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:

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

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”

“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.