OHSC Conference Resources

Hello everyone!

Thank you for visiting my web page Shift the Focus.  Please see below for resources spoken about during my presentation: First do no harm: raising the flag of school obesity prevention strategies”

Presentation- OHSC 2014 Raising the red flag

Presentation Handouts

Handout BMI screening

Feel your fullness activity

Research articles:

2013 Meta analysis school-based physical activity and nutritional education interventions on BMI

2011OSDUHS_Detailed_MentalHealthReport

2004 Associations between overweight and obesity with bullying

 

Thank you for all who came to see my presentation. It was a pleasure meeting all of you!

Please take a minute to provide feedback:

“You are now a registered donor.”

Yesterday I received my new driver’s license with my new home address.  This plastic card symbolized more than a legal passcard to drive in Ontario but also the new and exciting responsibility of owning a home with my family.  While holding the familiar card in my hands, I glanced at our ongoing renovations and broke a smile at my partner, acknowledging that we have come a long way since our dated kitchen, old window and roof.   To my surprise, in addition to celebrating my our new home,  receiving my Ontario driver’s license also speared a slew of feelings and questions when I saw the organ donor application form.

I had never registered before and always set it the registration papers aside to be recycled.   I never questioned becoming a donor and to be honest there was always this sense of discomfort about my organ being “harvested” after death.  A little extreme, but a perceived sense of ‘loss’ surfaced when I thought about donating my organs (even though I would technically be passed on when the organs would be donated).

I’ve read a couple of stories related to the importance of donating organs such as 65_RedRoses, a documentary about a girl (Eva Markvoort) living with cystic fibrosis and her story of waiting for lunch transplant and similarly, Helen Campbell’s a 21 year old Ottawa organ donation advocate and double lung transplant recipient.   While organ donation goes beyond lungs, these stories got me thinking about becoming an organ donor.

As I logged into the Ontario online organ donation registry an abundance of feelings surfaced. My heart started beating faster, my hands became colder and all I could think about was the “loss” of my organs and death.  Because, how can you not think about death when registering as an organ donor, right?

Overriding my thoughts of death I started inputting the necessary information to register myself as an organ donor. Instead of thinking of my death,  I kept running the following sentence in my mind

1 organ donor can save 8 lives.

EIGHT lives…  That’s pretty amazing.

In addition to repeating the sentence, I also had to deal with my thoughts of “organ harvesting”.  In order to do so, I started thinking about a teaching from one of my colleagues. I work at an Aboriginal Health Access Centre which provides a blend of holistic and western medicine to First Nation community members.  Our organization respects and honors medicine wheel teachings which guide our approach to health. The medicine wheel teaches us that health and well-being isn’t merely a physical state of illness or lack-of but, a woven connection with the physical, emotional, mental and spirit.   With these teachings, I started to understand that when I am gone, my spirit will no longer need my body (and organs) to move, play, and dance. After life, I won’t need a physical vehicle for my spirit.   And this is where I shifted my focus and remembered that my values and spirit are largely founded on the principles of helping others (hence why I became a dietitian) and therefore, becoming a registered organ donor would allow my spirit to continue helping people (like Eva and Helene) and perhaps even a family member or friend after my physical self is no longer needed.   Becoming a registered organ donor isn’t about losing my organ but honoring my values.

My heart rate is back to normal and my hands are finally warming up. At 9:45am, I became an official registered organ donor.

Yours in health and well-being

Julie Rochefort, registered organ donor

 www.BeADonor.ca

My (2012) letter to St- Stephen’s High School

I am sharing with you a letter I emailed to the principal, superintendent and program creator of the school health report cards, which includes BMI.  Recently in the news, the school has follow-up with many success stories of this school’s initiative.  While the BMI reporting erkes me greatly due to its poor measurement what erks me even more is that the school are becoming interim health centre rather than a place of education.  Subsequently, a recent Canadian-based study showed that some healthy-eating/healthy lifestyle initiatives may be triggering unhealthy/extreme food restrictions.  While Elicia Baxter, a grade-10 student interviewed for the story, may have improved some health indicators, I worry about the other students who have stayed silent.

with worry,  @julie_rochefort

January 10th, 2012

Dear Mr. Waycott

I am writing you today to express concerns regarding the use of medireports cards at St.Stephen’s High School. I am a Registered Dietitian who specializes in body image in London, Ontario. I have cc’ed Mr. Don Walker, the program creator along with the superintendent of your school district.

