An Open Letter to: AIA, Sovereign, Gemma McCaw, Cory Jane, NZ Teachers, Educators and Parents

22nd August 2018

To ‘The Healthiest School Challenge’ development & support team, Gemma McCaw, Cory Jane, New Zealand teachers, educators and parents.

We are writing to you express our concerns with the recently launched ”AIA The Healthiest School” challenge. We are healthcare providers working in the field of eating disorders, body image and anxiety around food and bodies. 

We commend and support AIA & Sovereigns interest in health promotion (and extra funding toward sporting equipment) however we believe the risks associated and potential harm caused albeit inadvertently by this program outway the perceived benefits. The Healthiest School competition and its intended us of pedometers by school aged children is problematic for the following reasons:

* Any motivation for children to move their bodies is all externally driven, there is no intrinsic motivation. Is this something that is going to encourage children to engage in health behaviours long term? We predict children will most likely lose interest either before or after the 6 week mark. At best, this competition/initiative  is likely to be ineffective, and at worst extremely harmful.

* This challenge reduces health to a number – and just one aspect of health (exercise) at that. Sending this message to children who are concrete thinkers puts children at risk of disordered thoughts and behaviours around health. This program does not consider a child’s emotional or mental health.

* The use of pedometers encourages children to disconnect from their body, instead relying on technology to tell them how much to move. Furthermore the use of pedometers and other devices measuring steps or energy expenditure teaches children to ignore important intrinsic body signals informing us when to move and when to rest. This ability to rely on internal regulation – a feedback system that is unique to each of us and communicates on the specific needs of our body should be nurtured not stomped on by the repeated silencing of body signals and reliance on external cues for movement and exercise.

* Inititiatives prioritising exercise further reinforce the dominant pedagogy currently used in nutrition and health education to school children – one that is deeply healthist, discriminatory, stigmatising and exclusionary (it is inaccessible for our most economically and socially deprived children, children of ethnic minorities and children living in larger bodies). Programs designed to target childhood obesity, through the promotion of measured energy expenditure and/or intake further reinforce the currently accepted, and incorrect narrative, that the size, shape and weight of our body is a good and accurate representation of our health status and wellbeing – and that deliberate, controlled and measured exercise will attain a body symbolic of “health”.

* This challenge is exclusionary to less physically able, those with health conditions and children with less access to extra opporutnities for movement outside of the school environment.

* The competitive nature of the challenge introduces an opportunity for children to build a self-concept (or view of self) that is rooted in deficit, not measuring up or being “good” enough, or “contributing enough” to the collective effort. School children experience a range of developmental changes both physically and emotionally, including navigation of interpersonal relationships, coping with conflict, bodily changes and development of puberty that are all associated with an increased body preoccupation. We do not need to introduce monitoring and measuring devices that will further encourage engagement in body checking behaviours and potentially facilitate the development of eating and exercise pathologies.

*Self-esteem becomes linked with a number on a pedometer with pride associated with a high step count, however this a case of diminishing returns resulting in children seeking to acquire higher steps than the previous day/week or competition school in ways that do not protect a safe relationship with movement and body. This creates a space for children to develop an antagonistic body relationship, one of guilt, shame and anxiety.

* We have been unable to find any materials associated with the program that offer guidance, advice and tools to assist in the screening of eating disorder behaviours or the predisposing risk factors for the development of an eating disorder, anxiety or obsessive compulsive behaviours – children whom are at most risk of disordered eating/exercise thoughts and behaviours have the potential to be triggered by this program.

* We encourage the inclusion of information and support for teachers to be able to competently recognise harmful behaviours/obsessions in children and outline steps to take after identifying these children in order to access timely intervention and support.

We ask if the possibility of a temporary increase in a child’s physical activity, through an initiative that has not demonstrated an extension into fostering a healthy relationship with exercise or body, worth triggering disordered eating, eating disorders or pathological exercise behaviours in children who may already be susceptible through varying levels of trauma – bodily and/or psychosocial – by inviting an initiative encouraging the use of pedometers/step counting, stigmatisation and discrimination of bodies? 

In permitting this program to go ahead unchallenged, we would be failing in our responsibility to work proactively in Eating Disorder prevention as; providers of eating disorder recovery services, a mother, and size diversity and body liberation advocates. We hope you will reconsider the appropriateness of this initiative in light of the concerns shared here in and we are keen to work with you to modify or redevelop this program should you see value in these concerns and recognise the serious risk of harm.

