Monthly Archives: November 2014

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.

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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.

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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.

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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.