Category: Wellness

At Winterberry we are dedicated to helping our patients live their best life. Part of that commitment is highlighting the truth about obesity, its causes and effective, proven medical treatments.

We are republishing a comprehensive series of articles that first appeared in USA Today. Our hope is that these articles will give anyone suffering from the disease of obesity new information and relieve because as our Medical Director, Dr. Steven Zizzo says, “It’s Not Fault”.

Series Introduction:

More than 4 in 10 Americans now fit the medical definition for having obesity, putting them at risk for serious health problems, including diabetes, heart disease and some types of cancer. The pandemic increased the stakes. In its first year, nearly one-third of severe COVID-19 cases were blamed on excess weight.

USA TODAY decided to take a look at how America’s weight has been changing in recent years, including advances in treatments and the scientific understanding of obesity. We spoke with more than 50 experts – in nutrition, endocrinology, psychology, exercise physiology and neuroscience – and people who are intimately familiar with the challenges of extra pounds.

The answers aren’t simple.

But they get to the essence of America: our issues with race, stigma, personal responsibility, economic stability and the power of corporations.

Karen Weintraub USA TODAY

ILLUSTRATION BY TRACIE KEETON/USA TODAY; AND GETTY IMAGES

Published 5:02 AM EDT Jul. 26, 2022 Updated 11:48 AM EDT Jul. 26, 2022

Barbara Hiebel carries 137 pounds on her 5-foot-11 frame. Most of her life she weighed 200 pounds more.

For decades she tried every diet that came along. With each failure to lose the extra weight or keep it off, her shame magnified.

In 2009, Hiebel opted for gastric bypass surgery because she had “nothing left in the gas tank” to keep fighting. She quickly dropped 200 pounds and felt better than she had in ages.

Over the next eight years though, 70 pounds crept back, and the shame returned.

“I knew everything to do to lose weight. I could teach the classes,” said Hiebel, 65, a retired marketing professional from Chapel Hill, North Carolina. She asked to be identified by her first and maiden name because of the sensitivity and judgment surrounding obesity.”I’m not a stupid person. I just couldn’t do it.”

The vast majority of people find it almost impossible to lose substantial weight and keep it off. 

Medicine no longer sees this as a personal failing. In recent years, faced with reams of scientific evidence, the medical community has begun to stop blaming patients for not losing excess pounds. 

Still, there’s a lot at stake.

Despite decades fighting America’s obesity epidemic, it’s only gotten worse. To try to understand why, USA TODAY spoke with more than 50 experts for this six-part series, which explores emerging science and evolving attitudes toward excess weight.

Obesity increases the risk for about 200 diseases, including heart disease, diabetes, asthma, hypertension, arthritis, sleep apnea and many types of cancer. Obesity was a risk factor in nearly 12% of U.S. deaths in 2019.

Even for COVID-19, carrying substantial extra weight triples the likelihood of severe disease.

Early in the pandemic, pictures from intensive care units repeatedly showed large people fighting for their lives. At Weill Cornell Medical Center in New York City, the average age for ICU patients was 72 if their weight was in the “normal” range and just 58 if they fit the medical definition for having obesity, said Dr. Louis Aronne, an obesity medicine specialist there.

As fat cells expand, the body produces inflammatory hormones. Combined with COVID-19, the inflammation creates a biological storm that damages people’s organs and leads to uncontrolled blood clotting, Aronne said.

The link between obesity and severe COVID-19 is surprisingly strong, said Dr. Anthony Fauci, who has dedicated his life to combating infectious diseases.

“The data were so strong,” Fauci said of a recent government study. Even for children, every increase in body mass index led to a greater risk of infection with COVID-19 and for a dangerous case of the viral illness. 

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Why are obesity rates so high in America? Learn the causes and why it’s so tough to cure.(1:57)

Obesity rates are weighing down America. Why is it so hard to cut down the pounds? We look into the causes and challenges.

“The more you learn about the deleterious consequences of obesity, the more reason and impetus you have to seriously address the problem,” Fauci said.

But despite more than 40 years of diets and workouts, billions of dollars spent on weight loss programs and medical care, and tens of millions of personal struggles like Hiebel’s, the obesity epidemic has only gotten worse. Nearly three-quarters of Americans are now considered overweight, and more than 4 in 10 meet the criteria for having obesity.

To try to understand why, USA TODAY spoke with more than 50 nutrition and obesity experts, endocrinologists, pediatricians, social scientists, activists and people who have fought extra pounds. The reporting resulted in a six-part series, which explores emerging science and evolving attitudes toward excess weight.

The experts pointed to an array of compounding forces. Social stigma. Economics. Stress.Ultra-processed food. The biological challenges of losing weight.  

They agree people need to take responsibility for eating as well as they can, for staying fit, for sleeping enough. But simply promoting individual change won’t end the obesity epidemic – just as it hasn’t for decades.

It’s time to rethink obesity, they said.

Experts offered different ideas to change the trajectory.

Subsidize healthy food. Make ultra-processed foods healthier or scarcer. Teach kids to better care for their bodies. Provide insurance for prevention instead of just the consequences. Personalize weight loss programsto support, not stigmatize. Learn what makes fat unhealthy in some peopleand not in others. 

