Dispelling nutrition myths, ranting, and occasionally, raving


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A dietitian’s take on the new Canadian Adult Obesity Clinical Practice Guidelines

Here are my thoughts on the new Canadian Adult Obesity Clinical Practice Guidelines (written as I read each chapter):

Reducing Weight Bias in Obesity Management, Practice and Policy

I was really pleased that they put this chapter first and I really didn’t find anything to object to in it. I was especially pleased to see the recommendation that weight not be a target for behaviour change, both on a population and individual level, and that other indicators be selected for assessing the effectiveness of population health interventions.

Epidemiology of Adult Obesity

This chapter discusses the prevalence of obesity in Canada among different age groups and changes in obesity rates over the past ten years. A definition for obesity is also finally provided:

Obesity is a chronic disease characterized by the presence of excessive and/or dysfunctional adipose tissue that impairs health and wellbeing. Obesity is a complex disease in both its etiology and pathophysiology.12 In epidemiological research, obesity is often determined using the body mass index (BMI), calculated as weight in kilograms divided by height in metres squared (kg/m2).

One thing that bothers me about this framing is the assumption that obesity is a disease in and of itself. I also don’t feel that enough emphasis was placed on the fact that BMI is not intended to be used at an individual level. This despite the fact that nearly every doctor (and many other healthcare professionals) uses it as such. There is disappointingly no mention of the significant limitations to BMI; i.e. that it is not appropriate to use with populations other than white adult men up to about the age of 50.

Essentially, what I get from this chapter is that “obesity” is a major “problem” in Canada but there is no real accurate way to measure it. So, call me crazy, but perhaps if there’s no good way to measure it “obesity” in and of itself is not a true disease or health concern. Perhaps instead, we should be focusing on tangible issues.

The Science of Obesity

A little bit more about BMI at the start of this chapter: “BMI is a fairly reliable anthropometric measurement to stratify obesity-related health risks at the population level.” I think this statement is debatable given the significant limitations of BMI. I truly think that we need to just let go of BMI altogether. Just throw it away. BMI is like the partner who constantly mistreats and gaslights you but because you’ve been together for so long you don’t want to “waste” all that time and energy you invested in the relationship so you stay with them even though that’s only going to prolong your misery. Just dump it already. Just because you don’t have a better option lined-up doesn’t mean you should forge ahead with this complete dumpster fire.

Then there’s this: “The increased availability of processed, affordable and effectively marketed food, abundance of sugar-sweetened beverages, economic growth, behavioural changes and rapid urbanization in low- and middle-income countries are some of the key drivers that promote overconsumption of food.” Sorry, what? Didn’t we just establish that “obesity” is complicated? And yet here we are boiling it down to people eating too much “junk” food. Sigh.

The chapter then goes on to discuss the biology and physiology of “obesity”. Even though previously establishing that BMI is only appropriate at a population level, there is still use of it for individual classification. There is also mention of a percentage of individuals “with obesity” who are metabolically healthy. Another problem, in my mind, of assuming “obesity” is a disease in and of itself. Essentially, you have people who have no health concerns but are labelling them as diseased solely on the basis of the size of their bodies. Didn’t we just talk about the harm of stigma? How is it not stigmatizing to say someone has a disease just because their body is classified as a certain size (based on a flawed measurement)? Why can’t we just focus on known health concerns (such as heart disease) and leave “obesity” out of the discussion entirely.

The chapter concludes by saying that, “Obesity, or excess adiposity, is the result of an imbalance between energy consumption and energy expenditure by an individual.” Boiling the “complex” “disease” of “obesity” (sorry for all the quotation marks!) down to eating more calories than you burn off which is an oversimplification and just further encourages the belief that fat people simply need to get more exercise, which I hope was not the intended message of the authors but nevertheless is what’s implied.

