Nearly half of all Canadians are either overweight or obese. Overweight is defined as a BMI >25 and obesity is defined as a BMI > 30. The increase in childhood obesity has almost tripled in the last 2 decades…what staggering statistics!
It is not just weight alone, but where this weight is located, that increases the risk of other health implications. Is the individual a ‘pear’ or an ‘apple’ shape?
Many of us know our lifestyle, our preference for unhealthy food choices, (highly refined, high saturated fat, high trans fat, salty, convenience foods); lack of exercise, and increased stress all play a role in this epidemic. The research is out there, the data is out there, so what is it that we do not understand? Do we not see ourselves as part of the problem?
As Educators, do we need to re-evaluate the way we disseminate healthy lifestyle messages? Are the messages too vague…not fun and sexy? We know quick fixes and magic bullets don’t work…yet how do we convince clients of this?
At one time it was thought, that as adults we couldn’t “make” more fat cells, research proves this is no longer true; we can make more fat cells and this happens when calories in exceed calories out, resulting in bigger fat cells. When these cells are stuffed, so to speak, the body then starts making more fat cells, once these have filled the usual spaces, these fat cells move into organs such as heart, liver and muscle. When we attempt to lose weight we can only reduce the size of each fat cell; we cannot actually decrease the number of fat cells and this becomes a concern with sustained weight management.
It was once surmised that fat was an inert substance now we know that fat is an active endocrine organ. Fat, especially around our girth affects our ability to lose weight; it increases the risk of certain cancers and can lead to insulin resistance, which in turn predisposes individuals to hypertension, prediabetes, diabetes and coronary heart disease.
There are many guidelines to assist in achieving a healthy lifestyle and a healthy body weight, having said that, we need to look at these recommendations realistically, for example, the Acceptable Macronutrient Distribution Range (AMDR) is one of these guidelines:
- Carbohydrates: 45-60% (total caloric intake)
- Protein: 10-35%
- Fat: 20-35%, further divided into:
- cholesterol: < 300 mg/day
- high Triglyceride levels: lower cholesterol to < 200 mg/d
- omega 3 Fatty Acids: (ALA, EPA, DHA): 0.6-1.2%
- omega 6 Fatty Acids: 5-10% of the total Omega 3 FA
And yes, it is necessary for a Dietitian to have this clinical knowledge, but the above is too vague and doesn’t mean a thing to many individuals. How many of us have seen client’s eyes glaze over as they state, “just tell me what foods to eat”, or they ask us for a list of ”good” and “bad” foods?
Clients also come to us with many myths and misinformation found on the Internet, read in Tabloids, or they have been told the latest and greatest from a well-intentioned neighbor or friend. Then, not only do we have to teach new information, but we also need to address and dispel these myths regarding, weight loss, fad diets and ‘fat busting’ supplements.
There is a myriad of information and misinformation “out there”… some of these myths, such as foods that have been touted as fat burning or weight management miracles are beyond believable, with no scientific research behind them.
Take for instance the following foods, (this is by no means a complete list), which have been exalted as “fat fighters”:
- “Natural” fat burners – cranberry, seaweed supplements, onions, pineapple and grapefruit
- “Herbal” Fat Burners – Ma Huang (Ephedra), Ginseng, Guarana, Hoodia, Hydroxy-Citric Acid, L-Carnitine, Natural Licorice, Guar Gum
- Conjugated Linoleic Acid (CLA), excess Fiber, Green Tea, Bitter Orange, Chitosan (“fat blocker”), Chromium, Ephedrasil, Usnic Acid
So far the research does not show the above as being ‘fat fighters’; and some are downright dangerous, such as Ephedra.
Canadians are spending billions of dollars on supplements; we hear many complaints about the cost of healthy foods; for many we know the message about the importance of a healthy lifestyle is not being heard. Why is it that many Canadians would rather spend billions on supplements (that are not proven), yet we complain about the cost of healthy foods?
We need to provide clients with reliable/credible nutrition resources, and provide practical ways of incorporating these messages into daily lifestyles.
