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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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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Why do we care how much Trump weighs?

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I know that we all want to clutch onto every piece of evidence we find that Trump is a despicable human, hold them close, let them keep us warm at night, and build bomb shelters from them. I also know that society and popular media have taught us that “fat people” are the villains. That they are lazy and gluttonous and deserving of scorn. It’s incredibly difficult to set aside these biases, especially when we want to believe these things of a person, but that’s exactly what we need to do. Trump has given us ample reasons to believe that he is a garbage human. His objectification of and assaults on women, his racist comments and travel bans, his mockery of people with disabilities, his complete and utter lack of diplomacy, and on and on. His weight is not one of them.

Weight does not reflect ones value as a human. This is true of you, of me, of your friends and family, of famous actresses, of poor people and rich people, and yes, even of Donald Trump.
We don’t get to say that body acceptance is important and that weight is not indicative of health or personal worth for people that we like and then go around making a big deal about Trump’s weight. Sorry but not judging a person based on their weight should apply to everyone, even people we dislike.


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Book review: Hunger by @rgay

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I don’t really feel like a review of a person’s memoir is appropriate. Who am I to be critical of anyone’s experience or how they choose to write about it? So this is not really a review, but more of a recommendation.

I’ve had this book on my reading list for about a year now. Ever since I heard about it on This American Life, I believe. Yet somehow I missed its release. Not by much, I don’t think. As soon as I saw that it was out I hustled over to the local bookstore to pick up a copy.

Hunger is Roxane Gay’s memoir about growing up, suffering trauma, and the huge role that food has played in her life subsequent to that experience. Hunger is more than a memoir though. It’s an eye opening entry into someone else’s world. A world that most people like to pretend doesn’t exist. The world of someone who is “morbidly obese”. For people of all sizes, this book provides important insight into the world and how we could all make it a little bit better for everyone living in it.

As I read, I marked the pages of passages that I wanted to refer to in this post so let’s take a little look at some of the parts that stood out the most for me.

On page 6, Gay writes about the arbitrary cut-off point for obesity and how the term “morbidly obese” essentially frames fat people as “the walking dead”. This goes to show the deep level of stigma around fat in our society and how that attitude is ingrained in medical professionals.

On page 66, Gay writes about losing weight and how as she became thinner she became more visible to those around her. It’s ironic that the larger our bodies are, the less visible we become to other people as fellow humans. Less worthy of attention, respect, and love. It’s sad that this is the way we have chosen to treat each other and I think that we should all take a hard look at our own biases and try harder to treat everyone equally, regardless of size. Pages 120-121 offer some insight into how “well meaning” friends, family members, and even strangers, provide “advice” in completely unhelpful ways.

On page 139, Gay talks about Oprah’s struggles with her weight and I love this passage so much:

In yet another commercial, Oprah somberly says, “Inside every overweight woman is a woman she knows she can be.” This is a popular notion, the idea that the fat among us are carrying a thin woman inside. Each time I see this particular commercial, I think, I ate that thin woman and she was delicious but unsatisfying. And then I think about how fucked up it is to promote this idea that our truest selves are thin women hiding in our fat bodies like imposters, usurpers, illegitimates. 

Then, there are other parts that were eye-opening to me. On page 157 Gay writes about strangers taking food out of her grocery cart and offering her unsolicited nutrition advice. I cannot even imagine how it would feel to have someone pass judgement on me and remove items from my shopping cart. It blew my mind that people do this.

I also never thought about the lack of clothing options for people who are overweight and how fraught shopping can be as Gay shares on page 180. Or the pain that many chairs can cause (p. 202). Or the difficulty that flying can pose (p. 209).

There were many more passages that I marked because I thought she put so many things so well but rather than retype her book here, you should probably go buy it yourself and mark all of your own favourite passages.

Hunger should be required reading for all dietitians, medical professionals, humans.