Moreover, I have provided a list of academic literature at the end of this
email which supports and underlies my concerns.

According to St Stephen’s mission statement, the school aims to “to nurture
students individual strengths and provide a positive learning environment
that offers the opportunity to develop the skills, knowledge, and attitudes
necessary to become happy, responsible and productive citizens”. Subjecting
students to graded evaluations of their body is likely to pose severe
negative consequences rather than create a positive learning environment and
attitudes.

While I believe that the report card project is well-intended as both
educators and healthcare professionals care about the heath and well being
of students; robust research has demonstrated that weight-centered
interventions- that is, programs that use weight as an indicator of health,
can lead to severe negative consequences such as:

1.      body dissatisfactions

2.      disordered eating

3.      weight cycling

4.      reduced self-esteem,

5.      eating and weight stigmatization and discrimination

While the public is well aware of the obesity statistics, I have listed
below research findings which offer an additional layer of concerns
regarding the severity of weight preoccupation within the adolescent
population

*         Those who are teased about their weight report more suicidal
thoughts than peers who are not teased.

*         37% girls in grade nine and 40% in grade ten perceived themselves
as too fat. Even among students of normal-weight (based on BMI), 19%
believed that they were too fat, and 12% of students reported attempting to
lose weight.

*         63% of overweight adolescent girls and 34% of overweight
adolescent boys participated in unhealthy and extreme weight-loss behaviours
such as

o   Using laxatives

o   Vomiting

o   Taking diet pills

o   Skipping meals

*         Obese youth are liked less, chosen less as friends, and rejected
more often by peers than “average weight” youth. Some overweight youth
attribute this rejection to their weight, and believe weight loss would
increase their friends.

Programs that focus on weight have yet to show long-term success3-6.
Addressing overweight and obesity is about promoting physical activity and
healthy eating as well as their underlying socio-cultural and environmental
determinants. Grading student’s weight has been shown to perpetuate weight
bias and discrimination among students which contradicts the schools
anti-harassments policy that “everybody should enjoy our school equally, and
feel safe, secure and accepted…”

A recent report written by the Chief Public Health Officer states that schools are an important component in addressing bullying. Consequently, implementing a program that measures and grades students weights risks to further amplify and justify weight-based bullying within the school environment thereby creating an environment that supports
inequality, potential harm [i.e. bullying] and peer/teacher rejection.

The grade report project at St.Stephen’s school has many potential negative
consequences, therefore, alternative efforts to promote health at St.
Stephen’s should be considered and the study be discontinued.

Should you have any questions or concerns, please feel free to contact me.

Best regards,

Julie E. Rochefort, MHSc, RD

First, do no harm. Raising the red flag on school obesity prevention programming

Once upon a time…

School’s typically sold foods associated with weight gain: pop, chips, chocolate bars, fried food, etc… In 2011 the government of Ontario decided to save the children from the BAD foods by creating the School Food and Beverage Policy which provided guidelines for foods sold in school cafeterias. Subsequently, more and more  ‘healthy eating’ teaching were surfacing  in every part of the curriculum from counting calories in math class to label reading in gym class.

Two years later, health practitioners/researchers of a Canadian Study found an association between ‘well-intended’ healthy weight/ healthy eating school programs and the development of an eating disorders.

“A 14-year-old, grade-A student with perfectionist tendencies decided he was going to be “the best” at following the healthy living program at school. He signed up for track and field and soccer and began exercising compulsively. He ate only chicken, fruit and vegetables in ever-shrinking portions and began reading food labels.”

The main author who also happen to be Psychiatrist at Sick Kids hospital in Toronto states that “the programs present this idea that weight loss is good, that only thin is healthy”  and something small such as a ‘healthy eating’ teaching from a dietitian could trigger

In one case, a 13-year-old girl’s “progressive food restriction” began after a visiting dietitian talked to her class at length about what foods students should and should not be eating.

While not all dietitians speak about good/bad foods, I can’t help but feel that red flag rise as I reflect on the many food-based nutrition education presentations I have facilitated to students.

