Dispelling nutrition myths, ranting, and occasionally, raving


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A bit about that working mums make kids fat study

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This article: The Impact of Maternal Employment on Children’s Weight: Evidence from the UK came out a couple of weeks ago and I was appalled. Essentially, the article is blaming working mothers for making their children fat. As if working mums don’t have enough guilt dished out to them already. As if there’s a simple causal relationship between obesity and maternal employment. And as if there isn’t already enough unhelpful fat-shaming going on in our society. I was going to blog about it but a number of other people already have so why reinvent the wheel. Instead, check-out these pieces:

Working Mothers Don’t Make Children Obese by Gid M-K; Health Nerd on Medium explains why the reporting on this study was all wrong.

Aiming the Obesity Blame Game at Working Moms by Ted Kyle on ConscienHealth reminds us that correlation is not causation.

A TL;DR thread from Sean Harrison breaking down the many limitations of the study.

If you’ve come across any other great criticisms of the research (and media surrounding it) please share in the comments. I would especially love to see some from a weight-neutral perspective as the majority of the criticism has been around the study methods and sexism but I think that sizeism is a major problem with the research as well.

 

 


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Top 10 of 2018

Easing back into (or maybe out of) blogging in the New Year with my top 10 most popular posts in 2018 (based on number of hits). Thanks for reading!

  1. Being thin is not a qualification for providing nutrition advice
  2. Are Clif Bars a healthy snack?
  3. Are pharmacists the new dietitians?
  4. Call in the food police, we’ve got another unruly body
  5. Breathing vs raw food. Should we be getting our oxygen from our diet?
  6. Whole Life Challenge review
  7. I don’t know why you say Hello (Fresh), I say goodbye
  8. Naturopaths are jumping onboard Nutrition Month and this boat ain’t big enough for all of us
  9. A smile doesn’t hide your weight bias
  10. To keto or not to keto


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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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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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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!