I think when we see HAES in social media, it's often talked about from a perspective of healing eating disorders or disordered eating, which makes so much sense. Like Lauren on this podcast, I kind of considered HAES to be "just for" that area but my eyes flew WIDE OPEN when I heard someone talking about how we prescribe in people of larger bodies what we treat as an ED in people of smaller bodies.
Dieting and size manipulation are disordered behaviors in people of all bodies, and all bodies deserve the compassion that comes with a HAES approach. At that point, I honestly felt at a loss of what to do. Almost every unit in medical nutrition therapy when I was in undergrad/my internship had "weight management" listed as the first intervention for nutrition. I started to get skeptical and worry that this approach completely undermined what I knew about nutrition and its role in disease. I also started to think that maybe HAES was okay for all bodies, but not the ones that needed MNT.
I'm sharing this because I think reflecting on our journey toward HAES plays a huge role in how we introduce it to others, and lets us do that with compassion and empathy instead of judgment for not immediately switching gears. I dug in and started reflecting on and reexamining all of the MNT I knew, and when I started working in a clinical setting again I felt more prepared to both incorporate these two concepts (that are not mutually exclusive) and let my patients teach me how this best plays out. Here's some of what I've learned so far:
OUTCOMES AND BEHAVIORS ARE DIFFERENT
Weight is an outcome, not a behavior. And while outcomes can be affected by behaviors to a degree, there's a ton of factors that go into determining the actual "final product" so an outcome is never guaranteed. This is true of all medicine and pretty much all situations in life - I like to compare it to baking a cake.
You can measure/mix/design the perfect cake but the humidity and temperature of the oven/room, your ingredients, etc. still have a huge effect on the final cake. So one helpful MNT practice is remembering that goal setting around behaviors is best practice. You can also use this when introducing HAES to your patients for the first time - it helps shift the focus off of setting weight goals for them as well and puts it into more digestible terms.
MAKE MNT EDITS
One really tangible way to start interpreting the MNT from a HAES lens is to look at a written copy of the MNT for a particular condition and physically cross out the weight-centric recommendations. Then, adapt what remains to a behavior. Even if you're having a hard time processing HAES, this can be a really useful step in making your recommendations speak to your patients.
I hate using specific numbers in nutrition therapy like a 2g sodium diet, because that means nothing as you go through your day and make countless decisions about food. So once you've edited the MNT in your mind to be behavior-centered and free of weight talk, it's also helpful to edit your handouts/worksheets to reflect that as well.
EXPAND, EXPAND, EXPAND
One thing my patients and I end up doing early on is addressing misconceptions they may have about food and weight. So as they begin to tell me about their goals and why they want to work with a dietitian, I get to see a fuller picture of not only what they're eating, but why they're eating it. This is where motivational interviewing comes in heavily as I like to ask a lot of open-ended questions and really get to know about their "head knowledge."
We typically dialogue about head and body knowledge and the difference between them and how they can work together, and then we get into some of that head knowledge. Carbs' role in the body is a frequent topic with a lot of patients lately so we'll get into what carbs do and how they're vital for life, etc.
I think fearing a certain food or group is pretty natural if you hear fear-inducing statements about them in the news all the time, so explaining the actual science behind why eating all foods is beneficial can help challenge that fear.
MEET PEOPLE WHERE THEY ARE
A lot of people are going to come to you with weight concerns. Unfortunately, that's the society we live in. You will also probably get a lot of weight-centric referrals from providers because HAES isn't well known. Generally, if patients have weight concerns at the front of their mind, they'll bring them up - I don't love to be the person to introduce weight to the conversation unless it's medically necessary (for example, a pregnant woman whose weight is not changing as her body does) because I'd like to introduce nutrition and relationship with food as important regardless of weight.
This also helps set the stage for the conversation of how nutrition isn't a weapon for size manipulation but instead something to enjoy and a tool to support your body. Motivational interviewing is a huge part of this as well, because it's so important to reflect on and be open about people's feelings about their weight. Ignoring the weight conversation will just make them feel unheard and will damage their trust in you as a practitioner.
Dietitian friends, I hope you found this helpful for your practice! If you incorporate health at every size into your nutrition practice, I’d love to hear your perspective in the comments!