Taking Stock

Every now and then it seems that I go through a bit of a renaissance when it comes to the world of nutrition.  Just like the science of food, my knowledge is ever-changing and new information leads to new beliefs. I never abandon my old beliefs but a new layer is added to them.  Consider my own evolution:  As a student I thought weight loss would be my main focus, helping others shed pounds would be my contribution to the nutrition world.  As a dietetic intern, I thought maybe I'd be better served by working as a dietitian for those admitted in hospitals, working with doctors and other healthcare providers to help the acutely ill to recover and play a role in helping them get better.  But then as I became a working RD, I read Intuitive Eating (IE) and that added a profound new understanding about eating which made me realize that my place is better served in the outpatient world helping individuals learn to change and improve their relationship with food.  Layer that with the belief in Health at Every Size® (HAES®) and that focusing on health rather than weight is an important factor in helping people change their behaviors.  And layers continue to be added like what I've learned about Blue Zones and weight stigma.

So here I am, like an onion, with all these layers, some new and some old.  So today's post is sort of a "taking stock" of where I am.

Here are some of the current beliefs.

1. At my core, I believe in IE as a model for eating.  It is a fundamental belief that is at the heart of my practice.  What I take most from IE is the notion that all foods are equal and that I will continue to try to not label foods as good or bad.  My neutrality towards food is not how most of the world of nutrition functions.  We labels things in black and white and with that we add a moral judgement to foods.  That judgement transfers onto us when we eat those foods we've labeled and that clouds our ability to pay attention to internal cues of hunger and fullness.

2. Next, I believe that we are doing a disservice to our country by continuing to fight this ongoing "War on Obesity." This way of addressing the issue of weight is incredibly stigmatizing and potentially damaging, especially when it's focused on our nation's children.  When there is a war, there are winners and losers.  Lose weight and win, stay heavy and lose. Black and white, no middle ground. What a horrible message to send to our children.  And how do we define winning anyway--losing weight? And at what cost?  With such an intense focus on weight, we perpetuate a diet mentality that sabotages our ability to trust our internal cues.  This focus on weight blinds what our real focus should be, healthy behaviors and not healthy weights.

3. Just like the name of this blog, I believe in moderation and balance.  I know there are many dietitians who disagree with me but for me and my practice, I find that moderation is possible.  And when I say moderation, I mean that all foods can be a part of your diet, without judgement, because again, that is how we really make peace with food and begin to tune into what our body tells us.  But this is an area where I begin to struggle, because the term "moderation" has been co-opted by big food companies. This leads me to my next belief:

4. There are things inherently wrong with our food system.  I believe that we rely heavily on overly-processed foods that have allowed big food companies to exert a strong control over our daily food choices.  I don't like the way foods are marketed to kids and I don't like how my professional organization is sponsored by big food companies. I struggle with the nuances of IE at times like this because even though I don't label a candy bar as good or bad, I still don't want it marketed towards my kids and I don't want it used as a reward for their good behavior.

5. Despite what seems to be popular belief, I refuse to demonize sugar.   Sugar is not the root of all our nutritional problems and to think that if we just go sugar-free we'll fix the problem is overly simplistic and setting us up for future problems. That's part of the reason that I won't go see the movie "Fed Up". The other reason I won't see the movie is because of how it addresses childhood obesity and my fear that we are stigmatizing our nation's children.

6. I am not a food elitist, (and to call someone that is rude) but I think that we should be eating more whole foods and spending more time in the kitchen.  Cooking more meals at home helps us connect with our food.  Connecting with food helps us appreciate where our food comes from.  With that respect we might learn to eat with a deeper understanding and eat slowly, paying attention to hunger/fullness/satisfaction.  That doesn't mean I never eat at In 'N Out, it just means that it's not somewhere I go every night, every week or every month.  It's a "play food" that my family will eat on occasion because we enjoy it.  That is moderation.

7. I'm sick of the constant flood of new diets and religious-like zealotry of nutrition beliefs about food.  If I really stay true to my IE roots, then my body dictates my food choices and I tune into that. So if I want to eat more organic, locally sourced food because that's what makes me feel better, then bully for me!  If your body says to eat gluten-free because you think that you feel better because of it, then good for you.  Either way, my diet is my business and I'll be happy to respect yours as well.  That being said, I do have one caveat: if you are going through each different diet plan--one after the next--with the goal of losing weight, then that's where I have an issue because when our diet mentality drives our food choices, we lose sight of the big picture and ignore really listening to what our bodies are telling us.

