The new eating disorders movie “To The Bone”

On Friday July 14th Netflix released a documentary about eating disorders and anorexia called “To The Bone”. The movie stars Lily Colins as Ellen who has been though treatment for anorexia many times and her family decides to try an “unconventional” approach with Dr. William Beckham, played by Keanu Reeves. The movie features characters from Ellen’s treatment center struggling with various eating disorders, as well as a focus on Ellen’s family life. The trailer for the film was already controversial and many eating disorders experts had commented that the movie could be triggering for many to watch. I have loved reading everyone’s thoughts on the film over the past month but wanted to wait until I saw the documentary before officially commenting.

I respect the fact that you cannot easily make a movie about a controversial topic and that many are going to disagree with details and have strong opinions about the outcome. However I really do appreciate that the project was made in the first place and know that it was made with the best intentions. Both the movie’s director, Marti Noxon, and star, Lily Colins, admit they have struggled with disordered eating and wanted to bring awareness to the public about this topic. This specific documentary has raised so much awareness about anorexia and eating disorders in a way that no “safe” educational documentary would have done. I believe the movie showed the pain and obsession that people go through when it comes to struggling with disordered eating. It presented a picture of anguish around food and showed all characters struggling with anxiety and depression, which is very true of clients with eating disorders.

With appreciation for the creation of the movie, I do have many concerns as others have expressed. My main concern is not really about triggering details, but rather about the overall concept that the movie showed “eating disorder treatment”. This “unconventional treatment” was NOT eating disorder treatment. In the movie this character was actually told “she needs to hit rock bottom before getting better”. Umm WHAT? Would you ever tell someone “Well you need to get to stage 4 cancer before getting chemotherapy?” The movie didn’t show the realistic amount of food someone actually needs in a day of ED recovery. The movie didn’t show therapy needed to process thoughts, feelings, and emotions of recovering from an eating disorder. And unfortunately it didn’t mention all the negative side effects of anorexia, including that anorexia has the highest mortality rate of any mental illness.  Some clients in the movie were given a TON of freedom, allowing for the “dramatic effect” to play out. Clients were allowed to skip meals if they choose to do so, and one client was allowed to eat peanut butter as a meal, not realistic in eating disorder treatment. As a side note, of course that “peanut butter client” had to be overweight and struggle with binge eating disorder, presenting a dangerous stereotype.

It’s a passion on mine to educate others about weight inclusive wellness but also weight-inclusive struggles. I liked the fact that the movie did not give specific weight numbers when characters stepped on the scale or talked about their body image (although the movie did reference calorie amounts), but I feel they could have done a better job at educating others that people in all different body shapes and sizes can struggle with disordered eating. There was a lot of controversy surrounding the main lead Lily Colins having to “lose weight in a healthy way” to play the role of Ellen. I understand that she worked with a nutritionist and had a lot of medical supervision, and was fine throughout the process. However, my jaw still dropped when I heard that considering she admitted she struggled with disordered eating. Trying to lose weight or “diet” when you’ve come from disordered eating is a recipe for disaster and can be a major trigger for stepping back into disordered eating.

Recovery is possible and unfortunately this movie missed the opportunity to educate others about that. I truly wish they showed what the other side of ED recovery is like instead of ending at unknown points with so many of the clients that were struggling. Even just a brief 10 minute closing about recovery would have made such a difference in this movie because it would have shown that life is worth living. I also would have loved to see resources about getting help, but there was no mention of valuable resources like NEDA (https://www.nationaleatingdisorders.org/) or ED referral (www.edreferral.com) to reach out to get help. But yet, to all the people involved with “To the Bone”, THANK YOU for getting people talking. If this movie was “safe”, it wouldn’t be receiving the attention it is. My husband sat with me as I watched the movie and actually had thoughtful questions about eating disorders and mental illness. I talk about this topic all the time but it took this movie for him to think about it in a different way. Remember if you are struggling, reach out for help because recovery is worth it.