Unfortunately this fairy tale has no happy ending. Children and society as a whole are being convinced that being or becoming fat is something to be ashamed of.

We need to re-write this story and create an ending that results in children being free of food prescriptions and health-ism.

The End?

With hope,

@julie_rochefort

Compassion deficit

Not surprising that this article “grinned by gears”.  Its disturbing that the conclusion I sensed after reading this story was the continued emphasis and assumption that someone’e weight dictates their worth.  According to the author’s comments in the news brief, if you’re a fat healthcare worker (or in our stance, dietitian) our advice has no value due to our waistline.

“It emphasizes, for example, why the obesity epidemic is so hard to fix,” Mukamal said. “Even people who know better don’t do better.”

Taking this example to the next extreme with clients suffering from anorexia, would they be better served by a skinny or fat dietitian? The skinny dietitian might perpetuate a thin ideal thereby reinforcing the anorexic voice and therefore cause more harm to the patient.

Does this sounds ridiculous?  Yes, because it is.  The qualifications of a health professionals area of practice is not a matter of their waistline.  Its the same critism we’ve heard about parents with fat children. Are they good parents? Would a thinner parent be better for this child? Should the child be removed from their home?  To be this sounds absolutely ABSURD. Why?  Because there are various, inter-locking factors that impact health and also parenting.

As a person of small stature, Ive been criticized when providing ‘body acceptance’ messages to fat individual because I can’t understand or couldn’t possibly empathize because ive never been fat.  While I’ve never physically felt the struggles of being overweight or obese,  as a human being I’ve felt shame, fear, rejection and bullying because of my ‘skinniness’.

In the words of one my favorite Social Workers, Brene Brown:

We are never more dangerous than when we are backed into a corner of never  (good/ rich/ thin /successful/ admired/ certain/ extraordinary/ safe/ in control/ powerful/ etc.) enough.  If we want to reclaim courage and compassion in our families, schools, organizations, and communities, we must open our hearts and minds to a new way of thinking about vulnerability and imperfection.

The human race  needs a serious compassion/vulnerability check.

Boo-Yah.

@julie_rochefort

Article->“Are smoking or overweight health workers hypocrites? Patient care specialists may not ‘practise what they preach,’ study finds”

Not everything that counts can be measured. Not everything that can be measured counts.- Albert Einstein

This post is a reply the  recent post “Why HAES will never go mainstream” post by Dr. Yoni Freedhoff, a family doctor and founder of Ottawa’s Bariatric Medical Institute.

I begin with replying to a specific comment by “Norma”

I also wonder about the use of “ANY” size…it apparently actually means only LARGER/obese size. Does HAES advocate that extremely thin people can be healthy? That anorexics, despite their mental illness, are “healthy”? Is a 5’10”, 107 lb couture model healthy? I know, I know; the HAES crowd ALL eat clean whole foods and exercise, but their metabolisms are slow and this is the way nature intended them to be…none of them eat any Chinese food or pastries or watch much TV. They’re all very conscious, portion-controlled, home cooking type eaters who walk the dog for miles a day and do Jillian  Michaels shred.  I’ve read their blogs. It must be true!

My reply:

Norma, the healthy anorexic is an oxymoron and I would HIGHLY doubt that any practitioner who is using HAES in their practice would categorize purging, over exercising, excessive weight loss, metabolic abnormalities and electrolyte imbalance which are often fatal, as ‘healthy’. HAES states that all size can be healthy and that making assumption that someone is healthy or unhealthy based completely on weight alone (re:skinny or fat) is a fallacy. Yes, the thinner individuals can be healthy but they can also be unhealthy-independently of a mental illness. HAES promotes a holistic model of health which looks beyond weight and asks patients: “how are you managing stress?, do you have social support?, do you have access to food? How are your sleeping patterns? etc.?.”

