When "do no harm" can mean NOT talking about dieting

There has been much controversy in the nutrition and weight management world about the sometimes harmful role professionals can play when trying to help a client lose weight. Since doctors carry so much weight (so to speak) with their advice, it is extremely important that they give useful, easy to understand and sympathetic advice. By sympathetic I mean advice that takes into consideration their clients as people (not just bodies) who have limitations, feelings and are probably doing more for their health than they see. Obviously, it is also important to that doctors know their limitations in knowledge and make referrals. Knowing your limits can be harder than you think especially if you come from a background of an "all knowing" profession like medical doctors. This is where a lot of my frustration stems from- the "all important god" that is better known as your doctor who gives harmful and often wrong advice on weight loss. One big argument is the fact that the hippocratic oath may suggests that bad weight loss advice is unethical by actually doing harm to their clients.
Before I go further, I must state that not all doctors frustrate dietitians or give harmful advice to their clients. Unfortunately, I only hear the sad stories from my clients.

Recently I had a few clients who were (and I quote) "traumatized by what my doctor told me about the need to lose weight". I can only guess that the doc's goal was to motivate the client to lose weight (little did he know that she is already doing many things to try to lose weight...did he even ask her?). However, I wonder the usefulness of stating that "[she] would be better off as a drug addict than addicted to food". Yes- that is a direct quote from the client quoting her doc.

Firstly, being obese is vastly different than being addicted to food (which is not a well supported theory amongst eating disorder professionals) so he first assumed she was addicted to food (again, not a diagnosis as popular as say, binge eating) and secondly that being skinny while doing drugs is better. Is that really based on science? Will that advice really help her lose weight? All that encounter did was make that day the "worst day of [her] life" (another actual quote). Was that advice ethical considering she may turn to unhealthy ways to lose weight such as diet pills, fasting, or very low calorie diets? All of which may lead to binge eating, skewed relationship with food and body hate.

Not only do my clients already feel ashamed and hateful of their bodies, but they have to return to see their doctor for a follow up. It's no wonder that they are scared, anxious, preoccupied about the upcoming visit. I wonder if these feelings will help or get in the way of communication at their next appointment?? It was certainly something that got in the way in talking about nutrition at our session. I was more than happy to discuss the encounter since issues that influence eating is something we discuss (not just diet advice) at appointments. However, I can only imagine how frustrated my paying client felt after leaving our session with little spoken about the topics for which she sought advice.

Weight shaming and weight bias as well as misunderstanding the complexity of weight loss is something that is expected from the masses. NOT from educated health professionals.

My advice to my clients who bring these stories to our session is easier to give than to take- find another doctor. Not an easy task in this city or in Canada. If that's not possible, perhap a firm but polite acknowledgement that things are being taken care of in the weight loss area with the help of another professional, then asking the doctor to get back to what they specialize in practicing.

Judging those who already judge themselves

Some people believe that judging people who "should" lose weight will help them to make the changes necessary to lose weight. Of course, those people are dead wrong but that is not the point of this post. The point is that judging others is useless since they often judge themselves more than can be imagined. 

This is especially true of people who suffer from binge eating disorder. Having a greater than normal concern for ones weight and shape as well as an over-evaluation of their weight and shape (meaning they feel they have more control than they actually have over their weight and shape) leads to much pain. These negative views of ones body and weight can be quite destructive as well as self-perpetuating. Having what is called a disturbed body image maintains an eating disorder and can actually predict success with therapy in resolving an eating disorder. 

As a dietitian, I rarely work directly with clients to treat a body image disturbance but I do work closely with many amazing psychologist who do just that. However, body image often comes up in nutrition sessions when clients insist they "should" or "must" lose weight. Losing weight before resolving an eating disorder (for those people who have a high BMI) is never recommended but many clients are convinced that losing weight will help increase their self-esteem. The basis for many people with an eating disorder is low self esteem or basing ones self worth on their weight, so does losing weight actually increase self-esteem? No. Surprisingly, despite the many protests from clients, losing weight does not miraculously increase their mood or self-esteem. Instead, dealing with what perpetuates negative thoughts, how to come to terms with ones body and how to enhance positive body image is what helps people feel better. 

