The Academy of Nutrition and Dietetics (AND) recently issued a draft of their updated clinical practice guidelines regarding medical nutrition therapy interventions for what they term “adult overweight and obesity treatment.” The very last point in their draft recommendations reads, “For adults with overweight or obesity, it is suggested that RDNs [registered dietitian nutritionists] or international equivalents not use a Health at Every Size® or Non-Diet approach to improve BMI [body mass index] and other cardiometabolic outcomes or quality of life.”
As you can imagine, the Health at Every Size (HAES) community is pushing back against the AND’s draft recommendations. The Association for Size Diversity and Health (ASDAH) published an open letter to the AND as well as one to the HAES community outlining the ways in which the AND’s position is problematic.
(Before continuing, I want to highlight that the latter publication makes reference to white supremacy and how it factors into the picture, which I can imagine might trigger some head-scratching from those unfamiliar with the history of diet culture. If you want to learn more about this topic, consider checking out Fearing the Black Body – which, to be candid, I have not yet read myself, so I am calling attention to it based solely on its excellent reputation – or the first chapter of Anti-Diet.)
While I do not always agree with ASDAH and we do not speak for each other, I completely support the sentiments conveyed in their response letters. Similarly, I agree with Ragen Chastain’s response, which goes into more detail than ASDAH’s letters. Rather than reiterate their same points, I want to take a step back and look at one of the dynamics at play in this situation and in healthcare in general: credibility.
Back when I was in school for nutrition and looking ahead to my career, I wanted to become a universally respected expert, which is one of the reasons why I worked so hard in school. Then I began my dietetic internship and quickly began to sense that my expectations might be unrealistic. While all of my clinical preceptors placed a great deal of emphasis on note writing, or charting, each of them differed in how they wrote them, yet each felt strongly that their way was best and the others were wrong. One preceptor would praise me for utilizing a writing style for which another preceptor would chastise me. With my superiors giving me contradictory guidance, I felt confused and a bit paralyzed. There was no winning, no way in which I could make everybody happy, for what they each wanted from me was mutually exclusive.
Once I began practicing, the theme continued. Each time I changed how I practiced, some patients and colleagues applauded my shift while others thought I was making a mistake. Forget striving for universal respect, as there is no such thing. Credibility is subjective, and the truth is that every practitioner, no matter their approach, level of success, or reverence, is still seen by many as a quack.
This dynamic is not unique to dietetics; it shows up in other branches of healthcare as well. Reflecting upon issues I was having with my back in late 2013 and early 2014, I remember meeting with six surgeons – all of whom were highly regarded – and receiving five different opinions regarding what type of surgery I should have. One of them went so far as to say that if one of his interns had recommended the procedure that his colleague had suggested for me, he would have given the intern a failing mark.
Just as I had to weigh the pros and cons of the surgical options and choose the one I felt was the best for me, practitioners and patients also must decide which approach to healthcare is the one for them while understanding that large groups of people will always think their decision is wrong no matter what they choose.
When I first discovered HAES, I was skeptical since it contradicted much of what I had learned up to that point. Additionally, I did not want to believe it because it posed a threat to the weight-focused care I was providing at the time. On a deeper level, admitting HAES had validity also meant having to face the harm I had inadvertently done to my patients. Nobody who chooses a career in a helping profession wants to admit that they instead brought about hurt. Perhaps the folks at the AND – an organization that reinforces diet culture and weight stigma – are feeling similar resistance now, hence their criticism of HAES, or perhaps they are critical of HAES simply because it is not the approach that they choose to practice themselves.