Many thanks,

Sarah Peck & Jessica Campbell

Eating disorder dietitian, mother- of-3- girls, nutritionist, medical student and size diversity & body liberation advocates.

Sarah Peck is Auckland’s Body Balance Dietitian supporting eating disorder recovery. Sarah specialises in childhood and family nutrition, food flexibility and improving relationships with food and your body.

As a non-diet approach Dietitian Sarah can support you to regain trust in your body through intuitive, mindful eating practices and self-compassion.

Sarah is available for 1:1 consultations and facilitates the in school program “Feeding our Futures” supporting teachers to engage in safe conversations about food and bodies, and the delivery of developmentally appropriate nutrition education in the classroom.

Jessica Campbell BSc PgDip, is a Non-Diet Nutritionist & Medical Student passionate about weight inclusive healthcare practices and Eating Disorder prevention & therapies. 

Jess is a New Zealand based non-diet nutritionist and owner of Body Balance Nutrition, a provider of food and body positive nutrition and dietetic care and eating disorder recovery services New Zealand wide.

Jess is active in the HAES New Zealand working group and co-facilitates the NZ Diet Free Nutrition and Health Professionals online network.

Coeliac disease in children – treating the whole child

By Sarah Peck NZRD | Eating Disorder and Family Feeding Specalist Dietitian

 
**The focus of this piece is on coeliac disease, there are similarities, but also differences, between managing various health conditions requiring food restrictions, please keep that in mind when reading**

I am a dietitian and a mum of three girls. My nine-year old twins have coeliac disease, for which they require a strict gluten free diet to help manage symptoms and health outcomes.

For many, there is no choice but to restrict certain foods from a child’s diet. My experience is that our health and medical profession have done (and continue to do) a good job in caring for the physical health of my children.   However, and also in my experience as both a parent and dietitian, I feel that we are missing a piece of the puzzle when treating conditions like coeliac disease in children. Emotional well-being is often left out of the equation. The intention of this article is not to induce fear, but an attempt to raise awareness and  a call for us (health professionals) to engage in these conversations with families to provide ALL the information we need to care for both the physical and emotional well-being of our child(ren).

Coeliac disease is an autoimmune disease that can have serious health consequences, it comes with a long and varied list of symptoms that may affect quality of life, result in nutrient deficiencies, higher risk of poor bone health and other autoimmune diseases including type 1 diabetes, thyroid conditions, and some cancers. At present, the only treatment for coeliac disease is following a strict gluten free diet FOR LIFE.  There are no medications or pharmaceutical drugs to effectively manage this disease.

Let’s take a look at another health condition that can also have serious health consequences……Eating disorders.

Eating disorders are a serious threat to our physical and emotional well-being and in fact have the highest mortality rate of all mental health disorders. The origins of eating disorders or disordered eating are varied and complex. But let’s explore for a moment, just some of the risk factors and how they relate to managing coeliac disease, allergies and intolerances in children.

Biological

much like coeliac disease we know that genetics can play a role in the development of eating disorders and can co-exist with other genetic health conditions including allergies, coeliac disease, type 1 diabetes and other autoimmune diseases as well as mental health disorders e.g. anxiety disorders. Like many health conditions, being genetically predisposed does not guarantee you will develop an eating disorder but it does make someone at higher risk especially when exposed to other biological and environmental factors.

Trauma & Stress

Traumatic and stressful events can trigger disordered eating thoughts and behaviours. Having being diagnosed myself with a chronic health condition and our twins with coeliac disease, it’s fair to say facing a diagnosis of a life long condition is very stressful. It is a common and very human reaction when we learn we don’t have full control over our health (or our children’s health) to become focused on the areas of our health we think we can control, e.g. our body size or the food we eat.

While engaging in health promoting behaviours to help manage conditions is a reasonable thing to do, hyper-focusing on food and weight can lead to disordered eating and taking us further away from our original goal of improved health.  Research shows that food restriction puts you at higher risk of disordered eating thoughts and behaviours. The tricky part being that when you are diagnosed with coeliac disease, you have no choice but to be hyper-focused on food and feeding practices if managing your disease is a priority for you. Your physical health relies on it.

Another consideration is food insecurity. While quite different to the level of anxiety stemmed from not knowing when you can next provide a meal for yourself and your family, managing a health condition with food restriction does contribute to a certain level of food insecurity.  The stress of not knowing if there will be food or enough food to eat at a school or family event, on a school camp, a friend’s birthday. While some children may externalise their anxiety, many may internalise their feelings of stress around food. We need to consider the daily compounded stress and impact on our children from this type of food anxiety. While parents of coeliac children work extremely HARD to avoid situations like this for them (exhausting right?), we just can’t control every situation.

