Wait…Why are we talking about my weight?

Raise your hand if you look forward to going to the doctor…

People, Weight Bias, Weight Stigma

Me neither.

Not long ago, I had a check-up that I had been dreading more than usual. I contemplated canceling several times. As I was considering whether or not I would go to the appointment, I thought about all that would be done at the check-up. One of the first things that came to mind was getting my weight checked. Lately, I’ve encouraged several of my clients to decline weighing at the doctor’s office if not medically necessary for their care as few of my clients look at the number on the scale as “interesting data.” I felt convicted to practice what I had been preaching to my clients, so I pondered what it would be like if I said “no” to the scale that day. When I started thinking about speaking up and not getting weighed, I -much to my surprise- started to feel nervous…my heart was beating fast!

I’ve had clients share that it’s easier to just get weighed to avoid getting questions or receiving funny looks from the nurse who is in charge of getting vital signs. If this sounds like you, you are not alone. I, too, was wrestling with the idea of refusing to be weighed! Many people fear making their doctor mad, seeming ungrateful for their help, or acting like they know more than their doctor. I’ve also had clients share that they were treated differently after refusing to be weighed at a doctor’s appointment, but it wasn’t until this particular day that I began to understand why my clients struggle so much with the scale in the doctor’s office.

I chickened out.

It truly felt easier to just step on the scale that day. The nurse took note of my weight. I saw my doctor, expressed my concerns, and attempted to get my questions answered. During my appointment, the doctor was not particularly forthcoming with lots of helpful information, but I was – for some reason- completely shocked at what she was forthcoming about. Right before walking out of the room, she decided to tell me, “And just so you know, you’ve gained [x] pounds over the last year.”

I stared at her blankly, basically in shock, wondering why she felt the need to tell me this information. I certainly hadn’t asked about my weight. Before I could formulate a response (or close my mouth after my jaw had dropped), she continued, “You’re still fine. It’s just something I tell everyone just so they know.” I think I managed to utter an puny “OK?” before she left the room.

Immediately, I was so disappointed in myself. I began thinking of all the things I should’ve said in that moment. Even more, I began thinking about my clients and the weight bias and weight stigma they have experienced. My weight remains in a range that is deemed “healthy” or “normal” by the medical community’s [sometimes arbitrary] standards, so IWait...Why are we talking about my weight? Weight Stigma & Bias by Healthcare Providers cringed thinking about how this conversation may have gone for a person who was considered “overweight” or “obese.” I thought to myself, “No wonder people decide to delay or avoid medical care!

I also thought about those who have struggled to gain the weight they need to be healthy. Hearing this comment could’ve been a major trigger for them. What if a patient gains muscle, making them stronger and healthier? What if the patient was recovering from an eating disorder? What about all of the other factors that can lead to weight gain?

Apparently, I’m not the only one who felt terrible about this one-sided conversation. It’s estimated that 20-30% of people will be strongly impacted by weight stigma from professionals but will not speak up for themselves, even when they know the truth about weight and health and want to be treated accordingly. The percentage is probably higher for those who receive unsolicited comments about their weight.

When it comes to weighing and weight, what can healthcare providers say and do to respect their patients?

What will I do differently next time (and what could you do in a similar situation)?

  • Plan and rehearse some responses beforehand to prevent being caught off-guard and subsequently left speechless when comments about weight are made or when asked to step on the scale.
  • Ask my provider, “How is my weight connected to the medical problem I have?”
  • Do my best to remain calm and engaged throughout the conversation. Ask as many questions as are needed to fully understand my provider’s perspective and assess whether or not it lines up with the research.
  • Consider sharing research with the provider.

Unsolicited comments about weight are not appropriate. Period. Fortunately, I’m at a point in my life where I feel confident and content with my health, shape, and size. It certainly hasn’t always been that way for me, and I’d venture to say it isn’t that way for most people in this world. As I look back on this experience, I’m grateful for the opportunity to share my perspective and hopefully prevent similar doctor’s office incidents. I’ve learned a lot from this recent check-up and couldn’t let it go before sharing it with you.

