Nutrition counselling is often about supporting people with habit change, whether it is adopting new habits, or letting go of ones that aren’t quite serving any more. It’s not uncommon for people to get “stuck”—a phrase that I hear often from my clients is “I know what I need to do, I just need to do it.”

If this sounds like you, here are three ideas to help you get “unstuck” and move toward sustainable self-care:

Contrary to popular belief, self-compassion isn’t “making excuses” or “letting yourself off the hook,” and for many, may actually be the missing ingredient to lasting habit change. My clients have shared with me that when they are feeling “stuck”, their self-talk can be quite “mean” or negative, like “You should know better,” or “Why can’t you do this?” Self-compassion is acknowledging that:

• Often our “bad” habits are still serving us in some way
• It takes time to unlearn behaviours and beliefs that are deeply ingrained
• There are external (sometimes systemic) forces that can influence our behaviour

Practicing self-compassion often means speaking to those parts of us that are sometimes left behind or ignored when we’re hyper-focused on change or “achievement.” It allows us to go from saying, “Why can’t you do this?” to “I know that doing this is comforting, and I’m ready to try something different.”

And sometimes, self-compassion can bring self-acceptance. For example, knowing that I’ve been struggling to go to bed earlier for pretty much my entire adult life (plus late adolescence, tbh) I’ve come to accept that I’m just a night owl

2. Remember Your “Why”

It’s not uncommon for people who are trying to heal their relationship with food to slip back into dieting thoughts and restrictive behaviours, partly because dieting isn’t all bad (see section 1) and diet culture is very good at shape-shifting and making itself seem very attractive.

In Intuitive Eating _{(Amazon affiliate link)}, authors Evelyn Tribole and Elyse Resch talk about “hitting diet rock bottom”—the moment that dieting is at its most hurtful, and you don’t see yourself dieting again. Sometimes recalling that moment, with all of its frustration, deprivation, and pain, can be a helpful motivator. Conversely, holding on to what you are working towards (and perhaps the benefits that you’ve already experienced) can be motivating also.

Some helpful prompts to consider:

• What made you decide to make this change?
• What are you trying to move away from in making this change?
• What are you hoping to gain/make possible?
• What, if anything, have you already gained in starting to make this change?

3. Review and Reflect

Goals are unfortunately not slow cookers—you can’t “set it and forget it”. If possible, plan for regular opportunities (monthly, weekly, or even daily) to pause and reflect, with compassion. This gives you the chance to celebrate and reinforce what’s working well, and also the opportunity to adjust, or perhaps abandon goals that are no longer serving you.

What are your thoughts on these tips? Have you tried some of them before? What are some of your strategies for habit change? Please share your thoughts in the comments below.

These foundations and the pyramid image are inspired by Satter’s Hierarchy of Food Needs, which is in turn inspired by Maslow’s Hierarchy of Needs, which is in turn inspired/stolen from Blackfoot ideas.

Why is “Healthy” in Quotation Marks?

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The perfectionism in the statement makes health inaccessible to most, if not all, people.

By putting quotations around the word “healthy,” my hope is to invite people to define the word in their own way that makes it more accessible to them, if attaining health is one of their goals. For example, the Association for Size Diversity and Health (ASDAH) describes health as “exist[ing] on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living.”

Although I would guess that most people reading a dietitian’s website are probably looking to improve their health through food and nutrition, it’s important to note that it doesn’t have to be a goal for everyone—health is not a moral imperative.

The 4 Foundations in Detail

1. Food Security and Clean Water Supply

It would seem obvious that in order to eat “healthfully,” you would need to “have physical and economic access to sufficient safe and nutritious food” and clean water. However, you may be surprised by how even some public health groups seem to want to jump past this foundation and recommend certain types of foods over others when people aren’t getting enough food and fluids in the first place.

By placing food security and access to safe and clean drinking water at the base of the pyramid, I hope to underscore that “healthy” eating is not just about food or individual behaviour, but also about systemic concerns. The lack of a safe, clean water supply is an ongoing issue for many First Nations within Canada’s borders.

Additionally, the importance of fluid intake is sometimes ignored when we talk about nutrition. You may have heard before that while we can survive weeks without food, we can only survive days without water. Our bodies are ~70% water, and so adequate fluid intake (whether it’s through water, other beverages, or even fluid-containing foods like fruits and vegetables) is important to ensure all the biological functions in our body run smoothly.