For real progress to come, they agreed, society must stop blaming people for a medicalcondition that is beyond their control. And people must stop blaming themselves. 

“There’s a lot of misperception among patients that they can somehow ‘behavior’ their way out of this – if they just had enough willpower and they just decided they were finally going to change their ways, they could do it,” said Dr. Sarah Kim, an endocrinologist at the University of California, San Francisco.

For the vast majority, trying to will or work themselves to thinness is just a prescription for misery, she said.

“There’s so much suffering associated with weight that is just so unnecessary.” 

Like many people who struggle with weight, Hiebel has a family tree that includes others with extra pounds. Her mother was heavy, as were other female relatives.

In childhood, Hiebel simply loved food. It gave her pleasure. A buzz.

In fourth grade, her mother brought up her weight with the pediatrician. He prescribed amphetamines.

Barbara Hiebel, who has struggled with her weight since childhood

“I was a fat kid who always wanted to be skinny,” Hiebel said. “My whole life. I wanted to be healthy. Thinner.”

She blamed herself. For not pushing away from the table sooner. For enjoying what she ate. For the thoughts about food that popped into her head every 30 seconds all day long. For not being able to throw away the plate of cake until she had devoured every bite.

Even though she was trained as a nurse, Hiebel, was petrified of getting medical care. “I spent 50 years largely avoiding doctors because they’re going to weigh me,” she said.

People who experience and internalize weight stigma are more likely to avoid health care and report lower quality of medical care, research shows. 

Many fear the waiting room won’t have chairs strong enough to support their weight. They won’t fit on the examining table. The doctor will mock or criticize them for being overweight without offering realistic advice for how to lose their extra pounds.

“We treat them as if we obviously don’t care because obesity must be their fault,”  said Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital. “We just tell them to eat less and exercise more, and when that fails, as it does 95% of the time, we don’t do anything about it.”

And people with obesity continue to punish themselves. Stanford tells a story about a patient whose weight kept climbing even after being prescribed medications that are usually effective.

The woman confessed she wasn’t taking the prescription because she hadn’t tried hard enough to lose weight on her own and didn’t deserve it. “I only do 15,000 steps a day,” the woman told Stanford. “I feel like I should be doing 20,000.”

Stanford ended up persuading her to take the medication. She explained that if someone had a disability weakening their legs, it wouldn’t be a failure for them to use a wheelchair.

Hiebel had excellent insurance coverage, but she remembers overhearing her internist arguing with the insurance company to get her weight loss surgery covered. She was required to try Weight Watchers for at least six months and a second weight loss program for another six months, although data shows the vast majority of people can’t lose substantial weight and keep it off.  

It felt as if the whole insurance industry was telling her she was guilty for being fat.

Shame and embarrassment led Hiebel to avoid seeking help when she started regaining weight after the surgery. “People did all this work on you. You spent all this time and energy and you’re failing yet again,” she said.

But she didn’t want to let all her progress fall apart. She eventually went back to her surgeon.

He told her to make an appointment with Dr. Katherine Saunders at Weill Cornell – and to wait as long as was necessary to see her.

When Hiebel eventually found herself in Saunders’ office, she heard for the first time in her life the words: “This is not your fault.”

“In my head, I’m going, ‘Of course it’s my fault. I’m weak. I’ve got no willpower,'” Hiebel said.

Saunders told her weight loss would take hard work. Her body was conspiring against her to keep on the pounds. The free snacks in her office break room would be a constant temptation.

She offered Hiebel some new tools, including medication to address metabolic issues and her mental state.

With other weight loss doctors, Hiebel felt embarrassed to return for another appointment until she had lost 10 pounds. That often meant never going back. But Saunders told Hiebel to call immediately if she started to struggle.

“She was inoculating me against that from the beginning,” Hiebel said. “‘This isn’t your fault. I can help. And if you get into trouble, don’t do what you would normally do and actually call me.'”

Trouble losing weight? You’re not alone.

The medication gave Hiebel some stomach problems. Saunders warned her that might happen and told her to tough it out for a few weeks. They would adjust the dosage or prescription if it got too bad.

Hiebel’s pounds started melting off. She felt great.

Then, for two days, Hiebel found herself repeatedly standing in front of her pantry. “Just looking,” she said. “I’d grab a cracker or shut the door. But you keep going back.”

Barbara Hiebel, who has struggled with her weight since childhood

Without noticing, she had missed two daily doses of Contrave, a prescription weight loss pill that also helps with mood disorders. Hiebel resumed taking the pills, and her pantry-gazing ended. “I went back to my normal habits almost overnight. Literally.”

That’s when she realized the power of the medications – and of the drive she carried within her.

“I always felt controlled by food,” she said. “Everything was about not eating.”

But the metabolic changes from the surgery and the boost from the medications finally changed that dynamic. Raw cookie dough, once her “fifth major food group,” lost its grip on her mind. “I kind of don’t really want it,” she said.

She can throw away a piece of cake after just a few bites, even leaving behind the icing. “Now I’m that person,” Hiebel said, “not because I somehow have the willpower, but because I don’t really want it.

“I feel liberated around food.”

Weight gain may be as simple as consuming more calories than you burn, but weight loss isn’t as simple as burning more calories than you eat. 

