Dear Fat Nutritionist – do people trust you?

I’m beginning to work through my email archives of letters people have sent me. Here’s one that I absolutely loved. (I’ve added my own emphasis and omitted some identifying details.)

Dear Michelle,

I’m wondering what it’s like to be a fat nutritionist. Just to give you my background, I’m in recovery from an eating disorder. I’ve worked with two nutritionists. My first nutritionist was wonderful and taught me a lot about nutrition. My current nutritionist is absolutely mind-blowing and is the most talented eating disorders treatment provider that I have come across. I hate to admit this, but to be honest, my nutritionists’ weights had a big impact on how much I am able to trust them. This is also true for most of the other eating disordered people that I know. I know that this thinking is disordered because, rationally speaking, I really believe in Health at Every Size.

Have you found that your weight impacts your relationships with your clients?

Have you found that your weight has come under fire from others in the field?

Thanks,
Anon

Hey Anon,

I’ve been mulling over your question since yesterday, and I think what it comes down to is this:

People are comfortable with other people for lots of different reasons.

For instance, when I’m choosing a doctor, I have the choice to go with a man or a woman. If I don’t like the way the doctor talks to me, or something about her/his office, or receptionist, or, hell, even their clothing choice, I get to pick another doctor. And this is not only allowed, but tacitly encouraged by just about everyone.

After all, how can you be expected to be vulnerable and open, and to do good work with someone you’re not 100% comfortable with? Even seemingly “silly” reasons for discomfort may be getting at a deeper issue that deserves to be heard and addressed.

So, for that reason, I really don’t mind if someone chooses not to work with me due to my body size. That is absolutely their right.

On a personal level, yes, it would hurt if someone came out and said to me, “I don’t want to work with you because of the way you look.” But, luckily, the way it works out is, no one ever does that. They simply avoid me, move onto the next practitioner, and hope for the best. I never have to know people’s various reasons for not choosing to work with me.

And, especially for people with eating disorders who are at a certain stage of recovery, I can totally understand not wanting to work with a fat nutritionist, or doctor, or whathaveyou. It only makes sense, in the context of the disorder, and I don’t think I would feel particularly hurt by that — it’s the reality of that disease, unfortunately, but as people recover, I think they are likely to get past that kind of thinking.

As far as my colleagues go, no — I’ve never had anyone question my competence due to my body size, and I’ve been hired for some pretty advanced jobs, given that I’m still a student. I worked in an outpatient diabetes clinic with very traditional, weight-loss-oriented dietitians, and they seemed to love me. They chose me over thin candidates who had their degrees finished. They never questioned me about my weight, and were willing to frankly discuss with me their concerns about their patients’ weights. They listened to me when I asked critical questions about the efficacy of weight loss treatments.

I’ve worked in various inpatient areas, and again, my weight never seemed to be an issue. I also worked in an outpatient cancer clinic — in both of these circumstances, the main point of my job was to encourage people to eat as much as humanly possible, because malnutrition was the biggest risk for these populations. I enjoyed it, and seemed well-suited to it.

I work in eating disorders occasionally, though not directly with the patients. I think that, more important than my body size, is my attitude toward food, and myself, and the world. I’m positive about food. I’m comfortable with myself. And I expect good things from the world. I think that, even in this rather sensitive area, these parts of my personality contribute more to my competence at work than my body size.

Anyway, thanks for writing and being so candid. Best of luck to you in your continued recovery. Don’t ever let the bastards grind you down.

As ever,
Michelle

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14 Comments

  1. Posted November 28, 2009 at 2:56 am | Permalink

    This is a terrific topic to talk about. I have had two very unique experiences with this subject-

    1. When I was 17 my parents sent me to fat camp (69 inches tall, and 220 pounds, good choice parents), and I was highly offended by the nutritionists that the camp employed because of the essence of bone that was on display.

    2. When I went to treatment for my eating issues (on the OTHER side of the spectrum of being almost 400 pounds) I was uncomfortable with the super-thin therapists, and the super-heavy therapists. Both extremes made my anxiety blow up-

    THE POINT IS… it is all a reflection of the internal battles I have with my own body-image, food issues, and perfectionist bullshit. BODY DOES NOT EQUAL QUALITY. If I choose to judge myself by that (terrible) standard- it is my choice. BUT I have missed out in life judging others by it.

    Thankfully I have challenged these thoughts.

    I think it is REALLY important for all sorts of people to be involved in all sorts of aspects of health care. I appreciate that you addressed it!

    • Posted November 28, 2009 at 9:13 am | Permalink

      Hmm, that’s interesting. And I do think it illustrates the idea that, the more harshly you judge other people, the more likely you are to judge yourself in the same manner. I don’t know if it works vice-versa, but perhaps sometimes it does.

  2. Posted November 29, 2009 at 3:05 pm | Permalink

    Hi

    yes I do jsdge people very harshly when I’m judign myself and when I’m being super nice about myself I can be much more forebearing about other people and tollerant.

  3. Eve
    Posted November 30, 2009 at 12:41 pm | Permalink

    The only nutritionist I’ve ever seen was a very thin woman my doctor sent me to when I was diagnosed with having fatty liver disease and high triglycerides. She told me to eat low-GI foods and have more veggies. She didn’t push weight loss after I told her I wasn’t interested. I’ve seen her a couple of times and honestly she’s nice enough but I would be more comfortable with a fat nutritionist. With the thin one I can’t help wondering if she wants me to lose weight rather than improve my health. I don’t have an eating disorder but I do tend to feel less comfortable with thin health professionals.

    • Posted December 1, 2009 at 3:30 am | Permalink

      Yeah, I have to admit to some mild discomfort with very young, very thin health professionals — that is, unless I find out they are size-accepting or believe in HAES. Then I’m perfectly comfortable.