2. Regular Eating

Eating regularly throughout the day helps to give your body the fuel that it needs to get through the day, and maximizes your chances that your nutrition needs are met. Though there has been an increase in research on the potential benefits of intermittent fasting over the past few years, most of it is short-term and often doesn’t consider the longer-term psychological effects of food and calorie restriction.

I struggled with the wording of this foundation, as I know “regular” is often regarded as a synonym of “normal” (though I do appreciate Ellyn Satter’s definition of “normal eating“.) I also know that the word “regular” can imply eating at the same times/intervals throughout the day, though that is not the expectation.

What about “eating according to hunger cues”? While that works very well for some and is aligned with intuitive eating, it’s not accessible to all—responding to hunger cues may not be available for people for a number of reasons, including neurodivergence, GI surgery, a long history of dieting, or simply the way that a person’s day is structured.

In practice, for those who are just starting, or getting back to eating more regularly, I often recommend planning to eat in regular intervals at first, and using those times as external cues to check in on your internal cues. With time, experimentation, and practice, you may find what “regular eating” looks like for you.

3. Variety of Food Choices

Eating a variety of foods again maximizes your chances of meeting your nutrition needs, and in some cases, many of the nutrients can “work together” to improve health and well-being. Furthermore, meals that provide a variety of colours, flavours, and textures can help increase satisfaction.

While I’m trying to shed the stereotypical dietitian adage of “choosing at least 3 of 4 food groups at every meal” some people do find planning to include a vegetable/fruit, grain/starch, and protein-rich food or a combination of the three macronutrients (carbohydrates, protein, and fat) helpful guidelines when thinking about what variety can look like from a nutritional perspective.

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4. Individual Needs

Though this foundation is at the very tiny, tip-top of the pyramid, it is doing a lot of heavy lifting. In addition to “health needs”, this section encompasses needs and desires based on culture, preferences, lifestyle, and so on. Similar to the “instrumental foods” level of Satter’s Hierarchy of Food Needs, there is a tendency to focus on this section when we talk about nutrition, but without building a solid foundation in the other sections of the pyramid, it makes it more difficult to ensure that individual needs are met.

Why is the pyramid curved at the bottom?

The unique shape of the pyramid is to highlight that nutrition is just one piece of the larger health “pie”. It’s important to note that the image above is not to scale (my Canva skills are limited ); nutrition might be an even smaller contributor to our health than what is depicted. Factors outside of individual control, such as social determinants of health and genetics, often have a far greater influence on health than individual behaviour.

What are your thoughts on these 4 Foundations of “Healthy” Eating? Is there anything that you would add or take away? Please share your thoughts in the comments below.

Personally, I still appreciate the change in the calendar year as a cue to pause, reflect, and think about what I’d like to experience in the year ahead.

What’s wrong with resolutions to “lose weight” or “get healthy”?

The most common arguments against these types of resolutions are that they’re too vague, or that weight loss/dieting doesn’t work. But more importantly, they uphold stigmatizing beliefs about weight and health. I could go on, but journalist Alia E. Dastagir summarizes it all in the article Why you should rethink weight loss as a New Year’s Resolution

If not weight loss, then what?

There is so much more to new year’s resolutions than health and weight—relationships, career, finances, or learning a new skill are all areas that you can set goals around. Even if you would like to work on improving your health in the new year, there are so many ways to address that desire beyond diet and exercise.

Lindley Ashline of Body Liberation Photos has put together a lovely roundup with quotes, ideas, and other resources for resolution/intention/goal setting. While this wasn’t my original intention when I started writing this blog post, I have a few more resources to add:

• The resource that I typically use is the end-of-the-year worksheets from Ink & Volt. This year’s worksheets look a bit different from previous years, so I will probably give them a try again. They also have a list of new year’s resolution ideas that aside from a mention of “lose weight” as a common new year’s resolution in the first sentence are not very diety, but many of the suggestions require a certain amount of ability/privilege. 
• I was recently pointed to YearCompass, which is a free download (you can choose printable or digital). The questions there also look interesting, so I am planning to give this a shot as well.

More inspiration…

If you’re looking for some inspiration, here are some Instagram posts that I enjoyed:

Are you setting any resolutions/intentions/words/goals for the year ahead? Please share your thoughts in the comments below.