Prevention and Harm Reduction of Obesity (Clinical Prevention)

Don’t be fooled by the title of this chapter. It is not about reducing the harm caused by healthcare professionals when treating “obesity”. It is about preventing “obesity” in patients. I found this statement particularly alarming: “pregnancy and the postnatal period may be particularly important periods for targeted primary weight gain prevention.” People’s bodies go through HUGE changes during pregnancy, and postpartum and it’s NORMAL for bodies to be permanently altered by the process. There is already enough stress and pressure on someone during pregnancy and as a new parent. We absolutely do not need to be adding to the pressure during that time by shaming people for gaining too much weight during a pregnancy or pushing them to lose weight rapidly after giving birth.

I’ve written about it before, but it bears mentioning again that we as a society (and especially as healthcare professionals) do people, especially women, a huge disservice by promoting the message that we should remain one weight throughout adulthood. It is actually normal and perfectly healthy to gain weight as we age, particularly during menopause, and this weight may actually be protective against illness in older adults.

One more thing that I am horrified by in this chapter is the suggestion of encouraging adolescents to self-weigh in an effort to prevent obesity. This is a recipe for creating eating disorders. We should not be pushing this narrative of measuring self-worth on a scale to youth. Rather we should be promoting self-confidence and encouraging them to embrace and respect differences in body shapes and sizes. Promote healthy choices to youth, not bathroom scales.

Enabling Participation in Activities of Daily Living for People Living with Obesity

This chapter is all about how doctors should provide advice to patients classified as having “obesity” on how to perform activities of daily living, cleaning skin folds, and avoiding falls. Which I find a little presumptuous and cringeworthy. I know that I would be offended if a doctor told me, unprompted, how to wash my own body.

The authors even state: “There are significant gaps in knowledge about what it is like to live with obesity in the context of participating in day to day activities including self-care, leisure and life roles.” Here’s a novel idea: how about we allow patients to state their concerns to their doctors and then let doctors provide solicited advice.

Assessment of People Living with Obesity

All the recommendations for healthcare providers in this section (save for one) are graded level D. I don’t know about others, but I am not comfortable moving forward with such low quality evidence.

I appreciate the author’s emphasis on avoiding stigmatizing patients. However, I question whether it is possible to do this when labelling individuals as having a disease on the basis of the size of their bodies. Also, I once again question the recommendation that healthcare providers assess BMI when it was earlier established that this is not an appropriate measure on an individual basis. Do we really want to continue to use a deeply flawed tool just because we don’t have something better? Perhaps we should focus on actual lab work and patient concerns rather than something we know is potentially harmful.

The Role of Mental Health in Obesity Management 

I do think that it’s vitally important to discuss mental health when we’re discussing “obesity”. However, I’m disappointed that this chapter implies that people classified as having “obesity” may have binge eating disorder. It is possible for people with larger bodies to suffer from anorexia and bulimia, and really all types of eating disorders. They are not the sole domain of people with smaller bodies and failure to recognize this increases the risk of harm. I would have also liked to see more connection between this chapter and the chapter on weight stigma. Many of the ill-effects of “obesity” may actually be attributable to weight stigma.

Medical Nutrition Therapy in Obesity Management

I don’t have much to say about this chapter. I might also just be getting tired of reading. I appreciate that the authors state that there is little evidence of calorie restricted diets being beneficial and mentioning that dietitians can provide support for patients.

Physical Activity in Obesity Management

I’m actually surprised that there is supposedly high quality evidence to support exercise for achieving “reductions in abdominal visceral fat” (Grade A!) and losing small amounts of weight and maintaining weight loss (Grade B). The vast majority of research that I’ve seen has shown that exercise is not effective at producing long-term weight loss in most people. Of course, the authors of this chapter also state that physical activity can be helpful in managing a number of health conditions and is beneficial even when not accompanied by weight loss. This is the messaging that I think is best. We should be focussing on being physically active for overall well-being. Otherwise people see it as “work” and a means to an end and it all too often is abandoned.

