Tag Archives: wellesley nutritionist

Fitspiration or Fat-Shaming?

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In fat-shaming news, Maria Kang, a 32-year-old fitness fanatic and mother of 3, posted a photo of herself and her three sons (then aged 3 years, 2 years, and 8 months) on Facebook with the caption “What’s Your Excuse?”  In the photo, Kang is wearing only a sports bra and tiny workout shorts, showing off her toned and sleek body.  Clearly, the photo and caption are meant to be “fitspirational” to all of the new moms out there who haven’t yet made losing weight their top priority and to show them that even with 3 kids under the age of 3, you too can have the body of a fit model.  Needless to say, the internet has been ablaze with both positive and negative feedback on the image.

I actually saw this woman on the Today Show this morning, and she was rather unapologetic about the message her photo is sending.  She reiterated the fact over and over that the photo was meant to be inspirational, not a knock against fat people.  That may have been her intention, but honestly, the caption clearly implies judgment against those who “haven’t lost their baby weight yet.”  That perhaps if these overweight women just tried a little harder, they too could bounce a quarter off their abs.

Kang, who is a former personal trainer and beauty queen, clearly has always been in good shape.  Given this fact, it’s not surprising that she was able to “bounce back” to her original shape after her pregnancies.  But the fact is that she is in the minority.  The average woman in the U.S. does not look like Kang and even if she were to put in all of the extraordinary time and effort to achieve Kang’s physique, it is very unlikely that she would be able to maintain it.

So, yes, I do believe that this image is fat-shaming. Instead of sending the message that if you just try hard enough, you can have a hard body after baby, how about telling new moms that they are beautiful and that they should appreciate what their bodies can do for them (e.g. give birth!).  Now that would be inspirational.

Individualized Nutrition Counseling

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I spent the last four days at the Cardiometabolic Health Congress, where international experts in cardiovascular and metabolic health gathered to discuss the latest developments in our field.  One of the talks that I think will be of most interest to you, our readers, addressed the question: Which diet is the best for losing weight?

The presenter discussed a study that compared the weight loss of subjects put on over 20 different popular diets.  As it turned out, there was no significant difference in weight loss between any of the diets.  The pattern was the same for each: sharp initial weight loss, followed by steady weight regain.

In other words, the study supports what other research has shown too, namely that dieting does not work in the long run.  Furthermore, it does not matter which diet one chooses, as each diet is just as good at ultimately failing as any of the others.

The presenter shared another study that looked not at weight, but at actual markers of health (i.e. cholesterol, blood pressure, blood sugar, etc.) and found that the dietary approach that a person takes absolutely matters in regards to these markers.

So, what is that dietary approach that makes such a difference for health?  An individualized approach.  There is no one eating pattern that will work for everybody; it has to be tailored to the person in question.  The presenter stressed the importance of taking into account the specific person’s preferences, risk factors, current habits, and goals.

In other words, to really make a difference in terms of somebody’s health, he or she does not need another diet, but rather individualized nutrition counseling.  We at Soolman Nutrition and Wellness LLC already knew that, which is why you see the term “Individualized Nutrition Counseling” on our website, business cards, brochures, and advertisements.  I will say though that it was nice to receive confirmation that the approach we take with our patients is supported by the most current research.

If somebody you know is sick of diets failing and he or she is ready to get healthy, send him or her our way and we will be happy to help.

Alternative

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Note: This post is a tangential companion piece to another piece I wrote, which you can read here.

Before I changed careers and became a dietitian, I put my math degree to use as an operations research analyst for the U.S. Department of Transportation.  I worked on many projects, one of which was helping to manage a mathematical model of the alternative fuels industry.  When I first joined the project, I wondered why – if energy sources other than gasoline existed – did we continue to primarily use gas for our cars?  Then I learned that all of these alternatives had serious downsides.  Fuel X would reduce tailpipe emissions, but cause massive pollution output at the plant where it was produced.  Fuel Y was so unstable that a simple fender bender could trigger an explosion.  Fuel Z was so expensive that it would price out many drivers.  I still remember one of my colleagues, who had been working in the field much longer than me, saying, “These alternative fuels are alternatives for a reason.”

Alternative medicine isn’t all that different.  If its unusual tests and approaches worked as well as its practitioners say they do, these tests and treatments would not be alternative, they would be mainstream.  I support an individual’s right to pursue the kind of healthcare that feels right to him or her, and I understand that not everybody wants to stick to the mainstream route.  In fact, I am glad there are people out there who question the mainstream, push the boundaries, and try new things, as that is often how progress is made.  My concern is just that alternative practitioners need to do a better job with transparency and disclosure.  In other words, they should be disclosing that a given approach is an unproven hypothesis, if that is indeed the case, not passing it off as a well-documented conclusion.