Social aspects

As a child grows, particularly towards adolescence they naturally seek more independence when it comes to feeding themselves – usually wanting to eat out more with their friends.  Adolescence and older children also tend to avoid standing out as being different. This can lead to those with food restrictions choosing to rather not eat than draw attention to themselves by trying to find something that fits within their food constraints.  Compounding those factors along with a period in their life when peer pressure, body dissatisfaction and dieting are rife, is it any wonder we are seeing an increase in food anxiety and eating disorder thoughts and behaviours in this age group.

For me, a dietitian but mostly a mum, the distress of my children’s diagnosis 4 years ago came down to that the fact that the management of one serious disease (coeliac disease) puts my children at risk of another serious disease (an eating disorder).  

WHY ARE WE NOT TALKING ABOUT THIS MORE? As an eating disorder and family feeding dietitian it’s my mission to ensure these conversations are being had with families.

So as parents, what can we do?

  1. Impose the least amount of food restrictions as possible on your child. It is tempting as a parent to want to fix our child’s health. Conflicting and often well-meaning advice can leave us trying to remove further food groups. If you suspect there are other intolerances (which does happen) I recommend seeking advice from a NZ Registered Dietitian before restricting your child’s diet further. If looking to improve nutrition, think about what you can add in rather than take away. I recommend to all parents (including those with coeliac disease, allergies and intolerances) to follow Ellyn Satter’s Division of Responsibility when feeding children.
     
  2. Have compassion for yourself and your child in this health journey. Parents and caregivers are their number one support and heavily responsible with how their health is managed but we do need to teach children to manage their own condition for their life-time and that does mean accepting they will make mistakes along the way – much like acquiring many other skills. You will also make mistakes. I’ve made mistakes, mostly due to the highly stressful situations clouding my judgement and thoughts. If your child has an anaphylactic allergy on top this adds another level of stress to the situation but I still recommend compassion for yourself and child while doing your best to follow the advice of your allergy specialist in managing their allergy.
     
  3. Your child is going to have autonomy over their health and food choices as they grow, reframing the disease management from restriction to self-care can help them learn to manage it with increasing independence. Every human being has different needs in terms of looking after their health and well-being. For children diagnosed with coeliac disease, threading through the dietary management as part of looking after themselves and their body can help them to WANT to manage their health and take care of themselves rather than something we say they just HAVE to do. Of course, it is important that they understand the serious consequences of not managing coeliac disease but I have seen instances when scare tactics have led to the naturally and understandable rebellious actions of not following a gluten free diet.
     
  4. If your child experiences food anxiety that impacts their daily life– please get your child extra support. Your GP will be able to refer you to a counsellor, psychotherapist, psychologist, or dietitian experienced in this area. Look at other risk factors for disordered eating that you can influence  e.g. creating a body positive environment, less exposure to dieting, coping mechanisms for anxiety disorders, avoidance or careful management of participation in aesthetic or appearance-based sports e.g. gymnastics. There are some children who will go on to develop eating disorders regardless of managing other risk factors, please know that is not your fault but early intervention is key.
     
  5. Seek support for yourself. You may experience a certain level of anxiety and feel the need to be hyper-focused on food and food labels, however try not to transfer your anxiety on to your child. Having support and your own coping mechanisms can definitely help with that. Whether it is through a health professional, friend or support group that understands your stress. It is well worth seeking that support for yourself.
     
  6. Gain further awareness of the side effects of food restriction. The health and medical profession is letting us down on this one. You should be made aware of the side effects of a pharmaceutical drug prescribed to your child. Why are we not being made aware of the side effects of food restriction to manage health conditions? Unfortunately, we aren’t given many choices on managing this condition for our children but at the very least if we are made aware of the possible side effects, we are able to watch carefully and be proactive to care for our children’s physical AND emotional well-being. I know as a parent, that is all that we can hope for.

For more information about eating disorders visit:

www.thebutterflyfoundation.org.au   

http://www.feedyourinstinct.com.au/ 

 

Sarah Peck is Auckland’s Body Balance Dietitian supporting eating disorder recovery. Sarah specialises in childhood and family nutrition, food flexibility and improving relationships with food and your body.