Break Up With the Scale

As a dietitian that believes in the Health at Every Size principles, I choose to practice something I like to call weight inclusive wellness. I respect size diversity and believe that people of various weights can have healthy behaviors and habits, and also have a positive relationship with food.

I had a really great conversation with a client last week about why I hate the scale. I cannot take credit for the following analogy but I love it! Dieting for weight loss is like playing the slot machines at Atlantic City. You see everyone around you winning (ding ding ding!!) and go into gambling thinking that YOU will hit the jackpot. But remember, we all know casinos get your money and statistics show we will not win. This is why weighing yourself does more harm than good: We all think we’re going to see a number we like (aka hitting the jackpot) but statistics show we will not win. The scale will probably creep back up over time and lead to negative feelings about food and body image. The good news is that there is a solution in weight inclusive wellness. You can be happy and healthy without focusing on the scale.

why scales harm

5 Ways to Measure “Success” Without Using the Scale:

Instead of focusing on the scale to measure progress, try to ask yourself these insightful questions:

1. How are you feeling about overall body image?

2. Are you responding to different emotions in a way that works for you?

3. What can you do to increase your self-care?

4. Can you try to eat when you’re hungry and stop when you’re full and mentally satisfied?

5. Can you move your body in a respectful, joyful way?

These questions can help guide you to a plan of action to feel happy and healthy about food and body image.

Resources For Eating Disorders And Intuitive Eating

I find myself suggesting resources all the time to clients and healthcare professionals to help everyone learn more about eating disorders, intuitive eating, and health at every size. I figured it’s time to share these valuable books/podcasts/e-courses with all of you.  It doesn’t matter if you are a client, family member, or healthcare professional- we ALL have a lot to learn.

 

Top Resources for Eating Disorders

International Federation of Eating Disorder Dietitians www.eddietitians.com/

International Association of Eating Disorder Professionals www.iaedp.com/

National Eating Disorder Association www.nationaleatingdisorders.org/

BOOKS

Life Without Ed, by Jenni Schaefer

8 Keys to Recover from an Eating Disorder, by Carolyn Costin

Overcoming Binge Eating, by Christopher Fairburn

Almost Anorexic, by Jennifer Thomas

PODCASTS
(Find these in your podcast app or itunes!)

The Recovery Warrior Show

The Eating Disorder Recovery Podcast

Resources for Health at Every Size and Intuitive Eating

Registered Dietitians for Body Confidence www.rd4bc.com

The Health at Every Size Community www.haescommunity.org/

The Association for Size Diversity and Health www.sizediversityandhealth.org/

Intuitive Eating Community http://www.intuitiveeating.org/

BOOKS

Intuitive Eating by Evelyn Tribole and Elyse Resch

Intuitive Eating Workbook

Health at Every Size by Linda Bacon

Body Respect by Linda BaconBody Kindness by Rebecca Scritchfield

Savvy Girl, A Guide to Eating by Sumner Brooks and Brittany Deal

PODCASTS
(Find these in your podcasts app or itunes!)

Love, Food

Body Kindness

Food Psych

Dietitians Unplugged

Life, Unrestricted

The Body Love Project

E-COURSES

EDRDPro Symposium:15 experts (myself included!!) presenting on eating disorders, HAES, and intuitive eating! The symposium begins April 28th.

Kylie Mitchell’s IMMAEATTHAT “How to Eat” Course 

Christy Harrison’s Intuitive Eating Fundamentals Course

 

Top 3 Tips for Improving Body Image

What is Body Image?
Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It encompasses:

  • What you believe about your own appearance (including your memories, assumptions, and generalizations).
  • How you feel about your body, including your height, shape, and weight.
  • How you sense and control your body as you move.  How you feel in your body, not just about your body.

Negative Body Image

  • A distorted perception of your shape–you perceive parts of your body unlike they really are.
  • You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure.
  • You feel ashamed, self-conscious, and anxious about your body.
  • You feel uncomfortable and awkward in your body.

Positive Body Image

  • A clear, true perception of your shape–you see the various parts of your body as they really are.
  • You celebrate and appreciate your natural body shape and you understand that a person’s physical appearance says very little about their character and value as a person.
  • You feel proud and accepting of your unique body and refuse to spend an unreasonable amount of time worrying about food, weight, and calories.
  • You feel comfortable and confident in your body.