Weight Management over the Reproductive Years for Adult Women Living with Obesity 

I wasn’t going to bother with the remaining sections (and this is out of order) because they address management of “obesity” and I feel like it’s kind of pointless for me to pass judgement on them when I’ve already established that I don’t believe “obesity” is a disease to be treated. However, as a relatively new mom I couldn’t resist taking a peek at the chapter on reproductive years. And I had a bit of a wtf moment when I read the following: “Primary care providers should offer behaviour change interventions, including both nutrition and physical activity, to adult women with obesity who are considering a pregnancy (Level 3, Grade C),7,8 who are pregnant (Level 2a, Grade B)915 and who are postpartum (Level 1a, Grade A)16 in order to achieve weight targets.” I mean, given that we’ve already determined that these are ineffective means for achieving weight loss why would they be recommended for that purpose? Also, can we please stop obsessing over women’s weight?? Why isn’t there a chapter on managing men’s weight through the reproductive years? Fuck the patriarchy.

Obesity Management and Indigenous Peoples

As a white person, I am uncomfortable commenting on this chapter. I don’t know the backgrounds of the authors but I hope that they are Indigenous. I was pleased to see the recommendation that healthcare providers educate themselves about Indigenous cultures. Also, that they recognize that health inequities exist. However, I’m question why this particular population was singled out and the discussion about Indigenous Peoples being disempowered felt a little condescending. I don’t think that we, as healthcare providers (or humans in general) should be making assumptions about people. Perhaps it would have been better to put a discussion about systemic oppression up-front with weight bias as there are many people who have been harmed by our white patriarchal systems. Perhaps it would be better to listen to patients about their experiences and concerns rather than making assumptions not matter how well-intended.

Final thoughts (aka TL;DR):

I get that the authors have devoted careers to working on treating and preventing obesity so it must be incredibly difficult to let that go. But we need to stop and ask who it’s serving to pathologize obesity, and as well-meaning as it may be if it is not actually causing more harm than good. We need to stop talking about “obesity” altogether and start focussing our time and energy on creating healthy supportive environments and systems. Let’s get a national school food policy, let’s dismantle the patriarchy, let’s implement a universal basic income, let’s eliminate poverty, let’s teach food literacy in schools, let’s create walkable communities, let’s encourage work-life balance.


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Is mom the TA for calling out her sister for buying her daughter a food scale?

I don’t have much to blog about lately. All of my usual sources of inspiration have been dominated by covid-19 for the past few months. My life revolves around my baby and we don’t go anywhere. I can’t even glean inspiration from the grocery store because I haven’t been there in over 10 weeks (11 weeks? I’ve lost count). I pretty much only check Twitter now to read posts from AITA (am I the asshole?) and Reddit relationships because it’s otherwise just an unending torrent of horror and frustration. So, I’ve now reached the stage of social isolation where I start to write about AITA posts. The one above really stuck with me.

Obviously the mom is TA (the asshole), as is the aunt. I started out on the mom’s side. Of course I would be super pissed if I had a teenaged daughter and someone bought her a food scale so that she can weigh everything she’s eating. And I 100% love the messaging that she can be healthy regardless of body size, not tying self-worth up with what her body looks like, and engaging in physical activities that she enjoys, not as a means to lose weight. However, I think both the mom and the aunt are giving the poor girl messages that are likely to lead to an unhealthy relationship with food and her body.

In the comments the mother says that she only cooks three kinds of vegetables, and only sometimes, because no one in their family likes vegetables. She states that they’re healthy but her comments indicate that the household engages in very little physical activity and doesn’t eat a balanced diet. She seems to be under the misguided impression that just because she’s preparing meals at home that they are de facto nutritious. Obviously, if she’s not including vegetables or fruit at every meal then they are nutritionally lacking (the current recommendation from Health Canada is to make half your plate vegetables and fruit). She also seems to think that vigorous exercise is unhealthy as she expressed concern that her daughter was sweating and out of breath from her home workouts. The current physical activity guidelines for children and youth (ages 5-17) start with a recommendation to “sweat” by accumulating at least 60 minutes of moderate to vigorous activity a day.

