Monday, October 24, 2011

Don't dig your grave with your own knife and fork (English proverb)

Today is Food Day, created by Center for Science in the Public Interest, and to a foodie dietitian like myself, it's as exciting as Christmas Eve (even after learning who "Santa" really is!).  These are the six principles of Food Day:
1. Reduce diet-related disease by promoting healthy food
2. Support sustainable farms & limit subsidies to big agribusiness
3. Expand access to food and end hunger
4. Protect the environment and farm animals by reforming factory farms
5. Promote health by curbing junk-food marketing aimed at kids
6. Support fair conditions for food and farm workers
My job is written into principle #1.  However, in school we're not really taught about agriculture systems so the remaining principles- and bigger picture food issues- have been ignored by future nutrition professionals. There's a huge disconnect between the farm and how food ends up on our plate and we're supposed to be the nutrition experts!  Unfortunately we pass along the naivete to our patients and unknowingly perpetuate the drive toward current factory farming practices. 
Modern industrial farming is shameful, in my opinion, and documentaries like Fast Food Nation, King Corn, Food Inc., and Super Size Me got me thinking "I don't want to participate in this anymore" and "I will make a serious effort to find alternatives."  My dream is to one day grow my own fruits, vegetables, and herbs, but I just don't have the land or space to do so.  Thus, I spend my money to support people and companies who do their best to grown food the responsible way.
Living in Northern California I feel so lucky to have fresh produce available year-round that I try not to take it for granted.  I support my local farmer's market for seasonal fruits, vegetables, eggs from pasture-raised hens, and occasionally some grass-fed meats.  It sucks to not eat tomatoes and berries year-round but I prioritize eating locally grown food as a way to minimize the environmental impact of flying produce in from all over the world.  Every now and then, though, the bananas call my name and I can't resist :)
I'm also grateful for Sigona's, a family-run grocery store in town, that also supplies me with organic produce, pasture-raised chicken, and grass-fed beef, with an abundance of products from California.  Sure, I'll probably never be able to afford a house in the Bay Area but the richness of our food supply makes it *almost* worth the financial stress!  
I encourage you to decide for yourself how you'll be a part of Food Day today and everyday hereafter.  Lots of buzzwords are out there if you'd take the time to do your own research:
Local... seasonal... organic... sustainable... food deserts... subsidies... Farm Bill... genetically modified organisms... grass fed... pasture-raised... fair trade... confined animal feed operations... and so on.

Need inspiration?  Browse Food Day Recipes from celebrity chefs!

Wednesday, October 19, 2011

First of all, I'd like to thank my body. Without it I wouldn't be here...

Heyyyyy youuuu guys!  It's Love Your Body Day and seriously, if just for one day, I encourage you to celebrate what that fine machine of yours has given you the ability to do.  Modern media has convinced us that a teeny, tiny, practically non-existent body is supposed to be the holy grail of shapes and in reality few people naturally fit that build.  Therefore, potentially many wasted hours/days/years of the greater majority's life is spent lamenting why those curves and rounded tummies won't go away.  It's time to GET OVER IT and appreciate what you got, just like my body hero, Christina Hendricks.

She WORKS IT and makes no apologies for being the way she is.  She (and/or her stylist) know what flatters her shape the most and she looks amazing.  She told Health.com "Q: What is your best advice for reaching total body confidence? Do you have it?
A: I guess my mom raised me right. She was very celebratory of her body. I never heard her once say, 'I feel fat.' " So for that, I have to agree and give major props to my mom for raising me similarly.  Our family consists of various shapes and sizes and never once did I get a memo that my size was unacceptable (apparently I was put on blast in dance class but luckily that blew over my head.  I wasn't trying to be a Rockette, ya heard?!) 
This article includes an extraordinary image of how much plastic surgery the model would need to achieve Barbie proportions.  Let's cut to the chase:
Yikes.  I don't think a carved out neck like that could hold up a human head.
An eating disorder survivor made a life-size model of Barbie and it looks like a circus act!

I'm not going to lie, there are some days I wish my pants slid over my hips a little easier and it makes me temporarily sad to get rid of clothes that don't fit anymore, especially since I have a scrapbook memory and remember how long I've had the item and the approximate last time I wore it... but I quickly snap out of it and remember that feeling comfortable and confident in my chosen outfit is head and shoulders better looking that squeezing into something a size too small.  Vanity sizing doesn't do much for our psyche either so rather than stress about the number or size on a hidden tag, I buy clothes based on how they fit and tailor them to fit me even better.  (Shout out to my "teachers" Stacy London, Clinton Kelly, Tim Gunn, and Nina Garcia for preaching that expecting clothes to fit perfectly off the rack is NOT typical!)
Besides being a medium for me to dress up, I've got to thank my body for being intelligent and healthy to get me through grad school, able-bodied to work, hike mountains, finish 5 and 10ks, bench press, chase around my silly dogs, love, laugh, and dream.
Respect.
Completing my first 10k last year :)