As a nutrition practitioner, I’ve observed many patients and even colleagues experience food disconnection primarily because food is seen as calories and its these calories that make you fat and, fatness is ugly and unhealthy. And this food disconnection is not a “fat person” or “anorexic” issue, this is a societal issue. The assumption that fat=bad automatically generates a medical intervention (re: weight loss) . While Yoni states “despite regularly telling my otherwise healthy overweight and moderately obese patients that their weights aren’t likely contributing much if anything to them in the way of medical risk” unfortunately this way of thinking is not the norm in medicine. This is why, as a practitioner, I encourage and promote HAES within my practice. HAES advocates against the assumption that fat individuals  are merely gluttonous and straining the health care system with their self-induced chronic illnesses. This promise that weight loss will lead to better health outcomes is not strongly supported by science; which is confirmed by Yoni: “healthy”, and “weight”, are not mutually inclusive or exclusive terms.

As nutrition practitioner, I apply the HAES philosophy by using alternative, more sensitive health indicators other than weight such as such as blood pressure, blood lipids, blood sugars etc). The reason is because weight loss may or may not happen with the adoption of  healthy lifestyle choices and without weight loss, people often continue to feel life failures regardless of their lifestyle successes (i.e. such as moving more, managing stress, engaging in social gatherings, included more veg and fruits. This overcasting shadow of shame and blame disrupts their healing process and may exacerbate underlying social and psychological issues.

Yoni criticized the movement using 1 article while using several studies to defend the supposedly, misinformation used by HAES researchers. This approach is disheartening to me because as a proponent of HAES, the comments and posts have generalized this group of practitioners and individuals as ignorant, radical and untrustworthy.

HAES promotes empathy (not to be mistaken with “feeling sorry for someone”) between practitioner and patient (regardless of weight) with the purpose of rebuilding and reconnecting people with their body, minds and spirit; something foreign in conventional medical practices. This leads me to my concluding (but not last) point:

I would encourage Yoni, the blog commenters and readers to expand their knowledge of HAES. What i’ve provided here is one perspective and application of HAES in practice.  While “showing the data” is an important piece to inform practice, not all successes can be captured with the medical measuring sticks and thus, this is likely why HAES is having difficulties “penetrating mainstream medicine”.  HAES acknolwedges that disconnections between weight and the HEALTH FOCUS that HAES attempts to reintegrate into medicine i.e. intuitive eating, self-esteem, body satisfactions doesn;t fancy the measurable-calculated-quantifiable scientifc rigor medicine justify’s iteself with.

Not everything that counts can be measured. Not everything that can be measured counts.- Albert Einstein

Respectfully,

@julie_rochefort

“Failure by instructors to appreciate other life priorities is an additional, and possibly academically fatal, stressor” (Taylor,M)

Comments have been generating from Dr. Jacqui Gingras’ recent compassionate and concerning post STRANGE LITTLE HURTS. In her post she brings our attention to the distress and harm that the dietetic internship creates among nutrition students.  I remember the application process like it was yesterday and I assume many others do as well.  Instead of celebrating four years, students were in constant states of anxiety, fears and self-evaluation. Our peers and friend were not a competition.  A competition towards a dream we’ve all equally deserved and worked for. With a 50/50 chance of being a successful applicant- a lot was on the line. 

While the application process is convoluted, political and very much subjective (my humble opinion); what grinds my gears the most about the road to becoming a dietitian is the lack of financial support the successful applicants have through their one year training.  

Below are some of the basic costs students must endure using PERSONAL financial means (we are not eligible to apply for student loans primarily because we’re not associated with an academic institution. The internships are  managed by each individual  hospital. <— click on Post degree internship tab to see list of available internships).

Application fee: $140 

Transcripts:  $60 

Internship tuition: ~$300 

Practice insurance:$175 *

Dietitians of Canada membership (mandatory for my internship- sigh*): $206*

Total internship program associated costs= $881.00

 * the annual membership and insurance schedule runs from April 1 to March 31st. Since my internship started in September 2009 I had to pay full membership fees to cover September until March and subsequently, purchase the full membership again to cover the remainder of my internship, April-August). 

Let’s not forget, I had to also to pay RENT, GROCERIES, BUS PASS and bills…about $10,000 for 12 months. While it would have been more economical for me to pick an intership in the city my parents reside; unfortunately, I didn’t have the privilege to such a choice. The internship picked me. 

