I want to be as transparent as possible about my feelings on this topic, so here goes.
I am not a fan of weight loss surgery.
I was not a fan of it when I first started to know people who were getting it, 20 years ago, even as I was steeped in diet culture. Twenty years later, I do not feel any better about it, based on the (scant) available evidence around the long-term outcomes, and on the personal evidence I have seen in my own life (weight regain, multiple surgeries, pain from surgery, and, sadly, even death). I don’t think the medical community does enough to prepare people for this surgery and the physical and psychological after-effects, and I don’t think it properly addresses possible underlying disordered eating which can continue even after surgery.
So that’s me. But I can’t make anyone’s decision for them. And I won’t judge anyone for choosing this surgery, especially in the fat-phobic culture we live in. What I can do is hold space for this kind of decision-making, and provide important information to help a person make a fully informed decision. (I, of course, prefer the path of radical body acceptance and Health at Every Size, but again, I can’t make that decision for others)
This Dietitians Unplugged podcast episode is part of providing that information. We talked to the wonderful, fierce HAES advocate Lisa DuBreuil, LICSW, who frequently works with clients who are considering or have undergone weight loss surgery. In this episode, we discuss the erroneous idea of “weight loss surgery as panacea”, how the medical community doesn’t do enough to prepare people before making this decision, and the possible medical and psychological consequences of having bariatric surgery.
I hear this from my clients a lot: “I’m afraid I’ll never stop gaining weight!” Thanks to societal weight stigma, I understand why anyone would have this fear. Large bodies have long been stigmatized and no one wants to put themselves in the way of stigma.
At the same time, how do we control our weight as we go through the normalization process with food? The answer: we really can’t. After all, wasn’t it trying to control our weight, over and over, that got us in this mess of weight cycling and food struggles in the first place?
And yet – the pain of weight gain is real. We want to be relaxed, happy eaters, but when it comes with weight gain, the whole process can feel confusing and discouraging.
So in this Dietitians Unplugged podcast, Aaron and I talk about that fear, and also about caring for your body as it is now.
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.
We decided to answer these questions in a podcast episode! You can check that out here:
I wish I didn’t still have to say it, but the reality is that the diet industry still exists, people still feel bad about their bodies, weight loss is still the go-to medical intervention for people in fat bodies, and harm is still being done.
So I will say it loud and clear again for the new year: WEIGHT LOSS DIETS DON’T WORK.
Or to be perfectly accurate, they may work for a while, but all the available evidence points to the fact that over the long run, they DON’T work — the weight people lose is regained within three to five years. The science could not be clearer on this.
Looking at it another way — the Center for Disease Control and Prevention’s National Center for Health Statistics reports that nearly half of American adults are trying to lose weight at any given time, yet the statistics for “overweight” and “obesity” remain static at about 1 in 3 adults for each category. I’ve been hearing these numbers for years…so if our massive dieting efforts aren’t changing them, then that tells us something.
It tells us that trying to permanently lose weight is about as futile as trying to permanently change your height. But the weight loss industry continues to take people’s money and then blame them when their product doesn’t work.
So for the new year, my friend and Dietitians Unplugged podcast co-host, Aaron, and I decided to talk about why dieting doesn’t work. This is a great place to start for anyone new to our podcast, and hopefully our long-time die-hard listeners will appreciate the reminder of why they, too, are trying a different path to health.
As a dietitian who helps others get over disordered eating after years of dieting, I’ve heard this many times: “I don’t have a limit when I’m eating. If I let myself eat what I want, I won’t ever be able to stop eating.”
To this I say: bunk. It just feels like that.
Everyone has a stopping point*. You might not think so because maybe you, like I did at one point, have stood beside the cheese tray at a cocktail party scarfing ungodly amounts of mediocre cheese cubes fearing you’ll never stop. Maybe you did eventually stop at that “I’m gonna burst!” point and regretted the whole ordeal. And maybe you simply don’t know your stopping point, as I did not, because you are hungry much of the time…so very, very hungry.
Here’s a little secret: dieting and calorie and food restriction create a false impression in your body that you are a bottomless pit. That you are a vessel that will never be filled, especially when you are confronted by a favorite or particularly delicious (or sometimes even mediocre) food. Maintaining a body weight lower than what is natural for you will also cause your body to constantly crave food, large amounts of it. This is a pretty reliable biological response regulated by a cascade of hunger hormones, and anyone who diets will in all likelihood experience this kind of mega-hunger regularly.
