People often send us questions for our Dietitians Unplugged podcast. We love getting questions and once in a while we’ll pick one to answer in our show. This one in particular was one we felt was probably on the minds of many people for whom HAES was a completely new concept.
Our listener wrote:
I just listened to Dietitians Unplugged episode about Tess Holiday. Can you explain to me your feelings around obesity in a little more context. I am confused with what you actually promote around being very overweight. I do understand intuitive eating. And let me note, I’m not commenting on Tess Holiday specifically or her being on a cover of a magazine. I’m talking about obesity in general. In your opinion obesity is not bad? How can you support that opinion if obesity is linked to an endless number of medical conditions? I see how one can be overweight but still healthy. Just as someone can be skinny and unhealthy. But at a certain point in time, if you are so over weight that you are declared obese then you have fat crushing your major organisms, you are shortening your life, and setting yourself up for a difficult aging processes. How can someone with that amount of excess weight still “healthy.” Thank you for reading, your inquisitive listener.
To be very honest, I wasn’t sure if at first we were being trolled. But I sometimes forget what a wonderful little HAES bubble I live in much of the time, both in my mind, and online (and even IRL with most of my local friends and acquaintances), and I realize that in fact, most people haven’t even heard of HAES and might have questions (and I’m pretty sure that early on, this was one of the skeptical questions I had very early on when being introduced to HAES).
For those of you who aren’t podcast listeners, I’ll give you the very quick and short answer to the question of, “Is there a size limit to HAES?”: No. Slightly longer answer: I feel that anyone of any size can benefit from Health at Every Size principles, and furthermore, dieting to lose weight is probably doing actual harm. My clients in large bodies have tried dieting more times than you can count, and aside from usually gaining even more weight than they lost in the first place, they come to be with extremely disordered eating and total confusion and frustration around the best way to take care of themselves with food and movement. And finally: I never promote a particular body size. To me, all bodies are good bodies. I am more interested in promoting the best, most sustainable and life-affirming ways to take care of the body a person has right now.
If you want the longer, much more nuanced answer to our listener’s question, give this episode a listen!
Something I’ve been thinking a lot about lately is diabetes.
I’m getting older and I have a family risk, and taking care of myself in the best possible way (where “best” sometimes means “good enough”) is something I’m always working on.
And of course, I don’t diet anymore and never will again. So the standard “lose weight to lower your risk” advice just isn’t going to fly with me (sorry, Doc!). I eat as healthfully as I can (knowing I get to determine what that means for me) and move joyfully, but those things don’t make me thinner, just like they don’t make most people thinner which is why people end up going on whackadoodle diets. But I do know that they can help to make me healthier, and hopefully decrease my risk for diabetes.
My Grandmother was diagnosed later in life and ended up living quite a long time despite some seriously flawed self-care over the years, in part due to becoming my Grandfather’s full-time caregiver after a stroke. She had been a life-long dieter who ended up at a much higher weight by the time she was in her 60s. She really did eat like a bird from what I could see, which doesn’t actually surprise me given what I know about how dieting affects metabolism. (Fun fact: this would drive my Mother crazy when she would cook a massive Christmas dinner once a year and Gram would then pick deliberately at it and leave most of it on her plate. Ah, families) All this backstory to say, she had diabetes and she still managed to have a life. I think it’s important to remember that a diagnosis of diabetes does not mean the end of one’s life.
At one of my day jobs, I have done a lot of diabetes education. Not once did I recommend weight loss. Why? Because we know that route, even if it did help with blood sugar control, is temporary at best and usually results in massive disinhibition with food later on which is definitely not good for blood sugar control.
Yet there persists this idea that while Health at Every Size (HAES) and intuitive eating are fine for the perfectly healthy person, it’s simply not doable for those with medical conditions.