(Taken from NEDA: https://www.nationaleatingdisorders.org/what-body-image)

Top 3 Tips to Improve Body Image
 

1. Focus on Body Neutrality First
It’s impossible to go from hating a body to loving a body right away.  Practice the thought of body neutrality, meaning that you can see your body for what it is (a body!!).

2. Respect Your Body
Appreciate what your body can do for you: walk, stand, sit, stretch! Treat your body with respect by giving it fuel, movement, sleep, and relaxation time.

3. Practice Body Self-Care
Wear clothes that fit you well and make you feel comfortable.  Do something everyday that makes you feel good.

Favorite body image resources: 

1. NEDA’s 10 Steps to a Positive Body Image:  http://bit.ly/1hDqGjC
2. The book “Body Respect” by Linda Bacon and Lucy Aphramor, On Amazon here: http://amzn.to/29iCjRQ
3. The Body Image Workbook by Thomas Cash, on Amazon here: http://amzn.to/29fQuXg
4. CSAB Body Image webinar by Marissa Sappho: http://icpnyc.org/csab/2015-2016-webinar-series/ (#13 for the recording)

5.  Rebecca Scritchfield’s Body Kindness Podcast: http://www.rebeccascritchfield.com/podcast/

Sharing My Recovery Story

It’s Eating Disorders Awareness week! This week always holds a very special place in my heart because I feel like our community comes together in a big way to support eating disorder treatment. This year is extra special for me because I’m sharing my own recovery story on Christy Harrison’s Food Psych podcast, Episode #91!

Spearheaded by the National Eating Disorders Association (NEDA), the goal of National Eating Disorders Awareness (#NEDAwareness) Week is to shine the spotlight on eating disorders and put life-saving resources into the hands of those in need. This year’s theme is It’s Time to Talk About It and we’re encouraging everyone to get screened. Take a 3 minute screening here offered by NEDA.

In honor of #NEDAawareness week, I want to highlight eating disorder treatment and recovery. Recovery is possible and I wouldn’t be able to do what I do without seeing the stories of hope, love, survival, and resilience. I am so proud of all my “recovery warriors” and so honored to be a part of your journey.

Sharing My Recovery Story

Help is available and you are not alone. Here are some ideas to reach out for support.

1. Talk to a parent, friend, family member, or healthcare professional.  Reaching out for help and being honest with another person about what’s going on is extremely hard to do. But this is often the start of finding treatment and can be the most important step in getting help.

2. Seek online resources. The NEDA helpline is often the first stop for many people who want to get treatment. Call, email, click to chat, or even text!! to get help that you need. NEDA also provides guides and toolkits for parents, coaches, educators, and medical professionals.

3. Find an Eating Disorders Dietitian. The International Federation of Eating Disorder Dietitians (IFEDD) community is filled with ED-savvy dietitians who are ready to help heal your relationship with food. Find one by zip code here.

4. Talk to a therapist. Eating disorders are about food and feelings. A therapist can help you navigate the difficult emotions that arise when talking about disordered eating. The best directory for finding a therapist is Psychology Today.

5. If you are local, please reach out to me if you need help finding a professional. Not all healthcare professionals are ED-trained but I know a lot of them in Rockland and surrounding areas!! Please know that I keep all information private and confidential and will honor that to anyone needing help or support.

 

Hearing stories about eating disorder recovery can be uplifting and positive for anyone going through treatment or in recovery. Here are my favorites!

NEDA Faces of Recovery

Recovery Warriors

Project Heal on Recovery

I was honored to be a guest on Christy Harrison’s podcast Food Psych #91 talking about my own journey and how I ended up as an anti-diet dietitian. I’ve been thinking that I should share my recovery story for so long and it was finally the right time. Back when I first started my private practice Eat With Knowledge, clinicians being so open about themselves wasn’t really a “thing”. But so many people have since “come out” and I think it’s made a huge impact on our profession, the awareness and education of eating disorders, and have impacted clients in such a positive way. So here is my story!!! All the way back to high school, through college and the ups and downs of my recovery, into intuitive eating and then in pregnancy and postpartum. Spoiler alert: I am pregnant again (!!) and talk about how I’m feeling now. In the spirit of being vulnerable I was open and honest about everything. Listen in itunes, your podcast app, or on Christy’s website.

