When health is not on your side.

This post is part of the crowdfunding campaign for my dietetic internship. It is not intended to replace advice from a doctor or other health care practitioner. It represents my opinion alone and not any organization of which I am a member.


Dear Michelle,

How can one achieve Health at Every Size if they don’t have health on their side?


Hi D.,

This question has a lot to do with how we define health, and also how we define Health at Every Size.

In our culture, we tend to look at health as a state or a place we can get to, a finish line to be crossed, and once you’re there, you’re finished. As you say, we look at it like an achievement.

By this definition, if you have good cholesterol, blood pressure, blood sugar, a BMI between 18.5 and 24.9, and no notable illnesses or conditions, then you’ve achieved health. Congratulations. Pick up your trophy.

And we tend to speak of Health at Every Size with similar rigidity — as using a particular approach (intuitive eating and exercise) to achieve a very similar trophy, minus the BMI requirement.

This definition of health excludes anyone with a health condition. There are lots of people in the world dealing with chronic conditions or disabilities, probably more than aren’t. Effectively sending the message that they’ve already “failed” at health, and no matter what effort they put in, they can never be healthy, is deeply discouraging.

I’ve heard people argue that defining health in exclusionary terms is the only way we can motivate people to care for their health. I disagree. I think that casting health in such a meritocratic, neoliberal way is deeply destructive and invokes healthism as well as ableism. I believe that people can be more effectively, and more ethically, motivated through compassion and acceptance, combined with the desire for positive change.

An exclusionary definition of health discourages the most vulnerable people — the people who actually stand to benefit the most from getting help or making positive changes — from caring for themselves at all. They may think, “Why bother? I’ll never be healthy anyway, so what’s the point?” Such a definition of health is oppressive. It’s also incorrect.

The reality is that health is not an achievement. It’s something you already have, and it looks a bit different for every person. Health is a dynamic resource that each person carries with them, in some form, through their entire life.

Here’s how Dietitians of Canada defines health:

“Health is a basic resource for everyday living. It is the extent to which one can realize aspirations, satisfy needs, and change or cope with the environment.”

The definition of Health at Every Size is also quite flexible and allows for individual needs and different health conditions, while also taking into account social and political barriers to health. Even people with diseases or health conditions — and that is likely to be all of us, at some point — can live with good health, provided we cope well, care for ourselves, and find meaning in our lives.

If you’re caring for yourself without using weight loss as a proxy for health, the bottleneck through which you funnel all your efforts, or the primary source of meaning in your life, then you are using the Health at Every Size approach.

By coping well and caring for yourself, in whatever way works best for your unique habitus and challenges, and by living a life that matters to you, you are also cultivating the health that is already yours.

Posted in Dear Fat Nutritionist, Liking Yourself, Unified Theory | Comments closed

Watch me eat raspberries.

I made a new eating video just for fun, but then it became the video for my fundraising campaign for my upcoming dietetic internship.

(Since videos of me talking are booooooring.)

Video transcript

If you want to help out, share my campaign, or get yourself a perk (including an ebooklet, private forum membership, t-shirts, and the right to tell me what to blog about.) We’ve got 56 days to make this happen.

In the coming days, you will also see some blog posts specially requested by some of my contributors. Should be fun/interesting/weird.

I can’t say thank you enough to all of my readers, and to all of the people who’ve already donated. You are literally making my life here.

Posted in Dietetic Internship, News | Comments closed

What I’m saying, and what I’m not saying.

Since people seem to be awfully confused.

What I am saying: “Weight loss interventions have very low permanent success rates for most people.”
What I’m not saying: “No one in history has ever lost weight permanently in a healthy manner.”

Health At Every Size is, fundamentally, a weight-neutral approach, which means it focuses directly on health-supporting behaviours, and allows weight to adjust as it will. Sometimes it will adjust up, sometimes down, and sometimes it will stabilize. It is true that only a small percentage of people seem to lose weight permanently, according to research, but I do not deny that those people exist. Some of them may have even lost weight by using a HAES approach.

