occam's razor

The simplest answer is often the correct one. I think the answer to my situation is that I must be coming from a very different place than my classmates.

It sounds dumb and pretentious, but this genuinely surprises me a lot. I'm not usually in the minority in much of anything, I'm a white, cis-gendered, able-bodied, high intelligence, well-educated, upper middle class, queer woman, among many other things. I'm in a graduate program surrounded by a strong majority of other white cis-gendered upper middle class women. While we have different backgrounds and experiences and values, we tend to also have a lot of the same assumptions about the world.

One of my classes involves a small group of 8 of us plus a faculty member, and we are working with a group living in a residential rehab program for women with mental health diagnoses, drug addiction, and children under the age of 10. We did a few surveys to determine exactly what they wanted to talk with us about, how we could best help them as nursing students and health educators, intending to plan "interventions" (aka - activities/classes) around those topics. Sounds easy enough, right? So why do I always leave this class feeling so on the outside?

I'm a pretty likable person. I get along with just about everyone, it's pretty much the one thing most people know about me - I'm friendly and cheerful. (I don't get close with anyone, but that's another story.) In this class I am not a likeable person. I feel like the stormy raincloud who keeps throwing wrenches in the works, and I can't seem to stop myself from doing it over and over.

Today we were planning an intervention on nutrition. From our survey, we learned that a) most of the women are obese, b) half of them are pregnant or breastfeeding, c) none of them exercise regularly or really have a place to exercise besides walking up and down stairs (boring!), d) they're buying food once a week using food stamps, e) there is a lot of confusion about nutrition and what a "healthy diet" even means, and f) a typical meal is cheap, processed, and microwaved or fried.

That's our starting point. Frozen pizza rolls and Cup o'Noodles. Keep that in mind.

We found a paper explaining how it can be a good start to just explain a food label - calories, portion size, etc. Another paper talks about how behavior change takes time, repetition, hearing something multiple ways, and can still take years to make large scale shifts, strongly correlated with motivation to change. These women didn't strike me as particularly motivated. Interested, yes! Contemplating a change, sure. Able to see the value in asking for inexpensive, healthy recipes. But actually ready to make a shift in their eating patterns? Maaaybe.

This isn't a judgement on them - I spent a good chunk of my childhood eating that way. It's taken me years to change my eating patterns, and I "slip up" all the time. I also have the advantage of a vast amount of nutrition education, a decent amount of personal motivation, and the money to spend on specialty foods like powdered peanut butter ($5/12oz jar vs $5/32 oz jar of regular PB) or nonfat Greek yogurt ($5/32 oz vs $2.50/32 oz regular yogurt). I buy jars of spices for $6 with only a little hesitation, and easily spend about $120-140/week on groceries because I have the ability to buy in bulk to save money on things I eat daily. I make a point of trying to eat fruits and veggies (the latter with only moderate success - one bell pepper costs $1.50, which is 7 bananas or 3-4 apples or almost a loaf of bread, or almost a bag of spinach). I even consider buying organic/cage free/etc, depending on how my budget is looking and how guilty I feel about chicken treatment that week.

Based on their comments in our survey, the women in this group do not have the resources to buy that kind of food, nor do they have a knowledge of basic nutrition. Nutrition is confusing! Fat is bad. No, fat is ok if it's "healthy fat" (do you walk up to it and ask how healthy it is?). Lard is bad, eat butter. Butter is bad, eat margarine. Margarine is bad, eat butter. Both of them are bad, use oil. Vegetable oil? Make that olive oil. Nope, just kidding, coconut oil (at $11/16 oz vs $3/48 oz). Carbs are bad. Except when they're good. Is fiber a carb? Are peas a starch or a vegetable? If it makes a rat obese/diabetic/cancerous, is it going to do that to me too? It's enough to make anyone admit defeat and just eat whatever the heck they feel like eating. Like frozen pizza rolls.

Two classmates of mine were planning this nutrition intervention. I tried to remove myself by doing other group work, but couldn't stop myself from chiming in from time to time. At one point the mentioned talking about avoiding saturated fats. For all my nutrition education I've never been able to keep that part straight - is it saturated or unsaturated that I'm supposed to not eat? And, honestly, who the heck cares? If a woman cooks one meal/day with her kids (required by the program) but still eats a cup o'noodles (or two) for lunch every day instead of leftovers, is she really going to suddenly start cooking several chicken breasts with brown rice and frozen veggies over the weekend to bring with her for lunch?
(clearly I think the answer is no)
The shock and horror that I received when I admitted that I don't pay attention to saturated fats on nutrition labels really stung, particularly with the immediate dismissal that followed. I don't think it was intended that way, but it definitely felt like a distinct judgement on my character. How dumb could I be to be in nursing school and *not* care about saturated fats? Clearly I'm some kind of outlier, *everyone* who cares about their health would never pollute their sacred body with something so bad for you, even looking at a saturated fat makes your love handles grow (and gives you hairy toes).

It's easy to get overwhelmed with information, especially when it is presented on a topic that you know you do (or ought to) care about, like eating healthy. People get wrapped up in the idea that not eating healthy is a judgement on their character, we do it to ourselves and each other all the time. That obese person eating cake? Lazy, no self-control. That boney girl eating a tiny salad? Anorexic (but with enviable self-control). I've fallen into the trap of "if I can't make all the changes, I might as well not bother since I'm a failure anyway." I think we're setting up the women to have that happen, to be motivated for exactly half a minute about making changes, and then overwhelmed at the prospect of a complete lifestyle overhaul in under 2 hours. And I think being the ones to give them that sense of failing before they've even started will hurt their trust in us, because it will be clear that we aren't understanding where they're at.

A tiny healthy change - eating at least one fruit and/or vegetable a day (even frozen or canned) - is a start. Changing one Hot Pocket out for a salad with some chicken is a win. Using half of the salt you normally would is an accomplishment. The percentage of their calories that come from saturated fat can be the next step.