Our challenge as educators is to engage the client, get them interested and excited about making changes. If we want to decrease the odds at developing CAD, cancer, diabetes and HTP, we need to provide information in such a manner that the client buys into the message and can see the benefit for their own health and quality of life. The following nutrition/exercise guidelines are great for Educators to know but we need to take this information, and translate it into practical, easy-to-understand, simple messages for the client:
- Attain or maintain a healthy BMI ≤ 25
- Attain or maintain a healthy WC: males: ≤ 90 cm, females: ≤80 cm
- Lower B/P to 130/80
- Lower lipid panel, especially LDL-C and total-C/HDL-C ratio
- Health Canada’s Physical Activity Guidelines: 10,000 steps or 30 to 60 minutes daily activity
- Blood sugars within normal ranges for those with PreDiabetes and T2 Diabetes
- Eating Well with Canada’s Food Guide:
- Decrease salt and salty foods:
- those with HTP: ≤ 1500 mg sodium /day
- others: ≤ 2300 mg sodium /day
- Decrease total fats, switch to healthy fats
- Saturated fat: ≤7% total calories
- Avoid trans fats
- Consider addition of plant sterols/stanols
- Increase fibre:
- people with Diabetes, 25-50 g fibre/day
- others: 25-35 g fibre/day
- Soluble fiber: 5-10 g/day (included in above)
- 8 glasses fluid each day
- Limit Alcohol intake: males: < 14 drinks/week, females: < 9 drinks/week
- Decrease salt and salty foods:
It is not just the information that we provide, (of course this needs to be evidence-based) but it is the way the materials are presented that makes the biggest difference and has the bigger impact on a client’s adherence and willingness/motivation to make the required changes.
If, after a number of sessions things are not moving along, or the client has hit a roadblock, the counselor needs to reevaluate their approach to the sessions and the client goals.
Was the stage set correctly in the first place? Were the goals realistic and obtainable; are these client goals or the counselor’s goals? Are open-ended questions being used to elicit a story or is the client giving ‘yes’ or ‘no’ answers? Is the client actually being engaged in the conversation? What is their ‘body language’ saying? Are they sitting with their arms crossed in front of them? What message is the Counselor’s body language implying? Is the counselor checking their watch and tapping their fingers? Are they actually listening, showing empathy for the client or silently wishing they would just hurry up and get their story over with?
After reviewing the above, and if it is still not the answer, reevaluate the client’s readiness to make changes, what “stage of change” are they at? If you think they are in the “action stage”, but actually they are only in the “contemplation stage”, there is a definite disconnect and the process may need to start again. Realistically, this may be the time to have a gentle, heart to heart with the client and suggest they come back when they are ready to move forward.
Lets say the client and the counselor are on the same page as far as readiness and goal setting, so where to go from here?
Keep information simple, brief sentences, make an action plan; if appropriate have the client write down their own goals rather than the Clinician. Ask the client to repeat their understanding of the information—it may come as a surprise that the information has been totally misunderstood.
With the client’s permission gradually introduce other healthy eating and activity goals. Take the complicated goals, put into user-friendly terms, and use practical ideas that can be easily understood. If we do this, we may be able to turn the tide on the obesity epidemic in Canada.
- Health Canada. Eating Well with Canada’s Food Guide, 2007.
- Dietitians of Canada. Fats, The Good, the Bad and the Ugly, 2007.
- Heart and Stroke Foundation of Canada, 2008.
- Canadian Diabetes Association. Clinical Practice Guidelines, 2008.
- Lawson-Meyer, D. Enette. Vegetarian Sports Nutrition, 2007.
- Laflamme, M., and L. Lagacé. Good Fat Bad Fat. Toronto, Stoddart Publishing: 1995.
- Josephson, R., Nutrition on the Run. Vancouver, Douglas and McIntyre: 1997.
- Brand-Miller, J., and K. Powell. The Low GI Diet Revolution. New York, Marlowe and Co: 2005.
- Davis, B., and T, Barnard. Defeating Diabetes.Tennesse. Healthy Living Publications: 2003.
- Vesanto, M., and B. Davis. Becoming Vegetarian. Toronto, Wiley and Sons: 2003.
- Centre for Science in the Public Interest. Nutrition Action Newsletter, October 2005, Volume 32, Number 8.
- Centre for Science in the Public Interest. Nutrition Action Newsletter, September, 207, Volume 34, Number 7.