What I am saying: “People have the literal, legal right to eat any food they like, because human beings are condemned to be free. Food choices cannot make you a better or worse person, and food choices are only one factor among many that influence health.”
What I’m not saying: “No food choice ever has an impact on health, and you can eat anything you like without having it impact your health in any way.”

Food choices do impact health, but food choices have also been spun up in the media as the only or the most important thing that influences health, which is not accurate. (The largest impact on health actually comes from living conditions and other social determinants of health.) You are allowed, as an autonomous human being, to choose to eat any food that’s available to you – but, as an autonomous human being, you will also be the one to bear the brunt of the consequences of those choices. Health at Every Size includes a focus on intuitive eating and getting good nutrition because we believe a healthy relationship with food, and a good quality diet, can help improve people’s health. Eating well, in the HAES philosophy, is not the same as eating in a restrictive, restrained manner that is the current popular conception of “healthy eating.” Instead, it focuses on understanding internal signals of hunger and fullness, truly getting enough to eat, improving one’s attitudes toward food so that you are not feeling guilty or anxious, and getting balance, variety, and pleasure in the diet.

What I am saying:Weight is not a behaviour. Weight is a multifactorial trait that is highly heritable. It is not completely within anyone’s control, and no one can simply choose how much to weigh.”
What I’m not saying: “Weight is never, ever influenced by behaviour [see the first point, above.]”

In arguments about fat and health, people often enjoy claiming that fatness (a phenotypic trait) is opposite but equivalent to anorexia nervosa, an eating disorder with a specific set of behavioural and clinical diagnostic criteria. I think they do this because it gives their arguments (often very abusive, stigmatizing arguments) a veneer of respectable concern and clinical authority, but it’s a false equivalence. Fatness is actually the opposite of thinness, which is also a trait. Traits can be associated with diseases, they can even be implicated in diseases, or symptomatic of diseases, but they are not, in and of themselves, diseases. If you believe fatness is an eating disorder, then in order to be logically consistent, you would have to believe that thinness is also an eating disorder. It’s not. Binge eating disorder is a disorder, and it can cause people to gain weight. However, most fat people do not have binge eating disorder. Moreover, the treatment for binge eating disorder is not dieting and weight loss, it’s learning to eat normally and intuitively, without shame.

What I am saying: “Giving fat people the autonomy to make their own choices around food and exercise and weight, instead of abusing, threatening, and coercing them, is not only more ethical, but also more likely to result in people prioritizing their health in a way that makes sense for them.”
What I’m not saying: “Encouragement to eat well, exercise, or value one’s health is inherently oppressive to fat people.”

Health at Every Size actively encourages people to eat well and find activities that suit them, while not hating themselves. Random strangers on the street shouting abuse at fat people “for their own good”? No. Not acceptable. Doctors withholding effective treatment for certain health issues on the condition that fat people engage in a risky, non-evidence-based treatment (dieting)? No. Not acceptable, and not health-promoting. Well-meaning but ignorant, or even frankly abusive, family members or friends tossing off health advice to adults who have not solicited it? No. Not acceptable.

Black-and-white thinking is the order of the day when it comes to discussions about weight and health. It’s tempting, but don’t get sucked in. A fun trick I like to use, when I encounter two statements that seem to be totally at odds, is to ask myself, “Is there any way both of these things can be true at the same time?” (e.g. Is it possible to believe both that fat people may have a higher risk of disease, and that they can take steps to gain health without losing weight? I think so!) Reality is usually complex enough to sustain seeming paradoxes. Sniff them out. They are good medicine for dichotomous thinking.


Refreshing nuance in comments.

Posted in Fatness | Comments closed

Why I’m doing a dietetic internship.

For the last four months, I’ve been working on something pretty exciting.

When I graduated from my nutrition program, I wrote, very emotionally and fairly defensively, about not being a Registered Dietitian. I wrote about how, even though my original intention in starting school was to become a dietitian, I had discovered that in order to do the type of work I wanted to do (teach people eating competence) I did not actually need to be one. And that some of the things I’d encountered along the way — including the research my peers have done on the experiences of dietetic internship applicants — made me question whether I wanted to be one.

