HAES’d and Confused No Longer

In 2013 I quit my job and moved to the Bay Area to begin a practice focused on Health at Every Size (HAES). I had recently transitioned from weight-focused health care—what I had been taught in school—to HAES. It was clear that dieting and the “calories in, calories out” mantra for health wasn’t working and it was wonderful to find a network of people in the Bay already discussing this. I packed up my life to start anew, singing the praises of HAES to the world. The following is what I learned about myself by moving to Oakland to become a HAES provider:

I harbored serious able-bodied, “good fatty” beliefs. This one was deep. I definitely bought in to the “if you eat intuitively and exercise you can be healthy at any size!” philosophy that was promoted by my HAES colleagues. I’ll address this further later, but briefly I will say that the ability to eat food, consistently, and with enough choice to decide what is intuitive requires a lot of privilege. Also, the time needed, safe place, and bodily functions needed to exercise require a lot of privilege as well. Fat people do not need to perform a set of behaviors nor carry around their lab results to prove their health, worth, and value, especially when these behaviors are limited to those with class and education privilege.

Health is complex. This is capital “H” Health. The Health that is a social construction, commercialized, and commoditized. What was once simply the absence of disease (lower case “h” health), has become much more and is sold to us as something that is attainable only if we try hard enough—spoiler alert—we all die in the end anyhow. Health is now a thing, that has moral implications and guilt-based messages. We now perform Health for ourselves and for others. It is rooted in patriarchy, class and white supremacy.

I’m not interested in centering Health. After my examination of Health, I realized I am not interested in the industry. I am more interested in helping people better connect with food, their bodies, and their communities. I’m more interested in helping people sift through the barrage of information about everything they “should” be doing for themselves, and instead learn what their individual needs are for healing and happiness. I’m more interested in working to remove the shame that society places upon those who aren’t presenting as Healthy or performing Health. I’m especially interested in working with communities of color who continue to be dealt the majority of the policing, patronizing and paternalistic messages about eating and Health.

I can’t ignore the ways that our identities intersect with health and Health. I am very aware of my class, education and ability privileges and how this influences my access to healthcare and achieving Health. I also carry the history of systemic medical violence against people of color and queer individuals each time I enter the doctor’s office. One-size-fits-all just doesn’t when it comes to Health and health, but unfortunately that is not the message shared with patients and communities.

I’m not interested in diversifying HAES. My first goal was to “fix” the HAES movement and diversify membership. With enough time I realized that continually asking for a seat at the table to discuss my experience as a queer woman of color was not giving me the results I sought. The table was still going to be majority white, and the whole concept of HAES had been constructed without people of color. Instead I decided to create a different movement WITH people of color and those who see the same gaps in HAES and society as a whole.

I’m not a Health at Every Size provider but I am an activist. I am beginning a movement for people who are interested in looking at their body, health, and society through a different lens. This movement is for folks who have experienced systemic medical violence, those who lack access to health services, and those who recognize the flaws in our current systems and narratives about bodies. If you’re interested in joining me please let me know!

Jessica Wilson is a dietitian in Oakland  @mykitchenRD


Is HAES Columbusing* Holistic Health?

This week I found myself wondering if Health at Every Size® (HAES) was considered a new discovery when the Principles were trademarked. HAES recommends examining peoples’ behaviors and identities rather than only using weight and numbers as health markers. I employ HAES both as an offering to clients and community members to increase individual health literacy while examining fat oppression and thin privilege, and also as a movement to examine the medical industrial complex, and the junk we’re fed in this society about the worth of our bodies. Healthcare and wellness that take all of our identities, behaviors and beliefs into account while looking at the system in which we live rather than just using weight and numbers as health markers is how I would define holistic health**.

In my understanding, there are many different ways to approach healthcare that is not weight-based and is often culturally specific. There are many people in the U.S., usually people of color, who have been disenfranchised by the institution of Western medicine and who have relied on internal and community wisdom to determine their wellness. Additionally, there are millions of individuals who do not live in Western countries who have been in charge of their well being for centuries, though these approaches may not be available in a PubMed or Google Scholar search.

While I absolutely honor and appreciate my HAES community, I wonder if we Columbused holistic health in the context of Western society, and if this is one of the reasons the movement has stayed white, that is, except for me and a few others. HAES tends to be heavy on academia and the Principles and light on global and community context, though the organization that governs the Principle’s claims to be an international organization.

I wonder if trade marking holistic health erased the experiences of those who have come before us on this journey to define health on our own terms.