      But I also think that, with my own increasing self-acceptance comes an increasing ability to feel comfortable around just about anyone, no matter if they’re likely judging me on the way I look, or not.

      Because if I know I’m okay, I don’t really give a damn what someone else thinks. The only way in which it would truly bother me is if it somehow concretely impacted my care, say, or my acceptance into housing or employment or something.

      But many times when someone is judging you harshly, the only consequences are social, and generally those social consequences are personal — only between you and them, and your acceptance into general society is not dependent on this one person accepting you.

      So, in that sense, I really care a lot less than I think.

      I think.

  4. Posted December 1, 2009 at 9:25 pm | Permalink

    I would no longer think a thin person any more wise or healthy than a fat person. In fact if anything I might distrust someone – like you say – young and thin, unless they demonstrated the wisdom of HAES or at least didn’t do the “if you’re this fat / fluffy you must be unhealthy” bit. Luckily it’s usually pretty easy to tell if someone has these biases or not.

    I do agree though – people have the right to be comfy or uncomfy and choose accordingly. You know what’s interesting? I have pretty problematic skin and honestly, no matter how well I eat or exercise (and I do plenty of both) I will always think I’m doing something “wrong” because I don’t have flawless skin. For other people weight or body size is their silent obsession / sadness – for me it’s my skin. Which can also be tied up in nutrition.

    Your skin looks pretty amazing, Michelle. I’d probably trust you to advise me on anything. Oh, it also helps that you’re super smart and funny and write a lot of mind-blowing articles. So thank you for that!

  5. Posted December 3, 2009 at 8:18 am | Permalink

    You know, it has just dawned on me that I have never heard the term ‘nutritionist’ used in Australia, it is always ‘dietician’. Unless there is some fundamental difference in the job description that I have missed… Interestingly, I wouldnt mind seeing a ‘nutritionist’ but I would go out of my way to avoid seeing a ‘dietician’. Each word conjures up a totally different scenario for me…

    Oh, and all the dieticians I have known… stick thin.

  6. Posted December 14, 2009 at 1:17 pm | Permalink

    I am so terrified that my weight will get in the way of me getting my internship, getting a job, getting clients. I’m 5’6″ and 218 lbs, so not exactly the fattest person in the world, but clearly much heavier than most of my peers in the dietetics program I’m in. They all seem to be cute, thin, energetic, blond 22 year olds (i’m also not cute, thin, energetic [i am chronically ill right now], or blond and i’m closer to 30). I worry I won’t be able to compete, even though i know that I have so many skills and so much life experience they don’t have.

    • Posted December 14, 2009 at 1:22 pm | Permalink

      I’m totally in the same position, and it scares me too. But if it helps, I’ve worked as a diet tech for a couple of years (and as a supervisor before that), and my weight has never been an issue with the RDs I work with, or at the hospital in general. I seriously doubt it will make a difference if/when I apply for internship.

      • Posted December 14, 2009 at 4:34 pm | Permalink

        Thanks for the encouraging anecdotes. I sit through classes where people say such hostile things about fat people, I wonder if these people are going to become my colleagues how I am going to be respected. I guess through doing a kick-ass job, I hope. So you’re not a nutritionist yet, or you *are* a nutritionist but *not* a dietitian? Just curious. I don’t know how things work where you are. What kind of program are you in? I’m going for my BS in Nutrition/Dietetics, the didactic program that’s required by the ADA to be eligible to do the internship and then sit for the RD exam in the US.

        • Posted December 14, 2009 at 6:12 pm | Permalink

          I’m still finishing my degree (I have roughly 5-7 courses left, depending on if I decide to finish my minor — all of my actual nutrition-related courses are finished, and I’m mostly doing liberal electives), but I have worked pretty extensively in hospitals (as a supervisor and as a clinical diet tech) so I call myself a “nutritionist” as a generic term, because it’s a term that doesn’t require qualification, is more recognizable to most people, and will still apply to me when/if I decide to get my RD. I may just finish my bachelor’s in nutrition; I may go on to get a MHSc, or I may go the RD route — undecided as yet.

          • Posted December 15, 2009 at 9:23 am | Permalink

            I really want to do the internship but they are extremely competitive (only half of applicants at my school go into an internship at all last year) and I have some health issues so I’m concerned about the intensity of it. My dream is a combination internship-masters program (there are some around here). If not, I’ll try a part-time internship and work part-time. Or a full-time internship and then afterwards hopefully I can go to grad school. I play around with the idea that if I don’t get into an internship the first year maybe I’ll go for a MPH or a MS in Nutrition and not bother becoming an RD, but we’ll see. I’m so glad you exist in the world! I told my partner all about your blog yesterday because it makes me feel like I’m not alone.

          • Posted December 15, 2009 at 9:26 am | Permalink

            Yeah, I’m pretty much terrified of internship too. That’s why I’m finishing my last few courses slooooowly, so I can make sure my health/mind is in a good enough state to be able to handle it.

            There’s also the possibility of doing a distance internship (through ADA — I’m an American/Canadian, so I guess I might be able to intern in either place since my degree is accredited and there’s some cooperation between DC and ADA in that regard) where you can kind of pick the hospitals and your supervising RD — but you have to pay quite a bit of tuition to the school who hosts the distance internship. In Canada, most internships are free (unless they’re a combined Masters program.)

  7. Posted December 14, 2009 at 1:27 pm | Permalink

    Oh, and in the interest of self-disclosure, I am also totally judgmental of the one extremely obese man who’s in one of my classes (he’s one of maybe two people in the program who I’ve seen who are bigger than me). I cannot imagine feeling comfortable taking nutritional advice from him. Being honest here. So yes, I think judging other people and judging oneself come hand in hand when it comes to bodies.

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