I disagree, and so does much of the science. People who have a good relationship to food have been shown to be healthier physically, socially and psychologically. Once a good relationship to food and eating has been established, from there it’s easy to work to improve diet quality (if that’s what’s needed) or add in joyful movement and compassionate self-care.
Back when I ran my Facebook group, time and again, people would post about how they were struggling to manage their diabetes diagnosis or risk (or other metabolic-type condition) without it feeling like they were going on a diet.
I’ll admit, there is an art to this. Nobody knows this better than a HAES RD.
This 4-week group (done via video conference) is open to anyone with a diabetes diagnosis or risk, or any other metabolic-type condition (hypertension, high cholesterol) and members will get direct support from the two of us.
Group size is intentionally small so that people get the attention they need. We have a few spots left in both tracks (Mondays 9 am and Thursdays 5:30 pm Pacific Time) so we hope you’ll join us.
One of the most common reactions to what I write about learning to accept our bodies at the weight they are and taking a Health at Every Size® approach is, “But I’m not at the weight I’m supposed to be…I should be XXX pounds because that’s what I was [when I was my healthiest weight; when I was an athlete in college; before I had three kids; before I developed this knee condition; when I ran marathons all the time].” I totally get it. Lots of us have that utopian time in our lives when our weight was perfect (or so we think in hindsight), our health was optimal, and we were going to live forever…and we so desperately want to get back to it.
Even when, intellectually, we know that dieting doesn’t work, that weight loss is typically short-term (<3 years) at best, that even when our own personal experiences tell us that previous weights were not sustainable, we resist in accepting this. I recently read a great term for this: data resistance, meaning no matter how clear the science is on this topic, people still want to believe that long-term weight loss is possible for more than a tiny fraction of people. The propensity for magical thinking is strong in us humans, and weight is no exception.
Let’s roll with it, then. Maybe you aren’t at your optimal weight. Do you want to diet to try to get there? Is that something that has been sustainable for you in the past? If not, why do you think things would be different this time? What happens if, despite all your efforts, you never get anywhere close to your desired weight? How do you live your life then? What happens if the weight you are now is your weight for the rest of your life? I think it’s worth it to have this conversation with yourself, so you at least have some options.
There are also important things to know before you decide what to do next. First of all, despite what we have been told ad nauseam by the diet industry, your weight is not really within your control, at least in the long term. If you’ve been reading this blog for a while, you are well aware by now that intentional weight loss has a 90-95% failure rate over the long haul (>5 years). If you’re new to this blog, head on over to my Scientific Lit page and have a look for yourself.
Your weight is really determined by a combination of your genetics, your metabolism, and your environment (past and present) – and not so much by the weight you actually want to be. Do you have fat parents or family members (genetics)? Have you spent any part of your life restricting calories or foods (environment)? And if so, did you know that your metabolism is probably running slower than if you hadn’t (metabolism, obviously)? Possibly most significantly, if you have made multiple weight loss attempts throughout your life or were put on diets as a child, your natural set point will be higher than what it might have been had this never happened. Unfortunately, we’ve all been fed the calories in/calories out bullshit, and have been taught that calories out are totally within our control, when in reality our sneaky metabolism comes along and adjusts everything to make sure we aren’t spending too much energy, because Lord knows the body loves homeostasis.
So now you’re well-armed with information about the spectacular failure of long-term weight manipulation. That’s all well and dandy, you think, but maybe I’ll be one of the 5% who keep the weight off. Maybe you will be! I was for a long while – before The Diet Monster took over my life and made me more miserable than I had ever been as a fat person. It’s a dicey gamble to make – you might be one of the 5% who manages to maintain long-term weight loss by making it your life’s work, OR you might be one of the 95% who gains some, all, or even more of your weight back, leaving you even fatter than you started. In the words of Dirty Harry, “You gotta ask yourself, ‘Do I feel lucky?” Well, do ya??
“But I’m simply not healthy at this weight.” Hey, you might not be. I don’t know your particular health habits or your lab values. Just remember, though, that weight is not a health behavior; it’s a size. Health at Every Size® does not purport to say that everyone is healthy at whatever weight they’re at; it simply means that whatever weight you are right now, you can start to work toward better health. So maybe your health isn’t great right now – is losing weight truly the only way you can improve your health? What about improving your eating habits or activity level? If you consider yourself too large to exercise, check out The Fat Chick’s webpage for activity for people of all sizes. Plenty of studies show that fitness is a better determinant of health than fatness and recently even more are showing that weight loss in some populations is associated with greater mortality rates.
“Well, I’m just not comfortable at this size.” I understand; moving in a thin body is different than moving in a fat body. While I personally don’t notice all that much difference (I’m lazy at both ends of the weight spectrum!), I also recognize that my weight difference might not be as great as someone else’s and that my experience is not universal (I also developed osteoarthritis in my feet at my thinnest, so even that wasn’t a guard against joint problems). Whether your discomfort is physical or psychological, how much do you think our culture’s prevailing attitudes about weight are influencing your discomfort with your weight?
I used to feel like I had to suck in my stomach, no matter what weight I was. As I regained weight, my stomach was beyond sucking in – I could tighten those ab muscles all I wanted, but that layer of fat wasn’t going anywhere. Sucking in made me feel physically uncomfortable. Not sucking in made me feel psychologically uncomfortable. I felt out of proportion, and I felt like I was being outed by my tummy as a fat person. When I finally acknowledged that how I felt about my stomach had more to do with how the world views fat people and less to do with how I actually felt, I eased up on my expectations of my body. If your feelings of discomfort are 100% physical, consider a HAES® approach in which you could find activities that you are comfortable doing right now, and work your way up from there. Bodies are amazingly adaptable, especially when we are being kind to them.
I wish I could tell you that our desires controlled our weight. That it’s just a matter of trying really hard and you’ll have some satisfying weight loss that lasts forever without totally ruining the quality of your life. My own personal experience, the experiences of all the other people I’ve met in the fatosphere, and the bulk of available science on the subject does not permit me to do so. I can only recommend a kinder approach in which you let your body decide what it will weigh – it will do that eventually anyway – while you find your own way of living as healthfully as you want and can. That will give you a stable weight that is right for you. Because, with this one life you have, how long do you really want to struggle against your body?
A little while back, two of our listeners sent us variations on the question, “How do I get my significant other on board with my HAES® journey?” How do you articulate that you are stepping away from the world of diets and body shame and toward something more compassionate? And how do you do it if your partner is still very much in the world of diets? We enlisted our friend, HAES® therapist Hilary Kinavey of Be Nourished to help us answer the question. Take a listen!
I’ve been waiting a while to write this post. Like, months. Because it’s a complex issue, and it deserved some thought. (Also, I figured I’d probably piss a few people off with my take on this, and I really needed some time to galvanize myself)
I think this question breaks further down into three questions:
Is it body positive to want to lose weight?
Is actively trying to lose weight a body positive act?
If I happen to lose weight, am I no longer being body positive?
Let’s start with the first one:
1. Is it body positive to want to lose weight?
We live in a culture that reviles fat bodies, heavily endorses one type of beauty (thin, white), and insists that if you just work hard enough you can change whatever body you’re in and suddenly fit into the impossibly stringent beauty standards that have been set up for women (and now increasingly, men). With all this pressure bearing down on us, I see it as completely natural to still wish for thinness in order to fit into the mainstream so we can get all that love that society sends out for those who’ve made it.
So no, I don’t think it’s necessarily unbody positive to still have this desire for societal acceptance. We are geared to want to belong, which is why we humans have, for the most part, gelled into tribes and communities and civilizations. We’re also geared, in general, to strive, to move forward, to achieve (though this is not true for everyone nor should it have to be). And often we want all sorts of things that we might never get, even when that desire isn’t rational or achievable.