I think that the international community of folks who feel the agency and ability to decide what their bodies’ needs are is already large; I don’t want to build that. Presenting a trademarked set of Principles may not be to anyone’s benefit when talking with people about their own lived experience. I don’t expect to tell them they are doing HAES when, in fact, it may be me who is doing something that came long before me. I would like to validate the journeys of those who have come before me and those who are working along side me to filter the messages of their society and define individual wellness. I would also like to work within my capacity to increase the ability for people to access whatever they need to feel well, and I would like to invite others to join me.

Let’s listen to others’ wisdom. Let’s build community. There could not be a better time than now.

*Columbusing: When white people claim they have invented/discovered something that has been around for years, decades, even centuries. -Urban Dictionary

**I am not referring to alternative or complementary medicine here ________________________________________________________________________________

Jessica Wilson, MS RD is a dietitian in Oakland, CA.

Let’s chat more about this in the comments or at Sunday’s meeting of HAES’d and Confused. I look forward to the feedback!

It’s not Brain Surgery

During my first weeks of the program I attended one of the monthly WLS support groups provided by the clinic to get a better picture of the services provided. It was sparsely attended, with folks who were pre and post surgery.  The topic was dealing with food and feelings. They shared their own stories and this is the story of the post-op group.


You were told this surgery would make your life better. Disease would disappear and willpower would replace it. That didn’t happen.

You were told WLS was just a tool; you would still have to work hard to diet. You heard this but didn’t believe. This surgery was going to do the work for you; if you were willing to go under the knife you must be able to stick to the program. But you didn’t.

This was stomach surgery. It wasn’t brain surgery. Your patterns and your history remained the same. You regained the weight, and were here to get back on track. To diet, that is, but now with a host of digestive issues.

You were sold a better life, you got a different life. And the scars to prove it.


All through my training the clinicians made it clear that the surgery wasn’t the solution; that restriction was the only way to achieve and maintain weight loss.

Sitting in that support group that evening I wondered what could have been different.  I wondered if patients would be able to trust and respect the body that society is constantly policing, pathologizing and demonizing if they were given the support needed to make behavior changes.

And I realized that I was now in the position to find out.

Lights! Camera! No Action

as seen

My launch into what will forever be termed the program was through an introductory course for those seeking WLS, taught by a dietitian and a surgeon. After discussing the different types of surgeries, the sales pitch was hard and fast:

  • Increased motivation and willpower!
  • More energy!
  • The ability to lose weight and keep it off!
  • Only two weeks recovery time!
  • Elimination of every metabolic health condition, and prevent those you don’t have yet!
  • Happy, Happy, Happy!

Whew! I think it blew my hair back a bit. It was like being in an infomercial studio! When were they going to tell me if I ordered today the surgery would be half-price and I would get a set of kitchen knives and a Chia Pet for free?! Preventing disease sounds like a great idea, and we wouldn’t even need to eat vegetables?! Never mind the fact that they won’t fit in a post surgery stomach, or be digested properly even if they did. And since when is happiness is for sale?! Well, indeed it could be if this surgery eliminated the daily stigmatization that people in fat bodies in our society face, and did away with the same, tired “if you lose weight ______ will improve/not happen.” After this experience I did not wonder why someone would choose to get WLS, and I did not judge them for making the decision to operate on their healthy organs; I now knew. This was the magical solution to end weight stigma and achieve “health” and thin privilege.

The presenters acknowledged that every diet had failed leading up to this point, but “WLS makes people better dieters.” If diets don’t work, how would getting better at dieting be worth the money, time, effort, physical and emotional stress?

Success* in the program came down to a singular action: avoiding carbohydrates, in the context of perpetual starvation.   But here’s the kicker; starvation makes our brain crave carbohydrates like nobody’s business because it’s the most readily available form of fuel. Therefore, maintaining that carbohydrate avoidance comes down to overcoming our human physiology and biochemical drive to fuel the brain and body, not “willpower”. A body performing as it’s hard-wired to do would eat the carbohydrates and avoid starvation.

With that the infomercial studio went dark for me; the Dr. Oz effect wore off and I wondered how in the hell I was going to sell this to my clients. Sure, the promises of a weight stigma-free life were thrilling, but what about the truths of physiology, the possibility of shame after failing*, the risks of malnourishment, and the lack of data to back up dieting as a tool to achieve long-term weight loss? I guess I would find out.


More on the lack of scientific outcomes for WLS later in this series.

*language used by the program and defined by the program; it is not my own. Your idea of success may have been different for you and you decision whether to have WLS, and your program may have different expectations.