The human body evolved over tens of thousands of years to hold on to excess calories through fat. 

“The default is to promote eating. It’s very simple, very logical. If it were not this way, you would die after you’re born,” said Tamas Horvath, a neuroscientist at the Yale School of Medicine. “When you live out in the wild, you need to be driven to find food, otherwise you’re going to miss out on life.”

Severe calorie restriction is dangerous, said Horvath, who, with his colleague Joseph Schlessinger, has been studying the brain wiring that drives hunger. 

In a study of mice whose calories were severely restricted, one-third lost weight and lived longer, as the experiment set out to prove, Horvath said. But nothing happened to another third. The remainder died young.

“When you engage in such behavior, you are basically playing Russian roulette,” he said.

Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital

Restricting calories seems to slow metabolism, meaning the body needs less fuel. “You have to keep restricting more and more to keep losing weight,” said Dr. David Ludwig, an endocrinologist and researcher at Boston Children’s Hospital. “This is a battle between mind and metabolism that most people don’t win.”

Genetics play a role, too. Some people seem destined from birth to be thin, like everyone else in their family. 

Only about a quarter of the population, those with a genetic gift for thinness, seem to escape extra pounds in today’s food climate. Even these lucky few can develop the same metabolic problems seen with obesity, becoming “thin outside, fat inside,” according to Jose Ordovas, a professor at the Friedman School of Nutrition Science and Policy at Tufts University. 

And everybody doesn’t gain the same amount of weight from overeating.

A 1990 study showed that a group of identical twin men fed an additional 1,000 calories a day for three months led some to gain roughly 10 pounds and others to gain 30. The twin pairs varied substantially from each other in how much weight they gained and where, but each twin responded nearly the same as his brother.

Overeating can distort the nerves in the brain that receive signals from hormones, said Aronne, at Weill Cornell. 

“As you get more damage there, fewer hormonal signals are able to get through and tell your brain how much you’ve eaten and how much fat is stored,” he said. “As a result, your body keeps expanding your fat mass.”

Exercise doesn’t lead to weight loss either. “You can’t easily exercise off obesity,” said Marion Nestle, an emerita professor of nutrition and food science at New York University. 

Still, experts agree that regular exercise is crucial to health at any size. And it may help prevent weight gain and regain. 

“The Biggest Loser” TV show ran on NBC for 17 seasons, following participants as they lost weight through diet and exercise. In 2016, Kevin Hall, a National Institutes of Health researcher, examined what had happened to 14 of the 16 contestants from the 2009 season.   

All but one regained some or all of their lost weight, Hall found. But the contestants who remained the most physically active kept off the most weight, he reported in a 2017 analysis of the results. 

Kevin Hall, a National Institutes of Health researcher

“The benefits of exercise when it comes to weight don’t seem to show up so much while people are actively losing weight,” he said, “but in keeping weight off over the long term.”

Adequate sleep also is essential for maintaining a healthy body weight and can help with weight loss, studies show.

To accomplish everything she wanted to do in a day, Hiebel often limited her sleep to five to six hours a night. Her solution to the resulting exhaustion was to snack. She remembers frequent coffee and cookie breaks, “as self-defeating as that is.”

Many people make the same decision to sleep less – and end up eating more.

In a study published earlier this year, people who had extra weight but not obesity were encouraged to sleep 1.2 hours more a night for two weeks. They ended up consuming 270 calories less a day than the volunteers who slept their typical 6½ hours or less a night. 

“It’s about sufficient sleep making you feel less hungry, making you want to consume fewer calories,” said Dr. Esra Tasali, who led the study and directs the UChicago Sleep Center. “Basically not eating the extra chocolate bar.”

Even though she knows how to work the system from her years in the insurance industry, Hiebel is struggling again to get her medication covered by insurance.

She may have to switch to two low-cost generics, provided at the wrong dose. “I’m going to have to cut a pill into fourths with a razor blade,” she said. “It’s ridiculous.”

But Heibel will do what she must to keep off the extra weight. 

She feels healthier without those pounds. She used to dread the hills she faced on hikes with her husband. After losing weight, she barely notices them.

“We’re not talking about Everest,” she said. “I’m not running marathons, but I can do this stuff and I don’t huff and puff.”

Before she started weight loss medications, she was heading into pre-diabetes. She had borderline high cholesterol and was managing hypertension. Now, her LDL and HDL hover around 70; 60 to 100 is considered optimal. 

Just knowing it was possible to break food’s grip on her life, that there was hope, was transformative.

Hiebel wants to talk publicly about her story, about the shame she endured for decades, because she wants others to know it’s not their fault and help is out there.

The incident with the Contrave made her realize she’ll probably need to take a constellation of medications forever. And they still give her a rumbly tummy sometimes.

It’s a small price to pay, she said, “to do something that for 50 years I wasn’t able to do.” 

“I’m happy as a clam, and I’m not looking back.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

During PRIDE month we sat down for a conversation with Shanna. Shanna is one of our team members who work with and support our LGBQT patients.

Q: What role do you have at Winterberry?

A: I am a primary care nurse practitioner at Winterberry and I work directly with our LGBQT patients as well as patients who are questioning their orientation or gender.