10 Easy Self-Care Practices for Valentine’s Day

Happy Valentine’s Day!!!

This holiday is usually all about celebrating those that you love, but what if we flipped it and made this holiday all about you? The most important relationship is the one you have with yourself. Self-love and self-care are concepts I find myself talking about all the time with my clients, especially as they relate to food!

So what can you do today to take care of yourself? Show yourself love and kindness this Valentine’s Day.

1. Learn something new! One way to boost self-worth is to gain a new skill set. Been wanting to learn how to woodwork, crochet, or bake the best Valentine’s Day cake? Take a local class or even an e-course.

2. Start a journaling practice. Taking even 5 minutes out of your day to reflect, jot down ideas, or even vent by writing in a journal has been shown to have tremendous benefits for mental health.

3.Disconnect from the internet for 2 hours. In our digital world, this is a tough one. We have become increasingly dependent on our computers and phones. However, this can often feel like we are forced to constantly check in. Taking a 2 hour break from all technology daily and instead taking a walk, an exercise class, or reading can do wonders for your self-care. 

4. Act like a kid – or play with a kid. Get a coloring book, a puzzle, or do some crafts. If you have kids or nieces and nephews, take some time to just play pretend with them. Let your mind travel to far away places, like Narnia or Oz. This gives your “adult brain” a much needed rest.

5. Join a book club. Not only will this force you to take time out of your day to disconnect and read a book for fun, but you will have a built-in social activity to look forward to at least once a month. You will also start to built new friendships who share common interests.

6. Be a tourist in your own town. Plan a whole day of activities in your very own town, as if you were visiting. Or, just head out for the day and let yourself wander. Who knows what you’ll stumble across – it could be your new favorite restaurant or spa spot.

7. Declutter! Decluttering your home is a powerful way to practice self care. We meet a lot of our needs at home: sleep, relaxation, nourishment, support, solitude and reflection. By cleaning up and decluttering, you make your space a place of sanctuary instead a place of chaos and stress.

8. Treat yourself to a spa day. This is something we rarely think to do for ourselves because it seems like too much of a luxury. But it’s important to treat yourself to luxurious things too. Book a spa day for yourself, or just get a manicure or a massage. It doesn’t have to be for a special occasion – it can be just because it’s part of your self care practice.

9. Edit your social media feeds. It’s sometimes helpful to go through your social media profiles and unfollow people who routinely make you angry, anxious, or upset. This can be a friend or even a celebrity who you have been following. If you realize that someone’s posts regularly make you annoyed, you can simply unfollow them. This “mutes” them even if you don’t want to un-friend the person.

10. Move around or stay still. Sometimes it’s incredibly healing to put on some music and dance in your living room for 15 minutes straight. Other days, it’s rejuvenating to lay down on your yoga mat in complete stillness and silence for 15 minutes. Ask yourself which one of these your body and spirit is craving regularly and let yourself do either – or BOTH!

Body Shaming

Over the past years, “body-shaming” has become a hot topic, not just online but in everyday life. Unfortunately, body-shaming can happen to almost anyone — regardless of gender, ethnicity, social class, or age. Celebrities, pregnant women, thin people, curvy people, fit people, athletic people, young people, old people — the list of who’s become a target for body-shaming is endless. We also have a tendency to talk negatively about our own bodies, not only to one another, but to ourselves.  As a culture, we’ve become obsessed about body size, shape, and weight.

What is body-shaming?

  • Inappropriate negative statements and attitudes about another person’s or your own weight or size.
  • Criticizing yourself or others because of physical appearance

Body-shaming can manifest itself in a variety of ways, but usually it will usually appear as:

    • Self-criticism of yourself and your appearance through comparison to another person.
    • Criticizing another person in front of them.
    • Criticizing others behind their back.