After putting my daughter in part-time daycare back in February, I was hoping I could spend more time in my private practice—seeing clients, launching the Weight-Inclusive Dietitians in Canada education platform, getting back to blogging and social media. Of course, like the rest of the world, COVID-19 put a wrench in my plans.

I know I’m fortunate in many ways. I don’t personally know anyone who has contracted the virus, my husband and I still have our jobs, our pantry is well-stocked and we’ve been able to get everything that we want and need. Still, like everyone else, we haven’t been able to escape the uncertainty, anxiety, stress, and panic that has come with this pandemic.

Now that I’ve finally been able to carve out a few moments to write, I feel like I don’t have anything to say that hasn’t already been said. There are already so many brilliant posts about:

• Why it’s normal and OK for your eating habits to be different right now.
• Why the “COVID-15”, “COVID-19”, “COVID-25” jokes are fatphobic and honestly should be the least of your worries when people are literally dying.
• Why BMI is not a risk factor for getting COVID-19 or having more severe symptoms.
• Why washing your fruits and vegetables with anything other than water might NOT a good food-safety practice.
• Why it’s OK to not be productive during a freakin’ pandemic.

So let me start by asking: How are you? Have you had a chance to check in and have a moment to yourself these past few weeks? Maybe you haven’t out of necessity—perhaps you are a front-line worker, perhaps you’re caring for others, or perhaps that how you care for yourself. Or maybe you have been checking in regularly, though it never hurts to get an extra nudge as a reminder and affirmation.

Wherever you’re at, if it’s safe to do so, I invite you to take a deep breath and check in. How do you feel? Are you noticing any discomfort, or tightness in your body? Resist the urge to fix, or to get rid of it just for a moment, and allow yourself to notice. When we live in a culture that encourages us to suppress, hide, or fix anything “negative” or uncomfortable, sometimes noticing and acknowledging the messages from your body—your inner wisdom—is enough.

If you’re at a place where you’d like to make a change, ask yourself: What can I do to get closer to having my needs met with the resources I have right now? Maybe it’s continuing to breathe and rest, getting a glass of water, going outside or opening a window for some fresh air, fixing a snack. Whatever you decide to do (or not do), be compassionate with yourself. It doesn’t have to be perfect, because we aren’t perfect.

#SelfCare question: What can I do to get closer to having my needs met with the resources I have right now? Whatever you decide to do (or not do), it doesn't have to be perfect, because we aren't perfect
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It’s OK if you still feel like you’re floundering. It’s OK to feel like you’re not doing enough, or that you’re a few steps behind. This is true at any time, but especially during these unprecedented times. We’re all trying our best in our own way.

For some folks it’s about keeping busy as a way to distract, to numb, or to feel a sense of accomplishment or normalcy during these difficult times. For others, any suggestion of work or productivity can feel overwhelming and paralyzing. For some, it’s closing in and keeping to themselves. For others, it’s lashing out because they don’t know what to do with their emotions. 

We’ve all been touched by this pandemic in some way (hopefully not by the virus itself.) It’s OK to not have it all together. Just surviving—and washing your hands and social distancing—is enough.

It's OK to not have it all together. Just surviving (and washing your hands and social distancing) is enough. #COVID19
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If I may ask again, how are you? Please share your struggles, fears, successes, and insights in the comments below.

For the past few years, I’ve purchased a tea advent calendar to help me count down the days to Christmas. This year, I’ve noticed something different. Whereas in the past, I usually drank the tea plain, this year, I find myself adding sugar (and sometimes milk) to most of the teas.

Perhaps it’s because I grew up drinking Chinese and Japanese teas, which normally don’t have sugar added, or perhaps it’s because it was for convenience—I would often take my tea to-go in my Bodum travel mug _{(Amazon Associates link)} which has a French press apparatus built in the lid, so if I didn’t add the sugar before, then it would be a bit of a mess trying to pull the lid off. But I can’t help but wonder if part of it too had to do with “being healthy”.

“Dietitian Guilt”

I’ve always had thin privilege and have never attempted to lose weight. Still, intuitive eating was something I had to learn; like the vast majority of us living in diet culture, I can think of many examples of where I ate based on external cues, such as “not wanting to be wasteful”, “getting my money’s worth”, and of course, “health”. In my case, there’s the added layer of wanting to be a “good dietitian” and “practicing what I preach.” With intuitive eating I’ve been actively questioning some of these beliefs, but even now something feels “off” if there are no vegetables in my meal.

