Dispelling nutrition myths, ranting, and occasionally, raving


4 Comments

How to end hallway medicine

End hallway medicine: ban hallways

There’s been a lot of talk about “hallway medicine” (i.e. patients receiving treatment in hospital hallways due to hospital overcrowding) in Ontario over the past couple of years. A recent report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine provided recommendations to the government on how to improve the current situation. The key findings from the report were as follows:

    1. Patients and families are having difficulty navigating the health care system and are waiting too long for care. This has a negative impact on their own health and on provider and caregiver well-being.  
    2. The system is facing capacity pressures today, and it does not have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures in the short and long-term. 

Following the release of the report I saw a number of articles and heard several radio interviews, all of which featured emergency room doctors and occasionally nurses. Undoubtedly they have experience which can contribute the the discussion. However, I was frustrated by what I saw as the glaring absence of input from public health. I think that perhaps everyone thinks that the problem lies within the hospitals and therefore the solution can be found there too, even if it’s the suggestion from ER doctors that more home care supports are needed. However, while not an immediate solution to the problem, I think that we need to look further upstream for real long-term solutions. Adding more beds, increasing home care, and improving system navigation for patients are all important but they don’t address the reasons why so many people are ending up in the hospitals in the first place. If we can prevent the need for emergency care then we can reduce the number of people in need of hospital beds.

I was pleased to see that alPHa (Association of Local Public Health Agencies) submitted a response to the report to the government highlighting the important role of public health in improving healthcare and ending hallway medicine. I was also pleased to see OPHA (Ontario Public Health Association) submit a letter to the Minister of Finance advocating for health promotion and chronic disease prevention measures that would help to end hallway medicine. Has anyone seen anything about this in the news though? I haven’t heard any public health officials or representatives publicly advocating for the important role of public health in ending hallway medicine. Public health needs to do better at getting their messages to the public. If people don’t know about what public health does to prevent injuries and chronic disease, reduce infectious disease, and advocate for the social determinants of health then how can we expect them to support these initiatives or even to recognize how these things contribute to the demand for healthcare services?

In addition to the importance of public health in ending hallway medicine I’d like to see more effort to connect with those who are likely most in-the-know about patient concerns: reception staff. Yes, doctors, nurses, other allied health professionals, and patients can all contribute important insights but who speaks to everyone seeking care? Who hears the complaints and concerns that people may not feel comfortable voicing to doctors? Who is at the first point of interaction with the public? Reception staff. I’m sure that they could contribute a great deal of valuable information to the consultation on ending hallway medicine.

If the government truly wants to end hallway medicine they need to consider the reasons that people need healthcare and the impact that their cuts (and decisions) in other areas is going to have on the demand for hospital services. Hallway medicine is not happening in a vacuum. Cuts to social assistance, ending the basic income pilot, cutting support for cycling infrastructure, reducing funding to the Trillium fund, reducing oversight for meat processing facilities, cuts to mental health funding, ending minimum sick days and reducing employee protections, cancelling the planned raise for the minimum wage, increasing accessibility and affordability of alcohol, and on and on, are all going to result in an increased burden on the healthcare system and our hospital hallways are only going to become more crowded.


3 Comments

Just because it’s “always delicious” doesn’t mean it’s not a diet book

Follow my diet to lose weight!.jpg

Last week I attended the Ambition Nutrition Symposium in Toronto, to which I was fortunate enough to win free tickets. The theme of the conference was “bringing it home” and was intended to help translate nutrition theory into the kitchen and onto client’s plates. While I’m not sure the day really succeeded in that regard, I still found it to be an interesting conference with a variety of speakers and delicious food (thank you George Brown culinary students!). That being said, from my perspective, there was an elephant in the room. That elephant was the tension between professions and dietary dogma.

We started the day with a great presentation by Dr. Kelly Brownell, director of the World Food Policy Centre, among numerous other titles. He spoke about the difficulty we often face when addressing food-related issues through policy as something that benefits one area (e.g. nutrition) may cause unintended harm in another (e.g. agriculture). The goal of his new centre is to bring stakeholders from all the areas together to try to develop policies that will benefit all areas. As an aside, one thing I noticed about the list of stakeholders he shared was the lack of the public. As “end users” I think that it’s essential that the public (or specific groups from the public such as those experiencing food insecurity) are involved in these discussions.