Examples of body-shaming:

    • Look at my ____ (body part).
    • I can’t wear that… because ____ (reason)!
    • I am such a “insert negative feeling” for eating that.
    • You shouldn’t wear that because of the way you look.
    • You’re so thin that you look like a skeleton.
    • You’re the kind of person who needs to exercise.
    • Did you see what she’s wearing today? (said in a negative tone)

Regardless of how or why body-shaming happens, it most often will lead to comparison and shame, reinforcing the idea that outward appearances are essential for human worth and love. The result — an unhealthy relationship with food, exercise, and especially an unhealthy relationship with yourself.  This just continues the cycle of shame, comparison, and never feeling like you’re “good enough”.

This month, I challenge you to become more aware of your relationship with body-shaming. Is this something you do on a regular basis? Is this a way you cope with being uncomfortable in new situations? Do you surround yourself with people who are body-shamers? What can you do to reduce and eliminate body-shaming?

 

Remove the Body Shame

 

Stop commenting on other people’s body shape and size. Find something else to talk about. End of story.

Enough with the negative thoughts and words. Instead of criticizing yourself, come up with ideas on how you’re going to move forward on your journey. For example, when you’re buying a dress and have tried it on, only to find it’s too tight, say to yourself, ‘I’ll get the larger size so it hangs better” rather than saying “My legs are so big and I’m so fat.” Acknowledge not being comfortable and embrace your body and self for who you are and where you are on your journey. All bodies fit.

Fuel your body with foods that empower you to live mindfully. Choose foods that make you feel good, energizing you to live the way you want. Keeping a food and symptom journal and working with a dietitian can help you identify what foods work well for your body, helping you achieve your goals.

Appreciate your body with a neutral approach. Instead of focusing energy on what your body is not, try to think of your body as a vehicle for your life– and that’s it! This simple shift into “neutrality” can make a big difference in the way you perceive yourself and your capabilities. In time, self-love and appreciation will in return result in a healthier body and mind.

Recognize that negative self-talk and body-shaming are not productive. Negative self-talk and body-bashing only sinks you into a deeper depression, leading to a cycle of self-loathing, emotional eating, and more body-bashing.

Practice self-love. Practicing self love means practicing self care. Nourish yourself with good food, movement, hydration, and rest. Remember to lift yourself and others up with positive words, thoughts, and actions.

3 Things to Do in January Besides “Diet”

Ugg… January is here! It really is “national dieting month” and even though I’ve tried to avoid “diet talk” as much as possible, I still hear friends, family, and clients talking about how they are going to be “good”, “eat clean”, “lose weight”, and “finally take control back”.

So if you know me, you know I’m all about creating a happy and healthy lifestyle. No diets needed! Dieting can increase disordered eating behaviors and habits, and also send you down a destructive relationship with food. So rather than diet, what can you do? Here are some ideas so you don’t have to diet and feel deprived. Rather live your life and feel fabulous about food!

1. Practice Your Intuitive Eating Skills. One of the best things you can do for yourself when everyone around you is trying to detox or go on the latest “New Years Resolution Diet” is practice your intuitive eating skills. Intuitive Eating is comprised of 10 principles that help you reject the diet mentality, honor your hunger and fullness signals, and improve your relationship with food and body image. Instead of removing foods from your diet this month, try adding in more healthful options and remind yourself that there is space for both apples and ice cream. Practice eating mindfully instead of restrictively by truly tuning into your body’s hunger and fullness signals. Finally, one of my favorite principles is “Challenge The Food Police” – which means that you practice saying ‘No’ to that voice in your head that tells you that you’re bad for not doing the detox that everyone at your office is doing, or good for skipping dessert at that party. Food is neither good or bad; food is just food and all foods fit into a healthy lifestyle!

