How do I stay respectful of my weight-centric preceptors?

HAES and intuitive eating seem to be really visible in the dietetics community lately (at least from where I'm standing) and I'm here for it. I've seen so many RDs and RDs to be being vocal about this topic and it makes my heart happy. I started learning about intuitive eating during my senior year of undergrad and HAES during my internship, which is also when I started to really internalize them as values. Lauren makes a good point in her podcast interview about how when she first learned about HAES it seemed to only apply to those with EDs or disordered eating. That really resonated with me because even if I didn't explicitly identify that belief, I went through it too. It wasn't until someone said "We're prescribing for people in larger bodies what we diagnose as an ED in people in smaller bodies" that it clicked for me. HAES is for everybody and every body - but it can be really hard to be HAES informed in a culture that doesn't hold the same values as you.

So I'm kicking off a few posts about how to be a HAES-informed intern in a "traditional" dietetics education system. Scroll down for a link to my email, where you can submit questions/topics for future posts!

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HOW DO I STAY RESPECTFUL OF MY WEIGHT-CENTRIC PRECEPTORS?

I think it's important to remember that it's not your job to sell HAES to your preceptors. Depending on how long they've been working/how open to new ideas they are/their previous exposure to HAES, it may or may not be the right time to bring it up. With anyone who teaches you (in the classroom or out) it's good to respect that they've given up time to help you become a dietitian and that you are going to learn something from them. But on the other hand, change won't happen in our field unless we push for it, so here's some ways you can navigate conversations:

Ask about their thoughts. You can say, "I've been learning a lot about health at every size lately; what do you know about that?" and go from there. They might tear it down and support a weight-centric approach. Or they might surprise you by revealing their knowledge. Either way, bringing it up in conversation can plant a seed.

For weight-centric talk: If your preceptor/fellow interns/providers/etc are harping on weight or using it as the only intervention, ask what they would do if the patient had a different BMI. This can help start a conversation about the differential treatment of patients based on their size, and help you expand your viewpoint on interventions.

Bring up better indicators of health. Review labs, BP, history, etc. Ask about how those may be playing into each other.

Question if weight loss is indicated. I had a student submit a question to me about a situation in which her preceptor wanted her to calculate a patient's energy needs and reduce them due to the patient's weight. The patient in question was acutely ill and in the ICU, and had several indications for increased energy needs. I think one helpful question in situations like this - especially during your clinicals/acute care rotations - is: Is weight loss indicated right now? Obviously, as a HAES-informed RDN, I think recommending weight loss ever is an unethical intervention. However, this question can help shed light the idea of not using weight loss as an intervention and it may resonate with your preceptor no matter their weight views.

Use the CUS acronym: Concerned, Uncomfortable, Scared/Safety. I love this acronym for raising concerns in all care scenarios, but especially for this. It's essentially an escalating system you can use to express discomfort with the situation. Begin with saying, "I'm concerned that...xyz", so you can say "I'm concerned that weight loss isn't appropriate at this time because of these reasons." Always bring some support to your statement to strengthen it. If that doesn't work, you can say, "I'm uncomfortable with this approach" and from there, "This is a matter of safety" or "I'm scared about xyz".

YOU COME FIRST

I also want to add the note that the most important thing you can do is to protect your own mental health. So take a break if you need, call a friend, repeat a positive affirmation (phone screen below), or even drop the conversation. Haley said something to me the other day that really resonated with me - it's okay if the only thing that happens is you planting a seed. If your preceptor continues to have a weight-centric approach or doesn't listen to you now, they may remember what you said in 5 or 10 years and you still will have made an impact on their life.

SUBMIT QUESTIONS

Email me your questions here or at amy@satisfy-nutrition.com!

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