Dear Healthcare Provider
Dear healthcare provider,
I’m a registered dietitian nutritionist working with clients who also receive care from you. I have a request for you, but first I want to make an effort to connect.
I’ve seen it in my practice, and I’m guessing you’ve seen it in your practice as well, the last year of the pandemic with its forced isolation and banket of constant fear and uncertainty, has had an impact on our clients’ bodies. We can see the changes. Many bodies we see have grown in size.
Our clients arrive at our doorstep (virtually or otherwise) with the same request: “Fix me!! Help me lose this weight!” And this plea is often propped up by the patient’s family, community, and the wider culture.
I won’t deny the strong pull to comply and to do anything within my power to help them fix their problem of fatness.
Is this your experience?
I’ve seen an uptick of this “fix me” plea lately. I don’t know if it’s because summer is around the corner or folks are moving from virtual back to in-person work, but I’m seeing a new level of desperation around “fix my body”.
Are you?
If so, I have a proposition for you.
Could you press pause on recommending dieting and weight loss medications in the name “health promotion and disease prevention”? Could we take a moment to slow down and locate the problem in its true place?
If this sounds surprising, careless, or negligent, please hear me out.
If our clients come to us with the problem of “fatness” (either self-identified or based on your findings), would you agree to take a moment to ask the client, “What has been the biggest disrupter to your eating patterns, sleep patterns, stress levels, and movement options in the past year?”
I’ve made a commitment to asking this question with my clients and here are some of the responses I’ve heard from them:
I lost my job and I can no longer afford to buy the food I prefer.
My fitness center closed down and I no longer have access to my favorite form of movement.
I have very little if any time to myself because I’m helping four children do online school at home while trying to work a full time job.
I’m worried about the future and my sleep has been negatively affected.
My company is laying off people left and right. My stress level is through the roof.
My spouse and I are arguing more because we are stuck at home together.
I’m lonely.
Everyone at work is talking about the COVID “19” (i.e. the 19 pounds many have gained or are worrying about gaining over the past year). It has me trying extreme diets for a couple of days/weeks and then giving up and bingeing.
These answers give insight into the actual problems. With this information, tell me, how would the pursuit of weight loss “fix” these core problems? How would Keto, Intermittent fasting, or a weight loss drugs support a person to:
find affordable grocery options
reclaim lost income
find a new source of income
find a safe place to move their bodies in a way that feels good
give them time to themselves
support sleep
reduce stress
resolve relationship strife
create connection
support body autonomy and respect
What I’ve learned in my twenty years of this work is that making fatness the “problem to be fixed” elbows its way in front of the real problem and creates a barrier for more impactful methods for achieving deep healing and true well-being. If you want to place blame, problematize the real issues: inequities in our healthcare system, racism, fat phobia, lack of affordable childcare, challenges facing public education, intimate partner violence, and so much more.
Circling back to my earlier proposition
I’m wondering, dear healthcare provider, are you interested in adding to the problem or working toward a solution? If you chose “solution” then Stop. Recommending. Weight Loss.
Start saying: I see your body has changed. This is a symptom of something bigger going on. Let’s try to get down to the bottom of the real problem. Then ask: “What has been the biggest disrupter to your eating patterns, sleep patterns, stress levels, and movement options in the past year?”
Then, recommending things like:
locations of local food banks
permission to eat enough of any accessible food on a regular basis (this reduces the urge to binge).
sources for employment support
more babysitting
guidance from a mental health/family counselor
stress reduction techniques
help from a fat-positive dietitian (hint, hint, me...or one of my many colleagues) to understand their relationship with food.
lab tests to check hormone levels
doing nothing. Recommend nothing. Hold space generously and with humility. Just listen, acknowledge, sit in the stuck place, and co-grieve the awful truth of your client’s reality. Perhaps saying, “No wonder your body…” and “I don’t blame you for…” and “I believe you are frustrated/sad/scared/angry. I hear you and I BELIEVE you.” and “I see your suffering. I’m here with you.” These acknowledgements create an external environment (your response) that mirrors the internal experience (your client’s big emotion), calming the alarm bells of their brain (threat response). In the context of neuroscience, your client’s brain will be more flexible and capable of behavior change.
The truth is, we just DON’T know for sure what will happen to the human form when the “real problem” is addressed. In my practice, I’ve seen people report freedom, joy, peace, a more meaningful and purposeful existence, deeper connections to true friends, more body acceptance, more self-compassion, and more attunement and trust to hunger and fullness cues. I proudly and ethically stand by these outcomes.
Another truth is we DO know what dieting and weight loss drugs do to the human form over time (in studies ranging from 6 weeks to 5 years). According to research, diets create preoccupation with food, result in weight cycling (short term weight loss followed by a gain in 80-95% of people who diet), and increase the risk for eating disorders to name a few. This doesn’t sound like “fixing” anything to me.
A intention to set: When our client comes to us with “Fix me!”, what would it be like to mentally reframe their plea into the statement “See me!” From there, we can take off the expert hat, put down the “fixing” tools geared towards weight loss, and ask to hear more of their story.
Healthcare provider, you bring medical expertise into each session. Our clients bring the expertise of their lives. Let’s invite them to share their story to find real solutions to supporting their well-being.