What is an eating disorder dietitian doing writing a blog about weight loss!? In truth, I work with many clients who wish to lose weight. It is, after all, once of the defining characteristics of multiple eating disorders. And it would be ignoring reality to deny that the desire to lose weight is often on the minds of many, eating disorder clients or not, thanks to the social and psychological constructs of diet culture, patriarchal culture, racial injustice, trauma history, underlying illness, developmental interruption, unconscious defenses, and a host of other factors that drive thin ideals.
One of the reasons I do not use “HAES” or “Health at Every Size” language in my work is that to me, this is a value inherent in every human, akin to saying “respect at any size” or “humanity at any size”. The fact that there has been entire movement devoted to reminding people that everyone matters speaks to layers of complex oppression and narcissistic devaluing of the “other” that cannot easily be untangled. My clients are, first and foremost, human. And it is my job to know them, and if they want to discuss their weight loss wishes and goals and fantasies, is not my job to stop or deter them, but rather to understand them and approach their wishes with curiosity and inquiry.
I can’t make bodies lose weight. In fact, I can’t make bodies do anything! It reminds me of when I work with parents of younger children who come to me and say, “I can’t get my child to eat (vegetables/anything beyond pasta/fill in the blank) and often my first thought is, “of course you can’t!”. The only way we can “get” people to do something is usually through some kind of manipulation or cult-like adherence, neither of which are ethical or part of my value-system as a clinician and as a human.
What I can and do provide assistance with is developing and recommending emotional and behavioral interventions that provide sufficient energy and nutrients, alongside complex illness treatment recommendations, environmental stability and relational strength, so that the body can settle to a weight range where it is naturally (i.e. genetically, environmentally, psychologically) inclined. Whether or not clients accept and apply these recommendations is a complex journey, rarely linear, that may involve repeated return to restrictive food behaviors and more active weight loss pursuits. By helping clients to work through resistances to treatment and real health, I can in turn help clients know themselves and understand what drives potentially destructive behaviors and what motivates the pursuit of more meaningful, growth-oriented ones.
In discussing weight loss, it bears discussing what is meant by “health”, as many clients and clinicians alike often tout weight loss in the name of health. In my work, it is important to understand each individual’s definition of the word, and not simply apply my own understanding. For example, I am consistently reminded that the same clinicians who recommended 1200-calorie diets to their patients to lose weight in the name of “health” then deem the same clients "lazy" because they have (obviously) been unable to maintain such unsustainable intakes, don't have the literal energy to exercise, have poorer psychological functioning, and ultimately gain more weight than where they began. This constant "yo-yo" dieting has left many patients in larger bodies than when they began their journey, and no amount of dieting and exercise is going to correct years of poor guidance by clinicians and laypersons alike, from a weight perspective.
What could help is focusing on factors besides weight like sufficient nutrient, fiber, and energy intake, cardiovascular stamina, weight-bearing exercise, and treatment and management of underlying illness that will vastly improve an individual's metabolic health markers, but not automatically move the needle on the actual scale in a meaningful way, at least by societal standards. Avoiding absolutisms about weight loss AND easing the myopic scrutinizing of numbers on the scale may very well be the most healthful approach - both are disrespectful to our clients at best and downright condescending at worst.