Dispelling nutrition myths, ranting, and occasionally, raving


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A “no seconds” policy will only feed disordered eating habits

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When I saw the headline “Could enforcing a ‘no seconds’ policy at dinner time help combat childhood obesity?” I thought “I hope this isn’t as awful as I think it’s going to be”. I’m sorry to say that it was every bit as awful as it sounded, and then some.

I was horrified to read the following in the first paragraph: “doctors are warning that parents should ban their children from second helpings to protect them from becoming overweight”. It didn’t get any better. This suggestion was based on research by a behavioural obesity researcher. The crux of her argument being that children are becoming overweight and obese because their parents are allowing them to stuff their greedy little faces at mealtimes. She is quoted as saying: “all parents should be being vigilant about portion control, so a no seconds policy” so, unfortunately, it would seem that her opinions are not being misrepresented.

Apparently the reason that many children are becoming overweight and obese is because they’re eating 12 more calories at every meal than they need. I’d just like to point out that if this were in fact the case, then these children would not be getting sufficient calories for healthy growth and development if they were denied seconds as a second helping of nearly anything would likely exceed 12 calories. Twelve calories of most foods would amount to a minuscule quantity.

According to Dr Llewellyn (the researcher mentioned above), “Some children are unable to regulate what they eat for themselves and many will not turn down food, even if they are not hungry”. Indeed, there are some children with genetic disorders, such as Prader-Willi Syndrome who are constantly hungry. However, disorders such as PWS affect about 1 out of every 15, 000 children born. That’s nowhere near the third of children estimated to be overweight or obese.

I think that enforcing no seconds policies will only lead to increased rates of disordered eating. Most children are born with the innate ability to eat when they are hungry and stop eating when they are full. Most children unlearn this ability as they get older and are encouraged by parents to clean their plates, are bombarded by food advertisements, observe the eating habits of family members, are served excessively large portions at meals, are offered treats and snacks throughout the day, etc.

More important than a theoretical excess 12 calories at each meal that a child may or may not be consuming is the formation of a healthy relationship to food. Arbitrarily placing limits on servings at mealtime will only feed an unhealthy relationship with food. This sort of thing teaches children not to trust their hunger cues, having the opposite of the intended effect. It teaches children that food is emotionally wrought. Denying hungry children food teaches them that they cannot trust their appetites and may also teach them that their self worth is measured on the scale. Pretty much the definition of an unhealthy relationship with food.

Rather than making mealtimes a minefield, parents should be role modelling healthy attitudes and eating habits. They should be providing their children with nutritionally balanced meals at regular times and allowing their children to decide when they’re full. Whether that mean that they leave food on their plates or ask for more.

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Childhood obesity is not something to be battled

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Image by Mike Mozart on Flickr. Used under a Creative Commons Licence.

“Disappointed” doesn’t cover how I felt reading this article from the CBC. I’m used to hearing people blame individuals for being overweight. It’s always frustrating. However, it’s enraging to see a director of a Childhood Obesity Foundation laying the blame squarely on the shoulders of parents. He should know better than that.

In the article he says that the government should assume some responsibility for “combating childhood obesity” but that “the buck sort of does stop with the family”. So much no.

Obviously parents want to raise healthy children. Yes, it’s the parents who buy and prepare the food for the household. That doesn’t mean that the onus for “combating childhood obesity” should lie with them.

Our society is designed in such a manner as to make healthy choices incredibly difficult. Forget about combating obesity – can I just say how much I hate that wording? We should be talking about fostering health. The proliferation of cheap calorically dense and nutrient light quick and easy meal options makes the unhealthy choice all too easy. The lack of value on time spent cooking and the over-emphasis on time spent at work makes these options all too appealing. There are myriad reasons that children are overweight and/or unhealthy. Most of which stem from societal issues; not from lack of parents caring and trying to do the best for their children.

Tom Warshawski, the director of the Childhood Obesity Foundation gives three tips for parents to “fight childhood obesity”. The first tip is to “take authority”. Stand-up to the Lunchables and big sodas. Fair enough, until our government stand-up for its citizens and makes these types of food less heavily marketed, affordable and available, it really is down to the parents to try to swim against the tide and limit purchases of such items.

Tip number two, sticking to a recommended diet, is one that makes me cringe a little. It’s that damn four-letter word. Sure, ensuring your child, and you, follow a nutritious diet is important for good health. That doesn’t mean that any specific diet regime need be enforced. Being overly strict about food may backfire and lead to disordered eating later in life. Go for nutritious meals that the family enjoys and let there be treats. Try not to take the pleasure out of eating.

Tip number three is that it’s a family battle. While I wholeheartedly agree that the entire family should be making the same healthy choices, I disagree with the way that this is framed. This is not a battle. If you think about food as a battle then you are always going to lose. Food is not the enemy. Healthy eating isn’t an all or nothing scenario. You don’t all have to give-up chips and pop to be healthy. Parents should lead by example and role model healthy eating behaviours and attitudes. Leading their children into battle against food is not doing this.


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Only the thin die young

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I’m all for looking at overweight and obesity in new ways. I absolutely believe that it’s possible to be overweight and healthy. I am, however, sick of seeing claims that being overweight is protective against death. The implication being that those of us who are “healthy” weights are actually more likely to die than those who are slightly overweight.

Yet another article came out last week touting the headline: People deemed overweight may actually have a lower risk of dying than those who are healthy, study says. The fact that we’re all going to die notwithstanding there are other significant issues with such claims.

