Considerations with Prescribing Weight Loss and Intuitive Eating

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This is an incredibly tricky topic to discuss, but difficult conversations are where we learn the most. What makes difficult conversations productive is choosing language that is honest and compassionate, instead of unkind and belittling. My intentions are to bring light to a topic I believe will greatly improve the work we do. Whether you are a helping professional who has recently adopted the Intuitive Eating (IE) or Health At Every Size (HAES) paradigms or if you have become interested in IE as it has gained recent popularity, welcome! I welcome you to this community because I truly believe that it is the most ethical and evidence-based way to support people’s mental, emotional, and physical well-being.
 

With compassion and understanding, I would like to address prescribing both weight loss and IE as a practitioner, or as an influencer through your social media content. I have been there before myself. When I first opened my private practice, I tried to straddle the line. I was afraid to completely shift from offering weight loss because I thought it would mean I would lose business. I didn’t fully understand that it could be harmful to offer both simultaneously, as I was still in the process of learning about IE. If you are trying to play in both the weight loss/diet industry and the IE/HAES arena, I understand where you are currently. I understand how difficult it can be, and how much courage it takes to go against the grain. After talking with a few of my colleagues, they also confirmed feeling this way, but after gaining experience by working with clients, it became clear that weight loss as a goal can keep people stuck in the IE process.
 

It takes a lot of inner work to change your weight centric practice to a weight inclusive practice. It’s not as simple as just adding “non-diet dietitian” to your profile and tacking IE counseling to your services page. Bypassing the important education can lead to harm and dilutes the evidence-based paradigm. It’s also very confusing to the consumer to see weight loss and IE being promoted together. Practicing with a weight inclusive approach means we respect size diversity, and that all bodies are capable of improving health independent of weight. It’s contradictory to honor size diversity and promote the promise of weight loss.
 

Our goal as non-diet practitioners is to open the dialog around weight in our office. Weight isn’t a taboo topic. We aren’t saying that it’s unacceptable if someone happens to unintentionally lose weight on their IE journey. We welcome conversation about our client’s weight history or desires, which is often very telling. We promote weight neutrality, meaning your weight isn’t good or bad, and it doesn’t determine your health. It’s important that we break down the ways that weight and health are incorrectly linked most of the time.
 

What evidence tells us is that we can’t control people’s weight. There is not a single randomized-control trial that can show sustained weight loss after 2 years. In fact, weight regain is usually higher than the pre-diet weight. As a client stops dieting and begins to make peace with food, they may lose weight or gain weight, and some stay the same size depending on where they were in relation to their natural body size while they were dieting.
 

The aspect of health that we can control is about behaviors, and weight is not a behavior. Promoting the idea that being smaller equals healthier is dripping with weight bias and never addresses the underlying body image or health issues. It’s also important to point out that almost all behaviors that result in intentional weight loss can be considered disordered (ie. calorie counting, fixation on weighing and measuring, restricting). The mixed messaging is also problematic because you are offering people an empty promise, something that may or may not happen to their body in their IE process and journey to health. This unclear message will break your client’s trust in you and the process.
 

Non-diet practitioners are passionate about preserving the true meaning and principles of IE because we have seen the power it holds. Through clinical experience we have seen liberation from the chains of dieting, happiness and joy created, health gained, and body acceptance. As helping professionals we want to do no harm. We do this work because we want to help better people’s lives. I hope that you will consider continuing to learn more about IE and how to appropriately incorporate it into your work. I hope this conversation has evoked curiosity about the clarity and meaning of your nutrition philosophy.
 

Non-diet practitioners who are frustrated, don’t be afraid to step back and take a break. When you feel extremely passionate about something it’s hard not to get frustrated. Please remember how you felt when you first embarked on this journey and what it might have felt like if someone were to shame you for not fulling understanding. I know I would have welcomed this information with open arms, as I would never want to do harm or further hinder someone from improving their health!
 

Practicing and creating content from a weight neutral, HAES perspective is radical and counter-culture. It is brave work. It’s about deciding that what you believe is valid and really important, and then standing behind that truth. This is not a “you are either with us or against us” mentality either. We all have the same common goal of wanting to do better and be better promoters of health and wellness. We are all still learning. I’ll be the first to admit, I can do better too [insert hand raising emoji]. This is an opportunity to do better. Let’s continue having these conversations.



 

IE/HAES Resources and where to learn more: