Dispelling nutrition myths, ranting, and occasionally, raving


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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!


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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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Which fitness tracker gives you the best calories burned for your workout? An experiment

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Remember my rant a little while ago about how you shouldn’t think of exercise and food as an equation to balance? Or my post about not using the exercise component of calorie counting apps? Well, I just wanted to add a little more to that conversation today.

I use a Garmin watch to track my runs and occasionally I’ll look at the “calories burned” out of curiosity. After a pretty fast longish interval run I noticed that the calories burned seemed rather low so I started scrolling back through and was puzzled to find a shorter easier run that supposedly resulted in a very similar caloric expenditure. That left me wondering how Garmin determined the calories burned during a run. I looked it up and it turns out that it’s related to heart rate. Sometime the heart rate monitor is wonky and (especially when it’s really cold out) will register a heart rate that would be more likely seen when I’m sitting on my butt than when I’m out booking it through speed work. That means that my Garmin (erroneously) registers minimal exertion and thinks that I’m not burning very many calories.

Today I decided to do a little experiment. I wore my Garmin, as per usual, which is synched to my Strava account. I also fired up the Nike+ Run Club app for the first time in ages and I set out on an easy(ish) 10k run. After the run, I also entered the time spent running at the closest average pace into myfitnesspal. All of these apps have my height and weight. Any guesses what the results looked like?

Garmin: 463 calories

myfitnesspal: 517 calories

Nike: 526 calories

Strava: 1371 calories!!!!

Now, I have no idea how many calories I actually used during this run, I’d wager Garmin was probably closest to the mark considering that the heart rate monitor seemed to be working properly. But Strava, what the actual hell?? Considering that Strava gets all of it’s data from my run directly from Garmin I find it amazing that it estimated I burned nearly three times as many calories as Garmin thought I did. I’m sure that if I had other apps and trackers I would have gotten slightly different results from all of them.

All this to say, if you’re exercising and tracking calories burned, you probably shouldn’t give that number too much weight. Try to think of exercise as giving you health and fitness rather than taking away calories and weight.