I think it’s extremely sad that the mother would discourage her daughter from engaging in physical activity and prevent her from eating a healthy diet. Let’s not let the aunt off the hook either though. Given the mother’s strange perception of what’s healthy and unhealthy I’m not sure that we can trust her assessment that the aunt has an unhealthy relationship with food and exercise. Whether she does or not, it was completely inappropriate for her to provide a 14 year old child with a scale to portion her food. Teenagers are growing rapidly and need sufficient calories and nutrients to support this growth. In addition, if she is weighing her food, the daughter is not learning to trust her own hunger and satiety cues. Teaching her that food is something to be restricted to attain a certain body size is only going to lead to longterm hang-ups when it comes to food.

Both the mother and the aunt are pushing their own agendas on this girl. If they truly had her best interests at heart they would support her efforts to eat a healthier diet and to safely engage in physical activity. Ideally, the mother would lead by example by role modelling a positive relationship with food, physical activity, and her body, but if she can’t bring herself to eat a green vegetable, the very least she can do is to provide them to her daughter as she’s asking.


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How much do you weigh?

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How much do you weigh? That question seems to be asked of us all too often. It’s something that I never really gave all that much thought to as someone who had maintained relatively the same weight since university. However, as I’ve learned more about taking a weight-neutral approach to healthcare, and experienced the changes that my body went through during pregnancy and postnatally, it’s something that I find myself thinking about a lot.

So many of us tie our identities up in our size and part of that is our weight. We think of ourselves as being a certain height and weight and we talk about those things as if they’re static numbers but for many of us, that’s not the case. When we gain or lose weight unintentionally it’s as if suddenly our identities are called into question. We’re not the person that others are meeting for the first time; the real me is someone who’s 20 pounds lighter, or 10 pounds heavier.

The thing is though, our bodies change, and that’s normal and okay. Many of us gain a few pounds in the winter (there’s even a word for it in German: winterspeck) only to shed them again in the warmer months. Most people will weigh more in middle age than we did as young adults. And yet, we think that we need to be the same weight as our youthful selves. We talk about losing those “last 10 pounds” as if some weight on a BMI chart is our “true” weight. As if once we attain that weight we will have reached our final destination and our weight will never change again.

We are all changing all the time. Our bodies are always changing and it’s foolish of us to think that our weight is a magically unchanging fact about ourselves. It’s okay not to be the same size that you were 20 years ago, or two months ago. You are no more or less worthy of love and acceptance if your body is larger or smaller than it was in the past or will be in the future. You are no more or less yourself if you gain or lose weight. Your identity does not hinge on numbers on a scale.


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Lose the Weight Watchers

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Last year Weight Watchers rebranded as WW because they wanted to pretend that they were about healthy lifestyles and not just weight loss. This week they announced the release of their new weight loss app for kids (as young as eight!) and teens. They’re trying to frame it as “helping kids and teens build healthy habits” but when the central feature of the app is food tracking don’t be fooled; this is Weight Watchers points for kids and creating a “bad food” “good food” dichotomy is likely to do anything but help these kids build life-long healthy habits.

An eight year old tracking every morsel of food they eat with the sole aim of losing weight is pretty much the antithesis of a healthy habit. Rather than help kids develop healthy habits this app is far more likely to instil them with an unhealthy relationship with food and their bodies. And while I personally ascribe to the belief that weight is not indicative of health, I hope that all healthcare providers and parents can see why an app like this could be damaging to children whether or not they view “overweight” and “obesity” as a “problem”. Weight is not a modifiable behaviour and focusing on weight loss as an end goal doesn’t promote the adoption of healthy behaviours. Rather, it promotes restricted eating and quite probably disordered eating habits in order to attain that goal.

