Confessions of a Dietitian

My approach and views on body weight have changed a lot since I became a dietitian back in the late 90’s. I was taught that weight control could be achieved by simply balancing calories in with calories out. My diet plans consisted of a list of foods to eliminate. Moving to Canada in 2003 was a pivotal point in my career and personal growth. I was introduced to the Health at Every Size approach, a more holistic way of changing your lifestyle. I started focusing on foods that people could eat in my dietetic advice, rather than foods they needed to avoid. This is when I realized how different dietetic practice was here. And how focusing on weight can be damaging to one’s self-esteem and health, and damaging to society.

Written by Rola Zahr, MPH, RD, Nutrition Education Manager, BC Dairy Association
Rola Zahr, MPH, RD

Throughout my career, I’ve attended a lot of presentations. I usually walk away with a few ideas to put into practice. But very few affect me the way that one presentation did four years ago. The presentation was done by a marketing research company that was reporting on the results of one-on-one interviews conducted with teens in BC schools. The purpose was to explore the factors that influenced their food choices. While there were no specific questions on body image, a pattern emerged: How teens looked and how their peers perceived them was of high importance. Body image issues had a big impact on what they were (or were not) eating and how they felt. Girls were dieting, or avoiding foods perceived to be higher in fat, in order to lose weight. Boys wanted to bulk up. I was very concerned by these findings. My daughter was five years old at the time and I thought to myself, “This could be my child one day.” I was scared. I wanted to do something, but I didn’t really know what.

My opportunity to help prevent this issue presented itself soon after. I had started my Master’s in Public Health Nutrition and was enrolled in my first course: Community Nutrition. By the end of the course, I had to develop and deliver a project that addressed a nutrition concern in my community. Without hesitation, I chose to work on improving body image in teens. I researched the literature on the topic. I connected with key players in the community who were already doing work in that area and knew more about it than I did. I conducted a scan of the resources that were available. This is where I identified a gap that I could fill: Provide training to teachers so they would have the tools and confidence they need to teach about body image in their classroom.

As a nutrition educator with BC Dairy Association, I deliver teacher workshops across BC regularly. So this was a natural fit for the organization. With the support of my manager, I piloted a workshop with a group of teachers in Surrey. Feedback was great and evaluations very positive. The Healthy Attitudes, Healthy Bodies, Healthy Schools workshop was born. I have since offered this workshop to various groups: K-12 teachers, physical education teachers, school counselors, school administrators, university students and health professionals. I’ve learned a lot at every workshop I presented from the rich discussions we had and the scenarios we discussed. When I reflect on it all, I can summarize my experience by the following:

 

  1. Body image is an intimidating topic that teachers (or anyone else) are hesitant to address. They need support from experts to develop the confidence they need to talk about it with their students.
  2. We often underestimate the impact we have on our children. If we want children and teens to love their bodies and love themselves, we have to start with ourselves. Are we happy with who we are? Or do we worry and make comments about how we look? Do we feel guilty about eating a food we like because we’ve labelled it as a “bad food”? Are we dieting? When we engage in these behaviours, we are telling the children and teens in our life that it is OK for them to do the same.
  3. Many strongly believe that we can prevent weight gain through discipline and willpower by eating healthy and exercising regularly. So a person who is larger has no one else to blame but him/herself. The truth is that a person with all the strong will and discipline in the world can still gain weight. In the workshop, I spend time discussing the many factors affecting body weight. Many of these factors are beyond our control, such as genetics, the food environment, our metabolism, sleep, and stress. This is the part that I get the most challenged on and where I encounter the most resistance. This is not surprising given all the alarming reports about the obesity epidemic, the messages we hear around us about bad foods and good foods, and how healthy eating and physical activity are key to maintaining a healthy weight.
  4. We’ve learned that being fat is bad from a young age, through movies, cartoons, jokes, and comments we hear from the adults in our life. We’ve come to view larger individuals as unhealthy, lazy, unmotivated, and dumb. These negative assumptions we’ve internalized and normalized are what is called weight bias. It is so pervasive that it’s been referred to as, “the last form of discrimination that is still socially acceptable.”

 

In the workshop, I do an activity with the group called the Implicit Associations Test. This test looks at the implicit (unconscious) associations we make about larger individuals. Everyone struggles with it, even when they realize and understand what the test is trying to accomplish. Some get upset. Some are surprised. But it is always an eye opener for most.

I’ve learned a lot through this journey. Addressing weight bias is, in my opinion, the first step towards improving body image in teens. Even after being immersed in it for four years now, and offering many workshops to groups, I will catch myself automatically making assumptions about larger individuals sometimes. It isn’t easy to change the way we’ve been shaped to think. It takes time. But we have to start somewhere. I am not perfect. I am still working on being more aware of my own assumptions –  for my sake and for my daughter’s. I encourage you to do the same.

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Written by Rola Zahr, MPH, RD

Nutrition Education Manager, BC Dairy Association

 

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