On the flip side, honoring your appetite (aka, eating intuitively) has the opposite effect. Once you begin to eat satisfying amounts of food when you feel hungry and your body weight adjusts toward its natural set point, your bottomless pit starts to find its bottom. As you practice honoring internal cues more often, you may start to find that your stopping point is not, in fact, stuffed but satisfied. You may even find yourself easily leaving food on the plate, or turning down the offer of a homemade brownie if you are simply not hungry for it.
My bottomless-pit acquaintances are incredulous when I suggest that they do have stopping points. They don’t trust their bodies. Some are invested in maintaining a certain external appearance and don’t feel their natural appetite will support their desired size (and this might be true).
I sympathize. I was once a bottomless pit too. But I became sick of being ruled by food and by fear of the cheese tray. And I became tired of living my life solely to support a certain body size when there were so many other interesting things to do.
When I started truly honoring my internal signals of hunger and satisfaction (thank you again, intuitive eating), eating what I really wanted, and letting my body be, I no longer had fearsome insatiable cravings. Yes, I gained some weight, but in time (and with a lot of intentional effort) I began to lose the fear that had driven my need for a smaller body size; honoring my appetite came from a place of love and, for me, was the truest act of self-care (aka Health at Every Size®).
Eating what you want and as much as you want may feel scary at first. As your body adjusts, that fear may turn to comfort as you realize you are taking care of yourself and your needs and you no longer have to fear your own bottomless pit.
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?
You’ve been doing pretty well making headway with internally regulated eating (aka intuitive/attuned/mindful eating/eating competence), enjoying formerly forbidden foods with ease and seeing a decrease in the number of times you overeat. You’re feeling pretty relaxed around food and making choices based on what you actually like instead stupid diet rules. Food restriction is becoming a distant memory.
You’re doing a great job of embracing body acceptance, learning compassion towards yourself, and generally feeling much more comfortable in your skin. You’ve even bought a few new outfits and think you look pretty damn awesome.
You’re feeling so confident, in fact, that you decide to get on the scale. “If I’m feeling this good, I must have lost weight!”…even though that was never the point of all this good work.
Then you see the number. Surprise! It’s your highest weight ever.
Your mood comes crashing down. You feel the need to dive into a gallon of ice cream and get lost forever while simultaneously tossing out every last delicious food in your cupboard. You feel that all the clothes that looked cute on you before you got on the scale now make you look horrible. Worst of all, you feel completely unacceptable, unlovable, and unworthy. You so desperately want to diet to “correct” this weight situation even though it wasn’t even a problem a few minutes before.
If this has happened to you, it’s time to get rid of your scale.
At the height of my diet addiction, I sometimes weighed myself three times a day. The act of weighing was not an emotionally neutral act. I was constantly attempting to reassure myself that my societal acceptability – and depending on the number, superiority – was intact. If the number didn’t jive with what I expected, I was obviously a failure. I used these feelings to ensure that I never ate enough to satisfy my appetite.
Wow, just writing that kind of makes me feel sick.
After I started eating to satisfy my appetite, my weight started to go up rapidly. This, of course, is a normal bodily response to weight suppression below one’s natural set point, and I knew that, but before I was fully there body acceptance, the number glaring back at me, judging me, was just hard to see.
But because I had finally committed to letting my body do its own thing, to trust in its wisdom as I learned to enjoy eating again in a relaxed, healthy-for-me fashion, I knew I had to get rid of the scale that had the power to take me from a perfectly fine mood to a much darker, critical one. I knew, at last, that I didn’t need its judgement anymore.
The act of stepping onto the scale is one of self-sabotage. We are telling ourselves that we don’t trust in the process our body needs to go through to reclaim joy and normalcy in eating. We bargain with ourselves: “I’ll eat normally only if I haven’t gained weight…” And then all our good work in eating and body acceptance is undermined. We start restricting – maybe even unintentionally – and the next thing we know, we are overeating again.
If this has happened to you and you’re in a tailspin of bad body feelings, ask yourself – how did you feel about yourself before you got on the scale? If you felt good, why can a number that only represents the Earth’s gravitational pull on your body take that away? What was it you were hoping to find from the number you saw there? Approval? Acceptance?