Trying a different tea every day has brought my relationship with sugar to the forefront. While in the past I would’ve just drank the tea plain and told myself that’s how the tea is “meant to” taste, giving myself permission to add sugar has made most of the teas more enjoyable. And really, given that tea with milk and sugar is the norm in Western cultures, perhaps that is actually how the tea is meant to taste.

Food freedom is giving yourself permission to add sugar (and milk!) to your tea.
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What small “aha” moments have you come across as you practice intuitive and/or mindful eating? Please share in the comments below.

You’ve probably heard at some point in your life that meat is “bad for you” at some point or another. In fact, just a few years ago, red meat and processed meats were named “carcinogens” by the World Health Organization. So it may come as a surprise then, that a new set of guidelines coming from an international panel of scientists are saying the amount of meat we’re eating (about 2-4 servings per week) is OK. So what gives?

What the Actual Guidelines Say

Despite what carnivore, keto, LCHF, and Paleo proponents would have you believe, the guidelines do not recommend an all-out meat diet. Instead, they say:

“The panel suggests that adults continue current unprocessed red meat consumption (weak recommendation, low-certainty evidence). Similarly, the panel suggests adults continue current processed meat consumption (weak recommendation, low-certainty evidence)”

In layperson’s terms, this is essentially saying, “You do you… I guess?” Which is based on a very literal, albeit a bit unhelpful, interpretation of the existing research. But in our current environment (aka diet culture), it seems like if you’re not demonizing the latest “bad food du jour,” then you’re seen as “irresponsible” at best, and at worst, accused of killing people and worth suing over.

How Did These Guidelines Come About, Anyway?

The guidelines are based on five systematic reviews: four looking at meat consumption and health risk (specifically, heart health, cancer, and all-cause mortality) and one looking at why people choose to (or not to) eat meat. The overall questions that the panel was trying to answer were:

“1) Among adults, what is the effect of diets and dietary patterns lower in
red or processed meat versus diets higher in red or processed meat intake on the risk for outcomes important to community members? and

2) What are their health-related values and preferences for red and processed meat consumption?”

The systematic reviews included observational studies and randomized controlled trials that looked at people with varying degrees of red meat and processed meat intake for at least six months.

In the end, the reviews had similar findings as existing research, noting that decreasing intake of red meat and processed meat can lower your risk of heart disease and cancer, but the effect is very small (For example, if 1000 people decided to have three fewer servings of red meat per week, four fewer people would die of heart disease over 10.8 years, compared to if their diets stayed the same) and the evidence is weak.

Why Would the Guidelines Recommend Something Different if the Research is the Same?

Nutrition science is hard. Most studies are observational, meaning they look at people with different eating patterns (in this case, high vs. low red or processed meat intake) and see what happens to them over time. Observational studies can only show correlation, not causation. But to design a study to prove that red meat or processed meat causes disease, it would be expensive (heart disease and cancer are diseases that take a long time to develop, so the study would need to go on for a long time) and probably unethical (the lives, let alone the diets, of the people would need to be tightly controlled in order to prove that it was meat, and not something else.)

This is potentially one of the reasons for the differing recommendations—some have criticized the guidelines’ emphasis on the “quality” of the evidence when it is really difficult, if not impossible, to produce high-quality nutrition research.

Another criticism is that the reviews focused on the effects of what the authors considered a “realistic reduction in meat consumption”, which was defined as a decrease of three servings of meat per week, as opposed to say, comparing omnivores with vegetarians/vegans, which could have led to more significant results.

Finally, the panel did not consider animal welfare and environmental impacts of eating meat, stating that they were “outside the scope” of the review, and also did not give a lot of weight to cost, accessibility, and equity.

So… Is it OK to Eat Red Meat or Processed Meat?

There are lots of reasons why people choose to eat, or not eat, red meat, processed meat, or any other food for that matter. As a dietitian whose practice is informed by intuitive eating, mindful eating, and Health At Every Size®, I emphasize body autonomy and “gentle nutrition”. In other words, guidelines like this can help inform our decision, but shouldn’t be seen as the be-all-end-all. Trying to eat according to the latest research can only lead to frustration, especially when our other values are thrown to the side as a result. So if we go back to my initial interpretation of the “guidelines” as saying, “You do you… I guess?” Then I guess you could say that I agree with them.