As an example, consider the plight of one of my best friends from high school, who wrote to me recently because an alternative nutritionist told her she should go gluten-free to help her rheumatoid arthritis (RA).  My friend says she has read on many websites that gluten causes RA.  I suspect that one day we will have a good understanding of the role, if any, that gluten plays in RA development and exacerbation.  That day, however, is not today.  For someone to put it on a website or recommend it to my friend as fact is just, well, in my opinion anyway, irresponsible, unethical, and unprofessional.

Sometimes people feel so poorly and get so desperate for an answer that they will listen to anybody who gives them one, independent of whether that answer is correct.  I do not mean that as a knock against any of the patients, but rather as criticism of practitioners who capitalize on desperate people making emotional decisions when they should instead hit the brakes and help said people make informed decisions.  If, for example, the nutritionist explained to my friend that the gluten-free diet is an experimental approach to dealing with RA and my friend – fully understanding the experimental nature of the approach as well as its potential pros and cons – decides to go ahead with it, then by all means.

These practitioners should disclose that some of their approaches and tests are not terribly accurate and are not widely accepted as valid, but they often do not.  Paradoxically, offering this disclosure would probably give them more credibility, not less.  Remember in school when a student posed a question that stumped the professor?  The professor who admitted “I don’t know” earned trust and respect, while the professor who made up an answer that was clearly BS looked bad even though that is the exact outcome he hoped to avoid by inventing an answer.

Elimination Diets

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“Two separate people told me I should try going gluten and dairy free to combat my arthritis and go off my medicine.  Perhaps that could be another topic: elimination diets to combat various diseases.”

In response to my request for blog topics, a friend of mine suggested the preceding idea.  My response inspired a tangential post to which you can find a link here as well as about two-thirds of the way down.

Before we get to elimination diets, let us first consider some of the various ways in which foods might have a negative impact on us: allergies, intolerances, and sensitivities.

Food allergies involve the immune system and the reactions are rapid and often acute.  Think of somebody who accidentally eats a peanut and has to use his EpiPen to keep his throat from closing.  Doctors can test for food allergies with a high degree of accuracy.

Food intolerances do not involve the immune system.   For example, consider somebody who lacks the lactase enzyme in his system necessary to digest lactose, and as a consequence he experiences symptoms like gas, bloating, and diarrhea in response to dairy ingestion.  We call this lactose intolerance, and doctors can test for it via a hydrogen breathalyzer test.

Food sensitivities differ from both allergies and intolerances.  Symptoms associated with food sensitivities tend to set in slowly, leave slowly, and are more subtle.  The range of associated symptoms is also quite wide, including headaches, fatigue, joint pain, bloating, and nasal congestion, just to name a few.

The current tests for food sensitivities are, to put it kindly, not great.  In fact, there is no immunological society in either the U.S. or Europe that considers today’s food sensitivity tests valid.  One of the problems with these tests is that they can simply reflect exposure to a food.  In other words, if you have eaten a given food recently, it is more likely to come up positive.  Even worse, the results can actually reflect tolerance (yes, tolerance) to the food in question.

The best way to determine food sensitivities is through an elimination diet, a procedure in which somebody cuts out various foods and then reintroduces them in systematic fashion in order to see how his symptoms change in response.  Elimination diets can be slow (think weeks, not days) and tedious, and they require a tremendous amount of discipline on the patient’s part.  Another issue to consider is that the patient is unblinded.  In other words, he knows when he is or is not eating a given food and this can influence the results.  If someone or something has led him to suspect that a given food is responsible for his symptoms, then he might imagine or exaggerate a reaction due to expectation.  It’s sort of a like a reverse placebo effect.  Additionally, other confounding factors exist too.  All sorts of variables exist in our life, so the onset or dissipation of a symptom cannot automatically be attributed to a change in diet.

While elimination diets can yield useful data, the challenges and downsides associated with them understandably leave people looking for alternative approaches [At this point, I went off on a tangent, which I extracted and posted here.], which brings us back to the food sensitivity tests that I mentioned a couple of paragraphs ago.  These test results should never be taken literally, but they can be used for the basis of an elimination diet.  For example, if the results indicate that Foods X, Y, and Z are problematic, one can eliminate and then reintroduce these three foods to determine which (if any) of them are indeed problems.

Also remember that cutting out foods can have consequences and should not be done casually.  I know cutting out gluten is kind of the in thing to do these days, but going gluten-free without a good reason for doing so it not such a great idea.  Gluten-free products are often lower in fiber, iron, and some of the B vitamins.  Of course it is possible to get these nutrients elsewhere, but a gluten-free individual has to pay that much more attention to the rest of his diet in order to avoid a deficiency.  Additionally, gluten-free products tend to be more expensive than their traditional counterparts, and potential social repercussions warrant consideration as well.  Unless somebody has cause for eliminating a food and has discussed it with his doctor and dietitian first, cutting it out is probably not the best idea.

