The Dietitian’s Role in Body Liberation
August 9, 2023 • By Stasha Hornbeck, MS, RDN, LDN, CDCES • Guest Contributor
Stasha is a Registered Dietitian and Diabetes Educator with Kaiser Permanente, and a Certified Body Trust® Provider.
Many of us get into the healthcare field for the pursuit of “health and wellness” for our own self, our families, our communities, and maybe even the whole planet. For me, it was born from a fear of becoming ill and dying from what I thought of as preventable diseases that I saw the older generation of my family, often in larger bodies, struggle with: heart disease, type 2 diabetes, and even colon cancer.
When I graduated with my Master of Science in Nutrition, one of my dad’s sisters asked me if there was just one recommendation that I could give her to improve her health (meaning: be skinny). I pondered this for about 0.2 seconds, and responded: “Eat more vegetables.”
Fast forward 19 years and after years of unlearning and learning with The Center for Body Trust™, the Ellyn Satter Institute, and countless anti-diet, anti-weight bias, anti-racism books, podcasts, webinars; and actually sitting back and listening to those with marginalized identities, I feel like a different human. I’ve had a radical re-shaping of my mindset around what it means to have “health and wellness”; how my medium-sized, white, cis, hetero privilege has endowed me with a level of health most don’t or won’t have access to; and how I need to show up in a different way, even if it feels hard. If my aunt asked that question today, she’d get a much different answer as I now liken “eat more vegetables” with the harmful advice we give to “eat less, move more” (it’s privileged and tone deaf).
Instead I would pose an evocative question or two about her lived experience in a body that she has been told or has been led to believe is inadequate, flawed, and in need of fixing. I’d offer empathetic reflections as we explore unconditional permission to routinely and reliably feed herself foods that she enjoys; help her attune to her appetite and hunger; rediscover her fullness, satiety and satisfaction; and to find joy in moving her body given her desire, ability, and feedback from her years of lived experience with her body. When she tells me her therapist suggests her depression would improve if only she could just lose some weight, I’d ask her if she’d consider a new therapist that could help her heal from decades of diet culture and “thin ideal,” and anything else that might improve her emotional health.
I’ll admit that making this paradigm shift from a weight-normative to a weight-inclusive, trauma-informed approach, has had its share of confusion, anxiety, and fumbling with a loss of identity; and grappling with the harm I’ve caused with prescriptive diets and promises of weight loss. I am now acutely aware that as a professional in a helping field, this is a more ethical and evidence-based way forward.
We can all do better in sessions with patients, in conversations with our family and friends, with students, and peers. We can challenge the organization that we work for, and the people we work with, to look at their beliefs, practices, and policies around body size. We can speak up and challenge the language that we use to describe bodies, create spaces that are more accessible and welcoming, and we can ask that size diversity and size acceptance training is included in the equity and inclusion framework.
We can be more weight inclusive with the nutrition care that we provide by:
- Acknowledging that diets don’t work and that dieting and weight cycling are harmful physically, mentally, and emotionally.
- Doing the hard work to examine and challenge our own bias about body size, shape and ability; and to take a close look at our own relationships with food and our body.
- Listening empathetically and intently to each person’s body story, helping them return to their own truth and wisdom about their body.
- Focusing on eating competence (with permission and trust, people are capable of reliably and consistently feeding themselves foods that they enjoy, and have routine access to).
- Creating classes, or one-on-one sessions, and educational materials that help heal the wounds and casualties left behind after years, often decades, of hearing that your body and your eating are problems that need to be fixed.
- Updating language in our charting and in the medical record, and in our policies and interventions, to reduce harm and increase connection.
- Educating support staff and providers that refer to us about the harms of weight bias and weight stigma; that people of all sizes, shapes, and identities struggle with disordered eating and eating disorders; and that weight checks and conversations about weight can be traumatizing, cause disconnection and shame, and have a negative impact on many of the health conditions that we’re trying to prevent or treat.
Lastly, we can ask that our professional organization, the Academy of Nutrition and Dietetics (AND) stop promoting hypocaloric diets and training programs for O*esity Management. We can ask that instead they tell us the truth about how ~75% of our health outcomes have more to do with non-food and non-weight-related social determinants of health than individual behaviors; that restrictive diets and size discrimination often lead to disordered relationships with food and bodies, and lack cultural sensitivity for many of the people that we serve. They can be honest about the weight science, about the mortality risk related to weight cycling, and that having a larger body may in fact mean we live longer.
We can ask that they encourage more inclusivity when researching interventions that do actually promote the health and wellness of EVERY body. We can task them with creating dietetic training programs that have more screening and education around eating disorders, social determinants of health, and size diversity. In doing so, I hope that will ultimately foster a professional organization of dietitians who are compassionate, who will listen and trust their patients, to be able to come alongside them in their journey for health and well-being.