Dispelling nutrition myths, ranting, and occasionally, raving


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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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Book Review: Health at Every Size

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Thanks to Helen at Food & Nonsense starting the RD book club I finally got around to reading Linda Bacon’s Health at Every Size. Unfortunately, due to time differences, the tweet-up to discuss the book is taking place at 6 am on a Sunday morning for me. I’ve scheduled this post to go live at that time as my feeble attempt at participating in the discussion without waking up ;) If you’d like to check out the discussion just search for the #RDBookclub hashtag (was that redundant? Probably) on twitter.

Helen was also kind enough to post some discussion questions so here goes…

1. Do you agree with the HAES assertion that health not weight should be the focus of nutrition interventions?

Absolutely. The focus should be on health and well being, never on numbers on a scale. That being said, weight management is one of the main reasons that people seek out advice from dietitians. I don’t think that we can just ignore this fact. As health care professionals it’s our job to help people to understand that the numbers on a scale don’t necessarily matter all that much when it comes to health. That being said, weight is often inextricably intertwined with health and nutrition.

2. Is a health approach practical in todays aesthetic focused society?

This is an excellent question and one that I found myself thinking about quite a bit as I was reading the book. It’s all well and good that we know that people can be healthy at many different weights but how do you translate that into acceptance and understanding? As much as we tell someone that they are healthy at their current weight, if they’re unhappy with that weight should we help them to lose weight or help them to accept themselves as they are? Oftentimes, neither of these options is feasible.

3. Do you feel that the main concepts in the book were adequately backed up by the research presented?

For the mist part I did. Although I must confess that I didn’t take the time to seek out all of the research Bacon used to back-up her arguments. A couple of things did bother me: One, I didn’t like how much she mentioned that if you do this or that you’ll probably end-up losing weight. If your book is about being healthy no matter what your size, and you’re preaching fat acceptance, then I don’t think that weight loss should be a frequently touted benefit of your approach. Two, I’m not sure how credible her evidence to support that overweight and obese people generally live longer than their lower-weight counterparts is. Weight loss is an extremely common side effect of many serious diseases. Thus, thinner people may be more prone to dying than larger people as a result of an underlying illness causing weight loss, not as a result of being thin. If we’re talking health at every size we need to be careful not to tip the scale in the other direction. People who are overweight, obese, average, or underweight may all be healthy. Also, death is not the only thing to look at. Obese and overweight people may be living for longer but how many of them are healthy during these extended life spans? Health span may be a more important consideration than life span.

4. How should nutrition professionals use this information in their day to day practice?

I think that nutrition professionals should use this information to help themselves overcome their personal biases and to educate their clients that weight is not the be all and end all when it comes to health. We should also use it to help clients realise that our own weight is not an indication of our health nor of our ability to do our jobs well. I can’t tell you how many people I’ve had tell me that I’m a dietitian they might actually listen to because I’m slim, as though larger dietitians don’t have exactly the same knowledge and education as I do. As with any field, our weight is not an indication of our ability to perform our jobs well.

5. Were there any ideas in this book that you reject or find difficult to accept?  Why?

I think I covered this in question three. Oops! I was also bothered with a very small point in which Bacon was advising people on how to choose whole grains (p.79). She says, “Look for the word “whole” in the ingredients list.” Not entirely accurate. This is the point where I pondered whether or not it was okay to write in a library book. You need to see the words “whole grain”. Unfortunately, “whole” on its own is not sufficient. Anyway… This is a very small quibble in the scheme of things.

I did also find it difficult to accept that there is no relationship between obesity and disease states. While I absolutely believe it’s possible to be healthy (and conversely unhealthy) at any weight I do still believe that there is increased risk of developing certain conditions such as heart disease, some cancers, type 2 diabetes when you’re obese.

6. What is the main thing you took from this book? How has it been helpful to you?

The main thing I took from this book is the importance of self-worth and acceptance. We all need to stop aspiring to look like other people and learn to be happy being ourselves. Many of us also need to step away from the scale and stop letting the numbers on it define us. I also really enjoyed the chapters on food and fat politics.

For some more interesting perspectives on the HAES movement check out the following links:

http://www.weightymatters.ca/2013/12/guest-post-why-i-am-walking-away-from.html

http://www.weightymatters.ca/2012/03/why-haes-may-never-go-mainstream.html

http://www.drsharma.ca/obesity-the-science-behind-health-at-every-size-haes.html

http://www.sciencebasedmedicine.org/does-weight-matter/


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The “real food” fallacy

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All of a sudden, it seems that Zoe Harcombe is everywhere. She was providing ludicrous nutrition advice for sufferers of yeast infections (thanks @RD_Catherine for the link). Sorry y’all yoghurt won’t cure yeast infections. Yes, choosing a yoghurt with probiotics is great for overall health but it’s more because of the by-products produced by the bacteria (e.g. B vitamins) than because of the bacteria themselves. Unfortunately, most of the bacteria in yoghurt will not survive your stomach acid.