Later in the morning we had an excellent presentation by Nishta Saxena, a dietitian. Maybe I’m a little bit biased as an RD but I felt that she did a fantastic job of presenting the struggles we face in addressing healthy eating with clients when they are constantly bombarded by misinformation in social media. How do we combat “sexy” social media influencers as professionals who must provide evidence-based factual information and are less inclined to posed half naked with overflowing mason jars of green smoothies? Several years later and dietitians still aren’t sexy ;)

We also had Saxena and chef Christine Cushing call out juicing and juice diets (while a new cold pressed juice company presented at one of the breakout sessions and provided samples during food breaks). Cushing mocked the caveman diet and then we had a snack break with “paleo” brownies. Saxena belittled meal kits and our swag bags contained a coupon for Hello Fresh. Hello elephant.

Follow-up Saxena’s fantastic presentation with a discussion with Dr. David Ludwig and his wife chef Dawn Ludwig to promote their new book “Always Delicious” which we all got a copy of in our swag bags. Full disclosure, I have been critical of Ludwig in the past. I tried to come into it with an open mind though, I really did but the elephant would not settle down. Despite their protestations that it was not a diet book, if it talks about weight loss, fat adaptation, is filled with testimonials (from readers who have lost weight), and has a prescriptive DIET with three phases, it’s a goddamn diet book. I’m not going to get into the science of his insulin hypothesis here because my point is not to critique his beliefs but if you want to read more about it I recommend this short article by Stephan Guyenet. I’m also not here to question the “success” people have had on Ludwig’s diet. If people are happier and healthier following this plan, I think that’s great. My issue is with the framing of this diet as the best way to eat for everyone and that the best way of eating is one that promotes weight loss. They talked about “NSVs” (non-scale victories) but the only examples I saw in the book and heard during the talk were a reduction in blood pressure and going down a pant size (which while technically not a weight loss “victory” is still a “victory” over an “unruly” body).

For a day that was meant to promote health through food there was a whole lot of talk about The Obesity Problem which is really not the direction that we want to take if we want to encourage people to have healthy relationships with food and their kitchens. I encourage everyone to read this piece about one woman’s “life as a public health crisis”.  If obesity is a “problem” then food is the enemy. That mindset does not lead to healthy attitudes and behaviours. You don’t need to “retrain” your fat cells, they are not disobedient puppies. Rather, we as a society need to retrain our attitudes toward our bodies and our food so that we can once again be friends with both.


8 Comments

You won’t need a meal plan in the nanny state

90737a6c65589d8d33e8a1eb36fa5d0b--shopping-lists-sport

You know what I find ironic? And not Alanis ironic, which is really just crap luck, but genuinely ironic. How vehemently opposed to government “interference” in their lives many people are and how many people ask me to give them meal plans. I’ve had people say to me “just tell me what to eat” (if you’d like to know why I don’t do that, check out this old post). Which is voluntarily completely relinquishing control of what they put in their mouths and people are willing to pay for this service. Yet, people rail on and on about the “nanny state” and how the government should stay out of our kitchens when all public health wants to do is help make it easier for you to make healthier choices.

No one in government wants to tell you exactly what to eat at every meal. Through legislation public health dietitians would like to make nutritionally void foods (like pop and candy) less accessible. We would like to ensure that fast food joints can’t open across the street from schools so that your children aren’t eating shakes and fries every day. We would like to make sure that local food systems are strengthened so that farmers are making living wages and produce is affordable and accessible.

Unlike what people want from a meal plan, we want to make it easy for people to make healthy choices. We don’t want to forbid you from buying pop or chips, we just want to make it easier for you to buy carrots or to fill-up your water bottle.

Why is it that people are so ready to relinquish all control over their diets to a dietitian or nutritionist but when it comes to creating an environment in which making healthy choices would be easier suddenly everyone’s all up in arms?


