The following is a guest post from my dietetic intern, Mary Smith.
Essentially, I felt as if I had to enter a patient’s room, toss a shame grenade about her size, and run out before seeing it go off.
As I close in on the last 4 weeks of my dietetic internship, I am getting a lot of questions from peers, preceptors, and future interns: what’s the most important thing you’ve learned? This question causes me to reflect on my entire internship, as well as the reason I decided to pursue the title of registered dietitian nutritionist.
The most important thing I learned happens to be one of my most regrettable moments.
I was in my clinical rotation at a fast paced, high acuity city hospital and was asked by a doctor to visit a patient and provide nutrition education on morbid obesity. I remember thinking, “Morbid obesity education? What could that possibly say to a patient?”
As an intern, I had to do what I was told so I printed the education plan for morbid obesity and reviewed it. I read over the education and realized I would have to tell this woman that her weight could cause her to develop numerous diseases and health conditions and that she needed to start dieting in order to lose the weight. The document indicated that weight loss was her only hope.
Essentially, I felt as if I had to enter a patient’s room, toss a shame grenade about her size, and run out before seeing it go off. I remember all the rooms on that floor had their doors open, except for the one I had to visit. I nervously knocked and then entered. A woman lay on her bed, looking exhausted and discouraged. I introduced myself, and explained what I was there to do, and saw even more discouragement flood her face.
As I started introducing the obesity diet education, she told me she wasn’t going to eat anymore because “I got myself into this mess by eating.” She said she didn’t want to receive the education because she knew what she had to do: diet. Fast forward one month and the patient hadn’t lost any weight, but had actually gained weight through her dieting attempts.
Here’s What Nutrition Classes Aren’t Teaching: Dieting Isn’t the Answer
There are many misconceptions in this world. One of the most profitable is that dieting will bring happiness, health, and freedom. Oh, and weight loss. Here’s what the multi-billion dollar industry doesn’t want you to know and what nutrition classes aren’t teaching: dieting isn’t the answer. It doesn’t bring happiness, health, freedom, or weight loss. The reality is that dieting is a brutal cycle that dietitians should save clients from, not encourage.
Food/calorie restriction, or a diet, leads to an increased desire for food and creates the “famine response” in our bodies. The dieter may lose weight initially, but once they “fall off” their diet, they regain the weight.
A panel of experts assembled by the National Institute of Health1 summarized that “One third to two thirds of the weight is regained within one year [after weight loss], and almost all is regained within five years.” The regaining of weight creates more negative emotions and shame towards the dieter’s body, so they start the diet cycle all over again.
Diets Have Negative Psychological Effects
As a future dietitian, I believe the dietetics field should aim to end this dieting cycle and prevent the damage it brings. Not only does this vicious dieting cycle bring more weight gain, but it also has psychologic effects.
Bacon et al2 found that “weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination.” Additionally, Tann et al3 found that “weight cycling is linked to heavy emotional distress for patients, increases the risk of eating disorders, and furthers weight stigma.”
Weight Stigma from the Providers who Should Care About Their Health
Harriet Brown4 and Gina Kolata5 both state in their articles that overweight/obese men and women are less likely to go to the doctor because of the shame the physician places on them. Their articles note that physicians can’t see past their weight, claim their weight as the source of their specific health crisis, and put the patients on a 1,200 calorie diet. Kolata’s article provides personal testimonies of patients who had serious health concerns but were ignored because their weight was assumed to be the problem.
Let’s Create a Better Future
So to all my fellow future dietitians, here’s what we need to know about dieting: dieting isn’t the answer and isn’t maintainable. While it may provide temporary weight loss, it can cause more weight gain and may lead to other harmful health conditions such as eating disorders.
It is crucial that we understand the negatives of dieting because we are the food and nutrition experts that doctors, clients, and even our friends and family will turn to for advice.
As mentioned above, focusing on someone’s weight induces shame, prevents them from getting efficient care, and might prevent them from receiving care at all. As the future of the field, we have a responsibility to society to see more than a weight. We have a responsibility to see a person and provide interventions that don’t sponsor a never ending weight driven cycle of self-hate.
Going forward, we have to understand what’s going wrong. Simply stating “ you need to lose weight” to patients and reading them a number off of a scale is not motivating, but rather exposing a patient to more shame of his or her body.
Support the Pursuit of Health for All Bodies
On the other side of the diet spectrum, there is the weight neutral approach, or Health At Every Size approach (HAES). This movement focuses on encouraging behavior change through regaining understanding of one’s body, hunger queues, and utilizing motivating factors that don’t revolve around a number on a scale, but rather the way one feels. HAES does not mean health-y at every size, but does allows practitioners to meet clients where they are in their journey, protect them from the shame grenade, and teach them how relearn eating and physical activity.
Overall, one of the most important lessons I’ve learned through this internship is that weight loss isn’t a behavior, but understanding and respecting your body can be. Dieting promotes negative body image, negative and obsessive thoughts, harasses a person with shame, and doesn’t provide the health, happiness, and weight loss desired. If I could go back to the woman in the hospital, I would discuss with her the HAES movement, a life free of diets and introduce intuitive eating and joyful movement to her.
Free Research and Support for Dietitians and Future Dietitians
To read more research on Health At Every Size, intuitive eating, and about the negatives of dieting, subscribe to RD4BC. Registered Dietitians 4 Body Confidence (RD4BC) is an organization that highlights the most recent research and aims to educate the food and nutrition field on the downsides of dieting.
- National Institutes of Health (NIH): Methods for voluntary weight loss and control (Technology Assessment Conference Panel). Ann Intern Med. 1992, 116: 942-949.
- Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr Journal 2011, 10:9.
- Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J: Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer. Am Psychol. 2007, 62: 220-233.
- Brown H. The weight of the evidence. http://www.slate.com/articles/health_and_science/medical_examiner/2015/03/diets_do_not_work_the_thin_evidence_that_losing_weight_makes_you_healthier.html. April 12, 2017.
- Kolata G. Why do obese patients get worse care? Physicians can’t see past the fat. https://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?_r=0 April 12, 2017.