The Need for Nutrition Education in Medical School Curriculum

Today’s post comes from Lindsay Leduc (& excerpt from Lee Rysdale). Lindsay is a Registered Dietitian and a medical student at the Northern Ontario School of Medicine. She is also the current Recruitment Coordinator of the CON-SNP National Executive. You can find more about Lindsay here


Many describe learning in medical school as trying to drink from a firehose. There are many things to learn and only a small amount of time to attempt to retain and consolidate an abyss of information. Unfortunately, one major constituent missing from said firehose is education on nutrition and weight management. We know that 60% of the factors that influence health and quality of life are related to lifestyle (1). We also know that many chronic diseases such as metabolic syndrome, diabetes, cardiovascular disease, hypertension, mental health, and so on are highly linked to nutrition and lifestyle, and yet, future of health care providers are not being adequately trained to address these topics and issues. We can proficiently describe the physiological basis of hypertension and prescribe the recommended antihypertensives, yet we are incompetent and uncomfortable giving the lifestyle and nutrition recommendations that are pertinent to our patients’ condition. There is currently a disconnect between our medical education and what patients really need from their health care providers.

https://www.timeshighereducation.com/news/opening-of-private-medical-school-delayed-after-gmc-raises-concerns/2015567.article

At first, I thought that this was an issue of our education being “outdated” and that the curriculum was behind the times. But I noted that we are on par when it comes to the newest medications available, imaging study technologies, and cancer treatments and biologics. Therefore, it is not the education, but the culture around medical education that needs an overhaul. Society looks very different than it did 30 or 40 years ago, yet we still value the pharmacological “quick-fixes” over re-evaluating the bigger picture changes that have occurred that need to be addressed.

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Canadian Obesity Student Meeting 2018: Expect the Best!

Today’s post comes from Nadia Browne. Nadia is a registered dietitian and a PhD student in the Department of Pediatrics at the University of Alberta. She is also the current Vice Chair of the University of Alberta’s CON-SNP and the Chapter Representative of the CON-SNP National Executive. You can find more about Nadia here! 


We are counting down the days until the 6th Canadian Obesity Student Meeting (COSM). The Canadian Obesity Student Meeting is a multi-disciplinary, bi-annual meeting organized by students, for students. This year, COSM will be held June 20-22, 2018 at Western University in London, Ontario, Canada with the support and collaboration of Western University, University of Alberta, and the Canadian Obesity Network.

By sharing knowledge and practical tools, COSM aims to enhance student growth and development. The meeting will focus on important advances in obesity research and provide opportunities for new professionals (5 or fewer years of completing your education) and junior researchers (e.g., student trainees, clinical fellows) from across Canada, the United States of America and overseas to present research findings and network with like-minded individuals.

For more information about the meeting schedule, click here. You can also follow the Canadian Obesity Network on Twitter to stay up-to-date with what’s happening.

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Including Food Security in Discussions of Weight

Today’s post comes from Casey Sobool. Casey is a dietetic intern at the University of Alberta. 


In discussing weight, it can be easy to blame individual choices and laziness as the culprit of weight gain. Socioeconomic factors are often left out of the conversation. Food security is one of the many factors that may impact a person’s weight. Food security exists “when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life,” (Food and Agriculture Organization, 1996).

http://africanleadership.co.uk/mauritania-ifads-u-s-21m-grant-to-boost-food-security-nutrition-and-reduce-rural-poverty/

In the Canadian Community Health Survey (CCHS) for 2007-08, 961,000 households were classified as food insecure (Health Canada, 2008). A higher prevalence of food insecurity was found in households with low income, single-mother households, households with children, recent immigrants, and indigenous households not on reserves (Health Canada, 2008).

 

While it would logically make sense that having unstable access to food would lead to lower intake of calories and a lower BMI, many studies have found the opposite to be true. Food insecurity was positively associated with overweight status in women when excluding the severely food insecure (Townsend, 2001). Mildly food insecure women were found to be 30% more likely to be overweight than their food secure counterparts (Townsend, 2001). One explanation for this higher weight in food insecure population could be that as money fluctuates throughout the month, so does food access resulting in a binge-type eating during periods of bounty and restriction-type eating when waiting for the next payday. It is well known that food restriction leads to overeating as the body compensates for the previous lack of energy and prepares for another period of restriction (Janet, 1994).

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Motivational Interviewing and Pediatric Obesity

Canadian Obesity Network

Today’s post comes from Nadia Browne. Nadia is a registered dietitian and a PhD student in the Department of Pediatrics at the University of Alberta. She is also the current Vice Chair of the University of Alberta’s CON-SNP and the Chapter Representative of the CON-SNP National Executive. You can find more about Nadia here!