Tales of a HAES RD in weight loss surgery

All of November and December I will be posting about my experiences working with a weight loss surgery team.

This series will chronicle the rollercoaster of experiences and emotions that present with this work. It will hopefully create an opportunity for HAES dietitians who work with bariatric clients to seek support and share ideas because right now that’s lacking. Emails to HAES-related listservs about bariatric surgery outcomes often result in comments shaming the original poster and those who choose the surgery, stifling discussion about this topic.  I’d like this to change.

I will address the gaps I see in the surgery “science” and also in the support and respect weight loss surgery (WLS) clinicians receive from some people in the HAES community.  I had fashioned a plan to post these blogs anonymously, to protect myself from those who cannot fathom a HAES RD working with WLS patients, but that would only reinforce the shame and stigma associated with this work, so instead I am “coming out.”

How did this happen?

This work came with appointment to an eating disorder-specific position.  During my second interview that I was told that I may work with WLS clients. Had I worked with them before? Sure! after they’d gained all the weight back. I kept on and got the job, and was then appointed to the WLS team.  I was one of the dietitians last to clear a patient for surgery.   Great colleagues, benefits, salary, and opportunities to connect to eating disorder community; I couldn’t turn that down, and that’s how it happened. Maybe you would have quit, and bravo for you, quitting takes guts; it also takes privilege to decide that no job is better than a job you dislike. I decided to see what would happen if a HAES RD became the one to clear patients for WLS.

I have since left this job, but in this short stint my mind has been blown multiple times. I chronicled this journey to share with others what I have learned; invaluable insight into an insidious industry, capitalizing on our collective fatphobia, and the ways that professionals justify their work in the name of “health.”*

Hang tight, this will definitely be a bumpy ride.

If you’re interested in contributing to this project, I’d love to hear from you.


*Names, terms, and identifying details will be changed to protect patients, employees, and myself, from my former employer.

Let’s Broaden the Talk About Thin Privilege

Last fall, Melissa Fabello posted a piece about thin privilege. It had a meme that caught my eye; two women, one thin the other fat, with assumptions about them based on their size written on their naked bodies. I thought the piece was great and reposted it. Only afterward did I wonder how the assumptions would have been different if meme and author were people of color. I reached out to the author on twitter for her thoughts, but got no response so I left it until now.

As this article was circulating again this spring, Dr. Linda Bacon, one of the more prominent pioneers for Health at Every Size® (HAES), reposted it along with another article she adapted from a speech she gave to the National Association for the Advancement of Fat Acceptance (NAAFA). Dr. Bacon was speaking from her own experiences of thin privilege. She listed things that are different in her own life:

  • “Because of thin privilege, I had a larger dating pool, which made it easier for me to find the incredibly wonderful and supportive partner that I have.
  • Because of thin privilege, I have had easier access to meeting and gaining approval from other people socially, some of whom have provided career opportunities for me.
  • Because of thin privilege, I can go into a clothing store, get treated with respect, and have a larger choice of fashions and at cheaper price than fatter people.
  • Because of thin privilege, I can be assured of only having to pay for one airline seat, making travel and its accompanying opportunities much more accessible to me.
  • Because of thin privilege, I have developed a platform and persona that resulted in being asked to speak to you today.”

When I read her list, my first response was, “Absolutely” my second response was “because you’re thin…and white.” I then wondered if there was another thin person of color, like me, in the room and how they felt about that list. Was there anyone in the room at the NAAFA conference who, like myself, has walked into a clothing store and been asked to leave their bag at the door only to find other white shoppers with their bags? Was there anyone in the room who has been followed around a store to ensure payment for desired items, as I have? I wondered how it would have felt to listen to that speech as a fat person of color, and reflect on the ability to find a loving and supportive partner in a culture of thin privilege and white supremacy. Was there anyone in the room who needed to buy two airplane tickets to travel and experience a public hair pat-down by TSA, as I have, because they wore their hair naturally? Did anyone in the room wonder about the way that thin privilege intersects with other identities? Thin privilege definitely makes life easier for me, for Dr. Bacon, and many others, I am not questioning that. To fully address fat oppression in our society, though, I believe the conversation needs be broadened from the one-dimensional topic I have found it to be.

Some people may tell me I’m complicating the issue by adding topics like race to the mix. Yet, if I don’t “muddy the waters” about this then thin privilege and HAES will continue to come from a white narrative, and remain stagnant. By broadening the conversation, discussing what we know and more importantly what we don’t know, we can begin to notice the gaps and work to move the conversation forward.