Do you eat red or processed meat? Why or why not? Had you heard of these new “guidelines”? Please share your thoughts in the comments below.

Though I’ve been lucky that breastfeeding has generally gone smoothly for my daughter and I, it’s certainly not picture-perfect. She’ll sometimes come to the breast when she’s not hungry, falling asleep after a few shallow, lazy sucks. Other times, she’ll pop off the breast during a feed, only to start rooting and crying for it again seconds later. Even though she’s only weeks old, she’s taught me a lot about intuitive eating.

1. Intuitive Eating is Not About Hunger and Fullness

Many people who are new to intuitive eating often think of it as “eating when you’re hungry, and stopping when you’re full,” which Isabel Foxen Duke calls “The Hunger & Fullness Diet”.

Can a newborn baby really tell what hunger and fullness feel like? My first reminder that breastfeeding is not just about nutrition was when the nurse in hospital told me that my baby probably wasn’t actually feeding for 45 minutes, and once she stopped the strong, “nutritive” sucking, she was really just using me as a pacifier. The next reminder came at my Birth & Babies class, where we learned that a baby might feed more or refuse to eat in response to reflux—more because it can help soothe the pain, or refusal because it is too painful—just as in adults.

This has led me to believe that babies aren’t always responding to hunger when they’re feeding. Instead, it’s about responding to discomfort. This is actually in line with what Evelyn Tribole and Elyse Resch write in Intuitive Eating, _{(Amazon Associates link)} “finding satisfaction in eating is the driving force of this process”, going on to describe satisfaction as “The Hub of Intuitive Eating”.

#IntuitiveEating is not about eating when you're hungry and stopping when you're full. It's about finding satisfaction in eating, whether it's physical or emotional.
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2. Emotional Eating is Natural and Normal

Breast milk is a nutrition powerhouse, but like all food, it is more than fuel. Whether a baby is breast-fed or bottle-fed, the act of sucking has a calming effect. So much so, that it can be used as a form of pain relief for infants. Breastfeeding is also an opportunity for mom and baby to bond. We can’t separate the act of eating from the food itself; returning to the idea that a baby breastfeeds as a response to discomfort, breastfeeding is emotional eating. Similarly, if the goal of intuitive eating is to find satisfaction, that is driven by emotion as well. That is why the idea of stopping emotional eating is unrealistic; virtually all eating is emotionally driven to a certain degree.

We can't stop emotional eating because all eating is emotional.
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3. Diet Culture Shows Up From Day 1

I used to believe that babies were immune to diet culture, but I quickly learned that we can interfere with their intuition from day 1. Because my daughter had lost more than 10% of her body weight in hospital, I was placed on a feeding plan when she was only three days old! (Fortunately, my milk came in that day and she managed to gain 150 g literally overnight, so I was taken off it the next day.) Of course, recommendations like feeding 8-12 times per day are sometimes necessary to ensure baby is getting adequate nutrition, but there were other comments that were made during my daughter’s first few days of life that gave me pause.

Remember that nurse who told me that my baby was just using me as a pacifier? She also instructed me to unlatch my baby as soon as the strong, nutritive sucks ended. It wasn’t until later that I learned comfort nursing is a thing, though not before a lactation consultant suggested that frequent spit-ups were a sign I was “overfeeding” my baby. Even now, I sometimes question myself on whether I should feed my daughter when it “hasn’t been long enough” since her last meal. It really goes to show how insidious and invasive diet culture messaging can be!

Have there been instances where you’ve learned intuitive eating lessons from an unexpected place? What was the situation and the lesson? Please share in the comments below.

Mindfulness and mindful eating often get a bad rap for being “new age” or “woo-woo,” but a growing body of research is showing there are many benefits to a mindfulness practice in modern life. Whether you are planning to engage in a formal practice like meditation or mindful eating, or simply wanting to bring more mindfulness in your day-to-day, here are some principles to help you anchor your practice.

1. Press Pause and Be Present

Most of us live our lives at breakneck speed, always thinking of the next step and wearing “busy” like a badge of honour. Mindfulness is an invitation for you to switch gears; temporarily let go of thinking about the past or the future, and focus on the present moment.