2. Go for a daily walk. Gyms are notorious for their New Years Resolution marketing campaigns. If a gym is not for you, try the cheapest exercise on earth: WALKING. Taking a daily stroll for even just 15-30 minutes/day can do wonders for your health. Start with 15 minutes and slowly work your way up to 30 or longer. This is also a great way to manage stress levels. You can find a walking buddy in your neighborhood or at your office, walk your dog, or listen to your favorite podcast or music, all while improving your health and well-being.

3. Start a gratitude practice instead of “trying to change”. Unfortunately we connect “losing weight” to “being happier” when this simply isn’t true. Try to focus on what you have, right now! Actively thinking about what you are grateful for has been shown to reduce stress levels and increase happiness. Practice saying out loud one thing you are grateful for each day. Bonus if you can write it down or post on social media! Spread the word 🙂

Non-Diet Ideas for Health

I love these ideas to focus on health and well-being for the new year. All of these sound so much healthier than a diet!

  1. Go to a yoga class. Even better if you sign up for a class package!
  2. Try a new recipe and cook with your family
  3. Go grocery shopping and pick some new food items
  4. Eat out at a new restaurant
  5. Go on a hike
  6. Plan and BOOK a vacation!
  7. Go to bed 1 hour earlier tonight and get more rest
  8. Diffuse essential oils throughout your house or office
  9. Pick up a new book and read for 20 minutes each day
  10. Volunteer and give back to your community

Holiday Gift Ideas from Eat With Knowledge

Happy Holidays!!! Here are some amazing ideas to celebrate the gift of peace with food and a healthy body image.

#wear_IEAT clothing and accessories Help promote a healthy relationship with food by wearing an “I EAT” tank top, sweatshirt, or tote by Registered Dietitian Nicole Groman.

Spiralizer A 5-blade vegetable slicer that makes “veggie noodles” in a snap! Create zucchini noodles (“zoodles”), beet noodles, or even sweet potato curly fries.

Body Kindness by Rebecca Scritchfield, RDN This practical, inspirational, and visually lively book shows you how to create a healthier and happier life by treating yourself with compassion rather than shame.

Homemade Muffins & Theo Hot Chocolate Gift Box Spending the holidays away from home or at the in-laws? Come prepared with this box full of soft muffins and rich hot chocolate to enjoy with the whole family. The purchase of this gift provides weekend meals for one child.

Intuitive Eating Fundamentals e-Course A 13-week course to help you trust your body and make peace with food created by Registered Dietitian and Food Psych podcast host Christy Harrison.

Ninja Coffee Maker My favorite coffee maker! Ninja’s patent-pending brewing technology is designed to deliver better, richer-tasting coffee with variable richness levels that are never bitter.

Baby Bullet Baby Food Making System Make an entire week’s worth of healthy, nutritional baby food in less than 5 minutes

A gift certificate to a favorite restaurant. My favorites in Nyack include Communal Kitchen and Art Cafe!

Consider making a donation to a charity. Project Heal is my favorite – they fund eating disorder treatment for clients who cannot afford it.

My response to the CDR about the new “Weight Management” certification

I still remember getting the email from the Commission on Dietetic Registration (CDR) that said “Be one of the first dietitians credentialed to fight obesity in America”. I opened up the email and BOOM! In huge letters the email started off with “The wait is over.”  Obviously CDR is really excited about the new credential for Obesity and Weight Management.  See all the details on the certification here: https://www.cdrnet.org/interdisciplinary. However I am NOT excited about it, and in fact I am worried. I am so passionate about intuitive eating, body positivity, and forming a healthy relationship with food.  You can do that at any weight, and in fact some people even GAIN weight when this happens.  I decided to write my thoughts about this in a letter and posted it to one of my favorite Health at Every Size groups on facebook.  So many other practitioners signed this letter as well!

I hope with our response, CDR will notice our effort to include the Health at Every Size® (HAES®) principles in the certification material. But even if nothing happens to the certification, I hope this letter reaches dietitians, therapists, doctors, healthcare professionals, and clients. Know that you are not alone if you are trying to practice the HAES® mentality.  It’s hard in today’s world and we need all the support we can get.