Despite all of these potential downsides, elimination diets are currently our best option for determining food sensitivities.  If you are considering eliminating a food (or foods) due to a medical condition or symptom, talk with your doctor and dietitian first.  While elimination diets have their place, they are not always the appropriate first step.  Your doctor may wish to run other tests first.  For example, celiac disease can be more difficult to diagnose if somebody has already begun to reduce his gluten intake.  So, talk with your healthcare team first.  Your dietitian can help you to design the logistics of your elimination diet.  If you are going to put in the effort to do one, might as well make sure you implement it in such a way that will maximize your chances of gathering useful data.  Lastly, if and when you do start an elimination diet, keep an open mind to all possible outcomes and do not assume that a given food is going to be either benign or problematic.

“How do I get my children to not only eat, but also to eat foods that are good for them?”

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“How do I get my children to not only eat, but also to eat foods that are good for them?  Where is the line of encouraging children to eat without creating food issues down the line?” – JB

My first counseling position as a dietitian was at a pediatric practice and I continue to see many children here at Soolman Nutrition and Wellness LLC.  JB is not alone in her concerns, as many parents share the same questions stated above.  While every child and family dynamic is different, I do find that the following ideas tend to help.

Allow your child to help with food selection.  Take your child to the grocery store and let him pick out a new fruit or vegetable that he is curious about or finds interesting.  I remember not being a huge fan of carrots as a kid, but then one day I saw carrots in the supermarket with the green stems still attached, which made me think of one of my favorite cartoon characters, Bugs Bunny.  Suddenly, I wanted carrots!  If bringing your child to the supermarket is not appealing because of the potential for conflict over foods you do not want to buy, consider going to a farmers’ market instead where the non-produce temptations are less.  Having a garden that your child helps to maintain can be a great way to get him interested in vegetables.  Even an indoor planting system, such as the AeroGarden, can have a similar effect.

Involve your child in food preparation.  Your child can participate by performing tasks that range from pulling grapes off their stem, to slicing a pepper, to making a side dish, to preparing an entire meal, depending on his abilities and level of interest.

Give one alternative and that’s it.  If your child is a picky eater and does not want to eat what the rest of the family is having for dinner, offer one standby alternative, something that is easy for you to make and is relatively healthy, such as a turkey or peanut butter and jelly sandwich.  It is understandable that parents want to give their child what he wants, and the fear that he will not eat anything can also be stressful, but being a short-order cook usually leads to more stress and conflict in the long run.  Create an environment where the only options are Choice A or Choice B and your child will likely adapt.

Set ground rules ahead of time for trying new foods.  Children often fear trying new foods not because of the foods themselves, but because of what might happen if they say they like or dislike a new food.   Their rationale is often, “If I say I like this broccoli, are they going to make me eat more of it?  I don’t want more of it, so I had better say I don’t like it.”  Negotiate ground rules with your child ahead of time regarding how he will try new foods.  For example, how often will he be expected to try something new, how much must he sample, and what happens if he dislikes the food?  What if he likes it?  Just this week, I brokered a deal between a mom and her son that established the ground rules under which he will try new fruits, and they both walked out of here happy and excited.  Be nonchalant about the process and roll with whatever reaction your child has.  Remind your child that tastes do change over time and encourage him to keep an open mind to the possibility of retrying a disliked food again down the road.

Tap into your child’s motivation.  Many children have trouble appreciating that what they eat affects their health down the road, so instead draw a link between what your child eats and what currently motivates him.  If he wants to be a better soccer player, for example, talk about how eating can help him play better.  I find that nearly every child perks up if I ask him if he would like more energy.  That gets my foot in the door to talk about basic nutrition concepts.  The child does not care that what I am teaching him can reduce his risk of chronic disease decades in the future, but he is engaged and pays attention because what I am talking about will help him with what feels important to him right now.

Set a positive example.  In my experience, the families in which the parents eat one way while expecting their children to eat another way also tend to be the families with the most conflicts around food, and I do not believe this to be a coincidence.  Role modeling the eating behavior you desire for your child can have a very positive effect on his own eating.

Talk about balance and being mindful, not weight or dieting.  Eating disorders, disordered eating, exercise obsession, poor body image, low self-esteem, and associated issues often (but certainly not always) start with messages that children pick up at a young age.  How you behave and treat yourself rubs off, so be wary of going on diets, talking about diets, disparaging yourself, or discussing weight in front of your children.  Similarly, overly restricting children can lead to secret binges, as was the case with a recent patient of mine who snuck a bunch of 100-calorie snack packs and soda when his mom was not looking.  Labeling foods as “bad” can also be detrimental.  Children need to learn how to find balance while incorporating all sorts of foods.  Otherwise, think about what can happen when that child grows up and has the freedom to access previously-forbidden “bad” foods whenever he wishes.  Instead of all that, a much more positive message is to talk about listening to what makes our bodies feel good, honoring our preferences, and loving and accepting ourselves no matter what we look like.  Help your child to build a foundation of balanced eating that gives him the best shot at having a healthy relationship with food for the rest of his life.

Note: For the sake of brevity, I referred to a child as “he,” as opposed to “he or she,” but in no way was that to imply that these suggestions are specific only to boys.  On the contrary, I find that these ideas work well for both boys and girls.