The scale is simply not a way to gauge your non-diet journey progress, especially if you came from Diet Hell. Metabolic alterations from dieting and other processes that are out of your control have much more to do with what happens to your weight than eating-without-a-diet-plan.
Society puts so much emphasis on the weights of women and their ability to achieve and maintain smallness. This is not about our health; it’s about keeping us obedient. As long as you keep buying into this obedience by judging yourself by a number on the scale, you will continue to prop up the anti-female diet culture that denies us everything. And I know you don’t want to do that!
So the fix is easy: Get. Rid. Of. The. Damn. Scale. You don’t need to know the number to have a great life. It doesn’t tell you anything about your eating progress. It doesn’t measure your worthiness. And it makes you feel bad.
Aaron and I are kicking it solo (duo?) in this episode of ranty rantings about bad science around weight and health, celebrity weight loss pressure, and why we need our fat positive role models so damn badly. Some of my favorite Dietitians Unplugged podcast episodes are when Aaron and I get to catch each other up with what’s on our minds, and this is one of those times.
Is anyone else physically and mentally exhausted by the end of the Julian calendar year? This year was no exception for me, and with the addition of an emotionally draining U.S. election season that did not end in a way I had hoped it would, well, I went into a bit of a tailspin.
Actually, it was a huge, tornado-style tailspin.
Long story short, I ended up in a mildly depressed funk. I’d been here before, in the past, and I knew it would only last a few weeks during which I would remain a reasonably high-functioning human. But it doesn’t feel great. I do not sit will with the yuckiness of malaise.
As time marched on, I began to find myself preoccupied with my body. Specifically, how it looked. I found old, distant feelings arising – namely, dissatisfaction. As a result, I suddenly felt the tug of an old relfex: the desire to diet to control my shape and weight.
Now, luckily for me, I have a few things going in my favor: 1. I committed way back to never diet again. I never wanted to experience the bitter combo of futility, sadness and hunger that dieting left me with. 2. I have wholly committed to honor the wisdom of my body and have promised to fully support it in whatever shape and size it takes, even if it’s a size and shape that takes me out of the realm of societal acceptability. So dieting again IS NEVER an option for me, and for that, I’m so glad. I know that feeling bad about my body in these instances is the symptom, not the problem.
I started to remember other times I experienced depression, and my reactions in those times.
At the age of 22, when my mother was dying, I turned to dieting to distract myself and exert some form of control on my clearly out-of-control life.
At the age of 31, when I found myself in a committed, long-term relationship that didn’t satisfy me, I turned to dieting to get my “perfect” body to solve my unhappiness.
It’s obvious that dieting or a smaller body could not possibly have solved either of those problems, yet that’s exactly what I did to try to ease my suffering because diet culture tells us that we only need to lose weight to make our lives better. So it wasn’t surprising to me at all that this reflex arose at this time of sadness and insecurity and fear. The urge to deny myself my most basic need – food – in order to gain control at a time when I feel I have no control over what happens is so strong, but makes so little sense and is not kind.
Instead of diving back into restriction, though, I decided to just sit with those feelings. I made space for them. I pondered them. I thought about how that solution worked out for me in the past (spoiler alert: not so well. I still had to deal with all those messy feelings and situations in the end, and I was hungry on top of it). I knew I would not diet, and I knew I would have to sit with feelings of body and life and world dissatisfaction and just do my best to deal with it.
In enough time, I felt myself emerge, ever so slowly, from the darkness of these thoughts. I have a great support system at home and that helps. I did some gentle yoga to get myself back in touch with the physicality of my body — to sense what it felt like rather than what it looked like. I’m living with uncertainty without using starvation as a proxy for control. I’m caring for myself in constructive, not destructive ways. My body is not actually the problem, and I don’t need to try to change it.
If you’re finding yourself going down this particular road, stop and give yourself a hug. Think about what you really need. You’d be better off in a Snuggie with a hot cup of tea on the couch doing some comfort-TV binge-watching than trying to diet again. If you need to reach out for help, do that. Just know that dieting and weight manipulation is not real control, it’s not real power, and it just weakens us further. That’s not something that any of us needs in hard times.
Dietitians Unplugged News
Missing us? No fear! We’re just on a little end-of-year hiatus until January. In the meantime, catch up on all our episodes on Libysn, iTunes, or Stitcher.
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: