If you’ve recently read my blog you would know that I am currently on a break from placement. This has given me time to pick back up some extra-curricular tasks I left on the backburner. In particular I have been looking into disease and body shaming and how that effects people on an individual and population base level. Firstly I read Even Vegans Die, a quick hundredish page book which was in part authored by one of my favourite Registered Dietitians, Ginny Messina. The book highlights the degree of disease shaming in the vegan community, including but not limited to blaming vegans for their own illnesses, insinuating if their diet had been more pure they would not have gotten ill, and how this creates real fear that vegans cannot ‘come out’ as being sick due to the tirade of bullying they will face, creating social isolation and possibly even leading to poorer health outcomes. It also delves into being a responsible caregiver, accepting and grieving your situation, and how to ensure your legacy of compassion lives on after your death. It was a refreshing read as a student dietitian who is heavily involved in the vegan community, a person who has chronic illness, and as a person who still grieves losses years after they occur. It’s convinced me, a 27 year old reasonably healthy woman to write a will (if you want something of mine now’s the time to tell me!) and make guardianship arrangements for my cat should I die suddenly. I would really recommend reading it if you are a vegan, a diet professional with a particular interest in vegan and vegetarian nutrition, or even just an animal advocate/rescuer who hasn’t thought deeply about the legacy they could leave.
Secondly I completed a introductory short course by Fiona Willer (APD) on the Health at Every Size approach to nutrition care. This course is available for free to anyone who would like to take it. However, it is geared towards dietitians and student dietitians which means you may find it a bit content heavy if you do not have a particularly strong interest in diet science and experience reading scientific articles.
I strongly believe that the Health at Every Size (HAES) / Non-diet approach should be integrated as part of core curriculum for all health students, including dietitians and this is why:
1. HAES seeks to eliminate stigma and bias about body shape and size:
Stigma is an issue which is far reaching and has proven to be an ineffective tool in causing sustained weight loss. In America, discrimination against people with larger bodies is almost as prevalent as racial discrimination. With Australian society being highly comparable to American society it would not be a far stretch to say this is probably also true for Australia. A study which investigated the lived experiences of 76 Australians with BMI’s above 30kg/m2 (dubbed the “obese” people) found that 95% of participants felt discriminated against at some point in their lives, 47% experienced discrimination in childhood. Weight discrimination is also highly prevalent in the health professions, including dietetics. When comparing the health of two patients with identical background information dietitians consistently rated the person with the higher BMI as significantly less healthy, and the discussion turned away from the problem the patient presented with to weight loss. This is nothing if not a huge failure in duty of care, would you go back to a health professional who failed to address your concerns? Not only is weight discrimination shockingly prevalent it creates an environment where people are misdiagnosed, over-treated, under-supported and left to feel hopeless and unheard.
2. HAES challenges the false dichotomy:
Thin people are healthy and larger people are not healthy, right?
According to the National Health and Nutrition Examination Survey, approximately 24% of people with BMI’s between 18.5-25kg/m2 (dubbed the “normal weight” people) had risk factors associated with cardiovascular disease. 51% of people with BMI’s between 25-30kg/m2 (the “overweight” people) did not have any risk factors at all. An article posted only days ago found that 27% of Australian heart attack cases had no risk factors at all including higher body weight. Taking this point with the above paragraph a shocking picture is painted. If health care professionals assume people with smaller bodies are automatically healthy the symptoms of these diseases are likely to be overlooked, which could be catastrophic. Likewise if people with larger bodies are assumed to be unhealthy over half will likely receive treatment they do not need, often in lieu of treatment they do need.
3. The traditional weight-centric approach does not work, and may cause harm:
We all have heard that losing weight can help prevent diseases ranging from heart attacks to cancer, this is true, but did you know that 5 years post weight loss intervention almost all participants have regained all their weight? Many end up weighing more than when they started, which can lead to weight-cycling, also known as yo-yo dieting. Weight cycling has been associated with several negative outcomes including high blood pressure, heart disease, muscle loss, breaking bones, gallbladder attacks – which can lead to emergency surgery and loss of an organ, and even an increased risk of early death. Weight cycling also heavily effects mental health outcomes, this is well documented in the scientific literature and is also a common lived experience. I am positive that we are all connected with a diet or dieter which ended in disordered eating. In fact, Eating Disorders Victoria states “dieting is the number one risk factor in the development of an eating disorder”. Many people report having lower self esteem and more negative feelings towards themselves after dieting, which begs the question, can a weight-centric approach even be alignment with the medical overarching code of ethics Primum non nocere (first do no harm)? Is there any other treatment which has a 5 year success rate of virtually 0% and has been associated with both physical and mental harm which is regularly prescribed? Not that I know of, because it would be extremely unethical.
4. HAES promotes health without documented risk, and may improve health:
Now, this is when it really gets interesting. A systematic review published in 2015 showed improved psychological outcomes, including reduced disordered eating and depression, and improved self-esteem. When blood was tested it was shown that there was either an improvement or no difference in risk factors associated with diabetes and heart attack. Some argue that the results which show no difference in risk factors is proof that HAES does not work, and I wouldn’t necessarily disagree… but I think what’s more important is that there were no documented negative outcomes which is in contrast to the traditional weight-centric approach. Any reduction in risk factors are eliminated once weight is regained.
HAES promotes health, regardless of weight and these findings suggest that people would be better off ditching the diets in favour of self care. I have only just started my journey into this topic and I do not have all the answers, but it appears glaringly obvious that health professionals and the general population alike are unaware of the risks and woeful success rates of weight loss which leads to poor psychological outcomes. Let us focus on health, on nourishing our minds alongside our bodies. Making choices which make us feel good, rejecting guilt, and something I touched on in my recent recipe, understanding that all foods serve a purpose in nourishing our lives.
If you would like more information about HAES I recommend the following:
Thanks for reading,