Motivational interviewing (MI) is a collaborative communication style that can help to strengthen a person’s own motivation and commitment to change.1 It is patient-centered and designed to help people explore and express their own reasons for change. When people are ambivalent about making health-related changes, using MI can encourage them to have a conversation about their weight management goals and lead to positive behaviour change.2

To facilitate this behaviour change in pediatric obesity management, healthcare professionals (HCPs) trained in MI frequently incorporate these four core principles:3-5

  1. Express empathy through reflective listening
  2. Develop discrepancy between clients’ goals or values and their current behaviour
  3. Adjust to client resistance rather than opposing it directly
  4. Support self-efficacy and optimism

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Improving Your Health, One Step at a Time: Why Using an Activity Tracker May Help Reduce Prolonged Periods of Physical Inactivity

Today’s post comes from Andrew Hanna. Andrew received his Master of Science in Health and Rehabilitation Sciences from Western University. He is also the current Social Media Coordinator of the CON-SNP National Executive. You can find more about Andrew here!


It is well established that engaging in regular physical activity can improve various aspects of mental health and overall well-being including, but not limited to: improved sleep quality, reduction in stress related symptoms, depression and anxiety (Pederson & Saltin 2015). However, recent lifestyle changes in the Western world have caused an increase in sedentary behaviours, and often, many of us find ourselves seated for several consecutive hours throughout the day. This increased level of sedentary behaviour often can mitigate the benefits of regular physical activity and can lead to a phenomena known as the ‘active couch potato’, which is characterized by a person maintaining adequate levels of physical activity (minimum of ~150 minutes per week), however, also engage in prolonged periods of sedentary behaviours (Owen, Healy, Matthews & Dunstan, 2010).

http://garminforerunner.co/

While this population may meet (or exceed) the recommended levels of physical activity, the metabolic consequences of sedentary behaviour can be serious and may increase the risk of various chronic diseases (Owen et al., 2010). That being said, it is important to find ways to break-up prolonged periods of physical inactivity throughout the day.

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Leave Your Mark: Nutrition Labelling

Today’s post comes from Maryam Kebbe. Maryam is a PhD student in the Department of Pediatrics at the University of Alberta. She is also the current Chair of the University of Alberta’s CON-SNP and the Bilingual Communications Coordinator of the CON-SNP National Executive. You can find more about Maryam here!


What is nutrition labelling?

Nutrition labelling is information found on labels of all prepackage foods as mandated a decade ago in Canada [1].

What constitutes a nutrition label?

At a minimum, a nutrition label includes a (i) Nutrition Facts table (e.g., serving size, calories, 13 core nutrients) and (ii) ingredient list [1].

Why are nutrition labels important?

An unhealthy diet, normally characterized by consumption of foods high in saturated fat, sugars, and sodium, is a top risk factor for obesity, type 2 diabetes, high blood pressure, and heart disease. Nutrition labels provide us with the necessary information to make healthy food choices. By comparing and contrasting labels of different food items, we can make decisions on which products are a better option for our individual end outcomes, from limiting the amount of fat, sugar, and/or cholesterol to increasing the amount of fiber, calcium, and/or iron in our diets.

Health Canada has undertaken several initiatives in relation to food and nutrition; these include a revised Canada’s Food Guide [2] and now, a consultation on Nutrition Labelling. As part of the Healthy Eating Strategy for Canada launched on October 24, 2016, Health Canada is proposing mandatory front-of-package labelling for foods high in saturated fat, sugars, and/or sodium. The aim is three-fold: to (i) facilitate the process of choosing the healthy option by informing consumers of a product’s nutritional quality in a quick and easy way, (ii) help to improve the nutritional quality of packaged foods, and (iii) help health professionals educate consumers [3].

Specifically, Health Canada is seeking consultation on the ideal nutrition symbol for the front-of-package labelling of food packages in Canada. This consultation will remain open to the public until April 26th, 2018; you may take part online by clicking here.

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Weighing the Benefits of Scholarship Applications: What No One Tells Students

Today’s post comes from Melissa Fernandez. Melissa is a registered dietitian with a Masters in nutrition at McGill University. She is currently completing her PhD at Université Laval and is also the Vice Chair of the CON-SNP National Executive. You can find more about Melissa here


Thought Catalog

I’ve heard from many students that applying for scholarships is not worth the effort or time. Scholarships are often extremely competitive, and the time spent filling out applications outweighs the chance of winning an award. To the irritation of many, if they do manage to win any money, their supervisors reduce their stipends, faculties take away other awards or government bursaries are transformed into loans. For some, this entire process feels like a lose-lose or win-lose situation, and just ends in frustration. So, what’s a student to do? Here are a few lessons I’ve learned after years of applications.

Lesson 1: There can be a fine line between nothing and too much.

Find out the restrictions of your current scholarships, stipends and bursaries. Will winning a scholarship mean that other sources of income will be deducted? Find out if there are any limits for additional funding and how it affects your current and future financial situation. If you come out even in the end or worse off (yes, it can happen), discuss with your supervisor if scholarship applications are the best use of your time or if they are willing to compensate you in other ways.

