Jacqui Gingras

Sustaining Imbalance — Evidence of Neglect in the Pursuit of Nutritional Health

As dietetic students, we learnt of a category of patients who presented with ‘simple obesity’. Notwithstanding the notoriously high failure rates of treatment, it was these patients who were (and often still are) deemed most suitable for students to advise when first on placement. The advice given would be underpinned by the so-called energy balance equation. This holds that body weight is a function of the amount of calories consumed minus the amount of calories expended. A diet that gives a daily 600-calorie deficit would be typical of the sort of calculations we were trained to undertake, planning individualised meal plans designed to achieve a ‘safe’ and sustainable weight loss of 1–2lb a week. Granted some fat people might have an Eating Disorder, but the majority needed to be told (how) to eat less calories and/or exercise more: it really was that simple. Failure might arise from an individual’s lack of adherence but the effectiveness of the approach itself needed no scrutiny: assuming someone stuck to the prescribed regime, weight loss was deemed to be possible, predictable and profitable for health.

Helping People Change: Promoting Politicised Practice in the Health Care Professions

While this is an obviously contentious statement, we take this as the starting point for our analysis and efforts to expand the currently truncated obesity debate beyond its medicalised and reductionist focus on disease, risk and pathology. In saying that there is no such thing as obesity we don’t mean to imply that no one is fat. What we are saying is that the term ‘obesity’ — and more especially its assumed precursor ‘overweight’ with which it is often conflated — as currently used in the clinical and academic worlds with which we are familiar has little medical salience. For a very high percentage of populations reputedly in the grip of an ‘obesity epidemic’ (the United Kingdom, the United States and Canada for example) fatness and/or heavy bodyweight (taken as indicating overweight or obesity) do/does not, as is popularly promulgated, reliably indicate a person’s metabolic risk, except at extremes of the weight spectrum. By metabolic risk we refer to the metabolic dysregulation arising from a range of lifecourse experiences that can predispose people to diabetes, hypertension and cardiovascular disease. Belief in obesity (and overweight) couples weight and high metabolic risk as intrinsically related variables and thereby perpetuates what we, in our role as health professionals and critical weight scholars, view as a harmful conglomerate of inappropriate interventions premised on equally harmful ideological drivers.

Theorizing health at every size as a relational–cultural endeavour

Mainstream dietetics buttresses a conventional weight management agenda that is associated with weight preoccupation, body dissatisfaction, size oppression, and troubled eating. Coterminous with this agenda is healthism, which taken together, impede dietitians’ engagement with a health at every size (HAES) paradigm, a paradigm driven by concern for equality. Yet, HAES has also been critiqued for having healthist tendencies. The purpose of this paper is to explore how HAES might be reimagined through the lens offered by relational cultural theory (RCT) to offer a radical and more socially just vision of dietetic practice. We posit relational–cultural theory as a complementary theoretical perspective to deepen understandings and to politicize HAES-based dietetic practice. We suggest that RCT permits a critical, relational, and political revisioning of the weight-centred canon and elaborates HAES by emphasizing mutual empathy and reciprocal growth within and between the client and practitioner concomitantly. Moreover, questions of power, ethical survival, and knowledge emerge which is what we contend makes it possible for a socially just, nonhealthist HAES practice to flourish.

The passion and melancholia of performing dietitian

Dietitians provide nutritional care in various contexts and it is expected that dietetic subjectivity shapes and is shaped by health/nutrition discourse, but this has not been sufficiently explored. The purpose of this study was to further understand dietetic subjectivity, dietitians’ experiences of their education and relationships between educational and practice discourses. Twelve dietitians were recruited to participate in semi-structured research interviews. Feminist theoretical perspectives informed the research including the interpretation of data, which was analyzed according to the Listening Guide, a feminist voice-centered relational method. A theory of dietitian performativity informed by Butler (1999) emerged whereby dietitians expressed passion and melancholia for their practice. Also, participants experienced discontinuity between educational and practice contexts, which highlighted the need to integrate embodied epistemic perspectives throughout undergraduate education. These findings support a critical gesture in dietetic educational discourse away from positivism towards embodiment as a means for highlighting and reinforcing the complexity and fluidity of dietetic performativity.

Inside the Actors’ Studio Exploring Dietetics Education Practices Through Dialogical Inquiry

Two colleagues, Ann and Jacqui, came together, within the safety of an imagined actors’ studio, to explore the challenges that Ann faced in planning a new graduate program in public health nutrition. They met before, during, and after program implementation to discuss Ann’s experiences, and audio-taped and transcribed the discussions. When all three sessions had concluded, they reviewed the transcripts and discussed their insights further. In doing so, they drew upon the collaborative writing work of Wyatt, Gale, Gannon, and Davies, whose play featuring French theorist Gilles Deleuze, inspired Ann and Jacqui to consider what it meant to work together on this project. Of particular interest was the tension they encountered attempting to tell their stories in the first person narrative voice as well as their differing perspectives on the therapeutic sensibility of the discussions. Through this process, Ann and Jacqui gained insight into their educational practices and came to view dialogue as a valuable method of inquiry.