Friday, October 14, 2011

Woohoo! Thinking about thinking about making a change is part of the process

Coming out of school and my dietetic internship I was ready to transform lives and help people overcome their eating challenges.  I was bright-eyed and optimistic that my patients would achieve all their dreams in just one or two visits with me.  Therefore, that first meeting was a blitzkrieg of information, a verbal diarrhea if you will.  Never once did I consider how the patient was taking it all in, just assuming they instantly knew what I was talking about and so it was ok for me to plow forward.  It was time to stop talking when our appointment time was up, not when I could identify the glazed over look, a telltale sign the patient had mentally checked out of the conversation. 
I expected them to come running back a month later to proudly report all the positive changes that were going on in their lives.  In reality they would half-heartedly make an attempt to come in for a follow up or they would take the same-day-cancellation or no-show route.  We'd never be in touch ever again.  What went wrong?
Memories of learning about nutrition counseling as an undergrad and dietetic intern are hazy.  The lesson usually involved ridiculous/embarrassing "role play" so I never paid attention to the point of the exercise.  Such a waste of an opportunity to show baby dietitians how to be most effective on the job. :(  Besides at the time I was more focused on knowing "book knowledge" and having an answer for everything, not so much how to get to the desired outcome (controlled blood sugars, lowered blood pressure, begin exercising, losing some weight, etc). 
With my brains, sparkling personality, and extremely good timing in the job market, three years ago after finishing grad school I landed an outpatient dietitian job.  Having a supervisor and colleagues very cognizant of the complexities of behavior change has defined my career.  I finally began to see the bigger picture: there's no need to pester/use scare tactics/drag them to do something, or a need to waste your breath talking about something you fully know they will not follow through with.  You simply elicit what information they'd like in this moment and present them with a menu of options to meet that need. 
First it takes some exploring how aware the patient is that there is a problem.  Prochaska and others best described this in the Transtheoretical Model (TTM).  Depending on the patient's stage of change it's most effective to tailor your information to match their level of thinking and motivation.  Someone in denial they have diabetes?  Don't even think about giving the "carb talk" or show them how to use their glucometer.  Touch on the objective data like labs with reference ranges and leave it at that.  Even then some patients might deny their blood sugar is that bad but you've done what you could.  Someone all fired up to throw away the junk in their house?  Awesome game plan, so then what will you do when someone invites you to their house or you see treats in the break room at work? 
Most patients fail to recognize that their eating and exercise choices are lifelong so relapse is also part of the change process.  It does NOT mean the patient is stupid, lacks self-control or is a failure when old habits creep in again.  I encourage my patients to reflect on the experience and learn from it.

 STAGES-OF-CHANGE CHARACTERISTICS AND STRATEGIES
STAGECHARACTERISTICSSTRATEGIES
Precontemplation
The person is not even considering changing. They may be "in denial" about their health problem, or not consider it serious. They may have tried unsuccessfully to change so many times that they have given up.
Educate on risks versus benefits and positive outcomes related to change
Contemplation
The person is ambivalent about changing. During this stage, the person weighs benefits versus costs or barriers (e.g., time, expense, bother, fear).
Identify barriers and misconceptions
Address concerns Identify support systems
Preparation
The person is prepared to experiment with small changes.
Develop realistic goals and timeline for change
Provide positive reinforcement
Action
The person takes definitive action to change behavior.
Provide positive reinforcement
Maintenance and Relapse Prevention
The person strives to maintain the new behavior over the long term.
Provide encouragement and support
(Source: Zimmerman et al., 2000; Tabor and Lopez, 2004)

So you have someone ready and motivated to make changes?  Learn from my mistakes and don't overwhelm them with all the possible choices to make.  One of the most respected techniques for promoting behavior change is motivational interviewing.  Research shows it to be effective in helping people overcome substance abuse/addiction, eating disorders, and manage chronic lifestyle-related diseases like diabetes.  Patients who use their own personal motivations as the reason for making changes are more likely to stick to the plan than if they were told to do something by someone else.  What do they care if you think they eat too much salt or fat?  It clearly doesn't bother them (at least up front). Or maybe it does bother them but they haven't thought of a solution to beat that rut.  If there is a hint of dissatisfaction somewhere in their choices, carefully chip away at that barrier.  Training sessions from Molly Kellogg and Steven Malcolm Berg-Smith have helped me craft the right open-ended questions and forced me to be a better listener so I pick up on when a patient expresses something personal and motivating to them.  Then I use that to get the ball rolling on trying out a new behavior. It all ties back to them and what's ultimately going to matter most in their lives.  I get to be the supportive coach watching on the sidelines.
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Monday, October 10, 2011

Chuckles from the HAES community

Like I mentioned in my last post FNCE was an eye-opening, shameless display of the influence Big (Processed) Food has on "educating" fellow health professionals and how to spin a message in their favor.  Reviews of "The War on Obesity: A Battle Worth Fighting?" are rolling in and I have to say Marci Klein's review is my favorite because she captured the 5 most ridiculous comments from double chinned obesity researcher John Foreyt.  I was too shocked to listen that well, so I appreciate the efforts by others in helping remind me that fat stigma and the "Everyone wants to be skinny deep down inside" dogma still exists.
Linda Bacon's HAES blog added some behind-the-scenes information that brought to light Foreyt's multiple weight loss industry ties and that he had no problem taking money from ADA just to be there.  I know it's more painless to keep our head buried in the sand but what's at stake- clients'/patients' long-term wellness and healthcare professionals' ability to safely promote lasting behavior change- really depends on knowing the truth!
So what else makes me laugh?  This graph from another HAES blogger:
Lastly, I love the cajones on "super class 3 obese" dancer Ragen Chastain for posting her hate mail but linking it to the ad-supported blog page so she makes money off the ignorant haters!  Genius!  She and other inspiring (and a few sad) people are profiled in the limited released documentary "America the Beautiful 2: The Thin Commandments".  I can't wait for wide release and hope you make an effort to see it too.
Be well!
YFD