I started this blog 2 years ago as a way to share ideas, recipes and what I was learning it uni at the time with friends and family. My intention is still the same, however over these last 2 years I have had a change of heart in the way that I want to practice and write on this blog.
Thanks to some now colleagues, friends and course mates I was introduced to the concept of non-diet nutrition care, Health at Every Size (HAES) and Intuitive Eating (IE). These concepts have opened my eyes to what feels like a more compassionate and inclusive approach to helping people to look after their health, if that’s what they wish to do. It puts weight loss to the side as it is not only very unlikely to be maintained, but as studies such as this one show, weight is not necessarily indicative of health. It also puts emphasis on a more holistic approach to health where psychological and social health are held in the same regard as physical health.
A couple of people have recently had name changes on their social media feeds and blogs. I understand that they’ve done this to realign their names with their professional and personal values, having developed and learnt from previous experiences and maybe mistakes.
Although I don’t think that the name for this blog needs to be changed I’d like to take this opportunity to clarify my current stance on various topics, highlight where I have learnt lessons in the past, and also to apologise.
I’d like to apologise to anyone that has ever felt shameful of their food & lifestyle choices or bodies based on something that I have written here on this blog, on my social media feed or something that I have said in real life. I understand that part of it was not being aware of HAES/non-diet and also was intrinsically tied up in my own fears, poor body image and self-worth.
It has taken a good while of learning and immersing myself in the research, articles, podcasts and workshops to get to a place where I feel comfortable to say that I want to practice and conduct myself through a non-diet lens. In that sense I mean that I am actively incorporating the HAES/non-diet principles in my practice as a dietitian and I wish to do so on my blog as well.
I don’t want to delete the posts that contain language or topics that I feel uncomfortable about now as its been part of my development professionally as well as a human being. It’s ok to get things wrong – we all do it – and in an act of self-compassion I’m not being too hard on myself, rather thinking about how I can learn from this. Instead, I have highlighted a few of the points that I have made in the past and briefly explained why they no longer align with my values and beliefs.
I think it’s important to say that I am always, and will always be, learning about this field and particularly the concepts of fat-activism, the history of body positivity and the fight for equality (of all kinds). I want to try to help in raising awareness of these social justice issues in my day to day life, particularly fat acceptance and challenging fat phobia (in myself and others).
I’ll be trying to write more posts on these topics, as well as continuing to have guest posts, a few recipes here and there and more nutrition-focussed bits. I’d also like to gather and provide some more resources for students and nutritionists and dietitians just starting out – I figure if we share, it will hopefully be a little less of a struggle figuring it all out!
3 Things I’ve Learnt…
- BMI is not indicative of health, however sometimes it is still a required assessment tool
In these crib sheets I have included a space to measure weight and BMI. This is because a lot of traditional dietetics education and training encourages this and actually it may be required of you to pass (I have had a few discussions on various placements trying to explain why I am not taking a patient’s weight). There are also some clinical circumstances under which it is important to weigh your patient, including working with patients with some eating disorders, patients in a nutrition support clinic who you are helping to gain weight or patients with IBD may lose weight when their condition is in the active phase. Although the evidence is patchy on the health effects of being at a higher weight (see the above linked paper by Bacon & Aphramor) it is recognised that there is a weight under which health is definitely not supported.
However, the very practice of being weighed can be triggering for people and can set them back in if they are working on body image or IE. Therefore, I can recommend a couple of strategies;
- If your supervisor is likely to be receptive you could engage in a conversation (at an appropriate time) about the science surrounding weight science – there are good studies and resources to start with on Linda Bacon and Fiona Willer’s
- Blind weigh your patient – by that I mean ask them to carefully step on the scale backwards so that they can’t see the number on the scale. And don’t read it out either. Obviously tell them what you are doing so they don’t feel like you’re hiding it for malicious or weird reasons.
- ALWAYS ask if they are comfortable for you to take a weight and make it explicitly clear that they have the autonomy to say no.
- Portion sizes aren’t very helpful & can encourage people not to trust their bodies
In my flapjack recipe post I said, “Flapjack is quite high in sugar so be careful of the portion size”. I feel rather differently about recommending portion sizes. A tenet of Intuitive Eating is learning to trust your body to eat as much as it needs to feel satisfied. By giving designated portion sizes this encourages people to trust external direction about their eating rather than their own internal hunger and satiety cues. I would consider a serving suggestion in a recipe different though, as I can’t imagine how impractical a recipe would be if we didn’t know how many people, roughly, it serves!
The same goes for this post on salad building – ignore the amount recommendations and play around with how much of the different components provide a satisfying meal for you!
- Nutrition is important, but it does not “fight or feed” disease
In this post questioning whether ‘superfoods’ are really a ‘thing’ I said, “remember that the consumption of one, perceived, particularly healthy food is not going to repair the damage done by other unhealthier habits”. Whilst this is true of superfoods – there’s no such thing and they won’t ‘fix’ anything – I worry that this statement puts too much emphasis on the importance of nutrition and its contribution to overall health.
Now, I am a dietitian and I do think that nutrition is important, but I have learnt to put it in context. Health behaviours which includes nutrition, physical activity, smoking, alcohol consumption, practicing safe sex etc. are shown to contribute to 30-40% of our overall health. That is all of those behaviours together! Genetics have been shown to determine roughly 30% of our health, and social and economic factors (many of which we have no control over) can contribute between 15-40% of our health. There are also other factors such as access to healthcare which contribute. The exact percentages of these different determinants of health differ depending on which studies you read due to variables such as the study population, how they measured ‘health’ (early deaths or overall health, for example) or what they included within the various determinants.
I don’t say this to make you despair, but more to make the point that nutrition is not going to make or break you, contrary to what sensationalist headlines and many health food and supplement companies like to suggest.
Nutrition and helping people with what they eat is still important, especially for people with health conditions managed by diet, but for the average person we can get the nutrients that we need by eating a varied and enjoyable diet.
Also, eating what may be considered an “unhealthy” food does not “cancel” out the nutrients that your body has received from other things that you’ve eaten that day.
Ok, here’s one more for luck:
I find low-fat/low-sugar foods gross & won’t be forcing these upon any of you
In a couple of earlier posts, I mentioned making sure that you had low-fat dairy or low-sugar cereals. This was because we were being told at uni that in the UK we eat too much fat and sugar. Ok, maybe we do based on dietary guidelines, but restriction of any kind is likely to lead to binging or ‘overdoing it’. This goes for emotional restriction as well as physical restriction – i.e. you’re eating enough low-fat cheese to be physically full, but it doesn’t hit the spot. This is the case for other ‘diety’ foods – and I will say here that if you like these foods – go for it! But if you don’t, eating what is deemed the ‘healthier’ alternative may lead to diving head first into a tub of ice cream or something later.
I’ll be trying to cover more of these topics in more detail in future blog posts, so for now I will leave it here. I’m glad to be back, hopefully I won’t leave you guys hanging again!
Please let me know what you think about this post and if you have any questions about it, or any topics you’d like me to try and write about or share some great resources that have already covered it send me an email (firstname.lastname@example.org) or send me a DM on Instagram.