As a non-diet approach Dietitian Sarah can support you to regain trust in your body through intuitive, mindful eating practices and self-compassion.

Sarah is available for 1:1 consultations and facilitates the in school program “Feeding our Futures” supporting teachers to engage in safe conversations about food and bodies, and the delivery of developmentally appropriate nutrition education in the classroom.

A letter to my new grad self…

A letter to my new grad self….

Sarah Peck NZRD, specialist Eating Disorder, Non-diet, HAES Dietitian

Well you have finally graduated and can call yourself a dietitian. When you started studying, your only certainty was that you genuinely wanted to help people, now you are filled with knowledge and skills to take on the nutrition world. You feel important, not in an arrogant way, but dietitians are considered the experts on all things nutrition. You don’t come out of 4 years of intense study to not know the answers or where to find them……. right?

You will find a job in private practice which suits you well. You like to be able to spend more time with people. Weight loss counselling seems appropriate for you. If you are honest, it fulfils your need to help and fix. People are looking for the answers to fix their bodies, and they will come to you to find those answers. You are also very much a people pleaser, so meeting client’s expectations is important to you.

Your clients are successful at first, you will feel good at your job, but after a while, your clients are struggling to stick to the advice and plan you gave them. You try harder to understand the complexities and individual circumstances which drive their food choices, you will work tirelessly to come up with many different ways they can make this work.

Yet still after a few sessions clients are coming back saying they have failed, or worse yet they don’t come back at all, all too ashamed to admit they have failed again. In their mind, it is one thing to fail a generic or fad diet but the feelings of failure are magnified when they can’t be successful with the advice and support from a dietitian, an expert in the field, which is tailored to their own individual needs and circumstances.

At first you start to think you are just terrible at your job, but then you start to realise this way of practicing which is considered ethical in our profession feels outright wrong, in fact it feels incredibly unethical. You start to question everything you have learnt. You fall from such a high place of feeling like the expert to feeling like you know nothing at all. What was all that study for? You start to question if this is the career for you.

Changing direction works for a while, taking on clients with IBS, allergies, paediatrics you name it. You are again fulfilling that need to help and fix people. This is your flight response to those uncomfortable feelings that weight loss counselling gave you. But eventually you start to find the same patterns with your clients – feelings of failure, lack of trust in their bodies, poor relationships with food. Upon reflection you realise that the flight response may not be the best path.

You start to wonder what the fight response might look like.

On searching for an answer, you realise this picture is bigger than you ever thought. You will read about other approaches. You will learn about Non-Diet approach, Intuitive Eating, Mindful Eating and Health at Every Size (HAES). You read more and more. Finally, you feel like you have found your place and your home. You find a community of like-minded professionals. What you will learn will not only validate your own thoughts and feelings about weight centric health care and nutrition education but makes you realise how much more you have to learn.

You will find a group of health professionals who are so encouraging and willing to share their wisdom. There is no competition just lifting each other up. This community and these approaches will save your career.

There will be many important lessons along the way but the most career saving lessons will be the following:

Weight does not equal health

This will be the first big lesson you will learn. You always had a feeling this was the case, but you were taught otherwise. However, you will learn that there is a huge amount of science that tells us weight does not equal health. You will be relived to find weight neutral approaches are very much evidenced based practice, but built on the foundations of compassion. This meets your values both professionally as a dietitian and personally as a fellow human being. The perfect match.

You will feel like you have de-skilled 

When you first discover these weight neutral approaches to dietetics, your mind will be blown but it will at first feel very de-skilling and that is scary, however it opens the door to so much learning. Professional development will no longer be a chore but something you seek out constantly.
You will learn to stop talking and start listening – You will learn more from your clients than you ever did studying nutrition. You were trained to talk and educate but this is no longer your best skill, you will learn to stop, listen and truly understand another’s experience, perspective and truth.

You are no longer the expert

 One of the best gift’s you can give your client is your trust. When you give meal plans to a client you are implying you don’t trust them and nor should they trust their own body. Working with your client so that they can learn to trust their body again, sitting with them while they become the experts on their own body really will be a game changer for you and your clients. You are there for guidance, support or ‘advice’ when you client truly needs it rather than assuming it is what they need.