The problem with body positivity and weight loss is not the wanting, which stems from a society that tries to vilify or erase all sorts of bodies. The problem is with the actual attempting of weight loss. Which leads me to…
2. Is actively trying to lose weight a body positive act?
This is where it gets complicated.
Diet and weight loss culture is not body positive because it is rooted in the belief that fat bodies, bodies that do not conform to the very narrow beauty standards (thin, white, able-bodied, cis-gendered), are wrong, unattractive and/or unhealthy. Diet and weight loss culture simply does not respect the broad diversity of body weights and sizes that exist.
In addition to these nefarious underpinnings, dieting to lose weight simply isn’t sustainable, based on all the best available data (and for this data, you should read Traci Mann’s Secrets from the Eating Lab in which she reviewed all the most rigorous weight loss studies and discovered that…long-term weight loss doesn’t work). And when we say “diets don’t work,” what we mean is that they work for a little bit at first, and then, usually within three to five years, some, all or even more of the weight is regained for most people. Failure on this level is simply not a lack of motivation or willpower, and the diet industry is unable to show that long-term weight loss is achievable for more than a tiny fraction of people.
Weight loss for health is wholly unnecessary. Studies show that our health habits (balanced diet, fitness, not smoking, not drinking excessively, etc.) make more of an impact on our health and longevity than weight ever could. We can begin to work toward fitness and eating well at any weight. Weight loss may be associated with health improvements, but there are three problems with concluding that weight loss is the solution to health problems: 1. Studies that show this association rarely take into account the health habits that typically change when someone tries to lose weight, so we really don’t know if it is the weight loss itself OR the change in health habits that are affecting health. 2. We’ve seen from other studies that health improvements can be accomplished through change in health habits in the absence of weight loss (eg. Eating a more nutrient dense diet, exercising more, etc.), and 3. Since weight loss is typically short term, any improvements made to health based on weight loss alone may end up being short term as well.
Body positivity is founded on the belief that all bodies are good bodies and that a person’s value is not based on her/his body. Weight loss culture is founded on the belief that all bodies are better smaller. So no, participating in diet and weight loss culture is not, in my opinion, a body positive act.
Please know that I never blame or judge those who participate in diet and weight loss culture. They are victims of a society that profits from their insecurities. Keeping women busy with smallness keeps us from fully participating in society and therefore unable to change the rules to actually empower women; it also means we will buy whatever is offered to help us fit into this rejecting society, including weight loss “solutions.” Dieters are, by design, pawns of a $60 billion diet industry. But all of this is why an anti-fat-body culture is not body positive.
Allowing diet culture messages to highjack body positivity renders it just more of the same, and we are left with a culture that continues to insist that some bodies are good bodies, while others aren’t.
3. If I happen to lose weight, am I no longer being body positive?
Changes in body weight and/or size can occur for many reasons. Often a person’s body will change as they age. Sometimes bodies lose or gain weight with illness. Sometimes body size or weight changes can occur with improvements in diet, eating more intuitively, or increase in exercise. Change in diet or activity level is not a guarantee of weight loss, however weight loss may occur. Weight loss as a result of self-care is not inherently unbody-positive. It is simply something that happened while you were looking after yourself.
It’s important to remember that this loss may be temporary, or it may be permanent, but a focus on weight loss will eventually undermine attempts at sustainable self-care as we attempt to coax the body into a shape or weight that may not be natural for it. That is why Health at Every Size® is weight-neutral.
Focusing on caring for oneself in the best way possible while also learning to accept the inherent shape and size of your body is body positive. However, how the body responds weight-wise is better treated as a side-effect of self-care, not the focus.
These are, needless to say, my own opinions. I don’t own body positivity, I merely promote it. Also, it’s not a club where you can have your membership revoked if, heavens forbid, you do something unbody positive. It’s a movement that is trying to change the status quo of body hatred.
