I Can See Clearly Now the Fog is Gone

This morning I was revamping my research proposal, which actually should have been submitted weeks ago but since I was having some issues with it, I refused to do so until I was happy with it. I know understand why I was having such intense issues - I wasn't seeing the bigger picture. 

Prior to this revamping, I had an epiphany whilst chatting with my fiance, Kevin. I asked him to describe to me the current state of the economy so I could better understand what has and is going on economy-wise in Canada and in Nova Scotia (Kev's my finance guru). This discussion was what I needed to understand - and I mean completely understand - the trials and difficulties with getting schools and people to comply with the Food and Nutrition Policy for NS Public Schools. 

An insane 40% of chronic diseases including obesity, cancer, cardiovascular disease, and type II diabetes are largely preventable through diet and physical activity. However, simply recommending healthy eating and physical activity will not benefit the population as there are underlying factors that inhibit healthy eating and PA. Geography, demographics, socioeconomic status, employment status of families, single parent households, etc. all contribute to the ability of families everywhere (not just NS) to be able to provide healthy foods and safe environments for physical activity. This is why the SFNP is so important! It ensures that for one meal a day, children who might otherwise not have the opportunity to eat healthy, nutritious foods, get this chance! This allows them to benefit from these nutrients and hopefully helps contribute to their healthy development and the possible reduction of the development of chronic disease later in life through developing health habits at a young age. 

Prior to my discussion with Kev, I was aware of the above predicament, but it wasn't until I was explaining why I wanted to know about the GDP and economic state of Canada (and the world in general) in regards to my research project, that I actually understood the importance of considering the big picture. 

Such an amazing feeling to finally have the mental fog cloud lifted.

Food Service Assessment Numero Tres

Yesterday was a very early morning which started with a pick-up by my fellow assessor at 6:30am to allow for our long commute towards the western coastal region of the SW Nova District Health Authority. It was an absolutely gorgeous drive and I loved seeing a part of the province I hadn't traveled to before.
Surreal landscape and ocean views.

An Aside:
From a comment I received a la Barb (a professor and the person who challenged me to reflect on a regular basis) who suggested that I clarify the parameters for my declaring how well a FS assessment went in each school - and I completely agree. So before I continue with this post, allow me to specify my parameters for the past and future FS assessments, as yes, if you can't read my mind - and I certainly hope no one can! - then how are you to know?

For a school to be reviewed in a positive light on this blog, it is based simply* on how well the FS assessment (and our presence observing their jobs/routine) was received by the FS worker, principal, and others we come in contact with - positively, negatively, or neutrally. Of course, the FS worker would have the greatest impact on how smoothly or how rough the FS assessment goes as we have the most direct and frequent contact with him or her. A FS worker who is simply nervous, timid, or unsure of how to respond to our presence tends to respond well when rapport is developed (asking about his or her family, how long they've been working in this position, sharing stories with them - I have found that tossing the "I'm getting married" frisbee in casually has loosened 2 out of 4 FS workers up and made them feel more comfortable with me).

*the term "simply" is used to refer to the fact that the parameter of this blog (not in the formal report or outlined in the official assessment results) consists of the attitudes of the person who was involved in the FS assessment at each school and not on other factors - as all the schools being assessed were identified as needing immediately help complying to the policy, so it can be assumed that the menus need some tweaking. "Simply" does not imply ease as building rapport and questioning/observing someone's job is these are neither easy nor simple, but rather complicated undertakings that require a certain delicacy in our approach as assessors.

For a negative (or "it didn't go well") designation, the FS worker may have been hesitant, reluctant, or showed outward irritation that we were there AND that this affected how well we were able to extract information from him or her and effected the flow of the assessment. I found that in schools, so far, where our presence was met with resistance or disdain (which are vastly different from nervousness as observed in a positive/smooth FS assessment), we found that getting thorough and detailed information was very very difficult and could have, in actuality, affected the outcome of the assessment. A FS worker who is already angry, irritated, or offended that we were assessing the school food service that they work in, will not be ass receptive to rapport making the FS assessment a true challenge when it need not be.
End Aside.

So, with the basics outlined above, the FS assessment yesterday was unpleasant and frustrating for me at times. Upon arrival we were overall very well received by the FS worker, admin assistant, and the principal. However, the questions we asked - even though they were neutral in nature and said with an inquisitive tone/phrasing rather than judgemental (which would have gotten us nowhere) - quickly caused an irritation with the FS worker. When I noticed this I waited until the FS worker was out for recess duty then discussed it with my fellow assessor. I was curious to know if a) she noticed it too, b) if it was the way I was phrasing the questions or through non-verbal communication, and c) how she felt we should proceed with the assessment. So, long discussion short, we feel that it was simply that she was being questioned and was taking offense to the questions, perhaps thinking that we were judging her. We decided not to ask her about her resistance, which I support, as she opened up later saying that she was concerned that her job was in jeopardy. However, even after telling us this and us reassuring her that our goal is to keep her in her position to ensure the students received healthy foods, she continued to show annoyance with us. But we were able to finish our assessment and complete the observation of all food services taking place in the school.

What did I discover about this school worth mentioning ?

Unfortunately, it was largely that the FS worker has become demotivated (through years of poor sales and recently reduced hours) and even though she was concerned about her job, she has made no effort to make herself and asset to the school (by means of creativity in food served, following the school food and nutrition policy more strictly, etc.). The menu offered daily is the same one every single day, every month. If I were a student and had the same limited options for lunch, I too would get bored and stop buying. She said that she likes how she can do her job on "auto-pilot" and then later said that there is no one trained to replace her because anyone can make the food on the menu (basic sandwiches, canned soup, chicken or veggie wraps, frozen individual pizzas, frozen potato wedges). Personally, if I were concerned about losing my job, I would make an effort to keep it. Hopefully she takes our recommendations and supports will will offer (which she identified as being interested in - have students taste test new foods and survey students on which foods they would buy if offered) so that she does gain some job security as the Principal mentioned that the cafeteria is losing money and may have to be shut down.

I am delighted to mention, that despite the lack of variety on the daily menu, the items served were overall fitting with the policy. True moderate items were being offered much too frequently, salad dressing and sauce portion sizes were much too large, the mini pizzas offered daily were cook from frozen made a white crust with pepperoni, sauce, reduced-fat cheese, and no vegetables, and the potato wedges which are a major seller were par-cooked in oil first and had far too much sodium to be offered daily, but what I didn't see was chocolate (other than in milk form)! Hooray for no chocolate!

I do think that a lot of positives came out of yesterday in terms of the FS assessment and what we will hopefully be able to offer in supports to the FS worker... I just hope the FS worker eventually believes/agrees that it was a worthwhile endeavor.

Sugar + Sugar + Sprayed on Nutrients = Breakfast?

Today I am determining the recommendations for menus/foods sold at the two schools that have undergone the food service assessment so far. In my quest to find some examples of maximum nutrition cereals for the Breakfast Programs, I stumbled upon the following horrific items that I have not seen before today and would now that I have, hesitate to call food. I would not recommend that these cereals be consumed, especially as the main component of a meal. Although if you're an adult and feel that you want to eat sugar coating wheat coating even more sugar, then may I suggest having protein with it so your blood sugars don't skyrocket nearly as high as without the protein?

(as I'm typing this while on a break at work, I was just offered a massive Tootsie-Roll by a co-worker, good intentioned but ironic that I'm offered it as I'm writing about how I feel these items should not be labelled as food.)

So which cereals get the designation of being so nutritionally-void?

         

             

Yuck.

Fruitopia ≠ Fruit

Yesterday was the 2nd school that underwent a food service (FS) assessment by moi. Unfortunately, this time the assessment wasn't as inspiring as the last.

Despite the claims of the full-time FS worker that she was trying to follow the policy guidelines, the only evidence of which we witnessed was the Maximum Nutrition Foods poster hanging in the kitchen (not at all faded which leads me to believe that it was recently hung), the change on this month's menu to whole-wheat/grain products, and selling baked chips. However, regular white bagels were still being sold at the canteen for purchase at recess, and refined flour muffins are offered as long as they are in the kitchen (which is at least 3x per week according to their menu). Chocolate was everywhere and anywhere (granola bars, pudding, cookies), a large bag of sprinkles was in the kitchen, hard taco shells were on the menu, large portions of donair sauce to be served with garlic fingers as an entree, hash browns served as a vegetable, and Cheez Whiz or jam sandwiches are offered as alternate lunches daily. The FS worker responded to our questioning her menu with the defense that "kids won't eat anything else." But this begs the question, "have they been given the chance?"

I've noticed a trend that FS workers seem to be confused about the 70:30 maximum:moderate nutrition foods served. The policy guidelines are that 70% of the time (each week, for instance) the foods served to students must be of maximum nutrition value, and only 30% of the time moderate foods are available. At no point during the regular week (or to be sold at any time at any function the school puts on) are minimum nutrition foods (like pop, hot dogs, and chocolate - other than chocolate milk... le sigh) able to be sold at the school. Minimum nutrition foods can be given away at special functions (total of twice per month) as long as maximum nutrition foods (like vegetables) are also provided free-of-charge. Back to the 70:30 ratio: FS workers, as it seems, believe that as long as they have some maximum foods for sale, they can sell as many moderate foods as they like, or only offer a certain number of baked chip flavors daily. Not so much the case. The idea behind the guideline is that students only have the option to purchase moderate foods twice per week (30% of a 5-day school week), therefore, if baked chips are offered for purchase daily from the canteen, this guideline is not being followed. This is because, as I observed yesterday so my idea has merit, kids will more often than not choose baked goods such as freshly baked (not necessarily homemade) muffins, granola bars, or chips over fresh fruit. Not providing them with an option to purchase these moderate foods 3 days a week ensures that they get sufficient nutrients on those days. Seems simple enough to me, but I also have a nutrition degree and am training to be a Dietitian. Both times when this concept was explained to the FS workers at the schools, it was met with resistance and the protest that students won't buy the healthier foods. I say: give THEM a chance to decide for themselves! Perhaps they haven't tried these foods before. School is a place to learn, why not also encourage them to learn about new and different foods? 

So where does the title of this blog entry come into play?

Product comparison courtesy of Coca-Cola's website

Yesterday, the FS worker was telling me about the homemade desserts she makes to sell to the students, and one of which that she was particularly proud of was a frozen fruit pop she makes by combining yogurt and Fruitopia. Fruitopia is neither a fruit nor is it even permitted to be sold in schools as it is a minimum nutrition food. Having "fruit" in the name of a product, does not make a healthy food.

This example shows the level and degree of education and resources that we'll need to provide to the FS workers and their schools to help them better follow the School Food and Nutrition Policy.

Unfortunately, my time in my Public Health rotation will be over before I can help administer the supports that were determined to be necessary for the schools. Perhaps a lucky integrated intern will catch the tail end of it in the spring.

Fun Food-Related Stuff I Stumbled Upon

I'm feeling like sharing a smile - so here are some fun things I came across while on a break from writing my research proposal. Enjoy!!

...Sigh...

 

Mini Food!

Van Gogh Cake

Rice Krispie Square Watermelon

"Never eat more than you can lift." 

-- Miss Piggy, Muppet extraordinaire

 

The "Absolutely Ridiculous" Burger weighing in at 338 lbs, 540,000 calories.

Wheat is the Devil: A Resurgence of My Former Frustrations

My Aunt Kathy sent me a birthday card with an article in it she photocopied from Maclean's Magazine, and asked for my opinion on it. I had read it, was slightly outraged, gave it to one of the Public Health Nutritionists at work to also have a wee giggle at this Doctor's extremist view. Then I forgot about it. 

Today, on Facebook, a holistic nutritionist who taught me while I attended the Canadian School of Natural Nutrition (CSNN) posted this article in support of it. A resurgence of all the fear mongering and lack-of-research based instruction I received while attending this school came flooding back. For the record, I enjoyed the experience but am still questioning the information I was taught - I crave factual backing to my education and they were unable to provide it. With that said, I have no problem with views that are different than mine - to each their own. What I do take issue with is when those views are published in widely circulated magazines and presented as fact (people will believe what they are told if they perceive the person doing the telling to be a professional).

Breathe.