Q: Is there special training involved in working with such a diverse population?

A: I have done extra training through Rainbow Health Ontario to become certified in Gender Affirming Care in the adult population.

Q: How do you support LGBQT and questioning patients?

A: I provide gender competent care and  hormone therapy. I have discussions with patients and their families about gender identity. We discuss health and gender related goals so that I can best assist their needs. 

Q: What is involved in gender affirming care?

A: It can include hormone therapy and surgical referrals as well as ongoing support and assistance where needed.

Q: Are you the only team member at Winterberry with a focus on LGBQT patients?

A: Right now, yes, but we will be training more staff in the near future which is exciting! 

Q: What’s the benefit of LGBQT patients receiving care specific to their unique needs?

A: Patients who receive LGBQT competent care develop better therapeutic relationships with their provider and are able to have both their health and gender needs met.  

Q: Are there common reasons why LGBQT patients don’t receive the care they need in other settings?

A: Common reasons that patients don’t receive care for their unique needs include stigmatization, negative prior experiences with health care, higher rates of anxiety and mood disorders, and difficulty openly discussing their gender and sexual health related issues. I know this because in my practice, when I initially meet patients, many have expressed negative experiences in healthcare in the past. It is important to trust and have confidence in your health care provider so during my appointments we work towards rebuilding that patient-provider and patient-health relationship.

Q: What’s the goal for your patients?

A: To be confident, happy and healthy!

Meet Dinisha. She’s a Winterberry Family Medicine Nurse Practitioner who works closely with our senior patients. Her goal is to ensure seniors in our care have the accurate information and healthcare they need to live their lives as actively and happily as possible. 

We caught up with Dinisha in June and asked her a few questions:

Q: What is your role in the Clinic and how does that fit into working with senior patients?

A: I am a primary care Nurse Practitioner focusing on health promotion, disease and injury prevention, cure and rehabilitation. Through my experience working in palliative care, I have taken a focus with our senior patients. 

Q: What kind of “senior-specific” services does Winterberry offer?

A: Winterberry provides holistic care by acknowledging the physical, emotional, social and spiritual wellbeing of all our patients, including seniors. Our team is composed of highly skilled dieticians, social workers, counsellors, nurses, doctors, nurse practitioners and physician assistants who have been trained to assess and treat our seniors well.  Winterberry acknowledges the burden our seniors have with managing their chronic health conditions and provides home visits by Nurse Practitioners. Providing options of home visits for health care management not only aids in addressing their physical well being, but also their mental health.

Q: What unique needs do seniors have that other patients do not?

A: The needs that our patients have while aging may include financial security, personal security and safety, health care and health challenges, mental health, and self-actualization. At Winterberry we work together with the patient to best address all their needs all while preserving their dignity and autonomy. 

Q: Are there common reasons seniors don’t get the care they need? Obstacles that prevent them from living as long and healthily as possible?

A: Often seniors do not get the care they need due to difficulties attending their appointments. With changes in mobility, vision, hearing, cognition, pain and strength, attending an in-office appointment can be very difficult. With patients living in long term care facilities, assisted living and/or living at home alone, transportation is the biggest concern. Due to missed appointments and/or inadequate follow ups, their concerns get unseen and as a result, built up. At Winterberry we work with senior patients, no matter where they live, to ensure they have access to the care they need.

Q: During the pandemic were there specific things Winterberry did to ensure our senior patients continued to be well cared for?

A: During the pandemic, we set up routine scheduled calls to check in with our senior patients. We eased the sense of isolation through these frequent calls, providing compassionate and charismatic telephone calls regardless of if there were physical health concerns needing medical attention vs a mental health check in.

Q: Any last thoughts on serving seniors? 

A: We love and value our seniors here at Winterberry Family Medicine! 

COVID-19 fueled stress-related unhealthy eating habits that have resulted in expanded waistlines for almost half of North Americans.

Forty-eight percent of Americans packed on extra unwanted pounds during the pandemic (the average weight gain was 29 pounds) while 42% of Canadians gained an average of 6-15 pounds.

This doesn’t come as a big surprise when you consider diets, activity levels, sleep habits, and daily routines were turned upside down by the pandemic

The study on American weight gain found those who gained the most were more likely to be male, married, 45 or older with a full-time job. It also found that people were more likely to have gained weight if they were overweight before the pandemic and/or had depression.

“Even before the pandemic, stress was a major determinant of unhealthy lifestyles in adult Americans, and the problem continues to worsen for certain groups,” said study lead Jagdish Khubchandani, a public health professor at New Mexico State University. 

Children gained excess weight as well, due to disrupted routines, increased stress and less opportunity for physical activity and good nutrition.  

A study by the Centers for Disease Control & Prevention found that the percentage of obese children and teens increased to 22% during COVID. 

It’s natural to experience self-recrimination and self-blame about the changes in one’s weight and to be affected by societal stigma around being overweight. But it’s important to remember pandemic weight gain has affected a huge percentage of the population and self-compassion is in order.  

For those who want to lose weight, action is in order as well. Here are 5 steps you can take to try to bounce back after COVID-19, so you begin to feel — and look — more like your old self:

Turns out men and women have more in common than you might think when it comes to how they feel about their weight.