Guess what else it helps with? You got it- weight management. Weight shaming, guilt-tripping, judging and all those other negative abuses DO NOT HELP. Loving and accepting ones body and shape helps people eat healthier, move more and just live healthier lifestyles. It may be hard to accept or change the way you think at first, but change is possible! Professional help from a registered dietitian and psychologist speed up recovery from an eating disorder and help you feel happier.

Acceptance or: How I learned to stop worrying and embrace my shape

If you are unhappy with your weight, raise your hand. 

If you are planning on accomplishing that really cool/fun/amazing thing after you lose 5lbs, raise your hand. 

If you feel ashamed or disgusted by your body, raise your hand. 

Unfortunately, in my line of work, many of my clients would raise their hand if asked these questions. Perhaps it is because I am sensitive on the issue, but I feel that too many of my friends would also raise their hand.
So you can imagine how happy I was to see this article come to light:  Adults with Greater Weight Satisfaction Report More Positive Health Behaviors and Have Better Health Status Regardless of BMI.
This study helps to prove what I (and many other dietitians) have been trying to explain for years- hating your body does not help you to eat healthier or be more active AND loving your body does not perpetuate unhealthy habits. One way to look at it is that negative thoughts or emotions (example: I hate my body) lead to negative outcomes (example: I might as well not even try). Where as positive thoughts and emotions (example: I accept that my natural BMI is 27) lead to positive outcomes (example: I can allow myself to enjoy a few cookies every once in a while but try to enjoy fruit everyday).
Why is "weight dissatisfaction" a problem? It was reported in this study that people with greater weight dissatisfaction reported more dieting, yo-yo dieting, consuming fewer meals, and being less active. All of the these things get in the way of the very thing these people want to do: which is to manage their weight.
One thing that has to be kept in mind when trying to manage your weight is the fact that we have less control over our shape and weight then we think or are led to believe. This over-evaluation of our ability to eat less, exercise more and to control our weight often leads to strict diets or very restrictive eating. Both of which lead down the slippery slope of further disappointment, body shame and even disordered eating.
The Canadian Obesity Network has done a lot of work in the area of "weight bias" or judging someone based on their weight. Weight bias is certainly a contributor to body shame and hopefully with time is something that will decrease with more awareness.

skinny is the OLD "healthy". Welcome to 2013!

Study upon study has proven that it is more important to focus on living/eating healthy rather than just "being skinny" for healthy living. One major issue that perpetuates the misconception that skinny = healthy is the fact that other health professionals (doctors, nurses, etc) often focus on weight to help decrease risk for certain diseases or disease progression. Although it is true that excessive weight (if all other aspects of lifestyle are disregarded) may put certain people at risk, there are far more aspects to look at when evaluating a persons health. Perpetuating the idea that higher weights translate into unhealthy lives is also the result of weight bias in non health professionals.
On a similar note, ff you or someone you know can relate to the questions below, you may want to consider learning more about disordered eating (check out ANEB Quebec for more information):

I think that people who are thinner than me are happier and have a better life?
I am extremely afraid of getting fat?
I have difficulty maintaining an appropriate weight for my age, sex, and height? (a BMI between 20-25).

If the above facts don't change your mind about weight versus health, consider this: other studies have proven that people who focus on health and healthy living while making changes to their lifestyle (i.e. an overall improvement in their eating and activity habits) actually lost more weight than those people who only focused on losing weight. Imagine that! While not focusing on the numbers and the scale, people actually made more meaningful changes! This along with the fact that those people who "love" their bodies, accept their shapes and have higher self esteem tend to live healthier lifestyles (compared to those who have low self esteem and are unhappy with their shape/body) are great example that positive health goals can lead to positive changes.
So let's recap- focusing on healthy living rather than a specific weight (or losing weight) may lead more naturally to weight management and accepting and respecting ones body also leads to healthier living....perhaps the concept that thinking negatively (believing you have no willpower, are not motivated enough, are not good enough, not worth it) may actually lead to "negative" results.

Picture from Equilibre.ca