Content warning: cursing, discussion of weight and weight loss, diet culture beliefs
I knew I wanted to be a dietitian when I was 12. In my mind, "Nutrition was cool. Understanding how to eat foods to live your *best* life? F yeah!"
In high school, my understanding of nutrition was basic. I thought nutrition had something to do about… eating fruits and vegetables, staying thin, not eating bad foods, and maybe…. balance? eeeeeeee—I mainly correlated it with being thin and I also knew the power of thinness. Being thin was it; It was attention getting. It was healthy. It was right.
As basic and basic-ly downright wrong my thinking was at this time, I also respected the subject of nutrition and knew it was a science I wanted to know about. And—this one is important-- I understood I didn’t really know shiiit about nutrition.
Weight science was the focus of my education in undergrad, internships, and graduate school. The fact that I wanted to study weight probably had a little bit to do with my personal struggles with my body and growing up around diet talk but -you better believe- the main reason I studied weight was because I lived IN diet culture.
Diet culture is a system of beliefs that worships thinness and equates it to health and moral virtue, promotes weight loss to attain a higher status, elevates and demonizes certain ways of eating, and oppresses people who don't align with these statutes (1).
During undergraduate school, my knowledge of nutrition became more advanced; understanding more about its role in disease prevention and treatment, food service, and public health. At this point, I understood that the science of nutrition extended way past being thin. Also, my relationship with food and my body improved. During my dietetic internship at Tulane, I started to observe a certain type of lifestyle among my dietitian and dietitian to-be colleagues. This lifestyle included being confident in their body, eating the food they desired, and engaging in enjoyable movement. I didn’t have the words for this yet but I wanted to teach all my patients how to have these behaviors.
Once I completed the dietetic internship at Tulane, I passed the registered dietitian exam, and I was stamped and shipped off to the dietitian factory. Nine years in the making and there I was, a registered dietitian! During my work experience, I dabbled in different types of dietetic jobs (clinical, corporate, community), but I was able to find a weight focus in all of them. I designed, implemented, and managed programs all with the main focus on reducing the “obesity epidemic”. Here is where I would like for you to ask to see my resume 😊
After three years of work experience, I had extensive knowledge of program development, behavior change, nutrition, and weight science but I wasn’t satisfied with my impact in behavior change in weight management. Program efficacy was hard to measure because I found that either clients would become disinterested or ashamed and fizzle out of the program or that programs only lasted a short period of time and I wasn’t able to track long-term progress. To learn more effective interventions, I decided to go back to school to get my graduate degree.
So there I was, back in school at East Carolina University getting my Masters in Nutrition Science with a research concentration and a focus in pediatric weight management. After a few years of classes like Advanced Clinical Nutrition, Pediatric Nutrition, and Biochemistry, it was time to complete my final graduate project; a showcase of my accumulated knowledge. I wrote a literature review on successful weight loss interventions for families.
This project was a life changer. While examining the literature, I found that there were no interventions that showed a significant difference in weight loss after 5 years. I actually found the opposite. An overwhelming majority of people who participate in weight loss interventions regain the weight within 5 years and usually continue to gain (2). It appeared that those people would have been better off never participating in the weight loss intervention.
Cue- Wake up call.
This was why I was dissatisfied with my impact; the very idea of weight management is flawed. To try to shrink the body in the name of health causes a distrust of the body. Thinking back to my internship at Tulane and the healthy lifestyle I observed in my dietitian colleagues, I realized that the people who lived that lifestyle had thin privilege. Diet culture allows people in thin bodies to enjoy food, engage in fun exercise, and be body positive. I began to recognize that within a weight management framework patients in larger bodies aren't allowed the food and body freedom that creates these behaviors. Weight loss interventions cause people to have damaging health behaviors like increased stress over food and exercise, negative body image, food patterns lacking in variety, and disordered eating.
My search began to find a method that teaches and empowers people to increase health behaviors no matter their body size. I found Health at Every Size (HAES). Health at Every Size is comprised of three components: respect of body diversity, critical awareness to question scientific and cultural assumptions while validating lived experiences and body wisdom, and self-compassion in exercise and nutrition (3). The research around HAES is promising showing that this approach is associated with improvements in blood pressure, blood lipids, physical activity, mood, self-esteem, and body image (4).
Beyond the individual level, HAES is also a social justice movement. When you step out of diet culture, you can clearly see the oppression of people in larger bodies. You can identify the sexiest, racist roots of diet culture and how it disrupts cultural progression.
Many people I encounter dismiss Health at Every Size based on its name alone. They never take the time to look at the research and fully understand the movement. I urge you to have an open mind and to take the time to learn about Health at Every Size. And maybe, like my journey, it can lead you down a rewarding path.
(2) Rogerson D., Soltani H., Copeland R. (2016). The weight-loss experience: a qualitative exploration. BMC Public Health. 16 (371). DOI: 10.1186/s12889-016-3045-6
Maggie Perkins is a registered dietitian that does nutrition telehealth for families.
She focuses in family feeding, intuitive eating, and Health at Every Size©.
Her private practice, Tomata, is based out of North Carolina.
The material in this blog is not intended to be used as medical advice. Please work closely with a competent health care team on your specific medical needs.