Dietetics Link Dump 2

Another non-food photo - this is False Creek in Vancouver, taken when I was there with family over Christmas. A welcome sight on a cold, Calgary day such as this one. (OK, I know it's been colder, but work with me here...)
The last Dietetics Link Dump was so fun that I decided to do it again! Please bear with me if some of this is old news to you - I've been hanging onto some of these links for a while.

Maki of Just Hungry is back in Japan right now, tending to her mother who was just released from hospital after a bout of colitis (glad to hear that mom is ok!). She did an awesome write-up of how the dietitians there made effective use of food models, which inspires me to make better use of mine as a teaching tool. She also has a great series of photos on Flickr.

Are celebrities crossing the line on medical advice? My knee-jerk reaction would be "Yes", but this article raises some interesting points about how celebrities like Lance Armstrong and Katie Couric have made a positive impact by raising awareness about different types of cancer, encouraging people to get proper screening and donate money to research. But then towards the end, the article loses all credibility by quoting Dr. Oz (a celebrity doctor), who is no stranger to promoting fallacies himself.

As I mentioned in my previous post, I was recently doing some research on picky eating for a newsletter article I was writing and found Ellyn Satter's website. Ellyn is a registered dietitian whose practice focuses on our relationship with food - she has pioneered the concepts of division of responsibility when feeding kids, and eating competence and normal eating as adults. Her website provides a pretty good introduction to these concepts, but I'm thinking I'll definitely have to save up some money (and time!) for some of her books.

I really like Hypertension.ca, which is the portal for the three key organizations in hypertension in Canada. The Canadian Hypertension Society (CHS) is geared toward health professionals and academics, focusing on hypertension research and its dissemination. The Canadian Hypertension Education Program (CHEP) turns that research into clinical practice guidelines which are updated annually, and Blood Pressure Canada is a more consumer-friendly website. Unfortunately it seems to be more focused on proper blood pressure measurement at home and simply putting the clinical recommendations in layman's terms, but I'm hoping the Dietary Sodium Initiative and Sodium 101 will shine more light on one aspect of the dietary changes necessary to prevent/manage high blood pressure.

McMaster University has put together a literature search service called Online Best Evidence In Tackling obesitY, or OBESITY+, which compiles all the latest, best evidence related to obesity. It's free to sign up, and you can set up e-mail alerts for new, interesting articles. Users are also allowed to rate the articles on relevance and newsworthiness, as well as leave comments. The ratings and comments are sorted by the profession of the user (nurse, doctor, dietitian, etc.) so you can see how the different articles are viewed by the different health practitioners.

The Heart & Stroke Foundation wants to get more restaurants onto Health Check and I recently received a letter asking dietitians to participate in a survey of our views on the matter. You know, I know, Yoni knows, heck, even CBC knows that both the Heart & Stroke Foundation and the Health Check program have tons of room for improvement in their mission to improve the health of Canadians. So fill out the questionnaire and speak your mind! Canadians need more information on the choices that are available at restaurants, yes, but via Health Check? Not unless they toughen up.

OK, so I wasn't going to share this next link, but I recently found myself having to use it again so it may be helpful - It's a list of common GI/liver-related issues and each link provides an algorithm for treatment and referral. It's written for doctors, but I've found it to be helpful because I get to see how some of my patients may have reached the diagnoses they are coming in with, and I also get to read up on different diseases, diagnostic procedures and treatments related to all of these symptoms. I got this link via Nutrition and Diagnosis-Related Care by Sylvia Escott-Stump, who is also co-author of the popular Krause's text. I like the book because it's a quick reference for nutrition diagnoses and interventions, though occasionally I wish she ranked her points by level of evidence. It's also been a great resource for me to learn about the relatively new Nutrition Care Process concept.

Finally, earlier in the month, Marion Nestle linked to an interesting article in JAMA titled Extra Calories Cause Weight Gain - But How Much? The authors cite mathematical models that estimate that a woman with a BMI of 23 (within normal range) would need to create an "energy gap" (i.e. eat an excess of, decrease activity by, or a combo of the two) 370 calories a day above her energy needs to gain 35 lb over 16 years and become overweight (with a BMI of 29). For a 25-year-old man with a BMI of 25 (just overweight) to become obese (with a BMI of 35) within 25 years, he would need to create an energy gap of 680 calories. I'm assuming that weight loss would be the opposite - an "energy gap" of 370 calories in the other direction would only allow you to lose just over 2 lb a year (?), which is a far cry from the arbitrary "a pound of fat is equal to 3,500 calories, which means if you create a calorie deficit of 500 calories a day, then you should lose a pound per week". But then, you also don't want to decrease much more than that, lest you don't meet your body's nutritional needs.

The part of the article that stuck with me the most is how adaptable our bodies are - this wasn't a new concept, but certainly a helpful reminder and the article put it in words that I feel I could use with my clients. Weight gain will eventually plateau as your body now needs the "excess" calories to maintain the new tissue you've gained and allow you to "carry" it as you move around; weight loss will eventually plateau as it senses the calorie deficit and changes up our hormones, nervous system and muscles to conserve energy (plus you need less energy to move a lighter body around). In other words, your energy needs are constantly changing and you will need to consistently decrease your intake and/or increase your activity in order to keep losing weight - that's why people put weight back on so easily after a diet and they revert back to their old habits; it may have kept their weight stable when they were heavier, but after the weight loss that isn't their body's "setpoint" anymore.

So why is weight gain so easy and weight loss so hard? Although personal choices do play a factor, the authors conclude our environment makes it difficult to make good choices. Think about it - portion sizes at restaurants are bigger, which translates to bigger portions at home (because we've been trained that that's what's "normal"). Adding an extra 300, 600 calories a day is much easier than we realize - a blueberry bran muffin at Tim Hortons is 300 calories; a Mango Magic smoothie at Jugo Juice (5½ servings of fruit!) is 334. It's going to take decades to reverse the obesity epidemic and even longer (if not impossible) if we don't also change our environment to make it harder to gain weight.