Okay... so,

I am hesitant to promote an idea that could potentially scare people away from consuming foods that have nutritional value to them. Whole grains contain important nutrients such as B-vitamins (breads and cereals are largely enriched with vitamins that help to prevent health problems such as those developed by deficiencies like neural tube defects in newborns with a folate deficiency), vitamin E,  and soluble and insoluble fibre. The consumption of whole grains is recommended by such health bodies as the Mayo Clinic, Health Canada, the Harvard School of Public Health, Dietitians of Canada - and more! It is true that some people have food sensitivities and allergies and perhaps that is why they gain weight when consuming grains (as per the claims in the Maclean's article), although with celiac disease, people tend to be underweight, but celiac disease is just one type of allergy-related (gluten) health condition. Sensitivities and allergies present with numerous different signs and symptoms, so narrowing down which type and to which food (or other factor) a person might be reacting to can be tricky and require some allergy testing (although sensitivities may not show up in allergy testing). 

But I digress.

I think energy would be better spent focusing on the bigger picture - high cost of healthy foods, low cost of unhealthy foods, high fat high sugar foods, physical inactivity, obesogenic environments such as drive thrus... the list goes on. The scare tactic used to compare the consumption of wheat to tobacco use is, I believe, only hindering the progress of the credibility of the field of nutrition. Readers will see that the interviewee, Dr. Davis, is a medical doctor and will therefore believe, without question, that he is presenting research-supported facts. Some people can be sensitive to components of grains - and of many other foods as well - but the extremist view that wheat is largely responsible for present-day obesity, I feel, is unjustified. I had a biology teacher in high school who presented in class his idea that the reason North Americans have such a high rate of heart disease, is that we have flush toilets. His theory was based on the fact that people living in remote arctic regions do not have indoor plumbing and have also very low rates of heart disease. Therefore, they have a causal relationship.

Oh my. 

Perhaps if my teacher had done his research, he would learn that this relationship is actually correlational and not causational (if it is causational, I'll need to see the peer-reviewed research to prove it), and that perhaps the high quantity of healthy fats in the diets of Inuit peoples, healthy fats which have been proven to help mitigate atherosclerosis, are actually responsible for the low heart disease rates. Additionally, I do believe that there are fewer fast food restaurants in the arctic, restaurants, and grocery stores, so perhaps there is an absence of obesogenic opportunities to partake in up North. But regardless of what my biology teacher believed to be fact, at least his idea wasn't published in a national magazine.

I agree with the idea that wheat products are no longer the original crop that our ancient ancestors grew and consumed. However, I am interested to know why Dr. Davis isn't attacking the other 70-75% of foods that are in some way, shape, or form influenced by genetic modification?

Nutrition and Dietetics is a field where misinformation and incomplete information runs rampant. Dr. Yoni Freedhoff, author of the blog Weighty Matters, said it best when he commented on how some people feel they are qualified to provide nutrition advice simply because they eat. It is necessary for nutrition professionals to step-up to the plate to bat away... clarify... what is factual and what isn't. Not long after Dr. Davis' interview was published in Maclean's, a Dietitian was interviewed on CBC Radio and was given the chance to more calmly explain what Dr. Davis was talking about - better explaining his logic and whether or not she supports it. The PH Nutritionist whom I shared the article with originally heard this interview on CBC Radio and said she did a good job of talking down the accusations in Dr. Davis' interview and stating that she doesn't support his overall opinion of whole grains, including wheat, though agreed that it is no longer the same crop that it once was. However, in comparison to the viral spread of the Maclean's magazine, and my inability to find the CBC Radio interview online, I fear that this Dietitian's interview will not be heard.

Welcome to Public Hell-th

This morning in Public Health we decked out the office with Hallowe'en related paraphernalia.

Here are some of the ideas and themes we decided to use --> good for an end-of-week smile!



Witch's Brew: Alcohol Strategy, SWNDHA Public Health

Some other ideas for posters we had were:

• Let's Rot Your Teeth: Dental Hygienist
• I Want to Give You a Virus: Communicable Disease & Prevention Control
• The More Sugar, Fat, and Butter, the Better to Kill You With: Public Health Nutrition Services

  




Sugar Coma: Public Health Addiction Services



Mummy's Milk is Best for Babies: SWNDHA Public Health



"The supreme accomplishment is to blur the line
between work and play." 
~Arnold Toynbee