During my last semester of college, I took Medical Nutrition Therapy as a final requirement before I was officially announced a dietetic grad. Although typically this class consists only of how to treat diseases through the eyes of nutrition – I was lucky enough to have a professor who cared to expand our critical thinking beyond our textbooks [shoutout to Dr. Laing].
My professor bought the class a set of a new book that had just been released + was sparking a bit of controversy in the field. See, for most of our dietetic curriculum [or any clinical curriculums] we are taught that most diseases can be improved if only people would just lose weight. Weight loss was always one of the top solutions with any disease – Heart disease? Weight loss. Diabetes? Weight loss. High blood pressure? Weight loss. Back pain? Weight loss.
Most students in the class argued that obesity was a pandemic in the United States [only 7 out of 150 students disagreed – one of them being me].
This book argued that all of that was a lie.
#1] BMI Is NOT A Reliable Marker For Health
The Body Mass Index [BMI] uses height + weight to compare where you stand next to others as a marker of health. What it doesn’t account for: muscle vs fat mass, gender, age, ethnicity, + fat distribution. However, BMI is the standard for quick analysis of a patient. When Adolphe Quetelet created the BMI formula, he explicitly said it should not be used to gauge the amount of fat an individual might have. It was simply designed to be a quick hack at the time.
#2] Fat Shaming Is A Tool Of Systematic Oppression
People who genetically carry more fat tend to be women + people of color. Fatness was quickly weaponized as a means of inferiority around the 1800s since white men were usually skinnier. If you’re too worried about being ashamed of your physical existence + starving yourself – you’re not going to have the energy to fight against systematic oppression.
#3] Wellness Diets Are The Same As Any Other Diet
“Clean eating” + “Wellness diets” are almost always going to be the same kinds of diets we’ve seen throughout history – just with a different narrative. Don’t be wooed by the tone of “detoxes” + “lifestyle changes” – eating only raw fruits + vegetables is still a form of starving yourself no matter how you romanticize it.
#4] Dieting Does Not Work
What blew my mind the most in this book is that hardly anyone keeps off the weight they lose on a diet. Not because they’re lazy, or they return to bad habits – but because our bodies just put the weight back on in 3 to 5 years. Often times you gain even more weight back after dieting. “Success stories” usually stop after a year of exposure, which isn’t long enough to track what your body does in the long term.
#5] Fat Shaming Damages Health More Than It Fixes It
The stress of daily prejudice someone in a larger body faces outweighs the benefits of losing weight. When you are constantly concerned about being in public or even partaking in activities that might improve your physical health [like going for walks or going to the gym] you are going to experience a drop in your health. If losing weight isn’t sustainable or even a good marker of health – then limiting healthy behaviors that people in larger bodies feel comfortable with can do serious damage.
#5] Intuitive Eating Does Not Mean Eating Junk All The Time
When you are listening to your body about what foods taste good + how you feel after eating them, it might seem like you would crave cookies + hot dogs every day. While you may want those at first, because they were restricted foods in the past, at some point your body DOES crave fruits, vegetables, grains, + lean protein – you just have to trust it + follow your gut [literally].
#6] Fat Bias Breeds Poor Treatment In The Medical World
The book tells a story about a woman who went to see a doctor because she was having difficulty breathing. The doctor told her it was because she was overweight + that she just needed to exercise ++ lose weight. A few months pass by + the patient finds out that she has lung cancer ++ that it was the cause of the breathing issues. Had the doctor treated her like they would treat a patient in a smaller body, they might have been able to give her proper treatment instead of assuming that her weight was the issue.
#7] Fat Shaming Damages Health More Than It Fixes It
The stress of daily prejudice someone in a larger body faces outweighs the benefits of losing weight. When you are constantly concerned about being in public or even partaking in activities that might improve your physical health [like going for walks or going to the gym] you are going to experience a drop in your health. If losing weight isn’t sustainable or even a good marker of health – then limiting healthy behaviors that people in larger bodies feel comfortable with can do serious damage.
#8] Binge Eating Is A Symptom Of Deprivation
The reason why so many people feel like they have no self-control around certain foods is because those tend to be their “cheat foods.” By not allowing yourself to eat foods that your body craves occasionally, you create a psychological attachment to it.
#9] Hunger Cues Come Can Look Different For Everyone
I’ve always been really bad at identifying when I’m hungry – I don’t experience the traditional stomach pains or gurgle-y noises. This book helped me understand what my hunger cues are – like headaches, nausea, + irritation.
#10] Health At Every Size Does Not Mean Healthy At Every Size
A big misconception about HAES is that it promotes unhealthy behaviors just because it accepts people at whatever size they’re meant to be at, which is just not true. There are going to be people who are probably at weights that are unhealthy for their bodies, but weight loss shouldn’t be the focus of that patient’s treatment – changing behaviors that allow them to live healthier lives should be the focus. Adopting healthier habits may or may not result in weight loss – but it will result in improved health.
I’ve decided that regardless of if I need the patient to lose weight, I will not be the one to vocalize that to them, instead I’m going to focus on the medical nutrition therapy aspect of it. If a patient is overweight + has no health issues then there’s probably nothing to do there outside of what diet culture wants. But sometimes there are medical issues like hypertension or pre-diabetes that can be fixed with diet changes or increased exercise + I want to focus on the behaviors instead of the weight.
For me, it comes down to behavior science as well. People in larger bodies don’t seek out medical help as often because their doctors most likely will tell them to lose weight regardless of what they’re there for + that can feel upsetting ++ not helpful. I want to have a safe space in the field for patients to feel like they can be included in healthy behaviors without it coming from a place of shame for their bodies.
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