What I really want to address though, is her popular article in the Daily Mail (thanks to @ERHWG for sharing the article and her rage): Diets Make Us Fat. The Solution is Simple. The basic premise is that we need to eat “real food” as opposed to fake  “manufactured food”. Calories don’t matter, and we shouldn’t be counting them. All that matters is eating “real food”.

But what is “real food”? I don’t think you’ll find many dietitians who disagree with the importance of cooking and eating more vegetables, fruits, and minimally processed foods for overall health and weight loss. However, I don’t think the division between “real” and “fake” food is particularly useful. Nor is the vilification of whole grains. Grocery shopping is complicated enough and people are hard-pressed for time. Making them feel guilty for buying anything in a package is not going to help them to adopt healthier habits.

It’s also possible to be over weight when consuming a “real food” diet. You know why? Because calories do matter. I’ve met plenty of people who are over weight who eat very healthy diets. Simply telling people that if they eat “real food” is not going to solve the obesity crisis. If I was over weight and someone gave me this advice I would be insulted. Not everyone who is over weight or obese is subsisting on a diet of big macs and kit kat bars. Consuming more calories than we need, regardless of the source, will result in weight gain.

Finally, the reason that diets don’t work is because they’re short-term fixes. Not because people are necessarily consuming the wrong types of foods or because they’re counting calories. The problem with diets is that they have an end date. They are not sustainable lifestyle changes. The other reason that they don’t work is because our food system is broken. Our environment is structured such that the unhealthy choice is the easiest choice and it’s a lot of work not to be over weight. Placing the onus on the individual and suggesting that if they only stopped counting calories and ate “real food” doesn’t even come close to addressing the true societal roots of the obesity epidemic.


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Licence to eat?: My thoughts on classifying obesity as a disease

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Sometimes I need a little time to percolate on a subject before I weigh in. This was one of those times. A couple of weeks ago the American Medical Association decided to classify obesity as a disease. This, of course, created quite an uproar. On one side, there are the people who are saying that this will lead to a decrease in personal responsibility for the condition as well as those who believe that it will mean those of us who are not obese will be footing the bill for surgeries and new obesity drugs (1). On the other side, there are those who believe that this will lead to increased efforts to curb rising obesity rates and may be beneficial to those who are suffering from obesity (2).

Personally, I’m not sure that calling obesity a disease will lead to any improvements in obesity rates but I certainly don’t see it causing any harm. Considering how well we’ve being doing reducing obesity rates thus far I figure that classifying obesity as a disease is worth a shot. While I agree with the point made in the Globe article that the current use of BMI to measure obesity is highly flawed I would also like to point out that there are other measurements of obesity being developed (e.g. the Edmonton Obesity Staging System) and perhaps the classification of obesity as a disease will lead to wider use of these more accurate tools.

I also take issue with the notion that classifying obesity as a disease will lead to people throwing up their hands and saying “not my fault, I have a disease” and then going for a big mac meal deal. When alcoholism was classified as a disease in 1956 did alcoholics cheer and say “now I have a licence to drink!”. No. The classification raised served to raise awareness that this was a serious medical condition and increased treatment availability and options.

Did anyone else notice the photos of headless obese bodies accompanying the news articles? I hope that this classification will lead to increased sensitivity toward those who are obese.

My concern is not with the classification of obesity as a disease (keep in mind that over weight is not the same thing as obese and that individuals who are over weight may indeed be healthier than their “healthy” weight counterparts but yes, I am concerned that this classification may detract from the notion of health at every size) it’s with our current medical model in North America. Our focus is on treatment when it should be on prevention. This goes for all diseases, not just obesity. In Canada, our system will cover many treatments once you’ve fallen ill but will not cover most preventative measures. We need to start covering (at least some of) the cost of things like dietitians, certified personal trainers, gym memberships, sports equipment, etc. regardless of disease state. In the long-run it would be a lot less costly to keep people healthy in the first place rather than waiting until they become ill to provide medical and professional supports.

Yes, there is much more than our medical system that needs to be involved in preventing and curing obesity. Our food systems, environment, and societal structure are major contributors to our current high levels of obesity. However, as we’re talking about the AMA classification today I wanted to focus on the medical side of the issue.

So, these are some of my thoughts on the subject. I’ve seen many other thoughts out there as well, mostly from medical professionals and the media. What I’d really like to see are thoughts from those who are most likely to be directly affected by the classification of obesity as a disease. If any of my readers, or anyone you know, is currently (or was ever) obese and would like to share your thoughts on the recent classification of obesity as a disease by the AMA I would love to hear your thoughts on this subject. Please email me at dmc555 [at] gmail [dot] com to let me know what your thoughts are. With your permission, I will share your thoughts in a future blog post.