Tag Archives: diet

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

 

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.

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.

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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.