In addition to my 40- hour per week intensive “accredited” training,  I had to find a job to support myself; even though its often “frowned upon” to work during your internship (why that is, I have no idea!!!).  This added responsibility and financial constraint made it difficult for me to process what I was learning from my rotations and limited my ability to provide self-care.  Accordingly,  in a questionnaire distributed to dietetic interns 79% of students identified “Limited funds/debt” as a STRESSOR (Lordly, D and MacLELLAND Can J Diet Prac Res 2008;69:126-130).  

As such, when we consider the stressors student’s experience while in internship (e.g  financial+ no sleep+ job+ caregiving..etc), its not surprising that Dietetic Educators identify the performance issues listed below (Lordly,D. Can J Diet Prac Res 2007;68:36-40).  

Personal issues: actions attributed to the student as an individual
– Sick a lot  
– Argumentative
– Psychological problems
– Not motivated
– Insecure/low self-esteem/no confidence
– Uncooperative

While this may seem like the  typical “poor-student” dilemma, its disheartening that the dietetic profession who works endlessly to promote health, seems to ignore the financial burden of our professional training. Just because the process has always been this way doesn’t make it right.

We need a strategy to make dietetic training accessible to all applicants, regardless of their financial status.  Who will help us in this process? Who will be our advocates? 

“Failure by instructors to appreciate other life priorities is an additional, and possibly academically fatal,

stressor” (Taylor,M: p.10)**

 **Taylor M. Generation NeXt comes to college: today’s postmodern student ODCE Conference; 2006 [cited 2006 18 Jun]. Available from: http://www.oln.org/conferences/ODCE2006/ODCE2006papers.php

With concern,

@julie_rochefort

“Good Grief”- Charlie Brown

Have you ever wondered why dietitians anticipate the month of March? No, it’s not because there is legitimate excuse to drink green beer and eat green pancakes! Albeit, I do indeed enjoy my green lager!

Every year Dietitians of Canada (the professional group that helps promote the profession… think of it as PR) highlights a nutrition-related theme and promotes it via flyers and organization specific programs over the month of March. This year, the theme is “busting up popular food and nutrition myths by bringing truths to Canadians“.  Please note the emphasis I have placed via red letters.

While this may look as though Dietitians are the ones called upon to protect you from the nutrition BS. BUT, if you are to take a critical look at the nutrition busters something very, very obvious starts to surface.

•  Tip #2 Avoid carbs if you want to lose weight. […] The best weight-loss plan is one you can stick with. To lose weight and keep it off, exercise regularly and use Canada’s Food Guide to plan a balanced diet with good food choices in the right amounts for you.

• Tip 3. Late-night snacking will make you gain weight. Late-night snacking can lead to weight gain, but it’s not due to the time on the clock. The trouble is, after-dinner snacking can lead you to eat more calories than your body needs in a day, especially if you’re having high-calorie snack foods and sweetened beverages. Still hungry? Sip on water with a squeeze of lemon, or go for small portions of healthy choices like whole grain cereal with milk, a piece of fruit, or plain air-popped popcorn. 

• 13. Certain foods, like grapefruit, cabbage soup or celery, can burn fat and make you lose weight quickly.Sorry! There is no food that burns fat or makes you lose weight more quickly. Weight loss diets that focus on single foods, like grapefruit, cabbage soup or celery, are restrictive and lack nutrients needed for good health. It’s true that when you eat only one type of food, like cabbage soup, you might eat less and take in fewer calories than you need and maybe lose weight at first. But in the end, these diets are boring, don’t create healthy habits you can stick with, and don’t help with long-term weight loss. The best way to lose weight is to eat healthy foods in the right portions and be active.

• 17. Cows’ milk is only good for baby cows, not humans. THE TRUTH: […] Milk has other health benefits too. For example, as part of a healthy diet, milk might help protect against high blood pressure and colon cancer. Canada’s Food Guide recommends you enjoy two cups (500 mL) of lower-fat milk every day for good health. 

   —> Interesting contraction to  Tip #25  If a food is low in fat or fat-free, it must be healthy […] THE TRUTH: Just because a  food is low in fat or fat-free doesn’t mean it’s healthy. […]  Choose foods wisely: Read food labels and consider a food’s overall nutrient content. Don’t judge a food by fat alone!

• 19. There is no difference between a dietitian and a nutritionist.THE TRUTH:  A dietitian is your smart choice for credible advice on healthy eating.

