Healthy Living in the North

Helping or Harming:  Reflections from 20 years of being a Dietitian

A crowd of people attends a farmers' market

“Healthy” comes in all shapes and sizes.

Oh, the conviction of youth!  Long gone are the unshakable beliefs from my dietetic internship about how to define “healthy” and the importance of weight in preventing disease. Twenty years have passed and, in that time, I’ve worked in five different provinces with a variety of patients and partner organizations. For instance, young families; schools; clients living with diabetes, heart disease, cancer, and disordered eating; and seniors in care homes, all of whom came from very diverse backgrounds.  In nearly every case, health was defined, in part, by weight. Today, I question that belief. Why? Because I’ve seen so many instances where a subtle emphasis on weight has contributed to some harm.

I’ve learned that while weight is often one of the first lines of treatment when someone is diagnosed with a chronic disease, research tells us that less than one percent of people successfully keep weight off after four years, and usually regain the lost weight plus some. In the end, after treatment, people are at a higher weight and often feel bad about themselves. This can’t be good for health.  Does it make sense to promote a treatment that is doomed to fail?

The recommendation to lose weight perpetuates something called the “thin ideal” (believing that a slim body is the standard for beauty and health), which is based on an assumption that people defined as “overweight” (as per the problematic standard of BMI or body mass index) eat poorly, too often, and do not move enough. My twenty years of experience tell me that this is not the case. Rather, healthy bodies come in all shapes and sizes and are supported by healthy and intuitive eating, active living, and positive self-esteem. Thus, a better plan is to focus on supporting everyone, no matter their size, to live well.

The “thin ideal” has normalized weight bias and stigma, where we live, work, play, and are cared for. What is weight bias and weight stigma?

  • Weight bias is a negative judgement of someone because of their weight, shape and/or size.
  • Weight stigma is what a person experiences when weight bias happens to them.

Weight bias and stigma can seem harmless and might even be done in the spirit of helpfulness, but it still hurts. Examples of weight stigma include:

  • Refusing to offer dessert to someone and/or questioning whether someone “needs” that serving of dessert because of their size.
  • Using headless images of “overweight” people or images of “overweight” people being sedentary in handouts and presentations.
  • Using the word “fat” as an insult instead of what it is, which is a physical description of body composition.
  • Assuming someone is unhealthy if “overweight” or healthy if “underweight” or “normal weight.”
  • Failing to offer healthy food at school because “we don’t have fat kids at our school” (yes, one school actually gave this as a reason why they didn’t need to follow the Guidelines for the Sale of Food and Beverages in BC Schools!).

Weight bias needs to stop.  It starts with us thinking about what our own biases and assumptions about weight might be (take the Weight Implicit Attitudes Test) and developing respect and empathy for people who are impacted by weight bias. Last week was Weight Stigma Awareness Week, but it’s an issue that we need to be aware of all year round. Learn more here.

Flo Sheppard

About Flo Sheppard

Flo has worked in northern BC for over 20 years in a variety of roles. Currently, she is the Chief Population Health Dietitian and Team Lead for the Population Health Nutrition Team. She takes a realistic, supportive, and non-judgemental approach to healthy eating in recognition that there are many things that influence how we care for ourselves. In her spare time, you are likely to find Flo cooking, reading, volunteering, or enjoying the outdoors.

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Diverse bodies are healthy bodies

healthy bodies, diverse bodies, move for life

Accept your body at its current size and shape and then enjoy your body by moving and eating in ways that support your health.

Growing up in outport Newfoundland, everyone was the same: the same skin colour, spoke the same way, attended the same church, and all without cable TV or the Internet. Needless to say, this did not provide an opportunity to know diversity. When I moved to Toronto in the early 1990s, I remember standing on the corner of Bloor and Yonge Streets and being overwhelmed by the diversity of people all around me. Overall, Canada ranks high for accepting diversity, especially to culture, language, religion, gender and sexual orientation. Where we, and the rest of North America, fail is with accepting size diversity.

Society, fueled by the media, tells us that bodies (male and female) should look a certain way – a way that very few people can achieve.  However, that doesn’t stop people from trying and the costs are great:

  • In a study of 5,000 teens, more than half of girls and a third of boys engage in unhealthy weight control behaviours.
  • Teen girls who diet are at 324% greater risk for obesity than those who do not diet.
  • 81% of 10-year-olds are afraid of being fat.
  • 98% of females are unhappy with their bodies.
  • Canadians spend more than $7 billion per year on diet programs, diet books and diet pills.
  • However, evidence tells us that 98% of people who lose weight will regain the weight and more.

Despite what TV makeover shows might suggest, the human body is not easily transformed.