I did meet the woman who owns the body positive trademark (and she is pro-HAES®), so if you want her take on it, her website is here. She didn’t trademark it for financial purposes, but to protect it from the diet world co-opting this term for profit, as we see happening now.
Recommended further reading: This is a great article by Virgie Tovar that further explains why body positive spaces need to be free of weight loss talk.
Last week to register for Stop Dieting and Start Living
If you’re ready to stop dieting, or already have, and would like some help with your intuitive eating skills, check out my online course and group coaching program, Stop Dieting, Start Living, which will help you do just that. Class starts February 6 and this is the last week to register. Come join us!
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Dietitians Unplugged is back with a new episode! We interviewed Melissa Toler after she sent out a recent newsletter about how she was tired of the mainstream body positivity conversation. Melissa tells us all about her journey from a weight-loss centered body coach to a weight-neutral one, and what she sees missing from the current body positive movement. No punches pulled here!
If you’re ready to stop dieting, or already have, and would like some help with your intuitive eating skills, check out my new online course and group coaching program, Stop Dieting, Start Living, which will help you do just that. Class starts February 6! Registration is open until February 2 or until the class is full.
Free Group Coaching Call January 28
I’m hosting a free group coaching call on January 28 at 10 am PST. The topic is “Why can’t I stop eating even when I’m not hungry?!” I’m only sending the call details to people on my newsletter list so sign up here if you want in on the fun.
Join our Facebook group community!
We have a very cool little community going on over at Facebook called The Dare To Not Diet Society. Members give each other support, cheer each other on in their non-diet journey. I’m there too! It’s a body positive, non-diet, non-weight-loss focused community, and we’d love to have you.
If you’re a regular reader of this blog, you might be someone who finds it a total bummer that while you’re trying to live diet-free, everyone else isn’t. Everyone else seems to be on some sort of diet, and they’re telling you about it all the time. Everyone else is worried about their weight or how they look, or how their health is affected by their weight. It’s sometimes hard to imagine a world without diets.
Well, this weekend, I got to experience it. I had the great fortune to attend the Binge Eating Disorder Association (BEDA) 2016 conference in San Francisco. My friend and podcast co-host Aaron Flores convinced me back in May that I had to go – lots of people in the HAES® world would be there and it would be a great opportunity to meet them. And also to learn a lot! So I signed up to go and waited with great anticipation for the time to arrive.
As the date approached, many of us HAES® dietitians and therapists who hang out together in social media started planning some casual get-togethers. I managed to book a restaurant whose main feature was that it would take a large group of 15. I thought only seven people at most would end up coming out (I always figure on a 50% no-show rate for any social event taking place in California).
The first night came and we all met up at the conference’s reception. It was soon apparent that at least 15 of us were headed for dinner together, and maybe even more! At dinner, I was seated across from Evelyn Tribole, one of the authors of the book Intuitive Eating. Yes, someone who I considered one of my personal heroes was seated right across the table from me. Gulp! I hoped I didn’t accidentally drop food on my shirt. Also seated near me were Dana Sturtevant and Hilary Kinavy of Be Nourished, Fiona Sutherland of Body Positive Australia, Marsha Hudnall of Green Mountain at Fox Run, Kathleen Bishop of Body Peace and Liberation – all people who have become my online friends and mentors and who are part of a strong online HAES® community. Aaron was beside me. Dr. Linda Bacon, author of the book, Health at Every Size (and of course, the nutrition instructor who introduced me to HAES® and basically changed my life) was also there. All of these people (and more whom I will name below so you can check out their work) are people I consider personal role models and heroes. They are people who fight against the weight-centered paradigm that is so thoroughly prevalent in our society (despite the total lack of evidence to support it) simply because they know it is better for us not to diet. I was thrilled and almost a little emotionally overwhelmed to be in these folks’ presence.
