HAES® and Illness

Food RxOne of my readers asked if I could talk more about how Health at Every Size® works for people managing certain medical conditions, specifically ones for which dietary changes are recommended.

There are indeed medical conditions for which changes in diet can help. Diabetes, hypertension and elevated blood lipids are the ones I work with most often in the aging population I serve in my job. Treating medical conditions and their associated symptoms with dietary intervention is called medical nutrition therapy (MNT), and all dietitians are trained to do this. I think HAES® fits well with MNT because HAES® is about supporting health, simply without a focus on changing weight. One can still aim to make diet changes that support a particular condition without having to focus on losing weight, because frankly there isn’t solid evidence to show that weight loss 1. helps to improve health long-term or reduce mortality in people with certain medical conditions (witness this recent finding  and this one too) and 2. is possible to maintain long-term (>5 years) for more than a tiny fraction of people even if it did improve health, therefore making this a temporary treatment at best that will most likely result in a higher weight in the long run.

On the other hand, some studies show that using a HAES® approach does improve health over the longer haul. In Linda Bacon’s study of a HAES® approach, non-dieters showed improvements in blood pressure and lipids at the end of the study. Dieters showed those improvements initially as well, but they lost those improvements as weight was regained, and many of the dieters (41%) dropped out of the study (while only 8% of the HAES® group dropped out), which means to me that the dieting intervention wasn’t a sustainable treatment for the long-haul.

We’ve established, then, that weight loss isn’t necessary (and might not even help) to improve health. How do you manage your medical condition nutritionally then? First, if you’re asking this question, I highly recommend you talk to a registered dietitian who can help you understand what will help and what won’t (and of course, I’d love for you to find a HAES®-minded dietitian, but that will definitely take some investigation on your part).

In my dietitian training and experience, I’ve found there are very few conditions which require heavy-duty dietary restriction. And I’ve personally found few people who can adhere to strict diets either. An internally regulated style of eating does support health, and the science says so too. Listening to your internal signals of hunger and fullness will ensure you don’t eat too much (or too little) for your body, and providing yourself with regular meals, as with the eating competence model, will ensure you eat a good variety of foods. I believe one can still manage medical conditions following an Intuitive Eating style, but if you’re having difficulty with the demand-feeding schedule, I wrote about Eating Competence last week for this very reason.

Within the framework of eating regular meals and snacks and using your body’s intuition to tell you how much and what to eat, dietary tweaks for various conditions can still be made easily. You can provide yourself consistent carbohydrate meals for diabetes (which is recommended by the ADA). You can aim for more foods lower in sodium if you have hypertension. You can aim to include one or two fruit and/or vegetable choices (that you like, that are prepared in a tasty way) at each meal which will benefit any condition. If you aren’t doing so in a restrictive way that leaves you hungry and robs you of permission to eat food you enjoy, this should work without causing too much drama. I’m of the mind that making a few changes while still feeding yourself regularly is way easier than making dietary changes while going hungry because you’re trying to suppress your weight AND manage your condition. One is self-care, the other is pure punishment.

I frankly think if you’ve made it as far as providing yourself meals that include the four food groups and you’ve tuned into your appetite and are honoring your fullness signals, you’ve already come a long way in managing a nutrition-related medical condition.

With all conditions, you still need to feed yourself regularly, you still need to feel satisfied and not deprived, you can still enjoy food with good planning, and you can still keep an eye toward nutrition without getting totally restrictive. The key, of course, is intention. Is it your secret intention with your dietary change to lose weight? If it is, you will undermine trust in your body to eat the correct amount for yourself; you will eat either too little, or foods that you don’t like, and eventually you will end up back in the restraint/disinhibition cycle.

You may also have to recognize that diet perfection is usually unattainable and unsustainable. Isabel Foxen Duke recently wrote about this problem and had this brilliant thing to say:

Are you comfortable with the possibility that you may not be able to follow your health intentions 100% of the time despite your best efforts? Because—as most binge-eaters know, but too often forget—the reality is that your food choices are not only controlled by willpower, but also by instinct— instincts that are impacted by biology, psychology, emotions, and a million other factors outside of our control. If “breaking” your decision to avoid a certain food makes you feel guilty, ashamed, or like there’s something fundamentally wrong with you because you can’t “stick to” your health choice, you may end up in “falling off the wagon” style binge-eating. (In other words, can you get down with the gray-area of self-care?)