However, at the end of November 2013, I attended a lecture at my alma mater given by a nutrition professor who’d greatly encouraged and inspired me when I was a student. It was my first time back on the university campus since graduation, and I wasn’t sure how I would feel. It was a wonderful evening. The lecture was great, of course, but I was surprised how affected I was by seeing former classmates who had since moved on to being dietitians, catching up with former professors, and meeting new RDs and dietetic interns who were promoting Health at Every Size in their work.

That evening, after reconnecting somewhat with the world I’d left behind, I started to seriously consider applying for a dietetic internship.

First, I love clinical nutrition. I did not know when I began studying nutrition whether I would enjoy clinical subjects at all. As a student, I looked forward to them as a sort of litmus test of whether this field was really for me. It turns out that I did well in those clinical courses. No one was more shocked than me, I assure you. I enjoyed calculating TPN requirements and enteral feeds, even. My experience in the working world bore that out: I really do love clinical nutrition, even though it is not entirely what I came into this field to do.

Second, becoming an RD would solve the difficulty of trying to explain to people and the media exactly who I am and what I do. My position right now, as someone with an accredited degree, specific training, and years of experience — but without that overarching credential — makes this surprisingly confusing. I want it to be clear.

Third, one major reason I did not apply for internship immediately after graduating was because it is beyond me financially. I’m simply not in a position to not work for nine months without any financial aid. This prevented me from applying for a very long time. Ultimately, I decided it was worth it to see if I even had a chance, and then find a way to raise funds.

Fourth, I want to learn more. Nutrition is an ever-changing, complex field. I want to understand it better, have more intensive training, and have the resources to remain current with the research. As a dietitian, I will be able to do this by being a member of my dietetic association and by completing the continuing education requirements that all RDs must fulfill.

The fifth, and most important reason: I originally entered nutrition as a way of doing something positive for fat people. After teaching eating competence for four years, I feel I can serve people in a broader way if I am a Registered Dietitian. I can continue to teach eating competence, but I can also address clinical nutrition concerns when they arise. I am especially interested in finding out how eating competence might be combined with certain therapeutic strategies, as for diabetes.

So, I applied. I went through the fairly harrowing process of gathering references (four wonderful dietitians and one doctor were very helpful with this, you know who you are!), researching internship programs, writing letters, and restructuring my resume. I applied for several programs, I was called for interviews and, two weeks ago, I was successfully matched to an internship.

It was a bittersweet moment, because, on the morning I received the offer, I knew that many qualified and deserving nutrition students were staring at a rejection letter and experiencing the despair, the intense emotional pain, and the personal sense of having done something wrong that comes with it. To those students: you did nothing wrong. This is not your fault. There should be an internship spot for every student who meets the requirements, and I believe there should be financial aid to allow students of various income levels to train as dietitians.

Sadly, I am not in a position to change those things, but while I go forward with joy and excitement to attempt this thing that seemed so impossible to me, I will not forget the very deserving students who have to make other plans.

For now, I must turn my attention to fundraising so that I have the best possible chance to make good this opportunity I’ve been given. The last four months have been a wild ride, and things are only going to get more intense. I hope you’ll wish me luck.

Posted in Critical Dietetics, Dietetic Internship | Comments closed

Cooking for yourself: You are worth the effort.

I think this is a lesson that all of us could stand a refresher in, myself included, as we continue down the path toward feeding ourselves like competent adults.

Caveat: Feeling that it’s not worth the effort to prepare food for yourself is very different from literally not having the energy or resources to prepare food for yourself. The latter happens sometimes to all of us – either we are just bone-tired and pressed for time and eating is just not going to happen (or can only happen in rudimentary form), or we honestly don’t have the money to buy the food we want or need, or we haven’t yet learned to cook in the way we want or need. I have personally been in every single one of these situations at some point, and none of them are easy. But they are not what I am talking about in this article, just to be clear.

What I am talking about is that feeling, when you genuinely do have time and energy and food and skill on hand, but you manage to talk yourself out of making food that would truly nourish you because somehow cooking “just for yourself” doesn’t feel worthwhile.

Story time: the last time I was in this situation was when my husband starting working really late hours, not getting home until like 8pm. Previously, we were eating dinner together around 6:30, and then I would have evening clients afterward. This change in his schedule meant we were each on our own for dinner, and I wouldn’t even see him until 9pm.