As we were tucking into our dinner (and I was able to relax a little), I suddenly had a thought, which I then verbalized: “Isn’t it so great that we’re all just sitting here and eating good food and no one is talking about how ‘bad’ or ‘guilty’ they feel for eating, or how they need to eat less so they don’t gain weight? How novel!” It was something I haven’t experienced since the 1990s, when I thought I was just about the only one dieting (which I did secretly most of the time). This time, even I wasn’t dieting. How refreshing! We all ate as much as we wanted of the foods that we wanted. There was a wonderful variety of food on the table – not just salads without dressing as I’m sure some people imagine dietitians to eat!
That night, and in fact during the whole of the conference, there was an array of body weights, shapes, sizes, colors and abilities/disabilities present. I could feel the confidence and empowerment in the rooms – because nobody was expected to change their bodies. It was intoxicating! People doing great things – not just trying to fit into a narrow societal ideal. Everyone looked beautiful to me. Their brains, knowledge, experience and compassion dazzled me. I felt humbled to be in the presence of such greatness, and relieved to find others who, like me, strive to live a life of substance beyond diets.
Aaron gave a great talk as part of the closing keynote. In it, he quoted Yoda, who, in The Empire Strikes Back, says to a frustrated Luke, “Judge me by my size do you?…And well you should not…Luminous beings are we, not this crude matter.”
Luminous beings are we. Yoda tells us that we are so much more than our earth suits. It is the perfect case to let go of diets to change our body size (if you’re still not buying all the scientific data). I could see the luminosity in everyone, and it was an amazing thing. This is what a world without diets and weight oppression might look and feel like.
This weekend I was surrounded by people who advocate for good health, and who know we don’t need to suffer for it. It was a heady experience. I was among my tribe and felt truly free and accepted. There was a palpable feeling in the air that we might eventually change the world for the better on a large scale. How I felt reminded me of the mantra the football players shouted before each game in one of my favorite TV shows, Friday Night Lights: “Clear eyes, full hearts, can’t lose!” My eyes were clear, my heart was full, and I felt like we would eventually create a world without diets for everyone.
Check out the HAES/non-diet/body positive work of these fantastic people I had the honor to hang out with this weekend:
One day last week, I found myself mentally running through what I ate that day – not for any reason other than as a memory exercise. I started tallying the different fruits and vegetables I ate just out of curiosity: peach, banana, green pepper, red pepper, onion, tomato, tomatillo, green beans, mushrooms and scallions. Wow, that seemed like a lot of fruits and vegetables – even for me! Yet I barely noticed it till I took the time and effort to remember.
I’m not trying to brag; rather, I just want to illustrate a point about what “normal” eating – aka, eating not-on-a-diet – might look like. I probably didn’t eat a whole serving of each of these vegetables – that’s a little too much volume for me. I may have made it to the recommended 5 servings, but I rarely count so I don’t know for sure. And not every day looks like this; some days I eat less produce (or food in general), others more. I’m convinced, however, that providing oneself reasonably balanced, varied and, most importantly, tasty meals on a regular basis will provide all the nutrients you need over time, and listening to our internal signals of hunger and fullness to guide our eating will ensure we get the right amounts. Good nutrition really isn’t that hard.
And yet, I didn’t eat like this when I dieted because I would have had to prepare the vegetables in such a way that they didn’t taste very good. In fact, when I dieted early on I ate very few vegetables and almost no fruit because I wanted to save every calorie for food I liked since I got to eat so little of it.
Since embracing a Health at Every Size® philosophy toward health, my diet quality has improved immensely from those days of restriction. How, then, I do I include fruit and vegetables so easily now? First and foremost, I make everything taste good. The peppers and onions came in a cheese quesadilla in a flour tortilla cooked in some oil I had made the night before, then topped with roasted tomato and tomatillo salsa (with some cilantro in there too). The banana may have had peanut butter or Nutella on it (or not). The other vegetables were cooked in a stir fry with pork in a sauce of soy sauce, brown sugar, sherry and sesame oil and served over white rice (because I don’t like brown) by my partner. And yes, it was cooked in oil and NO not some small diet amount, but enough to lubricate the dish and make it taste good.
