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!

The Holidays and Rejecting the Diet Mentality

The holidays can be a stressful time of year, especially if you're stuck in a cycle of dieting. Most family get-togethers revolve around food and meals. Many articles you'll see on social media focus on how you can survive the holiday's and all the food "temptations." Since our society as a whole is still participating in diet culture, it would make sense that most of the "tips" out there include a rule book on how to attend a holiday party and still stick to your diet. 

But what if we started to do things differently this year? What if we didn't worry about the food at the party? What if we didn't have to bring our own raw veggies to snack on just in case there's nothing "healthy" there? What if we could just enjoy the season for what it is? What if food was the last thing that caused us any anxiety this year? What would that be like?

The first step could be to reject the diet mentality. We need to make the decision to be done with the diets. Restrictive eating, rules and rigidity=a diet. Think about how things have worked out for you in the past when dieting. Maybe the first one went well, then it was a struggle from there on out. Get rid of the idea that life will be so much better if you stick to "the plan" over the holiday's this year. Wouldn't life actually be better if you spend quality time with loved ones, practice gratitude for all that you have, and give to those who have less? None of those things involve sticking to a diet.

Please reach out to me if you'd like additional guidance and to find out what the next steps could look like for you!

Resources for Getting Started with IE and HAES

I've referenced some of these books in the past, but I wanted to put together an easily accessible list, for those who are just getting started on this journey!

Health at Every Size by Linda Bacon, PhD. This book dives deep into the research behind the HAES theories. I would recommend that you read this book first to lay the foundation of your understanding. If you are struggling  with dieting and the desire to diet and control your weight, this book can change your mind. 

Intuitive Eating by Evelyn Tribole MS, RD, and Elyse Reysch MS, RD, FADA, CED RD.  HAES and IE go together. You need both principles for it to all fit together. So naturally, once you've accepted the non-diet lifestyle, intuitive eating is next. You'll learn about how to feed your body, the way we were created to, without fear or food anxiety. 

The Intuitive Eating Workbook (also by Evelyn Tribole and Elise Reyche). The RD's from Intuitive Eating also came up with this helpful work book to help you work through the 10 principles of intuitive eating. With lots of activities and exercises, you'll walk away with a deeper more comprehensive understanding of the IE way of life. 

Body Kindness by Rebecca Scritchfield, RD. This book is beautiful and so fun to read. Written by an RD, she combines both IE and HAES topics in this book. I think my favorite part of this book is how she explains that it's still important and beneficial to pay attention to good nutrition, while honoring IE/HAES. 

Body Respect by Linda Bacon PhD and Lucy Amphramor PhD, RD. A great companion to Health at Every Size. This one is a little bit quicker read, highlighting more of the topics brought up in the first book.