by Caitlin O’Connor, ND
Practicing medicine, especially naturopathic medicine, in a weight-obsessed culture can be tricky. Food and movement are two of the most powerful tools I have to help my patients feel better, but how do I apply those tools in a culture so obsessed with diet and exercise as a means to an end (get skinnier) rather than a foundation for health? Oftentimes, my patients come to me having been traumatized by not only the weight loss industry, but also by medical professionals who have blown off their medical needs and/or focused solely on weight loss as a singular approach to anything that ails them. Figuring out how to work with women of all sizes – in a society that desperately sells the idea of small and slender as the only markers for health – has been a huge challenge in my practice.
First things first, when I work with patients, I ask them to define their goals. I would guess that at least 50%, if not more, of the women in my practice list weight loss as one of their primary concerns. This opens the door for conversation. Why is weight loss important? What has their relationship with weight been over the life span? Is there any history of disordered eating?
Next, we talk about the reasons behind the goal. What does she think will change in her life if she loses weight? Are those reasonable expectations? Do those goals truly hinge on weight-loss, or has she accepted the myth that weight loss will make them happy.
We address the images in media, social and otherwise, that might be driving her desire – we talk about photo-shop, and starvation diets, and a laser-focused obsession with food and exercise. I try to point out areas of diet culture that might not actually be health promoting. Weight loss is not a promise of health. And the tools used to promote it might actually be a detriment.
Then, I try to reframe. Is there a movement goal she would like to achieve? Walk more, dance more, lift heavier things? These are the types of goals I can get behind and will very likely result in enhanced health – I would love to help those goals become a reality.
These conversations are difficult and I do not always navigate them gracefully. However, I think this discussion brings into focus what is truly going on and also gives me the insight to create a plan that is respectful of past experiences. Some guidelines that I have put into place include:
Don’t refer to food in moralistic terms. There are no good foods or bad foods. I will often point this language out to patients and, together, we figure out new terms. As I like to say, there are good people who eat brownies and bad people who eat kale. The food we put in our mouths does not define our moral character. The wording is often tricky, but I have settled on “health supporting” vs. “not- health supporting” choices. For example, if you know skipping breakfast and drinking coffee makes you grouchy, that is not a supportive choice. But making that choice doesn’t make you a bad person.
Define non-scale goals. I almost never track progress in pounds. In fact, I rarely, record a patient’s weight. Instead, we might pick a physical goal –feeling stronger, trying a new dance class, walking with more ease. Often, blood lab results can help us track progress – better blood sugar control, decreased inflammation, more balanced cholesterol – all attainable without drastic weight loss. Many people feel like a battle against the scale is one they can not win. They have fought and fought. I want people to get free from this battle and realize that there are other pathways to feeling better in their bodies.
Focus on pleasure. This is often a tough one because everyone knows that a healthy person must sacrifice all earthly pleasures, right? Nope. If your revolution doesn’t include joy, community and sensual delights – count me out. Exploring and experimenting with the types of food and movement that result in feeling good is a critical component of creating a long-term approach that is nurturing and nourishing. The same goes for how we choose to move. This does not have to include punishing regimens and feelings of deprivation. Instead it could involve movement that is fun and fulfilling, meals that focus on flavor. For health supporting habits to be sustainable, they must be enjoyable.
As a naturopathic doctor, I have had to actively observe and critique my training when it comes to embracing the principles of Health At Every Size® (HAES). Naturopathic medicine is a distinct health care profession that emphasizes prevention, treatment, and optimal health through a variety of tools including, but not limited to, nutrition, mind-body practices, botanical medicine, supplementation, pharmaceuticals, and minor surgeries. In some states we practice as primary care, while in other states we offer more specialized services. In this way, I think we sometimes are exposed to the worst of both worlds – the fat-phobic teachings of conventional medicine and the fat-shaming world of holistic health.
It is a work in progress, but I strive daily to meet the principles put forth by HAES.
I invite my fellow holistic doctors to observe how they talk about and use weight as a motivating tool in their professional practices. Observe your biases and feelings about weight – how has your journey been? If we are truly working with the whole person, we need to accept people for who they are and not try to move them to where we think they need to be. Often, patients who come to us are desperate and vulnerable, convinced that maybe we have the secret weight loss tool they need to crack the code. Don’t perpetuate the myth. Partner with your patients to figure out what can be done to truly enhance health and well-being. Focus on parameters and outcomes beyond the scale. Be the (potentially first) health care provider to ensure folks that their bodies are not broken and that health is truly achievable at any size.
Dr. Caitlin O’Connor provides Naturopathic care with a focus on women’s and children’s health. She pairs a philosophy of patient-centered, whole body, individualized care with an emphasis on nutrition, botanical medicine and a balanced approach to healthy living. She practices in Denver, Colorado, where she has been active in the political process regulating naturopathic doctors. She graduated from Bastyr University in 2008 with a Doctorate of Naturopathic Medicine and a certificate in Naturopathic Midwifery. In addition to teaching at the Nutrition Therapy Institute, she has presented for both lay and professional audiences including the Colorado Midwifery Association and the Colorado Association of Naturopathic Doctors. In the clinic, she strives to provide skilled, compassionate guidance with a focus on optimal patient outcomes. At home, she tries to be a centered and present mother, a caring partner and good friend to both herself and others.
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