What I Learned as a HAES Dietitian Working in Bariatric Surgery

I’m a dietitian who practices from a weight neutral, Health at Every Size perspective and for over a year and a half I was working as part of a weight loss surgery (WLS) team. I helped guide patients through the process to get approved by insurance and instructed them on dietary needs for pre and post surgery. Ultimately, I decided I wasn’t comfortable promoting those operations and was able to leave my position to pursue other opportunities. But today I wanted to share some of my biggest takeaways after working in the bariatric surgery field.

I hope it will be helpful if you’re a dietitian and find yourself in the same or similar position, or if you’re just someone who is learning about weight stigma and HAES and wrestling with your feelings about some of these “hot button” topics.

When I first started my job I wasn’t nearly as convicted about working from a weight neutral lens as I am today. At the time, I was just starting to learn more about the HAES principles and the benefits of intuitive eating. As I dove deeper into the weight neutral world and research behind it all, the more I started to understand how problematic and stigmatizing encouraging weight loss can be.

I began to feel a lot of uneasiness about the work I was doing. I felt like I was doing more harm than good by encouraging patients to continue going through the process toward receiving bariatric surgery. It didn’t take me take long to realize that it wouldn’t be the right position for me in the long term. However, I also knew I needed a job, and couldn’t simply leave without any plans for the future. So I changed my perspective on my work and tried my best to be a positive voice for patients while I was in that role and ended up learning a lot along the way.

First, I think there’s a big misconception about the doctors and health care professionals who recommend weight loss and bariatric surgery. I really believe that the majority of providers out there think that it’s the best option to allow their patients to live healthier lives. We’re all living in this weight obsessed world and we (mostly) all receive our education from that perspective. So I get it. It’s what we see every day, what we’ve been taught, and for many providers, it’s the only way they know. I don’t think most surgeons, nurses, doctors and dietitians are out to cause emotional or physical harm to their patients, they just haven’t seen, or taken the time to dive into another point of view. They are simply doing the best that they can with the information that they have.

That being said, there can also be a lot of weight bias in this area of health care. I’ve overheard my fair share of unhelpful comments about patients’ bodies. It’s heartbreaking and unfortunate to hear those things, even if it’s not said directly to the patient. Negative comments impact the culture and the way we view patients. If we speak about people as if they’re less than human, that’s how we’ll begin to see and care for them. Obviously this doesn’t apply everyone who works with bariatric surgery patients, but it’s definitely out there and I think it’s fair to point out so that we can take steps to make change.

Another big lesson I learned while working in bariatric surgery was the importance of being a weight neutral, HAES voice for my patients. After learning more and diving into the research behind HAES, I really started to feel like a hypocrite. How could I say I believed in Health at Every Size and work at a job where I was promoting the opposite message? I struggled with that question a lot during my time in WLS but eventually I came to realize it doesn’t have to be so black and white.

I discovered that I could still do my job and support my patients by incorporating weight neutral and HAES messaging wherever I could. Sometimes it just meant planting a seed about intuitive eating or discussing what joyful movement might look like for them. But for most of my patients, it was the first time they had ever heard a message like that. So many people in larger bodies are pressured by health care providers to focus on weight loss at any cost. I wanted to be able to share a different message, even as a patient was going through the process toward surgery. I wanted to provide a space where the patient could talk and learn without discussing or focusing on their weight. If you’re in the same position that I was, it can feel like you’re fighting a losing battle and contradicting other providers by sharing your message, but I believe it’s worth it. Even if all we’ re able to do is provide a judgement free space for the patients, I think we’re making a difference.

On that same note, I want to mention that while I support and encourage sharing a HAES/intuitive eating message with WLS patients, we still need to educate them on their dietary needs after surgery. As a dietitian our job is still to counsel them on the importance of focusing on hydration, specific macronutrients like protein, taking certain vitamins daily, etc. It’s a balancing act between sharing the information they need to support their health, and encouraging them to listen to their bodies. In more acute situations, like after a major GI surgery, it’s important that we lean a little more on the brain knowledge side of things rather than the body knowledge. It doesn’t mean we can’t utilize both, but we need that brain knowledge to be able to listen to our bodies well.

Overall, I’m grateful to have had my job during the season that I did, and learned so much from the experience. It really helped me to refine my counseling and clinical skills as a dietitian. Plus, I truly enjoyed the patients and providers I had the opportunity to work with. But my time in bariatric surgery also opened my eyes to a lot of the flaws in our health care system. We have a long way to go but I think we can start to make change by educating those around us. Talk to your own health care providers, family members and friends about non traditional, weight neutral approaches. We have the ability to start planting seeds of change, even if we don’t immediately see the results. The work is still worth doing even if the change is slow!

Please let me know if you have thoughts or comments about what I shared in this post! I’d love to keep the conversation going!

You Don't Need to Lose Weight For Your Wedding

We all know that planning a wedding is stressful. There are so many details to keep in mind from location and venue, to the food, decorations and attire. It’s a lot. Somewhere along the way, the pressure to look a certain way for your wedding can start to creep in. Whether it’s from trying on dresses, comments from friends and family or social media. The pressure to shrink your body for your wedding is a real thing.

Getting married is a super significant and sacred life event. It makes sense that we would want to feel our best on that day. But we shouldn't have to focus on weight loss for that to be true.

The pressure to lose weight and look a certain way for you wedding is a product of the diet culture we live in. It stems from the idea that thinner=better and more beautiful and we should strive to achieve that by any means necessary. There are so many companies devoted to selling brides on diets and workout plans, letting them know they aren't good enough to get married just as they are. But that's not the truth. Your future spouse should love you for who you are regardless of your body size. We don't need to change our bodies just because the diet culture is telling us we should.