Here is my letter.  Feel free to copy and paste (maybe change the part about your personal/professional journey because we are all different).  Send your own letter to interdisciplinary@eatright.org

**Edited to add: I created a change.org petition for this issue! Please read and sign for your support. THANK YOU!

haes-picture

The Commission on Dietetic Registration

120 South Riverside Plaza, Suite 2000

Chicago, IL 60606


Re: In response to the new Obesity and Weight Management certification program

To the Commission on Dietetic Registration:

I would like to express my concern, and offer some alternative education, for the new certification for Obesity and Weight Management.  I am compelled to write about these concerns after reading through the definition of a Certified Specialist in Obesity and Weight Management (CSOWN) practitioner, the content outline for the course, and the reference list to study for the exam.  I am hopeful that these remarks will make it to the Task Force and have some impact on coursework selected for this certification, and therefore an impact on those practitioners choosing to apply to take the examination.  Hopefully, you will hear from a lot of professionals, like myself, who practice dietetics with a Health at Every Size® (HAES®) mentality.  Like-minded dietitians like myself, who believe in the HAES® movement, passionately want our voices to be heard in the Academy of Nutrition and Dietetics and would support more education on the HAES® principles for dietitians, nutrition students, and healthcare professionals.

Ironically, as a Registered Dietitian, I always said I hated the word “diet” and preferred to talk to clients about a healthy lifestyle.  In the beginning of my career 10 years ago, I was a Certified Diabetes Educator and advocated for weight-loss plans through “dieting” even though I didn’t think I was educating clients about the diet mentality at the time.  Through clinical practice and experience, I learned that I was wrong to put clients on diets and focus on weight loss.  A weight-loss diet has a 99% chance of weight regain and an increased likelihood of disordered eating behaviors.  I started to find my way as a non-diet dietitian when I started to see eating disorder clients and became an eating disorders expert, especially in the area of Binge Eating Disorder.  This is when I discovered the Health at Every Size® movement, and the Association for Size Diversity and Health (ASDAH).

According to the description of this new certification, “Over half of American adults are overweight or obese. In order to better assist individuals in their weight loss endeavors, the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics, is unveiling a new specialist certification in Obesity and Weight Management.”  The main issue I have with this description is the reference to “weight loss endeavors”.  A diet for weight loss does not work long-term and the focus on weight can steer a client in the wrong direction.  It can have a negative impact by leading to weight cycling, weight stigma, in addition to the risk of disordered eating and developing an eating disorder.  Rather, health should be looked at as a puzzle and each piece is important.  It’s not WEIGHT that needs to be addressed, but rather a person’s relationship with food and exercise, positive behaviors around food, eating for well-being, exercise that feels good, and emotional, spiritual, environmental, social, and intellectual well-being.  There’s no question that nutrition and exercise are important pieces of the puzzle.  However, positive behaviors in these areas do not necessarily result in weight loss.  In fact, some positive behaviors are associated with weight gain.  The HAES® approach is weight-inclusive, meaning that clients with diverse body weights and sizes should be respected equally.

When I read through the content outline and recommended research for this certification, so much of the content is focused on weight-specific recommendations.  Many dietitians pride themselves in being evidence-based practitioners.  The evidence shows that weight is regained after a weight loss program, no matter the approach (see this study from Mann, T. 2007 https://www.ncbi.nlm.nih.gov/pubmed/17469900).  Why should the CDR train dietitians to promote weight loss if there is no evidence to support that weight loss efforts actually result in long-term weight loss?  Rather, it is known that positive behaviors around food and a healthy relationship with food will make a huge impact on a person’s health, regardless of weight.  A Registered Dietitian Nutritionist is the perfect professional to help clients on the journey to a healthy lifestyle, regardless of weight or the number on the scale.  RDN’s have the unique ability to use science, psychology, and physiological knowledge of the human body in order to help clients with weight concerns.  I would love to see HAES® concepts included in the content for the certification, or better yet, an entire section dedicated to the HAES® curriculum.  This would be helpful, not only to increase awareness among professionals, but to help clients who have weight concerns be taught the HAES® principles by those who receive this credentialing.