You might find it helpful to create a small ritual, like moving to a specific location or taking a few deep, cleansing breaths, as a way to signal to yourself to begin your practice. A mindfulness bell app, like Lotus Bud or Mindfulness Bell on iOS or MindBell on Android, can be set to ring randomly throughout the day as a reminder to “press pause” throughout the day.

During the practice, it’s normal to notice your mind wandering off to another thought throughout the practice. Simply “press pause” and bring yourself to the present again.

#Mindfulness Practice Principle 1: Press Pause and Be Present. Read on for three more:
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2. Curiosity, not Judgment

As we go through life, we bring with us our years of lived experience and education. This serves us by making our lives richer and more efficient—if we had to learn everything all over again every day, we wouldn’t get anything done!

In the context of mindfulness and mindful eating, our personal catalogue of experiences can hold us back. For example, we might be so used to eating in a certain way that it can be hard to change, or perhaps we’re used to eating some foods so much that we don’t think to take the time to really taste and enjoy them. Invite yourself to enter the situation as though you were a child, alien, or scientist (or child alien scientist!). The new perspective may help you let go of your preconceived notions and be present in the situation.

#Mindfulness Practice Principle 2: Curiosity, not Judgment. Read on for three more:
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3. Sensing, not Slowing.

When I first learned about mindful eating, I was taught to set a timer for 20 to 30 minutes and try to stretch my meal to last that time, or put my fork down between bites to slow my eating. This might be a helpful introduction for some, but the unintended consequence is that often people think “mindful eating” is simply “slow, undistracted eating,” and they miss the real reason behind slowing down. (Hint: It’s not so that you “eat less” and “lose weight.”)

The purpose of slowing down is to give you the opportunity to use your senses to experience each moment. What do you see, hear, smell, taste, and feel in your environment and in your body? Allow yourself to cycle through each sense from moment to moment. At the same time, you may notice different thoughts and emotions coming up. (Contrary to popular belief, the goal of mindfulness is not to “clear your mind” and think or feel nothing.) Some people may find it easy to cycle through their thoughts and emotions in addition to their senses, while others may want to simply focus on their physical sensations. Either way, the practice lies in being in the present, whatever that may mean or feel like, and over time, you might find that you don’t need to slow down to get the information you need.

#MindfulEating isn't simply "slow, undistracted eating." These prompts are there to give you the opportunity to use your senses to bring you to the present. Read on for 3 more #mindfulness practice principles:
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4. Practice, not Progress

I used to call this principle “practice, not perfection,” but I feel that even the expectation of progress and becoming a “better mindful eater” can be ways that pull us from the present moment.

I’ve written before that we live in a culture that discourages us from “learning for the sake of learning;” instead, learning is often about achieving milestones, getting good grades, bettering ourselves, and so on. As a result, it can be easy to get caught in the trap of thinking that you’re not “getting it right.” Mindful eating is not like a diet where there are set rules, restrictions, and a clear definition of “right” and “wrong.” Instead, you’ll be trying to undo lots of ingrained habits and beliefs that are often reinforced by society.

Returning to Principle #2, Curiosity, not Judgment, what would it be like to practice mindful eating without any expectation of an outcome?

#Mindfulness is an ongoing practice—holding progress as a "goal," let alone "perfection," can actually pull you away from being fully in the present moment.
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Do you practice mindfulness, either formally or informally? Please share your insights, thoughts and questions in the comments below.

Last week, the journal Cell Metabolism published a study on the effect of ultra-processed foods on weight. If you were only to look at the media and “nutrition Twitter,” you would’ve thought they’d found some sort of smoking gun. Science quotes a researcher (not involved in the study) calling it “a landmark first,” while Gizmodo claims that it “confirms your worst suspicions about processed foods.” Sociologist Sarah Bowen tweeted, “Michael Pollan is vindicated; processed foods seem to be bad.”

So what does the study really say? Do we really have to swear off ultra-processed foods forever, or is this yet another case of the media misrepresenting the science?

What Actually Happened in the Study

While the research on ultra-processed food thus far has been based on observational studies—in other words, observing people’s eating patterns along with different outcomes and trying to draw correlations—this study is the first clinical trial to compare an “ultra-processed” diet with an “unprocessed” diet.

