Wednesday, June 11, 2014

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.

Tuesday, June 3, 2014

Weight Stigma: Bad for the Body and Mind and Soul

This past week, I was fortunate enough to attend a symposium on the UCLA campus on Weight Stigma that was organized by a campus research group, Dish Lab.  It was a very interesting day and I learned a lot. 

Some high level things that really stood out to me were things like this:

  • Dr. Abigail Saguy discussed how the media frames the issue of weight.  If we frame it as a public health crisis we have the potential to unintentionally create negative consequences for anyone who is heavy.  
  • Dr. A. Janet Tomiyama presented some of her research that showed being told you are too fat correlates to higher BMI later in life.  Weight stigma leads to increased stress which then leads to increased cortisol levels.  Those high levels of cortisol may then lead to and trigger more weight gain which leads to more stigma.  
  • The keynote speaker, Dr. Brenda Major, shared how stigmatization leads to negative health-related behaviors. She also discussed that unlike other minority groups that might be stigmatized, those who are heavy tend not identify as a group or express pride in being a member of the group.  

As I sat there, I thought more and more about how weight stigma is so pervasive in our society.  From individuals to the media to even government, "obesity" is bad and if you have that "disease" you have a problem that needs to be fixed.  You are a burden on the healthcare system and you need to change. But what I finally realized was this: if you agree with Dr. Major's assertion that stigmatization leads to unhealthy behaviors then we need to understand what are these unhealthy behaviors.  It dawned on me like a lightning bolt: "Maybe the most common unhealthy behavior that anyone whose been stigmatized because of their weight has engaged in is dieting."

If you are heavy and feel shamed because of it (like many people do), you'll do anything to change that feeling of shame.  And unfortunately, the only way most people know how to fix it is to try to lose weight by going on a diet, and they might succeed for a short time but then the law of averages will likely take over and just like the other 95%, they will regain their weight and all of a sudden they are back to square one.

Just today, Evelyn Tribole, co-author of Intuitive Eating tweeted this:

It was an intersting research article discussing glucocorticoids and how they may play a role in weight gain.  Ever been shamed, made to feel less than or discriminated against?  It's pretty stressful.  Ever go on a diet or feel an intense drive to lose weight?  It's pretty stressful.  If we take some information from this article then we see that continued stress plays a role in our eating behavior.  BOOM!  Lighting bolt again for me.  Weight stigma, stress, dieting may be a cycle of events that dooms us to a constant struggle with our bodies and with food.

In the end, the day was more than just a day of learning, it was one of those days that was a real game-changer for me.  It solidified what I already know is true about Intuitive Eating and making peace with food but it added a new and very important layer to that understanding: feeling shamed because of your weight is not just bad for your ego, but it's bad for your health.  Although I wish we could change society and how we view those who are heavy, I can't.  So instead we need to start by changing how we view ourselves. Learning to accept and appreciate the body you have today is vital to learning to have a healthy relationship with food.