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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If you’re cheating on your diet, then you should probably break-up with it

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Yes, the above post is undoubtedly very cute. Using emojis is a fun way to make your point. However, I would argue that if you are struggling with your weight that you should actually reverse the suggestion by Dr Nadolsky.

I’m not saying, eat unhealthy food all day every day. I’m saying, take some of those “treat” foods from the weekend and enjoy them whenever you feel like it. Something more along these lines:

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If you’re struggling with your weight and you’re eating super healthy through the week and then you “undo” all your hard work by eating a bunch of crap on the weekend your problem is not the weekend. Your problem is the week. If your workweek diet is very restrictive and doesn’t allow room for treats, or carbs, or entire food groups, then it’s not a sustainable way of eating. If you feel deprived during the week, then it’s not a sustainable way of eating. If you can’t continue to eat the way you eat during the week through the weekend, then it’s not a sustainable way of eating. If your diet through the week is devoid of pleasure, then it’s not a sustainable way of eating. If you’re cheating on your diet whether it be for one day a week, or all weekend, then you should probably break-up with it.

Regardless of your weight, your diet should be one that you enjoy. That provides you with nourishment and pleasure. You should be able to enjoy your food every damn day of the week.


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Call in the food police, we’ve got another unruly body

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I feel the need to expand on something I touched on in my post last week. It’s related to people judging dietitians on the basis of our weight. My previous post mainly discussed why it’s inappropriate to judge anyone’s professional abilities, including dietitians, on the basis of their perceived size. However, I think this all too common judgement also speaks to the lack of understanding of what we do.

There’s a common (mis)perception that dietitians are all weight loss counsellors. As a result, if we don’t have that elusive “perfect body” people think that we suck at our jobs. After all, what else do we do other than police the food people put into their mouths. If we can’t control the food going into our own mouths, how on earth can we possibly control the food going into the mouths of all the other owners of “unruly” bodies. While some dietitians certainly do work in weight management, even those dietitians are not actually food police. The majority of dietitians don’t work in weight management. Curious what a dietitian actually does, check out this old post.

It is not part of my job to control my body so that it fits your perceived notion of healthy and fit. Whether or not I am large has no bearing on my knowledge of nutrition. It does not impede my ability to calculate a tube feed, modify a recipe, expound on celiac disease, or help someone with diabetes manage their blood sugar. Just as being small and having no knowledge of nutrition does not automatically imbue me with the capacity to do these things. As with any profession, the size of a dietitian is not a reflection of their knowledge, experience, or capability.

Dietitians do So Much More than help people lose weight. Despite the impression that our name gives, we are not all about putting people on diets. For many of us, aside from medically necessary diets (for example in the case of allergy sufferers or those with celiac disease) “diet” is a four letter word. We’re not all on a mission to rein in unruly bodies and create a world populated solely by thin bodies. When we do work in positions of counsel we usually aim to help people to gain greater compassion for, and appreciation of their own bodies. To help people view food as a source of pleasure rather than an enemy out to destroy our hard-fought-for chiselled physiques.


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

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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.


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Healthspan app review

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I read this article about a “new app that identifies your nutrition gap” a little while ago. According to the article, the app (Healthspan) will make individualized supplement recommendations that you can order in-app based on your diet. Naturally, I was concerned. Ideally, we should be aiming to obtain the majority of our nutrients from food. I envisioned an app designed to push supplement sales and was concerned about the safety and accuracy of recommendations made through an app. I figured I shouldn’t knock it until I tried it though so I downloaded the free app and tried it out for a week.

Healthspan is very similar to other food and activity tracking apps in that you enter your daily food consumption and your physical activity. I’ve written about some of the pitfalls of these apps before, in particular their accuracy when it comes to calories burned and the notion of “earning” more food with exercise.

When you first download Healthspan you enter your weight, height, age, etc and it gives you your daily caloric intake to attain your goal. According to the app, for me to maintain my current weight I should consume 1143 calories a day. This is quite low and certainly lower than the number of calories I actually consume every day. Of course, I “earn” more calories through my regular exercise. Just for fun I changed my goal to see what my daily caloric allotment would be if I wanted to lose two kilos. I now have a measly 914 calories per day to work with. To put that in perspective that’s roughly the calories in a Big Mac and medium fries. A 900 calorie per day diet is generally considered to be a very low calorie diet and not recommended to be undertaken without medical supervision. The app however, provided me with no warning. It just readily lowered my daily calorie goal. Interestingly, when I further decreased my goal weight to 44 kg (which would render me significantly underweight for my height) my calorie goal remained at 914/day.

Healthspan does offer you the opportunity to obtain free supplement samples when you register. Unfortunately, they’re only available to those in the UK so I was unable to determine what the samples were. Following that, you can order supplements through the app but the description of this process given in the original article is a little off-base. The app doesn’t make recommendations based on your recorded dietary intake. Rather, you complete a questionnaire and based on your responses it recommends a multivitamin supplement. The recommendation seemed pretty generic for any woman of my age (see below). Despite this, it still concerns me that supplements are available through the app given the questionable quality and safety of many supplements available on the market.

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Aside from this, another rather significant issue I had with the app was logging my food intake. While it was quite user-friendly to enter foods and beverages I’d consumed, the selection was extremely limited and there was no way to determine ingredients in mixed dishes, nor to enter your own recipes or nutrition information. For example, I made a vegetable curry for supper one evening. There was a vegetable curry option I could add but there was no way of knowing if the ingredients were similar to the curry I ate and for anyone who’s ever had curry, you know that the recipes can vary considerably. The same held for other dishes such as smoothies, lasagna, granola, stir-fry, and so on. There was also a number of foods that I couldn’t find at all in the database and had to make my best guess at what would be most similar. Based on this, I question the ability of the app to record calorie and nutrient intake even remotely accurately.

Each day, the app gives you a score out of 100 that appears to be based on your physical activity and calorie consumption. However, participation in challenges also counts toward this score. Without participating in these optional challenges, I was never able to achieve better than a 60 on any one day. On most days, I was even lower than this. Personally, even though I wasn’t using the app to genuinely achieve any goal, I found this really discouraging. If I was actually trying to reach personal nutrition and physical activity goals I can imagine this score would be off-putting.

I know that people really like apps to track things like food and exercise but I’d give Healthspan a pass if you’re looking for an app for these things.