Eat, Read, Learn | September 2025

NS Dietitians: Check out the DNNS Facebook page for more new foods, thought-provoking reads, and continuing education opportunities – and please share your own contributions as well!

If you have comments or suggestions, you can reach Meredith at meredith.lapp@gmail.com

EAT – Upcoming expansion of school lunch program in Nova Scotia

The Nova Scotia School Lunch Program is expanding this month to include middle and junior high schools, from its hugely successful start in elementary schools in the 2024-2025 school year. The Program allows families to order daily balanced meals for students as often as desired, with cost also determined at check-out: families can select on each order to pay full price ($6.50) per meal, a partial price, or pay nothing, with this choice remaining confidential and with no need to prove inability to pay. Dietitians can learn more about the Program here, including full menu listing with ingredients if counselling pediatric patients using the Program.

READ – New “Just the Basics” introductory patient resources available from Diabetes Canada

Diabetes Canada has refreshed their “Just the Basics” introductory nutrition handout, now titled “Getting Started: Healthy Eating and Diabetes”. This resource is typically provided to newly-diagnosed Type 2 diabetes patients while they wait to be seen by a Diabetes Education Centre or registered dietitian. Of note, the new resource no longer recommends “low-fat” diets or margarine, instead referencing choosing unsaturated fats (olive oil, avocado, nuts and seeds) more often; no longer dictates “3 meals per day” instead suggesting eating every 4-6 hours; and no longer includes two additional carbohydrate servings (fruit and milk) as part of the plate diagram, instead illustrating water as the beverage of choice and portioning fruit as a carbohydrate serving, allowing the patient more flexibility in choosing per-meal carbohydrate targets. Sample meal plans now contain more protein and less carbohydrate per meal, aligned with the shift in diabetes care over the last decade allowing for low- or moderate-carbohydrate eating patterns (130g/day, or 45% energy) for patients wishing to take a more lifestyle-intensive approach to their diabetes management, and supporting the need for adequate protein intake for the increasing number of diabetes patients using incretin therapies like semaglutide [Ozempic/Rybelsus] or tirzepatide [Mounjaro]). There is also reference to consulting the healthcare team about upcoming fasting (important for newly-diagnosed patients who participate in religious fasts), and many references to listening to one’s own body regarding hunger/satiety cues and judging physical activity intensity.

LEARN – Removing the barrier of BMI in access to ortho procedures

Dietitians providing 1:1 medical nutrition therapy have doubtless been referred patients frantically seeking dramatic weight loss to access needed orthopaedic surgery – hip and knee replacements, ankle repairs, and so on. These patients

are often stuck in a cycle – intensive exercise and significant changes to food routines are often not realistic interventions given the mobility limitations and complications of chronic pain/inflammation caused by the damaged joint, so

achieving significant body mass reduction from lifestyle interventions alone is not reasonable advice. For this reason, working groups organized by Obesity Canada and the Canadian Orthopaedic Association met in Fall 2023 to begin development of a consensus statement discouraging use of BMI as a gatekeeper to surgical approval, and highlighting the fact that any weight-reduction attempt incurs possibility of health risk to the patient: “Due to substantial uncertainty of research evidence, weight loss recommendations should be made judiciously, in the context of the patient’s unique clinical situation, including […] risk of malnutrition and muscle loss […]and the patient’s perspective, among other considerations. When pursued, weight management should be co-ordinated by the patient’s comprehensive primary care team.” In addition, the Recommendations state that should a practitioner not feel comfortable operating on a patient due to body dimension, the practitioner has a responsibility to ensure the patient is referred to a surgery site that can accommodate their needs.

Follow the DNNS Facebook group for more new foods, thought-provoking reads, and continuing education opportunities – and please share your own contributions as well!

Curated by Meredith Lapp, RD

If you have a blog, book, or online course that you would like to share with your fellow network members, please forward information to Meredith at meredith.lapp@gmail.com