Body shapes and sizes are the result of many factors beyond what one eats and how much one moves. For example, genetics, life stage, environment, cultural norms and socioeconomic status all influence body shape and size. In my 20 years as a registered dietitian, I have worked with many people who eat well and are fit and healthy but do not match society’s “ideal” body.

Body size and shape is not the determining measure of one’s health. To support health, wellness and positive body image, try these approaches:

  • Respect and care for your body. Accept your body at its current size, shape and capabilities.
  • Eat for well-being not weight loss. Listen to your body and eat according to hunger, fullness and satiety cues, nutritional needs, and cultural and family traditions.
  • Be active in your own way to support energy, strength and stress management.

For more information about challenges that youth are faced with when it comes to healthy eating, go to keltymentalhealth.ca.

How do you measure your health? When do you feel most healthy?

 

Data sources:

Neumark-Sztainer, Story, Hannan, Perry & Irving, 2002. Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112(4), 900-906;  findings from Project EAT (population-based study of approximately 5000 teens).

http://keltymentalhealth.ca/sites/default/files/Youth%20Disordered%20Eating%20Fact%20sheet.pdf

http://www.vancouversun.com/health/Diet+industry+expands+right+along+with+North+America+waistlines/8268951/story.html

Flo Sheppard

About Flo Sheppard

Flo has worked in northern BC for over 20 years in a variety of roles. Currently, she is the Chief Population Health Dietitian and Team Lead for the Population Health Nutrition Team. She takes a realistic, supportive, and non-judgemental approach to healthy eating in recognition that there are many things that influence how we care for ourselves. In her spare time, you are likely to find Flo cooking, reading, volunteering, or enjoying the outdoors.

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Tales from the Man Cave: men and eating disorders

You are youIncreasing numbers of males are developing eating disorders. The men’s health MANual dedicates over 19 of its 39 pages to eating healthy, a very important topic. However, one section that is missing is unhealthy eating in males (although it is implied throughout that our diets suck), and when I say unhealthy, what I actually mean is disordered.

Earlier this month was National Eating Disorder Awareness Week, a time to reflect on eating disorders and to share (by shouting out loud from the rooftops) the warning signs. It’s also a time to let those who have an eating disorder know what help is available (see below for a list of resources).

Our world seems obsessed by weight – everywhere I go there is some conversation about weight. It is said that this is the silent epidemic and that in their lifetime, 10 million males in the US will develop a significant eating disorder and overall 5% of males will have a significant eating disorder in the western world. This is apparently much higher in the gay community.

It seems to me that the world we live in is increasingly telling us that we are our bodies and has been doing so for almost 50 years. More specifically, it seems to say that we are what our body looks like. Well, we lads used to be able to nod our heads in sympathy that this was a woman’s world. But no more.

When I was a young lad, it was rare to see all those guys with muscle in places where, generally, muscle did not seem to express itself too much. I even spent some time in Glasgow’s Ingram street boxing gym, where the world Champion Jim Watt trained and never saw the kind of display you do now.

Maybe I am just a wimp but it occurs to me it was never needed. When we engaged in weightlifting activity, it was usually at work with a mate, such as running upstairs with a full beer keg on each shoulder. We both could do it – we were young strong men. No need to look like young strong men or stand naked in the mirror flexing muscles. No need to be into protein powders and steroids, just whatever you could grab on the run and that was usually made by mum or, in my case, Dad.

Now males are falling into the media trap. We are, apparently, what our bodies look like. We are our image and it’s distorted. We can never be buff enough, and so some young people are developing in the opposite direction and going down the anorexic road.

There is pressure from media in all directions and a confusing array of messages: Eat more. Eat less. Look like this. Own this. Have this. Need this. Be this. Did you notice how stupid men look in a great deal of advertisements? For goodness sake, shut up, I hear myself shouting at the TV! Truly adverts make me feel sick – it’s a subtle form of bullying that goes unnoticed, and I am tired of flashy lies being broadcast into my home. (Yes, I know, get the heck off the couch. Well that’s another blog post.)

The body comes in all shapes and sizes, so eat healthy, quit dieting, and let it be what it is. You are not what your body looks like. You are you.

Resources on eating disorders:

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

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Health at Any Size

self-image, weight bias, weight stigma, health at any size

A big part of being healthy is feeling good about yourself. How is that impacted by others?

Living in a small town where you are known by your work role (I’m a registered dietitian) can sometimes be a challenge. Awhile back, a stranger approached me in the grocery store, peered into my basket and said, “Just making sure you’re following your own advice,” and walked away. I can brush this incident off knowing that what was in my basket was in line with what I believe and say about healthy eating. This position includes a variety of foods – the foods highlighted in Canada’s Food Guide, but also chocolate and the occasional summer hot dog roast. But, this got me thinking about how we are judged by the foods we eat and this can impact what we eat, how we view ourselves, and – ultimately – our health.