The HAES® movement may have a reputation to some people as being “healthy no matter what”.  This is simply not true.  Taken directly from the Health at Every Size® curriculum website (https://haescurriculum.com), Health at Every Size® principles help us advance social justice, create an inclusive and respectful community, and support people of all sizes in finding compassionate ways to take care of themselves. HAES® is about respect for body diversity, including those bodies classified as “obese” according to the BMI chart.  Respect is so important because these bodies should be celebrated no matter what size they are.  These people have been “shamed” so many times and we all know that shame never helps behavior change toward health.  The HAES® movement is all about health, not weight, because people at any size can be healthy.

With that being said, I encourage the task force to read Linda Bacon’s book Health at Every Size: The Surprising Truth About Your Weight, as well as Body Respect.  I also encourage the task force to read the HAES Manifesto (http://lindabacon.org/HAESbook/pdf_files/HAES_Manifesto.pdf), which includes many links to research articles and more explanation of their position.  This article, “Weight Science: Evaluating the Evidence for a Paradigm Shift” (http://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9) evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.  https://haescurriculum.com/ and https://haescurriculum.files.wordpress.com/2013/07/haes-curriculum-resource-list.pdf also have many resources for professionals to learn more about the HAES® principles.

Thank you so much for your consideration of this information.  I appreciate your time to read my letter and hope you will consider including information about the HAES® principles in the new certification program.

Sincerely,

Jennifer McGurk, RDN, CDN, CDE, CEDRD

Health At Every Size® and HAES® are registered trademarks of the Association for Size Diversity and Health and used with permission

 

In my efforts to spread the word about my concerns for this certification and to hopefully include the HAES® principles, many of my colleagues came forward with their support.  These practitioners have agreed to add their names to this letter as individual signatures to show their support.

Valery Kallen, MS, RD www.valerykallen.com

Jamie Dannenberg, MS, RD

Josée Sovinsky, RD

Julie Duffy Dillon, MS, RDN, NCC, CEDRD

Darice Doorn, RD, LD

Aaron Flores, RD www.bvmrd.com

Michelle Kuster, RD, LD

Maggie Danforth, RDN, LD

Lindsay Stenovec, MS, RD, CEDRD www.nutritioninstincts.com

Beth Rosen, MS, RD, CDN http://www.goodnessgraciousliving.com

Erica Leon, MS, RDN, CDN,CEDRD  http://www.ericaleon.com

Christy Harrison, MPH, RD, CDN http://christyharrison.com

Lauren Fowler, RDN

Crystal Vasquez, MS, NDTR, Dietetic Intern

Rachael Hartley, RD, LD, CDE, CLTwww.avocadoadaynutrition.com

Annie Goldsmith, RD,LDNwww.anniegoldsmithrd.com

Ursula Ridens, RDN, Certified Intuitive Eating Counselor www.ursularidens.com

Dawn Clifford, PhD, RD www.motivatechange.net

Bobbi Hitchcock Boteler RD LD CEDRD Www.empoweredeatingblog.com

Julie-Anne Seale, RD

Mary Dye, MPH, RD, CEDRD, LD/N

Lauren, MS, RD, CPT

Alison Kouba, MS, Dietetic Intern

Brandi Olden RD, CSP, CD www.creatingpeacewithfood.com

Shanon Armfield, MEd, RD, LDN

Hillary Getty, RD

Julie Bowman, MS RD LMHC

Marci Evans, MS, RDN, CEDRD, LDNwww.marciRD.com

Danielle Miyazaki MS,RDN, CD www.creatingpeacewithfood.com

Elizabeth Saviteer, MS, LMHC, CN

Jill Sechi, MS,RD, CEDRD Www.jsechinutritiontherapy.com

Kelly Martin, MCD, RDN, CD www.creatingpeacewithfood.com

Julia Patterson, MS, RDN, CD

Cassie Barmore, MS, RD cassiebarmorenutrition.com

Megan Hadley MS, RDN, LDN www.simplenutritioncounseling.com

Aleta Storch, MS, CN, LMHCA