Both sexes would like to shed pounds for one thing. 

However, more women (57%) say they want to lose weight (an average of 18 pounds), compared with 47% of men who would like to lose an average of 13 pounds. This discrepancy can be attributed to the fact that women face more societal pressure than men to have a lower ideal weight.

But the seemingly inevitable weight gains of middle age creates feelings of despondency and low self-esteem in men and women alike.  

And since about 70% of North American adults are overweight or obese, that’s a whole lot of hard feelings to cope with.

A new study reported in Science Daily reveals that midlife men believe weight gain is simply an inevitable part of getting older. They blame family and career responsibilities for such things as preventing them from getting enough exercise and indulging in comfort eating.

The qualitative study of eight men between the ages of 35 and 58 also found  men had poor awareness of factors that cause weight gain, such as large portion sizes and the nutritional value of the foods they eat. 

“Many men would benefit from an education around food, such as food selection, integration of diet and sustainable weight management practices, in order to develop a more complete understanding of the relationships between food and lifestyle,” concluded the study’s lead author, Dr. Mark Cortnage of Anglia Ruskin University in England.

Even though many midlife men and women say they want to lose weight, this desire does not necessarily translate into doing anything to achieve this goal. While 51% of adults want to lose weight, barely half as many (25%) say they are seriously working toward trying to accomplish this, according to a report from Gallup. 

While more exercise and healthier eating are the cornerstones of any weight loss/management plan for both men and women, men are often at an advantage for losing weight. There are a few reasons for this:

•Men tend to have more muscle and less fat mass than women and since muscle burns more calories than fat, men have a faster metabolism.

•Men are not as big emotional eaters as women. Studies show that while men may turn to alcohol in an effort to relieve their stress, women turn to food.

•Because of their faster metabolisms, men’s bodies tend to respond more quickly to diets. One study found that men lost twice as much weight as women in the first two months of being on popular diets such as Weight Watchers. However, at six months, the weight loss between the sexes almost evened out, proving that consistency helps even the playing field. 

Photo by AllGo – An App For Plus Size People on Unsplash

At Winterberry we help our patients live their best life and part of our “whole body” care is offering easy access t our team of highly skilled and caring dietitians. Seeing a Winterberry dietitian is easy. Just call the clinic at 905-575-9004 and book an appointment with one of our nurses or nurse practitioners. Let them know you want to see a dietitian and they will get your appointment booked.

You might be wondering what dietitians do, how they’re trained and what their role in the clinic is. That’s understandable because not a lot of people know just how valuable and important dietitians are and how they contribute to health. This blog will:

What is a dietitian?

According to the Dietitians of Canada, Dietitians empower their patients, clients, and communities to embrace food, to understand it, and to enjoy it. The advice and information they provide is tailored to their clients and patients personal needs and challenges, including taste and accessibility. They translate the science of nutrition into terms everyone can understand to support healthy living for all Canadians.

Dietitians believe in the power of food to enhance lives and improve health.

How common are dietitians?

Again, according to the Dietitians of Canada, dietitians are everywhere. Whether collaborating with other healthcare professionals, undertaking scientific research, driving innovation in the food industry, informing public policy, or working with patients and communities across the country, our influence runs deep and it continues to grow.

Why would I need to see a dietitian?

Dietitians can support you throughout many phases of your life from pregnancy to eating well when you are older. Counseling sessions with a dietitian can also help you to prevent and treat health conditions like diabetes and heart disease.

At Winterberry, dietitians work as part of a team of other health care professionals like doctors, nurses, physiotherapists and speech pathologists. 

What are some concerns that a dietician can help me with:

Diabetes

Heart health

Cancer

Food allergies

Digestive concerns

Weight loss or weight gain

Infant and child feeding and nutrition

Picky eating

Malnutrition

Pregnancy or breastfeeding

Sports nutrition

Vegetarian and vegan diets

Meal planning

A dietitian will work with you to give you advice and information that is right for you by considering your culture and food traditions. They will also think about your personal needs and challenges, including taste, food skills, budget and health conditions. Dietitians help you cut through the clutter by consulting the latest scientific evidence and providing you with personalized guidance. 

What happens when I see a dietitian?

The first appointment, whether it be in-person, online, or on the phone, will be about 45 minutes to 1 hour. During this appointment, your dietitian will ask you questions to get to know you and the reason you contacted them. You may want to make changes in the way that you eat, have a food allergy, digestive issue, or you have a nutrition-related health condition like diabetes, heart disease, or high cholesterol. Each person’s reason for speaking with a dietitian is different. A dietitian’s job is to work with you as a partner to look at your needs and set goals.

What kind of questions will my dietitian ask me?

Your dietitian will need specific details about you to give you personal and practical information that you can use. The questions your dietitian will ask you will depend on the reason you are visiting them but may include:

Your current diet

What types of foods you or your family like to eat

Your culture and food traditions

How often you eat

How much you eat

When you eat

Where you eat

Your food skills

Your food budget

Any concerns you have about your eating habits

Your general health/medical history

Any medications or supplements you take

Any challenges you face buying preparing or eating foods

Whether you require specific equipment to eat or prepare food

Your height, age and weight (to access your nutritional needs)

How often you exercise

Asking these questions will help your dietitian get an idea of your diet and lifestyle and any healthy or unhealthy habits that you have. It also gives them the information that they need to do a nutrition assessment. This means that your dietitian can figure out if you are getting too much or too little of anything in your diet.