To start, I’d like to take exception to the headline itself. Who writes these things? If they had inserted weight after “healthy” it would have made quite a difference. As it’s written it implies that “healthy” and “overweight” are two discrete mutually exclusive categories. This is not the case. It’s entirely possible to be overweight and healthy. It’s entirely possible to be “healthy” weight and unhealthy.

Now that, that’s out of the way, let’s get to the bigger problems with the study results, as covered in the news article. When people are ill, especially mortally ill, they often lose weight. As a result, when looking at death rates and weight it’s incredibly difficult to tease these issues apart. Thus, claims that being overweight protecting against death are essentially meaningless and potentially detrimental. I say detrimental, because if people are dissuaded from eating healthily and exercising regularly by the suggestion that it’s healthier for them to be overweight then it’s quite likely that their health will suffer. We also know that many chronic diseases such as type 2 diabetes and hypertension can be better managed with weight loss, following a balanced diet, and incorporating regular physical activity. While it’s possible that being overweight is actually protective, it’s more likely that the apparent association between lower weight and death is a result of weight loss during illness.

The other significant problem with the claim that overweight is protective against death is that it doesn’t take into consideration quality of life. Many people who are overweight will be prescribed various medications to keep related conditions in-check. This may result in a longer lifespan than someone who’s “healthy” weight who, because of appearing to be in good health (as a result of the conflation of overall health and healthy weight) may go without similar treatment. The “healthy” weight individuals may lead shorter but higher quality lives without the side effects of medications (i.e. they may have shorter lifespans but longer healthspans).

To sum it up: yes, you can be healthy and overweight. You can also be unhealthy. Ditto for both for “healthy” weight. Regardless of your weight the best way to ensure that you lead the longest healthiest life possible is by taking care of yourself.

 


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Should doctors have to be “healthy”?

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While the question of whether doctors should be “required” to be healthy is an interesting one, I think that it’s the wrong question to be asking.

When looking at “health” this article focused solely on several health behaviours including being obese, smoking, or having a prescription drug problem. It’s my understanding that in any profession if a person is experiencing an addiction that affects their abilities to perform the duties of their job that they should be relieved of those duties until they are able to manage them again. Smoking and being obese are two different stories. Smoking is an unhealthy habit that in this day and age no one should be engaging in. However, I don’t think that smoking necessarily impacts a persons ability to do their job unless they’re an athlete or a trombonist. Obesity is a whole other kettle of fish.

Obesity is not a health behaviour. It may be the result of certain behaviours, medical conditions, or medications. While obesity is linked to many chronic diseases it’s not necessarily unhealthy in and of itself. It’s also not the only measurement of health.

If we’re going to punish doctors for engaging in unhealthy behaviours then we should be revoking the licences of those who drink alcohol, eat trans-fats, don’t wear a seatbelt, drive more than 10 km an hour over the speed limit, sit for the majority of the day, are anorexic, don’t wear a helmet when biking or skiing, and so on. You get the point, right? It’s about engaging in unhealthy behaviours, not about the outcome of that behaviour; especially when it can result from circumstances other than lifestyle choices.

If we’re going to say that doctors who are obese can’t practice then we should be saying that doctors who have lung cancer can’t practice, not those who smoke. Which is utterly ridiculous.

I’ll admit that I find it somewhat worrisome that doctors who are overweight are less likely to broach the subject of a patients weight with them. If someone’s weight is having negative consequences to their health then their doctor should absolutely be discussing it with them. That being said, the article focuses on doctors providing dietary advice. Something the vast majority of them are ill-equipped to do. How about referring to dietitians, the regulated healthcare professionals who are experts on food and nutrition. Novel idea, I know.

Finally, I like the points that the author of the article made that doctors are facing the same life stresses as the rest of us. Instead of blaming them for making poor life choices we should be making working conditions such that it’s easier for them to make healthy choices. The same should be said for all professions. We need to get away from the notion that productivity is related to being tethered to a desk and a screen and create workplaces that foster healthy employees.


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BANT Ill-being Guidelines

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A dietitian in the UK was questioning BANT about the new “Wellbeing Guidelines” they had posted last week. One of the most significant issues being the use of a skull and crossbones to denote foods that should be avoided. These foods being: Artificial sweeteners, Fizzy/sugary drinks, Alcohol, Pasta, bread, sweets, cakes & biscuits, Dried fruits and fruit juices, Eating between meals, Ready and processed meals (emphasis mine). BANT tried to justify this by saying that these particular guidelines don’t apply to everyone, just the people who are overweight or obese. They actually titled these guidelines “Fight the Fat – Beat the Bloat“. As if it somehow makes it better that “only” those who need to lose weight are being told that these foods are essentially poison. Because we all know that fear mongering and making people feel guilty about their food choices leads to weight loss, SIGH. And never mind that the majority of the population is classified as overweight or obese.

Sure, most of the foods to avoid are ones that people (no matter their weight) should limit. Oddly enough, there’s no skull and crossbones nor mention of foods to avoid on the guidelines for people who aren’t trying to lose weight (just a note to limit refined grains). Which is silly because healthy eating is healthy eating no matter what your weight and attaching a stigma to food for people who are trying to lose weight doesn’t exactly promote a healthy relationship with food.

The other significant oddity about these guidelines is the fact that those trying to lose weight are told to limit their consumption of fruit to no more than one serving a day while the general guidelines tell people to eat 1-3 servings of fruit a day. While I have known people who have consumed fruit to excess this is pretty rare and in any event, 1-3 servings is certainly not excessive.

While these are issues with all of the government issued nutrition guidelines that I’m aware of, these guidelines are not an improvement. Shaming people about food doesn’t promote wellness.