Twenty adults (10 men, 10 women) were admitted to a metabolic ward for 28 days—half of them ate an “ultra-processed” diet for two weeks, while the other half ate an “unprocessed” diet, and then they switched for the remaining two weeks. “Ultra-processed” and “unprocessed” were defined based on the NOVA system.

For both diets, the meals were presented three times a day, and people were given an hour to eat however much they wanted. Snacks for the day were placed in boxes in each subject’s room, so they could have them at any time. Both diets provided a similar amount of calories, carbohydrates, fat, and protein. The meals were also matched for fibre, sugar, and sodium, but this was not the case for the snacks—the unprocessed snacks, which were basically fruit and nuts, were much higher in fibre and sugar, while the processed snacks (Goldfish crackers, baked chips, applesauce, etc.) were much higher in sodium. Overall, the ultra-processed diet was higher in saturated fat, added sugar, and insoluble fibre, and lower in omega-3s compared to the unprocessed diet as well. Photos of meals and snacks from both menus were included in the study.

In the end, the subjects tended to eat more while on the ultra-processed diet than the unprocessed diet in terms of calories, carbohydrates, and fat, and they also tended to eat faster. While on the ultra-processed diet, average weight gain was 0.9 kg (2 lb), and with the unprocessed diet, average weight loss was 0.9 kg (2 lb). The change in weight was about half from body fat and half from fat-free mass in both cases, and the researchers noted that fluid shifts due to the differences in sodium in the two diets likely played a role.

Subjects rated their hunger, fullness, satisfaction and appetite similarly between the two diets; pleasantness and familiarity of the two diets were given similar ratings as well. Energy expenditure, blood glucose levels, and insulin sensitivity were not statistically different between the two diets either.

What the Study Doesn’t Say

We don’t really know why the subjects ate more calories and ate faster on the ultra-processed diet compared to the unprocessed diet, but that hasn’t stopped people (including the researchers) from blaming it on the processing. In terms of eating speed, this makes sense—processing can make foods easier to eat and digest. Looking at the photos of the meals, I can imagine it taking less time for me to eat a sandwich on white bread than chewing through a large, leafy salad.

One thing that I find interesting is that the amount of food eaten by the subjects was reported as calories, not volume. When I compare the meals between the two diets, it looks like there is a lot more food in the unprocessed meals in order to be able to match the amount of calories and nutrients available.

For example, here is lunch on Day 4 for the ultra-processed and unprocessed diets, respectively (which Science conveniently put side-by-side):

While I personally could see myself eating the two hot dogs with the condiments, drinking the juice and eating some (if not all) the chips and yogurt, the lunch on the right looks overwhelming to me, and I would likely end up leaving a bit of everything, so I definitely wonder how food volume and/or the way the food was presented might have played a role.

On a related note, even though the study title claims that this was ad libitum intake, the meals were provided at set times and subjects were given a limited (though generous) amount of time to eat. Could this structured eating schedule have affected intake, especially given the larger volumes of food presented in the unprocessed meals?

Finally, although subjects with active eating disorders or strict dietary concerns were excluded from the study, I wonder how disordered eating or relationship with food (i.e. internalized food rules) might have affected what and how much was eaten.

What Does This Study Mean for the Real World?

Even the study authors admit that “the inpatient environment of the metabolic ward makes it difficult to generalize [the] results to free-living conditions” amongst other limitations, like the small number of subjects, the short length of the trial, the lack of a run-in period before the study, and the lack of a washout period between diets.

What upsets me the most about how this trial has been picked up by the media is the way that it has perpetuated fatphobia and demonization of foods. Headline after headline claims that this study proves that “ultra-processed food makes us fat” or “causes obesity”. The average baseline weight of the participants was 78.2 kg, so a 0.9 kg increase represents a 1% weight gain. The subjects were considered to be “weight stable” at baseline, which was defined as a < 5% weight change within the past six months. Even though the change in weight seen in the study was statistically significant, it would not be considered to be clinically significant. It should also be noted that the study didn’t show any significant changes in health between the ultra-processed and unprocessed diets.

What also worries me is that this study could be co-opted to justify mindful eating as a weight loss intervention. One of the most common misconceptions of mindful eating is that it’s about eating more slowly. In The Mindful Eating Workbook, I talk about the idea of “sensing, not slowing.” Mindful eating is defined as being aware of the eating experience, without judgment. Though many people end up eating more slowly in order to help them engage their senses to become more present, it isn’t absolutely necessary to eat slowly in order to be mindful, and mindful eating is meant to be a weight-inclusive practice.