For the first couple of weeks, I was THE SADDEST, gazing out the window like fat Cyndi Lauper. I completely abandoned the wifely habit of having dinner ready promptly at 6:30pm (smoke detector blazing) and would just sort of listlessly snack on whatever random food came to hand. Toast, cereal, Cheetos, peanut butter from the jar, whatever.

Many cat selfies were taken during this dark time.

I was a tragic, grazing Camille, and inside a week, I felt horrible. Even more horrible than lonely. I soon connected the horribleness to the lack of eating an actual dinner. (Thank you, nutrition degree! $20,000 well spent.) So I resolved that I would Cook An Actual Dinner, no matter what time my husband came home, and I would even dish up a plate for him like the saddest make-believe tea party of all time.

It took some activation energy, no doubt. I had to convince myself to stop dragging my feet, and remind myself that not feeling like crap truly was worth the effort, that my own well-being (and by extension, I) was truly worth the effort. Through the bad-and-wrong feelings and the internal toddler whining, “I don’t waaaaant to,” I did it once. And it was tasty and made me feel better. So I did it again. And again.

I plated my husband’s part, wrapped it in foil, and put it in the oven to warm, just like I imagine many pre-microwave era housewives had done. He was appreciative, and most importantly, both of us were well-fed instead of coasting on fumes.

So, anecdote concluded. Not feeling like death: it’s worth it!

Let’s talk strategies. For those of you with roommates or significant others who share food, the cooking-and-keeping-warm strategy I did above can work if you’re already in the routine of cooking most nights. You could also keep it cold instead by putting leftovers in the fridge. Either way, you’re staying out of the temperature DANGER ZONE. (As well as the Kenny Loggins DANGER ZONE.) And for some reason, just feeling like you are cooking for more than one person, even if that person isn’t physically there, can get you over the hump.

For those of you who live or eat alone, things are a little trickier because you don’t have another person depending on you (and therefore motivating you) to cook something every night. When I was single, I solved this problem by cooking once or twice on the weekend and freezing it in portions. I tell you this as someone who is not a fancy cook: it’s not as hard or as fussy as it sounds. I believe in cooking things in a single pot, if at all possible – especially since at the time, I lived in an apartment whose kitchen was a stove, a fridge, a sink, one rickety square foot of counter, and a cart I bought from Canadian Tire.

More importantly, it is worth it if you are sick of eating out or scrounging. I have five or so basic recipes that I learned can be frozen in portions and reheated rather well: Hoppin’ John with rice, Beans Bretonne with arborio rice, beef stew, creamed chicken and mushrooms with mashed potatoes, and chili con carne. These all have the advantage of being one-pot meals (oh, except the mashed potatoes), and several of them make good vegetarian recipes with small adjustments. I make them all in a Dutch oven.

The trick is to remind yourself that having a stash of frozen meals does not mean you are obligated to eat those meals every single day. If you pressure yourself with this, there will be resentment and tears, trust me. These meals are your safety net for when better plans (going out with a friend, getting a roasted chicken from the store, ordering a pizza) don’t materialize. You will never be in a situation where you regret having a few frozen meals stashed away. Eventually, you may even come to prefer your own cooking to ordering pizza. But only if you don’t force it. Intersperse eating them with your scrounging method of choice.

I still cook and freeze something every other week, so I can have a hot, homemade lunch during the weekdays, and for emergency dinners. In fact, I just finished a nice cup of chili, an apple and some rye bread for lunch. It was delicious. Furthermore, I made it spicy enough that my husband won’t go near it. TIGER BLOOD.

(I know Charlie Sheen jokes are very 2011, but I’m old and time moves more rapidly for me.)

Alright, so here’s where I ask for your input, like a good little blogger: I am a pretty uninspired, workmanlike cook, so I’m sure the rest of you have even more brilliant ideas for 1) convincing yourself you are worth the effort, and 2) using amazing Crock-Pot technologies to sink further into lazy debauchery. Go for it in comments.

Posted in eating, Food and Recipes | Comments closed
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