What will I take away from my first visit with a dietitian?

Your dietitian will use or give you resources to help you with your goals like food models to show you healthy portion sizes, sample meal plans, healthy recipes, or a grocery shopping list template. You may be given written information to take home with you.

Always feel free to ask your dietitian questions or let them know about any concerns that you have during your appointment.

Will I have more than one appointment? 

You should expect to have a follow-up appointment. Diet and lifestyle changes are a gradual process and learning new information and skills can take time. A follow-up appointment is generally shorter and costs less than an initial appointment. You and your dietitian can decide on the number of appointments that you need and when they should be.

During a follow-up appointment, your dietitian will track your progress, provide you with more tips and information, adjust your nutrition plan based on how things are going, and discuss the next steps. These appointments allow you to ask questions, talk about what’s going well, what’s not going well, learn about new tools or resources and receive support and feedback from your dietitian.

What training does a dietitian have?

Dietitians are qualified to give you nutrition advice and information. They have a degree in food and nutrition from an accredited university program. They complete practical training and have to pass a national licensing exam*. Like all regulated health professionals, dietitians must stay on top of new research, skills, and techniques. Dietitians do this by taking courses to improve their skills and knowledge every year. Dietitians are the best source for nutrition and food information.

What is the difference between a dietitian and a nutritionist?

Dietitians are trained and regulated to ensure that you and your family receive safe and effective nutrition care, just like your dentist or family doctor.

The title “dietitian” is protected by law across Canada. This means, in Ontario only people who meet certain criteria and standards can call themselves a dietitian whereas anyone can call themselves a nutritionist.

To be sure, you are working with a qualified nutrition professional, look for the initials RD or PDt (DtP in French) after the person’s name. 

An important note: Titles like Registered Holistic Nutritionist and Certified Nutritional Practitioner are not the same as Dietitian. People using these titles are not provincially regulated health professionals. Dietitians are the only nutrition professionals regulated by law. Often people who have completed privately owned training programs use these titles. The length of training and education needed to use these titles vary.

Is there a code of ethics Dietitians must follow?

Check out this quick video from the College of Dietitians to learn more about their Code of Ethics.

Elizabeth Muggah (she/hers) MSc, RD, RSE

Registered Dietitian 

A little bit yourself and what inspired you to become a dietician?

I am originally from Cape Breton Island, growing up in Sydney, NS.

I started my career in the kitchen. I have always loved cooking. I decided to follow my passion and attended culinary school at Nova Scotia Community College. I have my Red Seal in cooking which required 5400 hours of work in professional kitchens along with the successful  completion of a national exam. 

After graduating from culinary school I decided to pursue my interest in nutrition and enrolled in a Bachelor of Science in Nutrition at Acadia University. After finishing my dietetic training, I worked as a Dietitian and Food Service Manager for Brigadoon Village, a camp for children and youth living with chronic illness and/or other life challenges. I moved to Southern Ontario to complete a Master’s degree in Food Science at the University of Guelph. Here I researched ways to improve food service delivery in long term care. 

My interest in nutrition started due to sport. In high school, I played volleyball and ran track and cross country. I became interested in the role of nutrition in performance. Growing up, cooking and eating together was very important in my household. My Dad passed down his love of cooking to me. Becoming a dietitian was a great fit with my interests and personal values. 

What’s your favorite part of your day at Winterberry?

I like when I can have fun with my patients. I love food and helping patients see how they can add variety to their diet; that’s really rewarding. When an appointment with a patient is finished my goal is for them to feel motivated, excited about food and being able to enjoy it. I also want to be sure they have felt heard and listened to and that they know the information they got was personal and specific to them. 

What simple advice can you give readers that can make a big difference?

Samantha Plantic, Professional Masters Diploma (Dietetics), BASc (Nutrition and Food), SCOPE certified, World Obesity Federation

A little bit yourself and what inspired you to become a dietician?

My name is Samantha, a Registered Dietitian at Winterberry Family Medicine. A bit about myself: I enjoy hosting dinners for friends and family, hiking and biking the many trails of the Niagara Region (born and raised!), exploring the seas and cuisine of my Croatian homeland, and am a lover of all things coffee. 

As a young student pursuing my Biochemistry degree at Brock University, I gained an understanding—both in the lecture hall and in my personal life—of how nutrition directly impacts our mental and physical health. It was during this time that I started to be more mindful of my food choices and lifestyle, and felt more energized, focused, and confident because of it. 

I directed my career path toward dietetics to help others, too, realize their health goals, while nurturing their relationship with food and navigating a world of conflicting health claims. Through an enriching road pursuing my nutrition degree and Professional Masters Diploma in Dietetics at St. Michael’s Hospital, I have come to realize that nutrition is an essential, personal, cultural, and rather complicated aspect of our lives. I work with my patients to make nutrition less complicated, and strive to use an additive approach in my counseling: what foods, physical activities, and self-care strategies can we add to reach our health related goals? I look forward to working with you! 

What is the best part of your day at Winterberry? 