I’d love for you to send me your feedback and share your experiences. Have you ever been the recipient of an inappropriate comment about your weight? If so, how did you respond?


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Food Trends and FNCE Highlights: Conference Recap

From the moment I drove into Nashville, it was non-stop food and nutrition with around 10,000 of my closest Registered Dietitian friends. The Academy of Nutrition & Dietetics hosted their annual Food & Nutrition Conference and Expo (FNCE) on October 3-6th, 2015 at Music City Center. This conference never fails to provide great opportunities for networking, over 140 sessions on a variety of hot topics in the nutrition world, and an expo filled with over 300 exhibitors sharing the latest products and food trends.

Saturday

To kick off the conference, master innovator and former president of Trader Joe’s, Doug Rauch presented his keynote address: “An Innovative Solution to the Hunger Problem” at the opening session. He recently founded Daily Table (read their mission statement and story here). According to Rauch, Daily Table provides affordable food that moves people forward.

Did you know?

  • 1 in 6 Americans are hungry. Many may have enough calories but not enough nutrients.
  • Code dates and expiration dates are not federally mandated, and many Americans do not understand how to read code dates anyway. For example, Rauch showed a photo of honey with a code date on it, but did you know that honey never expires?
  • Between one-third and 40% of the food grown in the U.S. is never eaten. Lettuce is often thrown away simply because it won’t fit in a bag or box.

These statistics and facts about food waste were eye-opening, but Rauch says “All of us together can, and will, make a difference.”

Sunday

Sunday sessions began at 8:00am sharp. Whew! Here are the sessions I attended on Sunday (By the way, these sessions will soon be available to purchase, download, and listen to at home by following the links below):

Claim the Spotlight! Beyond Traditional Media: Videos, Podcasts, and Self-Publishing (Speakers: Julie Beyer & Melissa Joy Dobbins)

  • Who knows what you’ll see from me in the future?!

Interrogating Host Microbiota Dynamics in Diet, the Metabolome, and Disease (Speakers: Charlene Compher & Gary Wu)

  • What we eat shapes the composition of our microbiome which can in turn change our disease risk. Check back tomorrow, and you’ll see how all of this new research about the gut microbiome is affecting food trends…stay tuned!

Satiety Regulation and Measurement: Can Appetite Be Controlled? (Speakers: John Blundell & Richard Mattes)

  • We talk about hunger and satiety all the time in our office. This session focused on various factors that impact food choices and satiety (specific tastes, food labels, textures, food components, digestibility, etc.) and how eating frequency, portion sizes, and composition and timing of meals impact satiety levels throughout the day.

After brunching with Leslie Schilling on Sunday, we headed to the Expo floor to meet up with Rebecca Scritchfield…it was there the trend-spotting began…

Rebecca Scritchfield, Leslie Schilling, Blair Mize with Sabra HummusI promise we were working…

Sunday evening, I was invited to a Rooftop Reception and Tweet Up hosted by Food & Nutrition Magazine and sponsored by StarKist, Lekue World, CanolaInfo, and National Peanut Board. It was a great evening chatting face to face with many RDs I normally only get to chat with through e-mail and social media!

Networking with fellow RDs at Food & Nutrition Reception
It was an honor to share my Music City Barbecue Sauce recipe with Food & Nutrition Magazine this year! The recipe was featured in the FNCE 2015 issue of the magazine.

Food & Nutrition Magazine Music City Barbecue SauceMonday

After an early morning (hilly) run, I attended the following sessions on Monday:

The Young Female Athlete: Medicine & Physiology (Speaker: Albert Hergenroeder)

  • This speaker provided such a refreshing, realistic, and experienced perspective on health (especially bone health) and training for the female athlete.