• 26. If you eat too much sugar, you’ll get diabetes. THE TRUTH: You will not get diabetes from eating sugar. It’s wise, however, to limit your sugar intake. Foods that are high in sugar, such as cookies, candies and soft drinks, are often low in nutrients and high in calories. Diets with too many calories can lead to weight gain, and being overweight is one of the main risk factors for type 2 diabetes. […]You can reduce your risk of developing type 2 diabetes by eating a healthy diet, maintaining a healthy weight and being physically active.

• 29. Fruit has too much sugar to be healthy. THE TRUTH: Fruit is a healthy choice. It’s true that fruit has naturally occurring sugar, but it is also chock full of vitamins, minerals and fibre that are important for good health. Choosing more vegetables and fruit, naturally sweetened by Mother Nature, can help you maintain your weight and reduce your risk of developing chronic disease.

While I am not one to promote eating tablespoons of sugar as a healthy thing to do, I am curious why the sweetener tip got a more positive spin “can be enjoyed in moderation, as part of a healthy diet” vs. the  naturally occurring sugars tip?

• 30. Honey, brown sugar and agave syrup are better for you than white sugar. THE TRUTH: Nutritionally speaking, they are all pretty much the same. While some people consider brown sugar, honey or agave syrup to be more natural, they are still sugars. All are concentrated sources of calories with very few other nutrients. Your body can’t tell the difference between them and white sugar. In fact, your body handles naturally occurring sugar in food or processed sugars and syrups in the same way. Excess sugar in any form gives you extra calories. Whether you choose to use honey, brown sugar, agave syrup or white sugar, use small amounts. 

• 31. Artificial sweeteners have too many chemicals to be healthy. THE TRUTH: Artificial sweeteners can be part of healthy eating. Health Canada approves all sweeteners for safety before they can be sold in Canada. Health Canada also develops strict guidelines for how food producers can use a sweetener, as well as advice on how much is safe to eat each day. Artificial sweeteners add a sweet taste while limiting calories and can be enjoyed in moderation, as part of a healthy diet. 

• 34. Dietitians only eat healthy foods – never chocolate, fries, chips or candy.THE TRUTH: No way! Dietitians eat all sorts of different foods, even chocolate, french fries, chips and candy…on occasion. Dietitians are nutrition experts with university degrees in food and nutrition. Dietitians have a real passion for nutrition, health and food. Just like anyone else, we enjoy foods that make our taste buds tingle! Dietitians believe that healthy foods are delicious foods. And we also believe that there’s nothing wrong with the occasional treat. 

What happens when someone encounters a fat dietitian? S/he must NOT be eating chocolate, fries, chips and candy on occasion. Shame to the profession. 

• 35. Drinking tea causes dehydration.THE TRUTH: It’s a popular belief that tea is dehydrating because it has caffeine, but the level of caffeine you get from drinking moderate amounts of tea, even strong tea, doesn’t dehydrate you. Tea is actually 99.5 percent water and counts towards your fluid intake for the day, so it can help keep you hydrated. Hydration is important for concentration, alertness and physical performance. Canada’s Food Guide encourages you to satisfy your thirst with water as a calorie-free way to help stay hydrated. Hot or cold, tea is also hydrating and, with no added sugar, is calorie-free and tastes great. 

Um… wasn’t the tip about hydration? Why is there a need to use calories to entice people to drink water?  How about the fact that our bodies are primarily made of water; that’s pretty cool, right?

• 36. Mayonnaise should be avoided when following a healthy diet. THE TRUTH: Mayonnaise can be included as part of healthy eating. In fact, Canada’s Food Guide recommends that we consume a small amount (30-45 mL/2-3 tbsp total) of unsaturated fat each day.  Choose a mayonnaise that has little saturated and trans fats (5% or less Daily Value [%DV]) and provides healthy unsaturated omega-3 fats. Small amounts of mayonnaise can help add extra flavour to your favourite healthy foods. 

This one really tickles my BS radar! The reason? Hellmans is one of the nutrition month sponsors.  Is this tip a coincidence?

