Weight Science and the Humble Evolution of a Non-Diet Dietitian
Updated: Sep 17, 2019
I used to feel badly that I had trouble helping clients with their weight concerns.
Sure, a part of me wondered if maybe I wasn’t a very good dietitian, but I mostly felt for my clients. They wanted to lose weight so badly, and they had tried so hard to do so. I heard their stories, and I heard their experiences; I witnessed their frustration and shame. And I knew their plateau or weight regain or binge or whatever it was that made them feel as if they were failing wasn’t for a lack of effort or trying. I believed my clients, and yet the shame and frustration they shared was palpable.
As a green dietitian trained in a weight-centric environment, I struggled to know how to address these concerns and this reality.
And then I learned about intuitive eating (and then, HAES) about a year into my career. It made so much sense. My mind was blown (and frankly, appalled) to learn we don’t have one single long-term study that supports long-term weight loss. Not one. Or about the dismal numbers that even “the experts” view as successful weight loss. Or the rates of weight regain, and the negative impact of the inevitable weight cycling that occurs. To paraphrase the wisdom of Deb Burgard, I began to recognize that we recommended the very behaviors we would diagnose as disordered in smaller folks (like, almond counting, or excessive exercise, ahem). I learned about my own thin privilege, and how it’s protected me from so much. I learned about weight stigma and that it likely impacts health more than weight actually does. And how social determinants of health play the largest role of all.
I was quickly intrigued, and wanted to jump right in to the non-diet approach. I'm sure there was unintentional fence-straddling between the two paradigms in the beginning. I can have compassion for myself reflecting upon these moments, but I now see fence-straddling as harmful and damaging, mostly for the consumer, who ends up confused and misinformed about what the non-diet approach really means. It's ok to have questions, and it's ok to know that you have more to learn. If you're wondering or unsure, know there are places to discuss these concerns - you are invited to learn more. It is important to say, however, that as providers, it's rarely helpful to hash out this weight-centric vs weight-inclusive debate in front of the lay public. Nor is it not helpful to make grand statements that are also somewhat contradictory to the original intent of the movement. This often doesn't allow for the exploration of nuance, and it's confusing, frankly.
As I began to read the research and listen and learn from the incredible teachers who have come before me, this science all made sense. The experience of others made sense. Weight science is far more complicated than calories in, calories out. I realized that while I was always against fad dieting, there really is no place to ethically promote intentional weight loss in my practice. The truth is, the science of weight regulation is the same whether one is promoting a fad diet or promoting a “sensible” plan.
I learned I can certainly continue to support those who want to lose weight without supporting weight loss itself. As long as we live in a culture that encourages weight loss above everything else, and touts weight loss as the “healthiest” thing you can do for your body - the “healthiest” thing you need to do for your body - people will continue to seek weight loss as a means of improved health and increased social acceptance. A non-diet healthcare provider won't shame an individual for seeking weight loss as a means to health and acceptance, but they WILL offer a different way.
Early in my career, I didn’t realize how little evidence there is to support intentional weight loss, and how much evidence there is to focus on other health habits and behaviors instead. There are so many ways we can help support a person with their health, while considering what’s accessible to them.
Unfortunately, the non-diet approach seems to be a point of contention within the health care community. If you’re confused, worried, or wondering what this means for you as a person who wants to lose weight or a professional, it’s ok. It’s understandable - we aren’t usually trained within the weight-inclusive approach. I encourage you to offer yourself some self-compassion, and I invite you to learn more. There are welcoming spaces to explore your concerns. You are invited to learn more.
This movement has been around for a long time, and there are so many resources available, and so many teachers hoping you’ll lean into your curiosity. There are research articles, books, podcasts, and webinars. There are professionals offering groups or 1:1 sessions if you’re a lay person, or continuing education and supervision if you’re a registered dietitian or provider.
If you’re curious, I invite you to learn more. If you're resistant, here's this. If you’re interested in getting started, I highly recommend reading the books Intuitive Eating and Body Respect. If you’re a professional and curious to see the research, please check many of the links I’ve provided. If you read one paper, start here. As Dr. Jennifer Gaudiani has said, this is the only way forward. Curiosity was what unraveled it all for me, slowly, and then very, very quickly. I’m so grateful to be a non-diet RD, and I look forward to seeing this area of practice evolve.