2 Comments

Warning!: Your groceries may be making you fat

UXfoWxVAyQyOZlk-556x313-noPad

My friend and fellow dietitian Gemma tweeted a link to this story: Bespoke health warnings on supermarket till receipts to fight obesity last week. After checking to see if she had a blog post planned on the topic, and receiving her go-ahead to write about it, here I am!

The idea is that supermarkets could print tailored nutrition advice on customer receipts based on the items they purchase. These would be warnings based on the purchases a customer makes. Too much fatty food? Your receipt might tell you to skip the chips next time and go for the carrots instead. Too much sugar? Your receipt might tell you to lay off the candy bars and buy some lettuce. As current efforts to curb the obesity epidemic have been failing, apparently Public Health thinks that this might “nudge” customers to make healthier choices. Because shaming works so well. *Tears out hair* Sigh.

Thankfully, this idea is still in the early stages. I hope that this means it will never see the light of day. Why? There are a number of issues with this endeavor. As I pointed out, fat shaming (or any type of dietary shaming) is not an effective method to induce behaviour change. Does anyone really want their grocery store judging their purchases? Telling them they shouldn’t have bought that ice cream for a party? I certainly don’t. I know that with all of the misleading marketing and packaging navigating the grocery store aisles can be difficult and time-consuming. However, I don’t think many people need to be reminded that what they’re buying is crap when they load up their carts with fries and pop. If a grocery store had receipts that made me feel badly about my purchases I would probably just shop at another store. That leads me to a few other issues.

One, if a public health campaign like this were to be undertaken, it would have to be implemented in all supermarkets in order to be effective. I don’t think anyone is going to choose to shop at a chain because the receipts there tell them they made bad choices. Two, would anyone even look at these nutrition statements on their receipts? I know that I rarely examine my receipts. If a campaign doesn’t reach most people, even if were well-designed, it’s unlikely to be effective. Three, public health would need to get buy-in from the supermarkets, and I don’t see that happening. Why would any retailer want customers to leave feeling worse about themselves than when they entered their store? Removing candy from the tills makes sense. It’s great publicity and it’s something that customers want. Shaming customers for their purchases is not good publicity, and as far as I’m aware, it’s not something customers are clamouring for.

My final concern is with how the algorithm to determine nutritional merit of foods would be created. Would someone be told to buy less fatty food if they bought a jar of coconut oil or a stick of butter? Would they be told to buy less sugar if they bought a bottle of maple syrup? How would “unhealthy” be determined? What about someone who buys mostly fresh produce and minimally processed foods but throws a bag of chips in there or some cheese? Would a block of cheese be given the same treatment as a bag of chips? After all, there would be more fat in a block of cheese than a bag of chips.

I see this campaign as both problematic and offensive. If public health really wants to see systemic change they should work to change the system, not the consumer.


8 Comments

Smart Swaps: Not so smart

SS_smartswaps_logo

Public health is hard. I get it. I was there. It’s hard to come up with ways to improve population health. Nutrition is a particularly difficult area to address. After all, it’s not like smoking where you know that it’s unhealthy and your goal is to convince people to quit (or never start). Nutrition and our relationships with food are complicated. Unfortunately, in most cases, public health campaigns fall flat. I’m afraid that’s going to be the case with the latest Smart Swaps campaign in Britain.

As a few people point out in this news article, money could have been better spent revamping the food system to encourage healthy choices. I’d also like to suggest core curriculum for students so that food skills can be learned young and shared with the entire family.

Beyond the issues raised in the article (i.e. that resources could have been better used elsewhere) I have a bit of an issue with the smart swaps included in the campaign. They seem to be predominantly focussed on calories and weight loss. Yes, there’s swapping sugary cereal to unsweetened cereal, and swapping  sugar sweetened beverages to unsweetened beverages. Not bad swaps. But how about swapping whole milk to low-fat milk, and then swapping that for skimmed milk?  Or swapping butter to lower-fat butter or spreads and cheese to reduced-fat cheese? Yes, that will save you calories but that doesn’t necessarily mean you’re making healthier choices. Fat is not the enemy. Too much of anything is the enemy. Too much highly processed convenience food is the enemy. Not cooking (using minimally processed ingredients) is the enemy. These simple swaps are too simplistic to address the growing problem of obesity and malnutrition.