8. I believe that children are naturally intuitive eaters and that if we, as parents, just take a step back and help foster that skill, many of the food issues we deal with as adults might never be passed on to our kids.  I believe that using a division of responsibility with feeding kids is vital to helping children learn to trust their own bodies internal signs of hunger and fullness.  It's my responsibility to plan a balanced meal with "play" foods and "growing" foods and it's my kids' responsibility to eat, choosing whatever is on the plate and how much of it they choose.

9. Lastly, I believe that we are diverse in our body size and in our eating habits.  As a private practice dietitian it is my goal to provide an environment where my clients can learn to trust themselves around food, to accept their body, to become confident in their cravings, to help them learn what moderation means for them, to help them feel confident around food, to find the joy of movement and to learn to stop worrying about food and enjoy life.

I know that some of these beliefs might seem in conflict with each other but that is why I struggle.  I guess I'm not very black and white with my beliefs.  I sort of fall in the middle on many issues which can make it a challenge to find an identity as a dietitian.

So here I'll stay in the middle ground, enjoying the world around me and hopefully finding some friends along the way who agree with a little, some or most of what I believe.

5 Things Every Parent Should Know About Feeding Themselves and Their Family

I recently spoke to some parents from my children's school about Intuitive Eating and feeding kids.  Here is some of the topics I discussed.  

1) Food is not good or bad! -- A cookie is just a cookie. It’s value is that of calories from carbohydrates, protein and fat and nothing more. The cookie does not judge you. It’s just a cookie. Negative thinking about food leads to poor long-term eating habits like restriction and binging.

2) The War on Obesity is not one worth fighting -- Health can come in many shapes and sizes. Your health is determined by your behaviors and not your weight. Making weight the focus of health, can lead to a negative body image and an unhealthy relationship with food.

3) Your body image will be passed down to your kids -- Body image is a learned behavior so be conscious of your "body talk". Is there “fat shaming” talk in your house? If you shame/hate your body, you child will learn that behavior.  Learn to love your body no matter what shape or size so that your children learn to love theirs as well. 

4) Children are naturally intuitive eaters so learn to nurture that skill instead of stifling it -- Children are born with the innate ability to eat when they are hungry and stop when they are full. Forcing your child to eat when they are not hungry or full can override their natural ability to listen to their own bodies cues of hunger and fullness.

5) Adopt a division of responsibility when it comes to feeding your kids -- It is your job to put a healthy meal in front of your children and it’s their job to eat it. Include plenty of "play foods" and "growing foods."  Once the plate is in front of them, let them choose what and how much to eat.  That means try to not bribe them by saying, "Have another bite of chicken or you won't get dessert."

Yes I Am an Overweight Dietitian

This is Weight Stigma Awareness week which is being organized by the Binge Eating Disorder Association.  This online conference has provided both healthcare providers and the general public with a wealth of information about what is weight stigma and how it affects us.  Going into this week I was planning on writing about weight stigma from a general sense but after I saw the tweet below, I thought a personal post might be more appropriate so, here goes.

If you're an overweight dietitian, how am I supposed to listen to you telling me how to eat ? -- Via Twitter on 9/25/13.

I've discussed it before but I will say it again, I'm an obese dietitian.  Comments like the one above are not new to me.  I've heard it before either directly to my face or from second-hand conversations.  The comments come in many different ways, "Why should I listen to you?"  "Well it doesn't look like you eat that way." "Why don't you practice what you preach?" It doesn't matter how you say it or the context you say it in...all of these comments are shaming.  It fits into the old mindset that if your BMI is anything above normal, then you must not be healthy; that having a tummy is a sign of laziness, filth and sloth.

The funny thing is, being a healthcare provider, I don't only get it from my clients, I get it from colleagues.  "I've noticed you've gained some weight?"  "I"m going to tell on you for eating that." "Should you really be teaching that class?"  Even if I don't hear the comments, I see how they look at me.  I hear what they say and I read what they write.

But I'm here today, during Weight Stigma Awareness week, to stand up and say enough!  Enough of you judging my body.  My weight, my body, my habits are MINE and NOT YOURS.  The topic of my weight is off limits.  I did not ask for your archaic, backwards, close-minded comments.  My body is MINE.   Mind your own business and keep your comments to yourself.  I have never judged you for coming in my office/class and gaining weight.  I don't care if you are 320 or 120 pounds.  I respect your body, now please respect mine.

For me weight stigma hits home more often than most will realize.  Maybe you have to be "fat" to know what it's like but fat shaming happens more than I care to admit.  When I was 300+ pounds, people stared at me.  They rolled their eyes as I sat next to them on a plane.  They stared as I ate my Jack 'N the Box Double Cheeseburger. They laughed as I took off my shirt at the beach. It was as if the stares, eye rolls and teasing was going to somehow help me. Well, guess what?  It didn't.  Like any normal person, the shaming led to self-imposed isolation.  Isolation led to more eating because I really didn't want to be alone. And my weight rose higher and higher.  It's a horribly helpless feeling and you don't know what it's like until you've been there.