While walking with a colleague of mine and telling her about this piece she asked me, “Do you think that [those authors] are able to write about thin privilege because they’re white?” She went on to explain that they won’t ever be judged as people who “complain about everything” as underrepresented groups discussing oppression often are. These white authors are better able to stick to a single issue of oppression, she said, and are therefore better able to be heard regarding the topic. This possibility broke my brain for a second, but also made a lot of sense. I had not thought to apply access to a conversation.

I’m glad the conversation was started by those authors, but let’s not let it end there; there are other chapters to this book. Let’s begin learning how thin privilege and fat oppression present to people of color and people with intersecting identities. A colleague and I have started a monthly conversation, currently focused on anti-racism work in the context of the HAES model. I’m excited to be part of the process to make the HAES movement more inclusive. Another opportunity to hear more about this presents at a 1-day event on October 25th in Oakland CA, where I will moderate a panel of diverse individuals discussing their experiences with weight stigma. I also hope to return to the thin privilege article by Ms. Fabello and recreate the meme of assumptions with bodies of all shapes, colors, abilities, and gender identities showing where we all intersect and where we don’t.


Jessica Wilson, MS RD is the owner of My Kitchen Dietitian, LLC, a dietetic practice devoted to the HAES® principles. She sees private clients in the San Francisco Bay Area, and has expertise in helping those healing from chronic dieting, and eating disorders.




This month I’m dedicating my posts to the hashtag #HorribleDietitian.

After recommending cured meats like prosciutto or salami to one of my clients she responded, “You’re recommending “bad foods”?!  You’re a horrible dietitian!”  Though she said this in jest, mixed with relief at “permission” to add these foods back into her diet, it got me thinking about the many ways that I am a #HorribleDietitian indeed!…when compared to traditional dietetic standards.

I’ve been “caught” recommending “bad foods” to my clients!

Today’s bad food is tomorrow’s good food and vice versa (coconut, eggs, & margarine anyone)! Stop listening to food rules, start listening to your body. All foods are good foods.

I don’t provide calorie targets or rigid meal plans!

Can I pull out a daily caloric and nutrient requirement receipt from your ear that makes allowances for wound healing, infection fighting, movement, stress, different types of movement and different life stages?! Absolutely not!  And even if I could, eating the same number of calories each day would not teach you anything about tuning into your body and tuning out the food not-so-experts trying to make money from you.

I don’t suggest weight loss to improve heath outcomes!

Gasp! Weight just isn’t a good indicator of health. Health is immensely complex, and for some reason our culture has decided that our gravitational pull upon the earth is a good way to also measure how healthy and well we are as human beings. One single measurement about a person tells us nothing; we need to look at the whole system.  To complicate this even more, body weight is not something that we can effectively control long term.  Instead, I focus on behavior changes that clients can make, and help them increase their own personal health literacy.

Stay tuned as I describe the reasons I am a #HorribleDietitian!

Become your own food expert!

Crop flier

Are you someone who spends time during your day thinking about what you should and shouldn’t do when it comes to eating and physical activity? Have you ever wondered how those patterns developed, years after our bodies knew how much milk and food we needed as babies?

There is no limit to the number of people willing to tell us what our bodies need to be “healthier”. They are screaming it from daytime and prime time television, from books, from home shopping networks, from newspapers and magazines. They are offering up these shoulds and shouldn’ts, in a way that seems like they’re doing us a favor. As long as we follow their rules we’ll be so much better off!

Upon examination these people tend to have a few things in common. They are usually 1. White, 2. Cis gendered and heterosexual, 3. Higher SES, 4. Have often self-appointed themselves the expert of everyone’s needs on the planet (Dr. Oz anyone?). 5. Have never met me.

Let me tell you, as a queer person of color, I am totally over straight white folks in self-appointed power telling me what I need to do in order to live my life, and be “healthy” as defined by the aforementioned stranger.

I think that this paternalism is just one aspect of the bigger issue here; as a nation our health literacy is in the toilet. With the constant barrage of “right” and “wrong” ways to do things—each of which contradict each other—we are completely without the knowledge to know that our body has individual needs and how to clue into them. As one recent conference participant put it, “I feel like each of us has our own unique…equation for what our body needs and we haven’t even taken the class to figure out how to answer it!”

I agree. As a dietitian I may be a food expert, but I’m not an expert about anybody’s body but my own. I encourage you to travel your own journey to find out what your unique body needs. If you were able to tune out all of the shoulds in your life, what else would you have space for?