You will be challenged 

Acknowledging your own privilege will be the key to unlocking a flood of compassion for your clients and human beings in general. You will care more deeply than you ever did before. You will get angry, sad and upset around issues of stigma and shame. You will become sensitive and defensive to other’s negative opinions and attitudes towards larger bodies and all other social justice issues. You will notneed to go out looking for examples of weight stigma, you will find them online, in your community and in everyday interactions with people. You will examine your own biases and how they may affect your language and practice. You will do all of this with curiosity and self-compassion. Forgive yourself for the mistakes you have made and will make in the future as you fumble your way through.

You will be rewarded 

The rewards are not your client’s successes or reaching their goals, your rewards are not going to be huge financial gain or a million followers on social media. The rewards are that you will have true connection with your clients. You will get to know them, you will hold space for them. The true reward for yourself is peace! The peace you gain from working from a place of authenticity and compassion for yourself and others. The peace you gain from no longer feeling you are part of the problem.

And so finally to my new grad self, listen to your instinct, it is right. Be brave. Keep learning, keep challenging yourself and others, keep caring deeply and definitely keep fighting!!

 

Sarah Peck is Auckland’s Body Balance Dietitian supporting eating disorder recovery. Sarah specialises in childhood and family nutrition, food flexibility and improving relationships with food and your body.

As a non-diet approach Dietitian Sarah can support you to regain trust in your body through intuitive, mindful eating practices and self-compassion.

Sarah is available for 1:1 consultations and facilitates the in school program “Feeding our Futures” supporting teachers to engage in safe conversations about food and bodies, and the delivery of developmentally appropriate nutrition education in the classroom.

Tortilla Pizza

LAURA MURPHY

Christchurch’s Body Balance Nutritionist

CRUNCHY | SAVOURY | SALTY | FRESH

Ready In: 30-40 mins 

Serves: 3-4 people

These tortilla pizza’s are super easy, fresh and crunchy (did I mention delicious?!) and perfect for dinner, school or work lunches or as a starter at the next dinner party. The toppings are entirely interchangeable depending on what you feel like!

 

Ingredients

  • Tortilla wraps (4 large wraps)
  • Pizza Sauce (Store bought or if you’d like to try homemade: 4 fresh tomatoes, half a can of tomatoes, 1 tbsp tomato paste, 1 garlic clove, a few sprigs of parsley and basil, 1.5 tbsp olive oil, and a pinch of salt; blend until desired consistency)
  • One red onion, sliced thinly
  • Baby beetroot, halved (I used canned, but you could roast some beetroot)
  • A handful of both cashews and pine nuts
  • Cubes of feta
  • 100g smoked salmon
  • 1-2 tbsp capers
  • A few basil leaves
  • ½ a courgette grated or sliced very finely
  • ¼ cup parmesan, grated
  • Drizzle of olive oil
  • Baby rocket (optional)

 

Preparation

1. Preheat the oven to 220℃ and place some oven trays (or a pizza stone if you have one!) in to heat up to ensure the bases are crispy.

2. Spread a thin layer of tomato paste on each tortilla.

3. For the beetroot pizza: arrange baby beetroot, basil and cashews. Crumble the feta as desired, drizzle with olive oil and cover with mozzarella if using.

OR/ For the smoked salmon pizza: put pine nuts and capers over the base, top with salmon flakes and grated courgette. Sprinkle grated parmesan (and mozzarella) and olive oil over pizza.

4. Place pizzas in the preheated oven for approximately 5 minutes or until the edges are curling and crispy.

5. Take pizza out and sprinkle with rocket and place back into oven for 30 seconds.

6. Take out and serve or allow to cool and store in an airtight container for lunches the following day!

Other topping ideas

Pesto, rocket, basil, chorizo, cherry tomatoes, mozzarella and pine nuts
Ham, diced pineapple, mozzarella, tomato and/or BBQ sauce

 

Laura is a non-diet nutritionist practicing online and in Christchurch, New Zealand.

Laura is a non-diet nutritionist practicing online and in Christchurch, New Zealand.

Ginger Chocolate Snowballs

Ingredients & Directions

Makes 15-18 balls

4 Weetbix
4 Gingernut biscuits (Smashed up fine with a rolling pin or food processor.)

Add finely chopped:
1/4C crystallized ginger
4-5 dried apricots
1/4C sultanas

Mix in:
1 Tbsp Cocoa
2 Tbsp Coconut oil (or any other plain flavoured oil eg canola or ricebran)
2 Tsp Honey (optional)
1-2 Tbsp warm water (as required to wet mix)

Squeeze mixture and roll into balls. Roll each ball through shredded coconut.

Pop in the fridge and serve cold (after you’ve taste tested one of course!