Lesson 2: Have the awkward conversation.

It is never easy to talk about money, but it will save you frustration and maybe even resentment down the line. Find out exactly what your supervisor is willing to provide and not provide, and if winning a scholarship means it will just be deducted from your stipend (assuming you have a stipend). I have known many students who have been excited about winning a scholarship, just to see other sources of income disappear in the same amount. Do not be afraid to make requests or negotiate with your supervisor. Find out if your supervisor is willing to top off your scholarship, pay for a conference, special topics summer school or even your tuition.

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Health at Every Size (HAES) – What’s it all about?

Today’s post comes from Janae Gallant and Megan Lamb. Janae is an honours student in Psychology at Carleton University and Megan is the Resource Coordinator of the CON-SNP National Executive. You can find more about Megan here


Researchers, journalists, and YouTubers alike all have wildly different (and equally strong) opinions about the HAES movement and its underlying motivation. While I do not claim to be an expert, I think it is important to promote emerging evidence that health looks different on everyone, and that society’s long-standing ideal continues to be wildly unachievable. We’ll explore how HAES benefits both healthcare providers and patients in a clinical setting while dismantling its many harmful misconceptions.

HAES Promotes Obesity

Honestly, I’m not sure what this means. Claiming ‘obesity promotion’ implies a simplified – and I’ll say it – wrong – understanding of what obesity even is and how it comes to be.

To clarify, some factors that impact obesity are: environment, genes, mental health, medical comorbidities, medications, and sleep (Buchholz et al., 2013).

Notice that feeling good about your body, which is the bottom line that HAES promotes, is not even a so-called “cause” of obesity.

 

Figure 1. Medical and Mental health Status of Children and Youth with severe complex obesityBuchholz, Hadjiyannakis, Rutherford, Mohipp, Clark, Adamo, & Goldfield (2013)

 

Simplified understandings of obesity overlook the established fact that significantly altering your body composition is incredibly difficult, and that increasing exercise and restricting caloric intake will not lead everyone to thinness.

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Highlighting Women in Science: A new CON-SNP initiative

Today’s post comes from Amanda Raffoul and Melissa Fernandez. Amanda and Melissa are the current Chair and Vice Chair, respectively, of the CON-SNP National Executive. You can find more about Amanda here and Melissa here


As members of the CON-SNP National Executive, we have the privilege of connecting with SNPs (students and new professionals!) across Canada. This year, we had a goal to grow these networking opportunities beyond our current network and develop even greater opportunities for professional development among SNPs.

In Canada, there are profound differences in STEM (science, technology, engineering, mathematics) program enrollment between women and men.  Beyond this, there exists a “leaky pipeline” in academia – although there are more women than men enrolled in undergraduate degrees, their enrollment and academic status tend to decline through their careers.

At a recent CON event, we found that, within the organization’s network of professionals, there were some incredibly talented and wise women scientists. As two women SNPs ourselves, we found their advice was invaluable, and were inspired to share some of their words with other trainees. With some help from the rest of the National Executive, we reached out to women scientists in obesity across the country to answer the following question:

As a successful female scientist, what advice would you give to your early career self?

We are launching this initiative in honour of International Women’s Day, but will continue to post their responses throughout the next few weeks. Follow along with the hashtag #CONWomenInScience, and feel free to share our first few quotes!

(click images to enlarge)

Sincerely,

Amanda & Melissa

CON-SNP Chair & Vice Chair

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One Size Fits One

Today’s guest post comes from Ian Patton. Ian is the Vice Chair of the Canadian Obesity Network’s Public Engagement Committee. You can find out more about Ian here.


In mid-December I was asked to share my experience to a room full of obesity experts as we worked together to develop much needed new Clinical Practice Guidelines for the treatment and management of obesity in Canada.  It is my hope that we can create a set of guidelines that, while being clinically relevant and evidence-based, will empower the public and patients to drive the treatment themselves, making them aware of their options and enabling them to ask the right questions. From a population that has, in general, felt forgotten, belittled or ignored by the health care system, this is a breath of fresh air and a sign of hope that things will be changing for the better.

I am a three-year post-op gastric bypass patient who is passionate about eliminating weight bias and advocating for access to care while building a vibrant community to empower people living with obesity. I want to make sure that my children grow up in a world where body diversity is accepted, and clinical obesity is treated with the dignity and vigour of any other chronic disease.

My personal journey with obesity started in childhood.  I was the “fat kid” in school; I knew I was “defective” by grade two, because that is when the bullying began. Luckily for me, I was so active and competitive in sports that I grew to embrace my size and excelled where my weight was an advantage.

At my largest, I was over 350 lbs, a hypertensive with sever sleep apnea at the ripe old age of 30.  I was so far gone that I was waking up every morning thinking that “today is the day that the weight was going to kill me.” I literally felt as if the life was getting sucked out of my body.

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