Dispelling nutrition myths, ranting, and occasionally, raving


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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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Do dietitians follow the Food Guide?

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The above inane tweet last week prompted me to post a couple of tweets in which I screamed into the void about a) people not following dietary guidelines anyway and b) weight not being indicative of health. Which then lead to me posting the following poll:

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Obviously, this is a completely unscientific poll but it does show that the majority (83%) of RDs who responded do not generally follow the dietary guidelines for their respective counties. This could be for any number of reasons. Most didn’t respond with a reason. Those who did said that they weren’t big on fruit of dairy or the carbs (that’s the grains food group) are too high. Personally, I suspect that some days I’m low in vegetable and fruit consumption or milk and alternatives. Other days I’m definitely over. And if I’m being completely honest, I have something from that “other” food group (aka sometimes foods) on the daily.

The truth is, the Food Guide is just a guide. It’s not a bible. It’s intended to provide people with all of the nutrients and energy they need to be healthy and active but everybody is different. We all have different needs and preferences. I know that people really like to rag on dietitians and say that all we do is preach the food guide but I’m here to rain on that parade. Dietitians are people too and we enjoy food for more reasons than just as fuel. We are not robots that run on kale and quinoa. I think that most of us think that the food guide could be improved (and fingers crossed it will be whenever they finally come out with the new version) but we also know that it’s just meant to be a tool.

Food Guides are meant to guide people toward nutritious food choices. They encourage a variety of foods from all of the food groups. The overall message that people should be taking from a food guide is that there are healthy choices in all the food groups and eliminating any one food group may result in deficiencies. Also, that eating only one type of food from each food group (e.g. lettuce as your only veg or bread as your only grain) is not going to provide you with all of the nutrients that you need. However, it’s also important to listen to your own body and nourish it accordingly. If you’re not hungry don’t sweat the fact that you’ve only had 5 servings of vegetables or 4 servings of grains. Conversely, if you’re extra hungry one day, don’t feel like you have to limit yourself to the servings recommended in the Food Guide.

Healthy eating really doesn’t have to be complicated or rigid. In fact, if you think that you’re eating healthily and you’re finding that it is complicated or rigid then you diet (or relationship with food) probably isn’t all that healthy after all.


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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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Can we take chocolate milk out of politics already?

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You would think that I wouldn’t have anything left to say about chocolate milk by now. I wish that you were right. I would have thought that I wouldn’t either until I read this article the other day about the school nutrition policy in New Brunswick and the current provincial election there. This uninformed inane quote from the leader of the PC party got me all riled up again:

“Brian Gallant is focused on taking chocolate milk away from our kids,” Higgs said in a press release. “I’d rather accomplish the same thing by giving our kids better access to organized sports activities and the character-building experience that come from participating in activities with peers.”

Higgs said in a press release that his government would scrap the nutrition policy entirely because, despite the importance of educating children about good nutrition, “we think helping them participate in activities with their peers is the goal – not legislating what’s on the menu.”

This is the sort of thing that makes me want to tear out my hair. It shows a complete lack of understanding of the issue at hand and sends the entirely wrong message to the public.

The first quote implies that 1. the issue at hand is obesity and 2. that we can compensate for whatever we eat through exercise. These are both patent falsehoods.

To address the first issue: the purpose of school nutrition policies is not to address childhood obesity. The purpose of school nutrition policies is to ensure that children are being provided with nutritious food when they’re at school. Schools should not be making money at the direct cost of the health of their students. In some cases, the only nutritious food that children receive may be when they’re at school. This has nothing to do with weight and everything to do with health, growth, and development.

To address the second issue: as much as we may all wish that it’s true, no amount of exercise can compensate for an unhealthy diet. Playing soccer is not somehow going to miraculously provide a child with vitamins and minerals and essential nutrients that are lacking from their diet. That’s just not how it works. As I’ve mentioned before, healthy eating and physical activity are not two sides of one coin, they are both essential components of a healthy lifestyle.