Embracing Vulnerability: Completing the Autofictive Circle in Health Profession Education

In this autoethnography regarding the writing and sharing of an educational autofiction, I explore the vulnerability inherent in moving from the imagined to the real in a pedagogical context. Autoethnographic fiction is a scholarly method with the potential to disrupt traditional, science-based discourses dominant in health profession education. This potential was enacted in a senior undergraduate dietetics class when students were invited to read and write their own autoethnographies. Marked by vulnerability, I came to embody the transformative theory of being unfinalized as I endeavoured to resist the way things have always been in dietetics and make visible the emotional process of writing autoethnographic fiction as a move towards personal and social transformation.

Exposed social flesh: Toward an embodied fat pedagogy

ABSTRACT Recently, a small but growing literature has emerged investigating and outlining what a fat studies pedagogy might entail. Missing from much of this literature is a discussion about how the material body becomes a site through which “obesity” discourse is resisted or reproduced in the classroom. The authors attempt to fill this gap by focusing in particular on the educator’s body. They present the deepened understanding that results when three differentially positioned feminist and fat studies educator-scholars engage in a reflexive analysis regarding their experiences of teaching fat pedagogy within the academy. They argue that for educators of a marginalized topic such as fat studies, corporeal risks emerge as classrooms become spaces where the social stigma of fatness intersects with and instigates careful surveillance of (fat) bodies. Each of the authors explores her experiences of these risks, interrogating how her body is voluntarily and involuntarily interpolated (or not) into the epistemological and theoretical frames of fat studies or critical weight curricula to become a site of learning for students. In addition, the authors reflect on how critical weight and fat studies—not only through the offering of critical fat studies literature, but also through students’ readings of their teacher’s flesh, can be used in the university as a means to resist “obesity” ideology and potentiate a reconstituting subjectivity, thus reinforcing a socially just pedagogy that upholds the necessary view that bodies of all shapes and sizes count.

Empowerment, Compliance and the Ethical Subject in Dietetic Work

In this chapter, we examine how dietitians use empowerment discourses as a means for ensuring compliance among those seeking and receiving their nutritional expertise. The question posed by the West Midlands branch of the British Dietetic Association (2005) ‘Can we empower our patients to increase their compliance to treatment?’ suggests that dietitians are co-opting empowerment discourses to generate compliance. They may also reinforce the commodification of nutrition knowledge through an emphasis on self-care that amplifies the impact of lifestyle behaviours in determining health. Wherever food work and expertise is primarily located, with attendant consequences for empowerment, this construction belies the fact that ultimately people’s health is not determined by access to health information or services. In an era of personal responsibility when ‘good citizens’ are encouraged to seek and act on health information to facilitate an efficient health care system, nutritional treatment is presented as necessary and unproblematic. The empowerment-compliance complex is implicitly positioned as a cost-saving mechanism within this health care matrix and as a way to reinscribe the moral character of the good citizen. In such a way, nutritional health becomes a property of individuals rather than something contextualised by the relationships individuals enjoy with family, community, organisations, society and the environment. By examining how dietitians have taken up empowerment discourses, we reveal how aspects of the profession of dietetics can become disempowering for both dietitians and their clients. As a response to the more problematic issues identified, we propose a dietetic practice that acknowledges people’s lived experiences in a dynamic social and political milieu, and we examine how people, in their role as professionals or dieters, may resist control and compliance discourses as a means of subverting and disrupting neo-liberal agendas that would position them otherwise.

Community–university research partnerships: a role for university research centers?

Community–university research partnerships (CURPs) are increasingly common, yet much of the existing research documents the experiences of individual projects or analyzes research methodologies associated with CURPs. Comparatively little is known about the role of university research centers in the design and implementation of CURPs. Even less is known about the role that interdisciplinarity (as a de facto characteristic of research centers) may play in enabling or impeding CURPs. This article contributes to filling this gap. Drawing from a reflective strategic planning process with research center associates and a broader faculty conference workshop, at Ryerson University in Toronto, Canada, this article offers reflections on the role of university research centers in CURPs.

Mandarin Peelings and Lola's Tinola: Exploring Subjectivity and Belonging through Cultural Food Narratives

Abstract Cultural food narratives and the pedagogical process to initiate such narratives offer meaning to our food memories, nostalgias and reminiscences. We theorize subjectivity and belonging through a performative process of “narrative conversation” enacted between student and teacher as co-learners seeking to dwell deeply among the interstices of language and silence, subjectivity and culture, self and Other. While we acknowledge the risk for exploiting the Other in our longing for connection, we propose a living food studies curriculum as a critical anti-colonial intervention that attends to inarticulate spaces, subjectivities and myriad contradictions. The narrative conversations we have with each other help us understand who we are and where we are coming from—a relational epistemology. These are significant conversations because they are risky and personal; much is at stake, but mostly our understanding of difference, originality, and an acknowledgment of diversity for those of us learning, teaching and being Canadian.