As I lost weight, people looked at me differently.  On some level I loved how their eyes and attitudes changed towards me.  I loved that now I was accepted by society because my belly was gone. But even though they saw someone new, the old person was still there (and on some level, still is today).  All that shaming that happened still affected my self-esteem.

So when someone asks, "If you are an overweight dietitian, how am I supposed to listen to you telling me how to eat?" my answer is simple.  You should listen, because I know what the hell I'm talking about.  Not just because I have a degree, completed an internship and passed a registration exam but because, despite what you think by looking at my stomach, I am a fantastic educator/motivator/coach/nutrition expert.  If all of you see is my stomach, you're going to miss out, not just what I have to say but what others who are just like me have to say as well.  My clients listen to me because I've been where they are.  You should listen to me because my full stomach is not a sign that I don't know what I'm talking about, it's a sign that I know exactly what I'm talking about when it comes to making peace with food.  I've fought the war against food and my weight.  The only casualty though was me.  Instead of fighting, I've made peace with food, my body, my weight and my critics.

I wish that I had a six pack, broad shoulders and rippling muscles but I don't.  I've come to accept my body for what it is.  Hopefully this post helps bring weight stigma to the forefront of our conversation. It's an issue that we need to discuss and that we need to be aware of.

And finally to thank the individual who posted their honest comment on Twitter thank you!  Thank you for your tweet that inspired me to write this down.  It has been cathartic to share my thoughts and without your tweet, they might have never made it out.

UPDATE: (9/26/13 8:45am)
I've been asked by the person who posted the original tweet to delete her name from this post.  After much consideration I've agreed to do that.  The reason I did: shaming someone, for any reason, is wrong.  I hope you respect my decision.

What's Wrong with Fat?

Photo Courtesy of Oxford University Press

I was fortunate enough today to attend a lecture with Abigail Saguy, PhD discussing her new book, "What's Wrong with Fat?"  It was a very interesting discussion and I'm excited to read the book to learn more about what she has to say about "fatness" and our society.

The major point of her discussion today was to help us question whether our society's emphasis on the "Obesity Epidemic" is really helping or are we stigmatizing those individuals who are overweight or obese.  By the way, Dr. Saguy used the word fat so I'll use that here instead of the former terms.

Her talk was very interesting and I'm not going list each point but the the highlight was learning about how we "frame" the obesity or fat issue has an effect on how we address it.  Most of my fellow employees in healthcare see fatness as a medical issue.  Something that can be cured or fixed with the right treatment.  Some of my fellow RDs see it as a public health issue where numbers are reaching epidemic proportions.  But lastly, there are some who would see fatness as a social justice issue, where fat is just a diversity issue and we must learn to accept people no matter what their size without bias or stereotypes.

She also discussed how no matter what perspective we use, there is research that would suggest that weight alone is not a good predictor of mortality.  One study she highlighted was Flegal KM, et al., 293[15]: 1861-7, 20 April 2005 in which the authors found this notion of an "obesity paradox" where people with BMIs between 26 and 29 (overweight) actually had a decreased risk of death compared to those in the normal weight category.

As we concluded she closed by questioning why our perception of fat changed over that last 100 years.  It used to be that being fat was a desirable trait but that is no longer the case.  But today, being fat is quite negative.  When you see someone who is fat, what do you think?  "They're lazy and weak. They're slobs and how could they do this to themselves?"  One interesting point that Dr. Saguy made was by explaining that a disproportionate number of minorities and lower income people are fat compared to other groups.  Fatness aside, these groups are also ones that are often discriminated against for other reasons so are we just adding another by making obesity such an issue?

As a dietitian, this topic is extremely important in the work that I do.  Many of my colleagues and other health-care providers will not agree with me, but I agree with Dr. Saguy and I feel that if we can take weight out of the equation we can focus on the behaviors that really matter.  Why should we force our clients to lose weight when 1) most will likely gain weight and 2) losing weight might not improve their health unless they change their behaviors?

As a individual, this topic hits home with me.  I am fat!  I have a belly but that does not limit me in my health.  I can run, I can play sports, I can bike and I am healthy.  I know that some of my clients and some of my fellow employees look at me and say to themselves, "Why is this guy teaching a class on losing weight! He should take some of his own advice."   Well to those folks I say this: my weight is just one part of me. From what I learned today and what I continue to learn, it does not mean I have five years less to live than you.

So what do you think, does Dr. Saguy make you change the way you think about how we frame the question of obesity/fatness?