The message that the would-be premier is sending here is the widespread misconception that health is measured by the scale and that we can make-up for an unhealthy diet by exercising more. This is just not true.

Finally, to address the second quote: we know that education (insofar as that means telling people what to eat, giving them a copy of Canada’s Food Guide, and lecturing them about calories) doesn’t work. However, creating a supportive nutrition environment in which healthy eating is the norm, along with teaching food literacy, can teach children life-long healthy eating habits.


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In the chocolate milk war which side will you take?

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A school in Ottawa decided to no-longer offer chocolate milk to students as part of their milk program. This, I should add, was based on a vote taken at a parent council meeting. Predictably, a bunch of parents, students, and assorted individuals from all over the province are outraged at this infringement on their freedom. This despite the fact that chocolate milk has not been banned from the school, the school is simply no-longer selling it to the kids.

I’m listening to the radio call-in program about this outrage and quite frankly I feel like throwing up my hands, saying eat and drink what ever you damn want, and going off to farm alpacas or something similar that will simultaneously allow me to forsake my current profession and keep contact with human beings at a bare minimum. I mean honestly, what is wrong with people. It is that vital that your child have chocolate milk at school once a week that you’re launching a protest over the removal of chocolate milk from the school milk program but you can’t be assed to pick up a carton of chocolate milk at the store to send to school in your child’s lunch? Do you not normally buy groceries? How do you feed your child outside of school if it’s too much of an ordeal to dump a cup of chocolate milk in a container and pop it in your kid’s lunch box? Lest you think I’m exaggerating, just listen to the first guest on the show. This is literally her argument. If you want your child to have chocolate milk so badly, give it to them yourself. You can let your kid guzzle chocolate milk at home until the cows come home.

Then, there are people arguing that kids should get chocolate milk as part of the school milk program because this may be the only little bit of nutrition they get. That may well be true (and this is incredibly sad) but may I be so bold as to point out that white milk is still available through the program? As my friend Yoni has often argued, suggesting that children be given chocolate milk for the nutrition in milk is like arguing that they be given apple pie for the nutrition in fruit.

I think that many of the people arguing for keeping chocolate milk on-offer in schools have fallen for the marketing hype and genuinely think that chocolate milk is a “health” food. There was one dad who called in and said that his kids drink chocolate milk every day and nothing else sweet, except juice. But he was all for pop being banned in schools because kids get too much sugar. Well, one cup of orange juice has 22 grams of sugar, the same amount of pop has 26 grams, and chocolate milk has 24 grams. That’s not a huge difference. If sugar is your concern, then chocolate milk and pop are on par with each other.

Removing chocolate milk from a school milk program is not denying parents the right to give their children chocolate milk. It’s removing one source in a landscape that is saturated in chocolate milk, pop, juice, sports drinks, and energy drinks. Should any and all foods be available for purchase in schools? Schools do not have an obligation to act as grocery stores. They do not have to sell any and all products that a child might desire. Making white milk the only option (for sale) in schools helps to make the healthy choice the default for students.

There is no good reason for schools to be offering children chocolate milk as part of their milk programs. I applaud this school for taking the initiative to remove the option of chocolate milk from their program. Schools should be places where children learn and that includes learning healthy behaviours, including making healthy food choices. Schools should not be profiting from selling children foods that should not be a regular part of their diets. It’s disgraceful that some parents think that daily delivery of chocolate milk is a greater priority than the actual health and well-being of their children. So much so that they are willing to publicly fight against a decision that was made with the children’s best interest at heart. If they have this much time and passion about school nutrition maybe they can take some of that energy and put it into fighting for a national school lunch program. You know, something that would actually benefit children. Sorry if I sound a little harsh but it frustrates me to no-end that people are so self-centred that they are unwilling to put the well-being of children, both their own, and others ahead of their own uninformed opinions. Cry me a freaking river (of chocolate milk).