“Fat” is not a four-lettered work. It is a descriptive word like short, tall or blond. Being fat is no more negative or positive than being thin. Healthy bodies come in a variety of shapes and sizes; sometimes these bodies are fat and sometimes they are thin.

Unfortunately, weight bias (negative assumptions, beliefs and judgments based on body weight) and weight stigma (being devalued based on your body weight) are more common than we’d like to admit.

No matter our size or weight, we all have the right to health. When I hear people talk about “getting healthy,” their first step is most often to try to lose weight. This comes from three very common myths:

  1. Weight loss will improve health – Strategies to lose weight are not always healthful. Attempts at weight loss are associated with increased rates of disordered eating and overall long-term weight gain. Studies have shown that weight “yo-yo”ing is more harmful to health than being at a stable, higher weight.
  2.  Fatness causes disease and early death – Studies show that people in the “overweight” body mass index (BMI) category live longer than those in the “normal weight” category and that poor health is more likely at the extremes (very “underweight” and very “obese”).
  3.  Weight management is about energy balance – Eating less and moving more is thought to be the magic bullet to lose weight, but this doesn’t consider things like family history, personal dieting history, socioeconomic status, the environment and the many other factors that impact one’s weight.

Research tells us that people who are the victims of weight bias and stigma are at risk for poor body image, low self-esteem, loneliness, depression, anxiety and suicide and are more likely to avoid medical care, experience stress-induced illness, avoid physical activity and engage in unhealthy eating behaviours. That doesn’t sound like health to me. We would all benefit from this prescription for life:

  • Eat well
  • Move daily
  • Hydrate often
  • Sleep lots
  • Love your body
  • Repeat for life
  • Let your weight settle where it is meant to be

 Weight bias and stigma must stop. Have you noticed weight bias in your day to day life?

Flo Sheppard

About Flo Sheppard

Flo has worked in northern BC for over 20 years in a variety of roles. Currently, she is the Chief Population Health Dietitian and Team Lead for the Population Health Nutrition Team. She takes a realistic, supportive, and non-judgemental approach to healthy eating in recognition that there are many things that influence how we care for ourselves. In her spare time, you are likely to find Flo cooking, reading, volunteering, or enjoying the outdoors.

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Starting something new to replace old habits

Start something new

Starting something new can be as easy as spending more time outdoors with family.

Welcome January or “Janus” as the Romans called it: the door to the New Year. The Romans considered January a time for celebration and a month to consider our fortunes for the coming year. If those fortunes include ending 2014 healthier than we started it, than we will lead richer lives.

Rather than making some half-hearted resolution this year, let’s begin with a plan for the long-term.  Let’s make records and compare them every month to see our progress. After all, Rome wasn’t built in a day… or even in a Janus.

It’s cliché, but it speaks to our common wisdom. And like Rome, some of our problems are “one day at a time” deals that force us to climb a mountain, step by resolute step, sometimes falling backwards, other times making great strides forward. That is real life. As the title of this blog suggests, we can add good habits with the hope that they’ll make the old, bad ones simply fall away.

For instance, you can introduce healthier foods into your diet and add an additional activity to your week. Start low and go slow so you don’t overwhelm yourself, but be aware this strategy is no picnic either- you really have to work hard to make small changes. I recommend keeping a record of progress to motivate change.

The best advice I have heard for weight control is to be the healthiest that you can be at any weight. I am not saying throw the scale through the bathroom window – it’s too cold for that! Instead, give yourself a break from it, add an activity to your life and build on that over the coming year till it’s an ingrained habit. Be fitter this year, not smaller.

Another one of those ”one day at a time deals” is tobacco use. There is no known safe level of exposure to tobacco due to the multiplicity of cancer causing chemicals in the smoke and chew. This is where another cliché comes to mind. As Robert the Bruce, King of Scotland, said, ”If at first you don`t succeed, try, try again.” On average, they say it takes at least five attempts to quit tobacco for good. Luckily, there is help in the form of clean nicotine which can help take the edge of the pain. You can add nicotine in the form of a patch or gum, but you must stop using cigarettes or chew. It will still hurt for a while. Cravings will come in the form of waves. Fortunately, unlike waves on a beach, they finally stop happening. The worst cravings are always during the first few weeks and if you can stay smoke free for a year, you are well on your way to breaking free of it completely.

So, to all a good new year, filled with blessings, and ending, for all of us, in a better version of ourselves.

Enter Northern Health’s photo caption contest for you chance to win a $300 gift card to support your healthy goals in 2014.

 

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

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