Please join me for a Fall group series, Satisfied? Become Your Own Food Expert, in Oakland starting mid October.


Creating the Health at Every Size of my Dreams!

My efforts these days are not about me.  They are about improving access to Health at Every Size®  (HAES) for all people, ensuring that someday everyone will enjoy the benefits that I have realized with HAES.  I imagine a future when HAES is known throughout every country, when we understand how weight stigma and fatphobia present in different cultures, and we have non-English speaking countries and individuals involved in the movement.

As a dietitian, HAES gave a name to something that I was practicing in isolation in Oregon.  Without this community I wouldn’t have the science and support to help folks understand why their weight loss diets and food rules just aren’t working, but in fact, are harmful.  I am very grateful to have found HAES, and my primary goal is for others to find it too.  I hope newcomers both see themselves in the movement, and feel comfortable contributing, should they desire.

ASDAH is the primary organization for HAES professionals, and I am a member.  I hope to see our organization grow exponentially and serve a broader community of people.  I look forward to the day that I can recommend ASDAH to any colleague without needing to describe the demographics of the group first.  It will be wonderful when the membership closely resembles the US population.  I look forward to doing the ongoing and ever changing anti-oppression and inclusion work needed for this to happen, and learning from my many mistakes along the way.  I can’t wait for an organization in which a diverse group of people will feel as comfortable saying, “I have found my people” as many current members do.

If you’re similarly interested in making HAES more inclusive I’d love for you to join the conversation!

Jessica Wilson is a dietitian in Oakland, CA

Good Intentions Only Go So Far

The last HAES’d and Confused meeting to discuss ways that Health at Every Size® can become more diverse was electrifying.  There seemed to be an understanding amongst the predominantly white group that we cannot have a conversation about the barriers to HAES experienced by underrepresented people until these people are actually at the table.  We then decided that we will make anti-racism work and creating a space that is inclusive of all voices the work of the group.

Fast forward four days.  The other HAES realm of my life, the Association for Size Diversity and Health (ASDAH), sent out an email announcement for their 2015 conference. The title is “Connect(ability): Creating an Inclusive Health At Every Size Movement.”  Okay, I know what inclusive means, but not “connect(ability)” so I read on to learn that it is an umbrella term for all of the ways ASDAH wishes to include people in HAES.  Not only from a power, privilege and intersectionality standpoint, but also from a some-people-think-HAES-emcompasses-sustainably-farmed-food-and-some-do-not-so-let’s-make-sure-everyone-feels-included-in-HAES standpoint, as was explained to me by someone on the planning committee.  Hmmmm, that definitely expanded my definition of inclusive.  The announcement ends by proclaiming to “bear witness to voices that have been silenced” at the next conference.

As one of two or three people of color at the last conference I was excited that ASDAH was stating commitment to do the work to make sure that there were more voices at this next one.  But a quick look at the planning committee members (all white, cis women except for one white man) told me otherwise.  There are some points I’d like to make clear:

  • To appropriately include new voices in a conference, these voices need to be on the Conference Committee
  • Inventing a new word like “connect(ability)” and making it a catch-all for any and all inclusion criteria—thus putting people who disagree about whether to shop at the farmers market under the same umbrella as societal oppression—feels really crummy
  • Excluding diverse voices from the planning of a conference that aims to address oppression within HAES is painful to watch
  • The nothing about us, without us mantra I hear from this community when lamenting that fat people are not often in conversations of “obesity” politics also applies to the voices that have been historically absent from discussions of intersectionality and oppression within HAES
  • Half-assed attempts at addressing issues like oppression are worse than not addressing them at all

I know that the people of ASDAH really do try their hardest and truly mean well, but good intentions don’t mean the work is done.  ASDAH declares that it is a social justice organization.  For me, that declaration comes with incredible responsibility to its members and community.  I would like to see the following:

  • The conference theme changed for 2015
  • Opportunities for members and leadership to learn more about oppression and privilege before attempting a conference like this in the future
  • People of underrepresented identities present on the Conference Committee
  • A Leadership Team that reflects the population that ASDAH would like to see in its membership
  • Transparency with membership, should there be a change to the conference theme
  • The support of other community members in asking ASDAH to reconsider the 2015 conference plans

I really do believe that HAES can one day be a movement for all people.  And I believe that most people want HAES to be inclusive.  The reality is that change takes time and effort if done well, and it’s time to begin reflecting upon what that process needs to look like for the ASDAH community.

Jessica Wilson is a dietitian at My Kitchen Dietitian in Oakland, CA.