Geographical fortune afforded me opportunities to recently attend two fantastic workshops right in my backyard: the Association for Size Diversity and Health’s (ASDAH) half-day workshop on Health at Every Size® (HAES) at the Multi-Service Eating Disorders Association, and the Hynes Recovery Service’s symposium on eating disorders in adolescent and young adult patients.
These conferences offered me chances to meet and learn from some brilliant colleagues, including, but not limited to, Ellen Glovsky, Lisa Du Breuil, Marsha Hudnall, Dawn Hynes, and Kim Dennis, some of whom I have known for years and others with whom I have been connected virtually but had never before met in person.
Dr. Glovsky’s talk, in particular, was terrific. They always are. She and I first met in 2007 when she gave a talk at the Beth Israel Deaconess Medical Center, where I was a dietetic intern. As soon as she finished speaking that day, I went up to the front of the room and introduced myself. We have stayed in touch ever since.
For lack of a better term, Dr. Glovsky just gets it. Having been a dietitian for approximately 40 years, she has evolved her counseling approach away from a classical directive style to the more effective motivational interviewing model that Joanne and I learned from her and use at our practice. Although Dr. Glovsky probably does not realize it, nobody has been a greater influence on my career than her.
Over the course of these two workshops, Dr. Glovsky and the other speakers shared many interesting points and anecdotes. The nuggets that really struck me are below.
- Research indicates that 95% of people who intentionally lose weight regain the weight within five years. Of those 95%, 60% of them will end up heavier than they were at baseline. Said differently, if 100 people attempt to lose weight, five of them will keep it off, 38 will return to baseline, and 57 will end up heavier than when they started.
- Because outcomes are only somewhat in our control, our goals are better constructed around performance and behaviors, not outcomes. For example, instead of saying we are going to lower our cholesterol by a certain number of points, we are better off setting goals to perform certain behaviors that may lead to lowered cholesterol with the understanding that some influential factors, such as genetics, are out of our hands.
- Parents and doctors often miss the signs of eating disorders or incorrectly explain away said signs with other conclusions. Joanne asked one of the speakers how much of a dip in the growth charts should be considered a red flag. The speaker said a drop of five (for example, a patient’s body-mass-index-for-age drops from the 50th to the 45th percentile) or more indicates that something serious, such as an eating disorder, is likely at play. That reminded me of a patient’s mother who literally laughed in my face and never brought her daughter back to see me when I expressed concern that her daughter might be suffering from a yet-to-be-diagnosed eating disorder. In addition to the other reasons for concern that I saw, over the course of the last eight months her daughter’s body-mass-index-for-age had dropped by almost 20.
- People suffering from an eating disorder or disordered eating frequently use the elimination of certain foods (“carbs,” dairy, gluten, animal products, etc.) as a means to restrict under the guise that the choice is supposedly about health, an allergy/sensitivity, or ethics.
- A lawyer I spoke with between sessions told me she is working on using occupational safety laws to implement regulations for models in the fashion industry. According to her, the World Health Organization defines starvation as having a body mass index below 16.0 kg/m2, while the average runway model has a body mass index of 14.0 kg/m2.
- Websites and social media groups that encourage eating disorders and offer tips to further their destructive behaviors are prevalent and easy to find. After a quick Google search that I did myself, I was shocked and saddened by what I saw in just the first few seconds. As one of the speakers explained, individuals with these conditions often seek out like-minded people online and isolate themselves from others. Pretty soon, these online communities become their entire world.
- For some people, the term “fat” is an insult loaded with unfair and inaccurate stereotypes. For others, the word is nothing more than a neutral adjective describing body shape or size. Practitioners need to pay close attention to the language that our patients use and the intended meanings behind their words.
- Every once in a while, I get someone who erroneously believes that HAES is just an excuse that larger people use to justify their size. As I looked around the room at the ASDAH event, I could not help but wish that those same people were there with me to share what I was seeing: People of all sorts of shapes and sizes were there, including many slender folks.