Meant for Each Other: Health At Every Size and Motivational Interviewing (Speakers: Ellen Glovsky & Molly Kellogg)

  • This was probably my favorite session of the whole conference. You know from this post that I’m all about eliminating weight bias, and these speakers gave concrete examples of how to practice weight neutrality while using motivational interviewing. They encouraged practitioners to affirm patients and clients based on behaviors, attitude changes, and personal discoveries rather than on weight.
  • This session would be worth a listen for anyone who needs help addressing concerns about weight with a loved one.
  • Though there are mixed opinions about how a person should be counseled on nutrition, fellow RD Reba Sloan made a good point, “I’ve never treated anyone who didn’t diet their way to obesity.”

Food for Recovery: Resolving Malnutrition and Disordered Eating Patterns in Addiction and Substance Abuse Populations (Speakers: Steven Karp & Megan Kniskern)

  • Did you know that RDs can support mental health and play an active role in detox by getting the addict nourished? The body and brain must be fed before true recovery can begin. In other words, food is the best medicine!

With so many booths at the expo, I took a time-out from sessions for Day 2 of trend-spotting…

Angie Wallick, Blair Mize, and Sara Foley at Raspberry booth at FNCE
Siggi's Yogurt Booth at FNCE

What can I say? Work hard, play hard…

After stopping by the Ketchum Reception for a bit, it was time for dinner at Husk…delicious!

Tuesday

Tuesday morning wrapped up FNCE 2015 for this RD…I attended the following 2 morning sessions:

Mastering Your Domain: Using Technology to Grow Your Business Online (Speakers: Regan Jones & Anne Mauney)

  • I’ll be using lots of these tools and ideas discussed in this session starting on this blog post! Dietitian or not, if you blog or use social media, this session would be a great listen!

Supplement Savvy: Playing Safe, Smart, and Legal (Speaker: Ellen Coleman)

  • Ellen Coleman did a fabulous job of keeping us engaged on a topic where it could be all too easy to get bogged down in *potentially dangerous* ingredients you can’t spell or pronounce. 😉 One tip she gave, “If your supplement contains more ingredients than a Big Mac, don’t take it.”
  • Check out USA Today’s Supplement Investigations and this Supplement 411 YouTube video before taking any more supplements.

After this non-stop, whirlwind trip to the Music City, the only thing between me and home was a 3 hour drive! I was ready to get back to my family and my own bed (although my friend Emily’s cot was surprisingly comfy!), and I am looking forward to sharing even more information with you and my wonderful clients.

FNCE 2015 was a huge success!


Want to hear more FNCE highlights and food trends? Tomorrow, check out the Top 5 Trends that stuck out to me at FNCE 2015.

Practicing Weight Neutrality in a Weight-Biased Healthcare System

PracticingWeightNeutrality

In recent years, our society has become more open and understanding regarding peoples’ differences, but it seems weight is one area in which our culture has miserably failed to become more accepting. When it comes to size and weight, people continue to be judged against unrealistic and arbitrary ideals. Where is weight neutrality in this picture?

Too often, larger people are criticized, shamed, and misunderstood because of their weight. Furthermore, the perception of many healthcare providers remains that “if people would just lose weight, they could be healthy.”

Where’s the weight neutrality?

How ridiculous it is to think we can begin our lives with entirely different sets of genetics and end up looking the same or staying healthy at unnatural weights for our bodies!

Non-diet dietitians are already like fish swimming upstream in a river of 61-billion dollars-worth of diets, and the current becomes even stronger when practicing weight neutrality, especially when serving as the only weight neutral provider on an interdisciplinary team.

For several months, I worked with a woman (we’ll call her Beth) whose goal was to manage her diabetes, blood pressure, and cholesterol. She wanted to be healthy and to live longer, and she initially assumed the way to do so was through dieting. Our first sessions were spent reviewing and discussing research about diets versus intuitive eating, and Beth emphatically vowed, “I’m definitely not going back to dieting EVER!!!” stating she loved the newfound freedom she had with eating.

Eating intuitively, moving mindfully

In the meantime, through learning to eat intuitively and incorporate movement mindfully, Beth managed to cut her triglycerides in half and bring her cholesterol down to a normal range. She gained incredible insight into her relationship with food and recognized how satisfied she felt when she ate healthy AND tasty foods.

Giving up the scale

But there was one major challenge she continued to face: giving up the scale. After much discussion, Beth recognized how the scale was blinding her to the progress she was making toward health. She reluctantly agreed to put the scale in the attic for a while and contact me if she felt the urge to weigh herself.

Changing the view of progress

Beth acknowledged her need to change her view of progress. She began to accept the possibility (which was becoming a reality) of being healthy in a larger body and to recognize that her size did not change her worth and value in life.

She moved away from… She moved toward…
·  Focusing on a number on the scale that she could not directly control ·  Focusing on behaviors that lead to health
·  Focusing on weight first and foremost ·  Concentrating on actions she could control
·  Asking: “How many pounds did I lose?” ·  Noticing her increased trust in herself with food
·  Questioning: “How do I look?” ·  Questioning: “How do I feel?”
·  Priding herself on having good willpower or self-control ·  Priding herself on recognizing inner body cues

(Adapted from Intuitive EatingEvelyn Tribole & Elyse Resch, 2003/2012)

At her next check-up with her primary care physician, the first topic addressed related to weight loss. The physician praised Beth, exclaiming, ”You’ve lost 9 pounds!” Immediately, her mind wandered back to the number she originally had in mind that might make her “healthy” again.

Already feeling ashamed and discouraged, Beth hesitantly told her doctor, “I’ve been feeling exhausted lately.” Her physician responded by stating, “You’re still carrying around lots of extra weight. Imagine carrying around your 10-year-old son all day. You’d feel exhausted, wouldn’t you? That extra weight is keeping you tired!”

Validate the patient’s concerns

In one conversation, Beth’s physician not only fueled her recent fantasy of weight loss as a magic bullet to solve her health problems, she also failed to validate her patient’s concerns. Rather than taking inventory of the lifestyle, psychological, or medical conditions that could be causing her fatigue and offering a plan of care to reach the root of the problem, she gave the simplistic answer: “Lose weight.”

Make evidence-based recommendations

According to the research, 97 percent of diets fail, and most people regain their lost weight in 1-5 years (Puhl, 2008). Combine dieting and weight cycling, and you have a recipe for a physical and emotional health disaster.

Leslie Schilling, MA, RDN, CSSD, LDN puts it this way: “If you were prescribed a drug with such a high failure rate, would you fill the prescription?”

People trust their providers to administer quality, evidence-based care; however, when they receive different messages from different providers, how do they know whom to trust?

It’s time all health professionals learn that the number on the scale does not define a person’s health, worth, or value. Our patients are human beings, not human bodies, and they deserve evidence-based guidance, rather than judgment, shame, or “easy answers.”

Equip people to advocate for themselves

Perhaps as you read about Beth’s experience, you felt anger, sadness, and frustration bubbling up. It is my hope that the feelings you experience throughout Weight Stigma Awareness Week will be used as fuel to begin to educate other providers and equip those with whom you come in contact to advocate for themselves.

Ignoring weight bias does not increase awareness or lead to change, but here are some practices that can:

  • Derail “fat talk” or weight-biased conversations and deflect them using research to support your case.
  • Engage in body activism and encourage body acceptance.
  • Focus on functionality versus appearance in your practice.
  • Listen to your patients and seek to validate their concerns.

And remember to start with yourself. Examine yourself, looking for weight bias in your own life. Though the previous case study only addressed weight bias from a physician, I think we’ve all been taught or heard ideas that perpetuate weight stigma in our training. I know I have.

Practice weight neutrality

As providers, let’s stop believing that differences in weight and size define a patient’s health or worthiness of quality care. Let’s practice weight neutrality. Continue to remove weight stigma and bias in the provider community by changing the view of progress, validating the patient’s concerns, making evidence-based recommendations, and equipping professionals with knowledge and people to advocate for themselves.


It was an honor to contribute this post to Binge Eating Disorder Association’s Weight Stigma Awareness Week 2015. See the original blog post here.

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