Nadia Browning (she/her), MAN, RD

A little bit yourself and what inspired you to become a dietician?

My name is Nadia Browning, and I am overjoyed to be working as a Registered Dietitian with Winterberry Family Medicine. 

I recently completed my Master’s in Applied Nutrition at the University of Guelph, where I also received my undergraduate degree in Applied Human Nutrition (Go Gryphons!!). Throughout my education, I developed the skills needed to provide evidence-based, patient-centered nutrition recommendations. 

I grew up in a large Italian family, where food was at the center of every birthday, holiday, and visit. So, naturally, I pursued a career in food and nutrition! My love for food led to a curiosity about how nutrition impacts our health. In the media, I was met with a large amount of misinformation, diet culture messaging, and recommendations that failed to consider the social determinants of health (such as economic stability, access to education and health care, environment, and social context). I decided that by becoming a Registered Dietitian, I could promote healthy relationships with food, challenge diet culture, and advocate for a lens on individual health that considers the social determinants of health. 

In addition to my love for food, I also love spending time outside! I have set a couple of goals for myself with regards to outdoor activities this year, including learning to downhill ski and successfully keeping a garden this summer. Wish me luck!

What is the best part of your day at Winterberry? 

The best part of my day at Winterberry is interacting with the Winterberry team members! Everyone is always so welcoming and supportive. New learning opportunities are always provided and encouraged, which enables us to provide the best possible care to patients. Furthermore, I always look forward to meeting with my fellow Registered Dietitians, there is so much we can learn from each other’s experiences! 

Alexandra Venger, MPH, RD, Scope Certified, Level 1, 2 Motivational Interviewing

A little bit yourself and what inspired you to become a dietician?

My name is Alexandra Venger, a Registered Dietitian (RD) from Toronto, now working with the wonderful staff and patients at Winterberry Medical.

I completed my Honours Bachelor of Applied Science degree in Food and Nutrition from Western University in 2015, and Masters of Public Health degree specialized in Health Systems Administration and Global Health Leadership from Haifa University in 2021. I have been fortunate to be working as a dietitian for nearly 5 years in areas of clinical nutrition and chronic disease management, sport nutrition, public health and community nutrition. 

I became a dietitian because I wanted to help others and was fascinated by the role of nutrition. It’s hard to say what first inspired my passion for nutrition and dietetics, but it was likely a combination of my family and coaches that valued healthy eating. Growing up in a Russian-Israeli household there was always healthy food (and Bamba) in the house. In high school I was a wrestler, and having to make weight was a natural part of the sport. The rest they say is history. My love for nutrition and helping others blossomed into a career as a dietitian where I have been fortunate to work with people from all over the world.   

What is the best part of your day at Winterberry?

The best part of my day at Winterberry is speaking with patients. I enjoy learning about their unique health and nutrition needs and getting to know them at a level where I can help them achieve their goals. It makes me feel like I can give back my nutrition knowledge and experience to help them achieve their goals and improve their health. To me this is rewarding and continues to fuel my passion for nutrition and helping others.

What simple advice would you give a patient that can make a big difference in their nutrition and health?

Don’t eat in front of the TV.  Often, people engage in mindless eating, such as eating while working or watching the latest show on Netflix. Like Pavlov’s dog, we are essentially conditioning ourselves to salivate as soon as we turn the TV or computer on, even if we aren’t hungry. Instead, aim to minimize distractions while eating, by turning off electronics, so that you can be more mindful of how much and what you are eating. 

As promised, we’re sharing a recipe that will help get more vegetables on your plate. This delicious dish was created by Elizabeth Muggah, MSc,RD,RSE and we’re sure it will become a favourite in your kitchen:

Simple Roasted Broccoli (~3-4 servings)

Prep time: 5 minutes

Cook time ~25 minutes Preheat oven to 375°F (190 °C)

Ingredients:

1 head of broccoli cut into florets 

1 tbsp olive or canola oil 

½ tsp garlic powder

Salt and pepper to taste

Optional: a shake of your favourite seasoning, you can customize this recipe to any entrée.

Directions:

Looking for more information about Dietitians? 

Dietitians of Canada www.dietitians.ca

College of Dietitians of Ontario www.collegeofdietitians.org

And remember, booking an appointment with a Winterberry Dietitian is easy. Call the clinic at 905-575-9004 and book an appointment with a Nurse or Nurse Practitioner.

Overweight adults can lose weight by getting more sleep—even if they don’t make changes to their diet or level of physical activity. That’s the finding of a small new study of 80 overweight adults conducted by the University of Chicago and the University of Wisconsin-Madison and published in JAMA Internal Medicine. The study found that participants who upped their sleep from less than 6.5 hours to 8.5 hours a night reduced the average number of calories they consumed in a day by 270 calories (some cut their intake by as much as 500 calories a day). 

This translates to a whopping 26 pounds of weight loss over three years.

It’s “a game changer in our efforts to tackle the obesity epidemic,” says the study’s author, Dr. Esra Tasali, director of the Sleep Research Center at the University of Chicago.