There are a few conditions which do require steadfast restriction of some foods – Celiac’s disease and food allergies are a couple. In these cases, find suitable replacements. There are many non-gluten-containing carbohydrates that you can substitute in order to round out your meals. It’s not an easy diet, but it is manageable as long as you are feeding yourself faithfully.

If you’re still working on recognizing and getting comfortable with your hunger and fullness signals, keeping working on it. Honoring those internal eating cues is not contraindicated for any condition. If you struggle with internally regulated eating and managing diabetes, I recommend Michelle May’s Eat What You Love, Love What You Eat with Diabetes.

And if your doctor is recommending weight loss to help with a medical condition, I would ask what science-based evidence he/she is using to show that this a sustainable, long-term intervention that works for a majority of people, and also what interventions are recommended to “normal” weight people with the same condition.

HAES® and internally regulated eating do support health. Again, talk to a registered dietitian if you need help. Educate yourself from reliable sources: Web MD, Mayo Clinic, PubMed, CDC are some sites that will provide science-based information; crack-pots like the Food Babe and David Avocado Wolfe do not. You don’t need to diet to be as well as you can.

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8 thoughts on “HAES® and Illness

  1. Lori Blough May 23, 2016 / 4:58 pm

    Thank you!!

  2. Aston Hiddleston-Foster May 24, 2016 / 2:34 am

    I’ve recently discovered your blog, and I find it refreshingly sound advice! I used to get crazy thoughts that I was killing myself with how I ate whilst trying intuitive eating (translate to fear of sugar etc). Now I realise it is about balance and trusting your choices, and getting to know the real hard science of what is healthful, not scaremongers. Thank you for sharing your thoughts!

    • GlenysO May 24, 2016 / 8:44 am

      Don’t worry, you’re not the only one who has suffered from this affliction! Unfortunately our culture supports it. When looking at the science, I always try to think, who benefits from putting out this information? Sadly, food fear fuels the futile weight cycling industry, so it is many people’s interest to keep it going.

  3. KatieComeBack May 25, 2016 / 6:11 pm

    Love this. It’s an approach that begets success and results!

    It’s frustrating when physicians hang their medical advice on weight only, when there are so many very unhealthy ways to lose weight. (Read the ingredients on a meal-replacement bar or drink. What even IS that?)

  4. Grab the Lapels May 28, 2016 / 1:31 pm

    I just bought the book you recommend on my Nook. I hope it’s a very peaceful sort of book. I don’t like books/health nuts that are hyper and yell at people, though I know that’s the way some individuals like to be motivated. It’s very “WOOOOO!!!” and I’m very “eat it, clown.” Thank you you for your blog. It’s like a calming whisper in my ear.

    • GlenysO May 28, 2016 / 3:43 pm

      I never recommend anything that yells at people, especially about food and diet! That said, what some people find calming, others may find upsetting, so I do hope you enjoy it!

  5. Lauren December 30, 2016 / 2:05 pm

    I’m curious if you are familiar with the low-FODMAP diet, that was studied by researchers at Monash University as a way to identify triggers for IBS? It’s a pretty complicated elimination diet, and requires pretty careful attention to serving size because some foods that are ‘safe’ (as in, unlikely to trigger symptoms) at a small serving size become ‘unsafe’ in larger portions because of the increased FODMAP content.

    Is there a way to complete an elimination period like that (2-6 weeks to hopefully reduce symptoms consistently, followed by a reintroduction of several more weeks) without slipping back into a dieting, restricting mindset? Is that a treatment that you as a dietician feel you are qualified to help a patient navigate, while also trying to escape dieting and embrace intuitive eating and HAES? Or should those things be handled separately?

    • GlenysO December 30, 2016 / 5:40 pm

      I do know that diet and it is a very difficult diet to follow. If you have a history of ED or disordered eating, you may want to consider seeing a functional medicine dietitian who is familiar with HAES/intuitive eating (I am in a group on FB with some RDs like this). Some HAES RDs do feel handling these separately, with normalizing the relationship to food coming first, is the best path. It’s also important to know that IBS can be stress triggered and not necessarily diet related (this is true for me); but if you want to go the elimination diet route, I suggest working with a dietitian knowledgeable in both areas. Best of luck!

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