But just as important as making food taste good, my relationship to food is such that I have the pick of all the foods available to me that I like. I’m also not going around in a state of chronic hunger because I feed myself according to my hunger and fullness. That means I’m not jonesing for something I can’t have simply because I feel like I can’t have it (a scientific phenomenon), and I don’t go around looking for the most calorically dense food I can find to fill a bottomless pit of a stomach. And in getting to choose any food I want, I choose foods that both taste good and make me feel good, which includes a variety of “whole” foods (a term I’ve come to dislike thanks to diet culture and healthism, but it is useful here nonetheless).
To be quite frank and not very dietitian-like, I am not a fan of using serving sizes to guide our eating. Like registered dietitian Ellyn Satter states in this article, I feel strongly that government-issued dietary guidelines take away permission to eat and leave people with disordered eating and probably a dislike of a lot of foods that are good for us. This especially rang true to me:
“The 2005 Dietary Guidelines…raised the recommendation for fruits and vegetables from five to nine a day. That is 4 1⁄2 cups of virtually naked fruits and vegetables—with only the smallest amounts of salt, fat or sugar. The intent, of course, wasn’t to satisfy nutritional requirements—four or five well-chosen vegetables and fruits a day and a similar number of breads and cereals is enough. The intent is to get us to fill up on relatively low-calorie food so we don’t eat so much. Such tactics defeat consumers’ best intentions. Well and interestingly prepared fruits and vegetables are tasty and rewarding. However, as any experienced dieter knows, trying to fill up on them— particularly when they are unadorned—is quite another matter. I have worked with far too many recovering dieters who have tried to do just that, and after a while they say that they simply can’t look at another pile of vegetables.”
Nailed it. When I was at Weight Watchers, vegetables were not recommended as a tasty, satisfying part of your diet – rather, they were something to be eaten to take up space in your stomach, to prevent you from eating other potentially high calorie foods that might actually satisfy you. I could not stand unadorned vegetables and mostly I just skipped them unless a particularly good recipe called for them. Fruits – why bother? You had to count those as points. My weight loss was not about health – it was about weight and societal approval. I did what I could bear, and while I could bear to be hungry, I could not bear to eat foods I didn’t like (although later on I would do this, too).
Fast forward six years after declaring my freedom from diets. I found out that a “well and interestingly prepared” vegetable is a thing of beauty, especially when I feel I don’t have to eat it. My diet rebel has a loud voice when it comes to “shoulds”, especially around food. I could experiment with foods to see what I truly liked.
Eating a balanced and varied diet that we like, aka eating competencedoes make us healthier – at least in terms of having better diets, physical self-acceptance, activity levels, sleep, medical and lab tests. ( And can you also imagine the wonderful by-products of people getting totally normal with food? No more boring conversations about what people can’t or won’t eat, about being “good” or “bad” with food, about having to punish themselves later for something they’re eating now. I mean, seriously, YAWN. We could talk about so many smart or interesting or fun things instead!)
I’ve said it before and I’ll say it again: what you eat isn’t nearly as important to your health and well-being as your relationship to food is. When you heal your relationship to food and eating, you’re free to experience the variety that is available to you without stress and drama. Let’s call a definite moratorium on food rules, get curious with our appetites and start exploring with gusto!
Do men get eating disorders too? Long regarded as a disease of girls and women, people sometimes don’t realize that men can also be affected by eating disorders. Aaron and I talked to Andrew Whalen of The Body Image Therapy Center, a treatment center for those with eating disorders, substance abuse issues and self-harm disorders. They also happen to specialize in eating disorders for men, and that’s the subject of this podcast. Andrew shares his personal story of suffering with an eating disorder, body shame and muscle dysmorphia.
One 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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