That’s not to say taking care of our bodies in the name of health is a bad thing. It's definitely not! In fact, focusing on health promoting behaviors before your wedding will probably help ease the stress of the planning process. But there is a difference between taking care of ourselves and the pursuit of intentional weight loss. Having the ability to care for our bodies with nourishing foods, hydration, movement we love, and adequate sleep is a huge privilege. They’re all positive things that can be incorporated into your lifestyle at any point.

Intentional weight loss through diets, restricting calories, or excessive exercise almost always leads us down a negative path. It puts us at risk for developing an eating disorder, weight cycling, restricting/bingeing, guilt, and an isolated lifestyle. We can pursue better health by taking care of ourselves-without the dieting and weight loss piece.

I have so much compassion for you if you’re in that season and wrestling with that desire to lose weight. It’s so, so challenging and ingrained in our society. If you’re hoping to go another direction and simply take care of yourself before your wedding I have a few tips that may help! Below are 4 ways to arm yourself against the diet culture messages before your wedding.

Diversify your social media- If you’re looking for photographers, dress ideas or other decor ideas on Instagram or other social media platforms, try to find users who are sharing a diverse representation of brides and wedding parties. Brides come in all shapes and sizes.

Shop for your dress at a store that will cater to your body size- While stores should cater to all bodies sizes, some obviously won’t. Consider calling or checking online before heading to the store, to be prepared and know whether they will have sample dresses that will work for you.

Guard your heart against harmful messages- Keep a list to remind yourself of what you know to be true about yourself and your body. If you resonate with health mantras, look a few up and keep them on your phone!

Remember that your wedding is only one day- When planning for your wedding it can be easy to lose sight of the purpose behind the day. You plan for the wedding but the wedding is only the beginning of your marriage. While you want to look great and have fond memories of your wedding day, don’t forget why it’s all happening. Keeping everything in perspective can be a great way to avoid falling into the diet culture trap.

Hopefully these tips are a helpful starting point for you during this season! Just remember that you’re not alone in the process and this work isn’t easy. Have lots of grace for yourself and others during the months leading up to your wedding and try to enjoy the process!

Pictures by Holden & Jessie

Intuitive Eating During the New Year and Beyond

We're a few weeks into January and still in the thick of "New Years resolution season." Most of the gyms and diet companies are still pumping out ads for their products like it's nobody's business. So if you've recently started working on your relationship with food, this can be a challenging time to continue on the road toward intuitive eating. Some major diet companies have even started using intuitive eating principles to help sell their weight loss products and brand. The temptation to fall back into old habits can be overwhelming.

But don't lose hope. It's normal and okay to feel that tension and to question what you're doing. Below I'm sharing a few tips on how to navigate the resolution hype and continue striving for freedom from diets and a healed relationship with food.

1. Remember that your reasons for pursuing a different route are still true, even during this season. Whatever it was that brought you to intuitive eating is still there. It's easy to second guess ourselves when we see what the rest of the world is doing and wonder if we should be doing that too. Consider keeping a journal to record your past relationship with food and what it has been like up to this point. Reference those notes to reflect when you start to feel like restriction is the better option.

2. Know that healing your relationship with food is not a fad. Unlike most of the products and plans being promoted right now, making peace with food is not simply a trend. The mindset shift can transform every area of your life. For most people, food is intricately linked to emotion and relationships. Healing the way you think about food can also help improve other areas of life. When we're not constantly worried about how many calories we're eating, we have time to spend with our loved ones, we can meet over meals without anxiety and spend brain power focusing on more important work.

3. Understand that taking the focus off of weight loss does not mean you're abandoning your health. You're simply giving yourself unconditional permission to eat all foods. And that doesn't mean you have to eat only desserts all the time to prove that you're doing it right. The point is that you're removing all the arbitrary rules that diet culture provides and instead putting the power back in your own hands. You have the power to eat foods that nourish you physically as well as emotionally whenever you want and need to. Health is so much more complex than sticking to a rigid calorie guideline and getting x amount of minutes of exercise/day. You're not a formula and following those guidelines doesn't automatically equal health.

Keep these tips in mind as you go forward in your journey to intuitive eating. It can be a long and challenging road, especially in January, but the reward is freedom and a fuller richer life. I'll be cheering for you!

Our Values Should Frame Our Health Decisions

We all have a set of core values. We use those values to inform the decisions that we make as we move throughout the world. An activity to try is to write down as many of your core values as you can think of, then spend time contemplating how you're currently living them out, how that will look in the future and what's getting in the way of living out those values right now.

This gives you a foundation to work from. When we identify what we hold most important in our lives, we know what to focus our time and energy on. So often our core values do not align with the concepts of dieting and pursuing weight loss. If we value time spent with loved ones and serving others, it doesn't make sense to also be engaging in diet culture. The lifestyle needed to manage our weight and food intake can be incredibly isolating. It would be difficult to maintain strong relationships with friends if we're always worried about our food choices. When we're doing something that goes against our values, we usually feel a sense of discomfort. We just have to be willing to be honest with ourselves about it.

Your values might be different than mine, or someone else, but that's okay! It's important that we take the time to think about what our own biggest priorities are. If you're ready to start thinking about how to align your values with your health, try answering some of the questions below:

Questions for reflection:

What are your core values?

Where do you see yourself in 10 years?

How will you think about and treat your body?

What food will you eat?

How will you move your body?

Think about your answers to these questions and decide what steps you can take to start aligning your core values with your health decisions and what might be getting in the way of living out your values.  It may be helpful to work with a dietitian to help you dive deeper into these topics. Please reach out if you have any questions!