• 38. The % Daily Value on the Nutrition Facts table is not very useful. THE TRUTH: The % Daily Value (%DV) is useful for anyone wanting to make healthier food choices. You can use the %DV to see if a food has a little or a lot of a nutrient. You can use it to compare products and make a better choice. For example, you might want to choose a product with less fat and sodium, and more fibre, iron, vitamin A and calcium. An easy rule of thumb: 5% DV or less is a little, and 15% DV or more is a lot for any nutrient.

WHAT THE “F-WORD” is rule of thumb doing here?GOOD GRIEF!  Rule of thumb is a rude reference to an old law permitting men to beat their wives with a stick no thicker than a thumb.

Well, there you have it.  The weight-loss experts, I mean DIETitians have demystified the words nutrition problems and confusion.  While intentions are great and well-intended, seems like they’ve missed one really pressing and important myth regarding nutrition: weight-loss.

JULIE’s MYTH BUSTER: 

Weight-loss leads to better health outcomes.

THE TRUTH: weight is an inaccurate measure of your health status.  Weight-focused interventions have failed to provide proof of any long-term sustainable improvements in your health.  A healthy body comes in differend shapes, sizes and BMIs. By building trust and providing compassion towards ourselves, we can begin to heal from pressures of the thin ideal.

~Accept your body the way it is- you’ve achieved a lot so far with it!

~ Move your body in a way that brings you pleasure and JOY!

~ Believe and trust your hunger cues- our bodies were made to survive.

With compassion and concerns,

@julie_rochefort

“We don’t eat numbers, we eat food” – Abbey Fitzpatrick

A couple days ago my twitter made @kornutrition shared an article from the Globe and Mail: “The new weight-loss math”.

Reading this article made me want to bang my head forcefully onto my desk!  While, this may seem like a dramatic description of my low-tolerance for medical quakery,  the content of this article is yet another display of how quantitative (i.e. measurable numbers) overlooks and discounts qualitative measures of health (i.e. satiety/fulness, intuition). In other words, it doesn’t matter how hungry you feel,  the numbers (calories allowance) dictate when you stop eating. Is this health or self-induced starvation?

The article  introduces a new “tool”  called the Body Weight Simulator  which promises a more accurate way to predict a dieter’s expected weight loss over time.  “ITS A MIRACLE!” [sarcasm].

We know from YEARS of research that a) dieting doesn’t work b) loosing weight seldom produces sustained health benefits and, c) being fat doesn’t mean you’re unhealthy- so why the need to lose weight?  But who’s going to argue with this romanticised- medicalized- body shaming equation? Don’t we all want to be skinny and finally fit in the jeans we wore a decade ago [sarcasm]!?

What aggravates me the most about this revised calorie equation is that,  instead of questioning the effectiveness of calorie counting in the first place, researchers are pouring millions of dollars back into to the diet industry and are reformulating an approach that has yet to demonstrate any benefits.  Why are we pouring more money into reformulating the equation  instead of revisiting the ideology that weight loss= better health.

De-constructing our hunger and eating experiences into calories reminds me of my colleague, Abbey Fitzpatrick TEDx talks. In her talk she reminds us that food is indeed more than numbers and calories but a(n) social, cultural, emotional, traditional and, sensual experience.

While I could continue this post by listing  the numerous studies and reasons that’ll “prove” why this formula is oversimplistic and damaging,  I’d prefer instead to provide information about an alternative and compassionate relationship we can build with our food and body. A “tool” that is number-free and already programmed in your body: INTUITION.

Intuitive eating

Intuitive eating  is one of the three tenets of HAES (Health at Every Size) which emphases pleasurable eating and internal cues of hunger, satiety, and appetite rather than following rigid dietary guidelines.  Take a moment to reflect on  the last meal you had. Was it pleasurable? Can you describe the taste, texture and mouthfeel?   Were you satistfied? If so, what did that feel like?

Having trouble answering these questions?

You are likely not alone forcing yourself through memory lane.  Life gets busy and we’re surrounded my an enormous amount of noise (i.e. advertisements) and  conflicting and contradictory nutrition advice that we are desperately looking for someone else to tell us what we should eat.

If the ditty that ‘you are what you eat’ is correct, why would you wait for someone else  to tell YOU what to eat?

Its not too late, thankfully.  Its not a diet, its not a pill and a celebrity (thus far!) isn’t going to entice you to ‘believe’ in the program.