How does adding a couple of hours of extra zzz’s help people lose weight? Sleep deprivation impacts two key hormones that affect appetite. Ghrelin stimulates hunger and increases with sleep deprivation whereas leptin sends a signal when we feel full and decreases with sleep deprivation. Another issue is that insulin resistance increases with a lack of sleep, and this can lead to weight gain. 

About one-third of North American adults are not getting the seven to nine hours of sleep recommended by the National Sleep Foundation. 

Looking for ways to boost your shut-eye? Try these 10 tips:

The desire to be thin in the skin they are in starts early — especially for girls. In fact, studies show that 80% of girls have been on a diet by the time they are 10 years old. And more than half of girls and one-third of boys ages six to eight wish they had thinner bodies, according to Common Sense Media.  

Media has a huge influence on how children think about their bodies. Eighty-seven percent of female characters ages 10-17 on TV are below average in weight. And measurements of toy male action figures exceed even that of the largest bodybuilders.

While genetics and hormonal factors can affect a child’s weight, parents may also play a role in how their children perceive weight.  For example, a parent who is constantly talking about dieting or criticizing people who are overweight or obese can instil fears about weight gain in their children.

It comes as no surprise that a recent study in Obesity reports that for young people a preoccupation with weight and the desire to be thinner can persist into adulthood and lead to compulsive eating and greater weight gain.

The study of  623 women began when they were 10 years old and ran for about 20 years. The participants were assessed five times during adolescence for their drive for thinness, reward-based eating and BMI. The study concluded that the desire to be thin during the critical development years can have long-term effects on adult eating behaviours tied to greater weight gain. It noted that there are likely to be benefits to early interventions to help girls and women manage negative thoughts and emotions about food and weight gain.

What can parents do to help their children not be so concerned about weight? Common Sense Media offers these suggestions:

Quick — what’s the first thing that goes through your mind when you see a person suffering with the disease of obesity?

If you’re like many people you may assume they eat too much, that they don’t exercise enough or that they don’t have any willpower.

These are some of the common stereotypes ingrained in society about those with a larger body size. People often think that those living with obesity have no one but themselves to blame. But the truth is, obesity is a complex medical condition that is caused by key factors that go beyond diet and exercise — including genetics, metabolism and other non-behavioural issues.

A recent international study reported in the International Journal of Obesity found that 58% of the study’s 14,000 participants who were actively trying to manage their weight had encountered weight stigma,  mostly from family members, followed by classmates and physicians. Their experiences were most common and upsetting during childhood and adolescence.

Almost 30% of Canadians suffer from obesity (the figure is 40% in the U.S.) and while public attitudes toward other traditionally stigmatized groups have become less prejudiced, weight bias still persists due to the fact that thinness continues to be celebrated in North American culture, as evidenced by the multi-billion dollar diet industry and negative portrayals of people with larger bodies.

Weight stigma only makes people who are overweight and obese feel worse about themselves (known as “weight bias internalization”), and this can lead to depression, anxiety, low self-esteem lower physical activity, disordered eating and avoiding health care appointments. 

For the first time in 2020, the Canadian Clinical Practical Guidelines for adult obesity management addressed weight bias and stigma. Recommendations to health care practitioners included: asking permission to discuss weight with patients, assessing the patient’s history to understand the root causes of obesity, discussion of treatment options, agreement on a long-term action plan with realistic expectations and assisting with barriers and drivers of weight gain (these can include lack of access to health care providers with expertise in obesity, lack of coverage of obesity medications by drug plans and long wait times for bariatric surgery, for example). Another recommendation is for health care workers to assess their own attitudes and beliefs about weight.

While weight stigma is still extremely prevalent, there are hopeful signs that societal attitudes are shifting. For example, the body positivity movement which has become popular over the past few years focuses on ending the culture of “fat-shaming” and challenges unrealistic body standards, particularly when it comes to female beauty. 

Photo by Kevin Wolf on Unsplash

Your boss gives you a poor performance review, so you stop for a fully-loaded pizza on the way home from work. Your teenager screams at you in the kitchen, and you “treat” yourself to a couple of donuts after he heads off to school. Things are tense with your partner, so you wolf down a large slab of chocolate cake before bed.

Or—a global pandemic has you ricocheting from despair about the future to hopefulness that life will soon return to normal.  

Call it what you want — “emotional eating,” “stress eating,” “comfort eating” — the symptoms are the same: the habit of responding to stressful events and difficult feelings by typically eating high-carb, high-calorie foods with little nutritional value (think ice cream, cookies and chips), even when you aren’t particularly hungry. Negative emotions can make people feel emotionally empty and food is a way to fill the void and create a sense of fullness.

About 40% of people respond to stress by eating more (while an equal number respond by eating less), making emotional eating highly common. The problem, of course, is that repeated bouts of this behaviour can contribute to obesity, which in turn, leads to health problems such as diabetes and heart disease.

Emotional eating is not necessarily related to binge eating. The difference between the two is the amount of food consumed. In order to qualify for a diagnosis of binge eating disorder, a person must binge an average of once a week over a period of three months. Binge eating is characterized by compulsive overeating, eating faster than normal, concealing the amount of food eaten and feeling shame and regret afterwards. 

So how does one change patterns of behaviour so that food is not used as a way to avoid feeling difficult emotions? Here are 6 strategies to consider:

Photo by Artem Labunsky on Unsplash