Given that very few adults successfully maintain intentional long-term weight loss, I find it baffling that WW claims that their new app is “evidence-based” and will somehow be more successful (if you are measuring success by pounds lost) in children and youth than similar programs have been in adults. It also makes me sad to see the quotes around “stopping arguments about food” so that parents and children get along better. Placing the responsibility for food choices in the hands of an app rather than working on fostering a healthy food environment at home may seem ideal but this doesn’t truly promote healthy behaviours. I know not everyone can afford to work with a registered dietitian (and not all RDs ascribe to the same school of thought when it comes to body weight); however, I recommend Ellyn Satter’s books which can be found at your public library if you want to help your child attain a healthy relationship with food.

It’s also important to keep in mind that WW is a for-profit business. They are not doing this out of the goodness of their hearts. They are doing this because there’s money to be made – one month use of the app is $69 USD. They’re doing this because a “fun” app is an easier sell to parents who are concerned about their children’s weight than working on the division of responsibility, role modelling healthy behaviours and positive relationships with food, and cooking and eating nutritious balanced meals together as a family. They’re doing this because weight bias is so rampant in our society that many people can think of few things worse than being fat and parents are desperate to save their children from that plight. I get that. Parents just want their children to be healthy. Unfortunately, an app that encourages a restrictive diet mentality is likely to achieve the opposite of health promotion.


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Book Review: @thefuckitdiet

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This review is not going to be as thorough as I like to be. I listened to this book on Audible while I was doing other things like cooking, cleaning, and walking the dog so I didn’t take notes and I wasn’t always paying the closest attention. That being said, for the most part, I thought it was great.

The overall message of the book is that we need to stop being so hard on ourselves for doing something as natural as eating food. That in order to reestablish a healthy relationship with food we need to stop dieting altogether and give ourselves permission to consume food in ways that we have told ourselves is “wrong”. For example, allowing ourselves to eat foods we’ve told ourselves are “bad” and allowing ourselves to overeat. This book is basically about undoing the conditioning we’ve done to ourselves over the years by making eating emotionally fraught.

The only real issue I took with any of the book was with some of the science, which I found to be questionable. I should have taken notes because I can’t remember exactly what Dooner was saying and having listened to the audiobook it’s not like I can easily flip to the references to look things up. I do remember her talking about the causes of candida overgrowth and mention of heavy metals being the cause (not sugar consumption). As far as I’m aware, there is still a lack of quality research in this area, and we really don’t know what causes some women to be prone to yeast infections. Dooner also mentions Chris Kresser as a source at one point (no, not a source of candida, but as an expert on something – again, I should have taken notes). I’m not a fan of Kresser. He’s got something to sell and claims to have the cure for everything that ails us. His website is a trove of red flags when it comes to nutrition information and he’s an acupuncturist and anti-vaxxer who cured his own chronic illness. Not someone I would want to be associated with. Anyway… as long as you don’t get hung-up on the science, I think that a lot of people could benefit from this book.

Dooner offers practical actions for the reader to undertake that should help move them closer to a healthy relationship with food. I think her attitude and approach are refreshing. I mean, her entire “diet” is literally: fuck it. Stop stressing so much about food. Stop trying to force your body to conform to some fucked-up wealthy white patriarchal ideal. Forget everything you’ve learned or told yourself over the years about diet, food, and what you should and shouldn’t be doing. Stop wasting time and energy obsessing about your weight and start living life to the fullest.

If you’re interested, Dooner is running an online book club starting on May 26th (you only have a few more days to enrol – enrolment ends on May 24th – so get off that fence if you’re thinking about it). This will include weekly Q&A sessions, discussion, and more. Check-out thefuckitdiet.com/club to learn more and sign-up. You can also follow Dooner on twitter and instgram @thefuckitdiet where she shares snippets from the book, quotes, and stories of her adorable dog.