Its being kind and compassionate to your body. Its about listening to cues- yes those grumbling noises and signals that say ‘thank you for the meal, I’m comfortably satisfied.

According to the “Intuitive Eating  Pro”online organization, the 10 (ten) principle of Intuitive Eating are

1. Reject the Diet Mentality

2. Honor Your Hunger

4. Challenge the Food Police

5. Respect Your Fullness

6. Discover the Satisfaction Factor

7. Honor Your Feelings Without Using Food

8. Respect Your Body

9. Exercise–Feel the Difference

10 Honor Your Health

Who’s with me on taking back control of our health?  Why let others dictate what and how much you eat?  This controlling approach had been around for years and, well has it worked for you in the past?

Its time to reclaim your health.  We don’t eat calories, we eat beautiful, colorful and most important, tasteful food that’s made with love.

Go ahead, eat intuitively!

Respectfully,

@julie_rochefort

“The power of intuitive understanding will protect you from harm until the end of your days.” – Lao Tzu

Guest Post on  Obesity Panacea

Iatrogenesis or Good Intentions? Why do Health Care Practitioners Continue to Ignore the Health At Every Size Philosophy?

Note from Travis: Today’s guest post comes from Registered Dietitian Julie Rochefort, in response to my post last week titled “Time to Watch My Weight“?  More information on Julie can be found at the bottom of this post.  On a personal note, I should add that I don’t believe that weight loss isalways a bad goal, but nor do I think it’s the solution for all individuals.  Enjoy the post!

PS. For those interested in the Health at Every Size Movement and the treatment of obesity, we will be hosting a debate in Ottawa in June of this year on the topic “Is Obesity a Disease?”, with two prominent speakers looking at the pros and cons of the medicalization of obesity, among other things.  More details on that event coming soon.

The Problem

As a frequent flyer within the twitterverse (@julie_rochefort; @shift_the_focus), I came across Travis’s tweet which indentified a       very pressing and ethical issue facing health care practice today: weight bias.

“my bmi is <25. at my physical, the nurse [asked] me to “watch my weight”, lest it should eventually increase to 25”

The Issue

Subsequently in his post, Travis questions why his nurse focused on his weight rather than other relevant health behaviours such as, food intake and physical activity.  While I cannot speak from a nursing perspective (albeit, there are many commonalities among health care professions); I argue that the way in which obesity is framed and discussed within healthcare professional education may help to explain the maintenance of the acceptable weight=health mentality.

The Dietitians’ View

During my professional development in dietetics, dietitians were identified as a key player in the national fight against obesity; which in turn defined our role as weight loss “experts”. Accordingly, during my education and training, I was taught and mastered, how to calculate the BMI and, appropriately classify individuals into their respective weight categories. Normal. Overweight. Obese. Obese Class I, II, III.  Once classified, I was expected to ensure those in the normal category maintained their weight and the fat people lost weight. Failure to keep individuals within the supposedly safe BMI range of 18.5-24.9 would question my duties as a professional and put my patient’s health at risk.

While research continues to demonstrate that obese individuals can improve metabolic indicators (e.g. high blood pressure, high cholesterol, insulin resistance and glucose intolerance) independent of weight loss (Bacon and Aphramor, 2011), why is there still such a focus on weight at the clinical level?

Critical Obesity Studies

The weight-centered approach to health was a singular focus of my professional education and training. I wasn’t introduced to an alternative way of interpreting the weight/weight-loss imperative until my second semester of graduate school. Why was this alternative view not incorporated as part of my professional education? Perhaps dietetic educators can help shed some light on that question.

The overstated associations between weight and the risk of disease have given us permission to correct and pose shame onto the fat body defined by a BMI >25.  While Travis was able to overlook the well-intended warnings from the nurse, unfortunately this is likely not the norm.

While clinicians often practice with the best of intentions, a shift away from promoting weight-loss needs to occur if we are to truly commit to our ethical responsibility to ‘do no harm”.

The Next Steps

Incorporating alternative views of fatness is imperative to promoting the health and well being of the population.  I am not sure how this shift will take place. A good way to start this shift is by questioning our traditional approaches to body weight and engaging in dialogue with all members of the health care team, including the patient.