While I respect that this study is the first of its kind, I think it’s too early to say that it has proved anything, let alone drive any changes in practice or policy. Even if down the road a more powerful study with more subjects, a longer intervention, and better-matched meals really showed that ultra-processed foods were detrimental to health, the solution shouldn’t be about telling individuals to avoid ultra-processed foods. Many (including the study authors) have commented that the financial and time cost of adopting an unprocessed versus ultra-processed diet may make it out of reach for many folks; the authors estimate that the weekly cost of ingredients would be $106 for the ultra-processed diet, versus $151 for unprocessed—a difference of over 40%. And we haven’t even gone into the psychological and behavioural consequences of deprivation, or looked at eating patterns that fall between the two extremes.

Solutions that would actually make an impact on people’s health will likely require systemic and societal change that addresses issues like poverty and oppression.

The 'best diet' can't truly improve health if it doesn't also address poverty and oppression.
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What are your thoughts on this study, and will it change the way that you eat? Have you changed your eating habits before as a result of a reading a study or article? Please share your experiences and insights in the comments below.

Not Knowing What to Eat Might be a Sign of Perfectionism

Last month, I wrote about how perfectionism can sometimes get in the way of eating intuitively, and I would argue that this is one of those ways that it shows up. While you might not identify with being a perfectionist per se, the idea that there might be a “right” or “wrong” way to eat, or the expectation that you “should” know what to eat, is rooted in perfectionistic thinking. Just as it is with babies, fed is best.

Here are a couple ways to help you break through the perfectionism, and just feed yourself already:

2 Strategies to Help You Decide What to Eat When Eating Intuitively

1. Just Eat It

Assuming that you have some access to food that is safe and not something that you’re allergic to, go ahead and eat as much of whatever is available until you decide it’s time to stop.

Then, get curious. What are the sensations that you notice in your body? Did eating the food change your level of hunger or fullness? Do you notice any other sensations?

Next, shift your focus to the thoughts that are coming up—often I find when people “don’t know what to eat,” they are concerned that they are choosing a food that doesn’t fit with cultural norms of what “should” be eaten, or they’re worried that while the food may be satiating, that it won’t be satisfying. Notice if either of those stories are coming up for you, or other thoughts and emotions altogether. Remember that there is no right or wrong answer—every time you eat is an opportunity to gather information that can help you learn more about yourself, and perhaps help guide the decisions that you make around food next time.

It may feel a bit frustrating or chaotic at first, but the more that you learn about what’s satisfying for you, and works with your lifestyle, it will help ease the decision-making over time.

2. There’s More to What You Want Than Your Tastebuds

When it comes to “what we want to eat,” often we rely on our “cravings,” which are usually based on taste. So when we don’t feel like we’re craving anything, it can be easy to say that we don’t know what to eat. This is also why I say that intuitive eating is more nuanced and complex than “eating whatever we want,” because what I really mean is, it’s more than what our tastebuds want.

Intuitive eating is about "eating whatever we want," remembering that *we* are more than our tastebuds.
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How do we know what we want beyond our tastebuds? There are lots of different strategies out there. For example, under Principle #6: Discover the Satisfaction Factor of The Intuitive Eating Workbook _{(Amazon Associates link)}, there is an exercise that walks you through thinking about taste, texture, smell, temperature, appearance, and amount of food would be satisfying in a given moment.

Another framework that I’ve shared with clients is Mindful Eating, Conscious Living co-creator Jan Chozen-Bays’s Nine Hungers: eyes, ears, nose, mouth, touch, stomach, cells, mind, heart. (Sorry, I’m not providing a link to this as I’ve found many parts of her work and the program, including the one blog post I found on the nine hungers, to have fatphobic elements.) Perhaps you might want to come up with your own list of questions, or an acronym to prompt you to attune to various cues in your body when it comes to deciding what to eat.

With that in mind, while this strategy might help you figure out what you want to eat, you might realize that what’s available doesn’t quite meet your needs. This is completely normal. Try to choose what will best meet your needs right now. Again, there is no right or wrong answer, rather another opportunity to get curious and gather information.

Have you struggled with not knowing what to eat when you let go of food rules and started eating intuitively? What strategies were helpful for you? Please share your thoughts and insights in the comments below.