualified doctor providing nutrition advice to people. In a way, it’s worse than having a self-proclaimed “guru” providing nutrition advice because people trust their doctors.

If the doctors referred to in the article truly cared about the well-being of their patients they would refer to appropriate professionals when needed, including registered dietitians. They should also work together with those professionals to provide the best care possible for their patients. Rather than assuming that they have superior knowledge of a subject which they were not adequately trained in.

How about rather than complaining foul when someone is rightly called-out for practicing outside their scope of practice, we talk about the real problem here. That our healthcare system is designed to treat illness rather than prevent it from developing in the first place.


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Ditch the meds: a dietitian dispensing drugs

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Image by mkhmarketing on flickr. Used under a Creative Commons Licence.

One of my biggest pet peeves as a dietitian is the fact that so many non-dietitians fancy themselves to be nutrition experts. It’s one thing when it’s a “holistic nutritionist” at least they have some degree of nutrition education. It’s another entirely when it’s another regulated healthcare professional who seemingly has no concept of scope of practice. For those, such as the pharmacist I came across on twitter who states in her twitter bio “Pharmacist who would rather dispense nutrition than Rx.”, who may not know what scope of practice is: scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. For a pharmacist, that means providing evidence-based advice and guidance on medications. For a dietitians, that means providing evidence-based advice and guidance on nutrition.

The pharmacist in question decided not to become a dietitian because she didn’t want spend the money to study the “low-fat” guidelines that apparently comprise the entirety of a degree in dietetics. How easy it is to be critical of a program when you clearly have no idea what the area of study consists of.

You know, I’d really like to be a pharmacist but I don’t agree with the excessive prescription of antibiotics. I think that instead of going to uni and studying pharmacology I’ll just start telling people what medications they should take for their ailments based on my own research and dispensing them online. Oh but that would be dangerous and I’d probably lose my licence to practice dietetics and face prison time. Yet, somehow it’s totally okay for someone who’s never studied nutrition to use their credentials as a regulated health professional (in a completely different field) to advise and influence people through social media, a blog, and conventional media. Ironically, as a registered dietitian I can’t even provide specific nutrition advice through those channels because sensibly one knows that I don’t have enough knowledge about the recipient of that advice to provide appropriate information.

Why even go to university for years, complete internships, pay to write a national exam, pay the college of dietitians $600 a year, and continue to learn about nutrition when it’s so easy? I could be cherry picking sensational “science” and promoting a “sexy” diet without having taken a single course in nutrition/dietetics. Sigh.

My point is, be savvy about where you get your information. Just because someone has credentials in one field does not make them a credible source of information in another field.

 

 


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Should doctors be treating obesity?

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Image “Bigger than your head” by Mandy Jansen on Flicker. Used under a creative commons licence

I was thinking about Western medicine the other day and how all too often it seems that the approach is to treat the symptoms rather than to determine the cause and to try to remedy that. That got me to thinking about our approach to obesity and how, in a sense, having doctors (or any medical professionals) treat it means that we’re treating the symptom rather than the cause.

Yes, there are many causes of obesity. But when we boil them all down it really comes to our environment and collective lifestyle as a society. The way our lives are set-up it’s a battle to avoid becoming overweight or obese. Our jobs, our food system, our neighbourhoods, our social activities, our sleep habits, etc. are all contributing to the ever climbing obesity rates.

Sure, many medical professionals are fighting the good fight. Some are trying their best to help their patients learn to reengineer their lifestyles to lose weight. Some are pushing for changes to our built environment. But these battles are large and weren’t intended to be fought by MDs, RDs, and RNs. None of us learned how to design communities, to build grocery stores, or to structure offices while we were in school.

The real battle needs to be fought by government officials, engineers, designers, and planners. These are the people who can get to the root of the problem. Maybe as healthcare professionals we can help direct them to the sources of the issue. We can also continue our efforts to treat the symptoms as they surely deserve some tending to. However, until we can create some sort of coordinated widespread interdisciplinary approach to curbing obesity we’re just going to be continuing to give out bandaids to those in our care.