Navigating Weight & Scale-Neutral Conversations With Your Doctor

Navigating Weight & Scale-Neutral Conversations With Your Doctor by Sara Remus, MEDA Social Media Manager

While the concept of Health at Every Size (HAES) is slowly making its way into the medical field, finding HAES practitioners remains a struggle. While they do exist, they are still few and far between. That makes it all the more important to know how to advocate for yourself when moving through the health care system, especially as it is very likely that many of your providers will not be HAES informed. In Massachusetts, there are just 14 healthcare practitioners on the official HAES registry.

This doesn’t mean that your provider may not share HAES values. It does mean that you should be prepared to champion your needs when visiting your doctor, and that goes well beyond your physical health. We’ve compiled some tips  to help you guide your interactions with your health care team to a place that is safe for your body and mental well-being. Read on for some ideas for having a weight and/or scale neutral conversation with your doctor.

If you have the opportunity to communicate with your provider through a digital platform, use it to start the conversation. 

Many health care facilities use secure digital patient portals to schedule appointments, provide test results, and offer payment options. This can also be a great resource for setting expectations when you request an appointment with your provider. Usually, these programs will give you the ability to submit a note when requesting to see your doctor. You can disclose as much or as little as you feel comfortable with. This is an example of how you could potentially make the request:

“Hello, I’m looking for an appointment to be seen for (insert issue and any details here). Please add a note in my request that I would like for this appointment to not involve any discussions around weight, and would prefer to not be weighed. If I must be weighed, due to something like medication whose dose is weight dependent, I request that the nurse and doctor allow me to be weighed with my back to the scale and not share any of my weight information with me.”

If you are comfortable doing so, you can share that you are recovering from an eating disorder, and that these sorts of conversations and having information about your weight tends to be triggering and not helpful in your recovery process. However, you are certainly not obligated to provide this information!

If there is not a patient portal available for communicating with your doctor’s office, you can also offer this information over the phone. If you’re not comfy doing so, you could also draft a hand-written or typed note that you can fax to the office ahead of time or hand deliver to any medical personnel when you arrive for your first appointment. You might find it handy to keep several copies of this note in your wallet or bag, so that you can hand it to a provider in a pinch. If, for example, should you end up in an emergency or last-minute situation where there isn’t time for the conversation to be had ahead of time.

If you have a behavioral health provider, ask them for help.

If you have a counselor, therapist, or social worker that is helping you through your recovery, ask them for advice in navigating your specific needs with a medical doctor. In many cases, your behavioral health provider will be happy to communicate with your doctor directly, with your written permission to do so. These communications typically happen over the phone or hrough a secure platform. You can ask to see what is being communicated between your providers (or not!). Your counselor, therapist or social worker can handle discussions with your provider that you may not feel comfortable having.

If you feel you are being diagnosed incorrectly due to your size, be vocal. 

It is a sad truth that some health care practitioners blame weight as the culprit for illness or injury before investigating and addressing other potential causes. We know that weight is usually not the cause of problems that typically lead us to visit our doctor.

If you feel that your doctor is attributing your pain or condition(s) to your weight, try asking them the following questions:

  • “If weight were not a factor, how would you go about treating me?”
  • “Would you give the same advice to someone who was in a thin body?”
  • “It is important to me that we look at all the potential causes for why I am experiencing these symptoms. Can you think of any other causes aside from my weight?”

If they insist that the issue is weight related and refuse to talk to you about any other potential causes, you can request to see a different provider. Having these sorts of conversations with your doctor can be quite uncomfortable, so if you decide not to push back on your provider, walk away from this appointment without answers and go elsewhere, that is completely understandable. It is important to remember that you are entitled to look for other doctors. When looking for a new provider, make sure to ask if they’re willing to have a weight-neutral discussion.

Lastly, if you have ever worked with a specialist for an eating disorder, they can be a great resource in helping you find educated medical practitioners suited to provide you with quality care that doesn’t revolve around weight. You may also find that asking around in your recovery group is a great way to find a doctor you can trust. Don’t be afraid to advocate for yourself. If that sounds a little scary, remember that it’s OK to lean on others for support!

Dispelling Diet Culture Once and For All

Dispelling Diet Culture Once and For All by A Recovery Warrior in the Community

Despite its pervasiveness in our society, “diet culture” is not an easy term to define because of the many facets it encompasses. That said, “diet culture” is a belief system that idolizes thinness and equates it with moral superiority and good health. Diet culture is more than going on a diet. It is, as mentioned above, a belief system, or a culture in and of itself. Diet culture is also insidious because of its ubiquity – it becomes difficult to notice because it is so dominant in our culture. This way of thinking about food and our bodies is so deeply embedded that it becomes hard to recognize. Often, diet culture masks itself as health or wellness. Think: Noom.

The impacts of diet culture are significant and harmful to folks of all sizes. Diet culture perpetuates eating disorders, normalizes disordered eating, and instills deep-rooted insecurities. In other words, it sets all of us up to feel poorly about ourselves, judge and compare ourselves to others, all while promising that losing weight is a panacea. Diet culture suggests that in order to be loved, accepted, successful, and happy you have to be thin.

In addition, diet culture oppresses people who don’t align with what diet culture’s image of “health” is. This has racist, patriarchal, ableist, healthist, and transphobic roots. The people who are harmed the most are women, BIPOC, transgender folks, and people with disabilities.

Despite what diet culture claims, healthy and unhealthy bodies come in every shape and size. Those who are deemed “healthy” should not be put on a pedestal nor should there be a moral obligation to be healthy. But even beyond that, the use of weight, BMI, or body size as proxies for health should be rejected. Weight is just a marker of size, not health. Health is a multifaceted construct and other factors such as the social determinants of health (e.g., education, income levels, discrimination, access to health care, etc.) play a large role in whether or not you are in good health.

Additionally, scientifically speaking, diets for weight loss don’t even work. So, what we’re left with is billions of dollars poured into an industry that is capitalizing off of people’s insecurities.

So how can you begin to break free from diet culture?

  1. Challenge and think critically about comments on weight, size, and shape as they relate to “health” and “wellness”.
  2. Learn about Health at Every Size ® (HAES), a movement that acknowledges that health is primarily driven by social, economic, and environmental factors, not weight. This approach encourages pursuing one’s own health, not as an obligation and independent from a focus on weight loss. HAES is built on five principles, including weight inclusivity, health enhancement, eating for well-being, respectful care, and life-enhancing movement.
  3. Consider intuitive eating. Created by Evelyn Tribole and Elyse Resch, intuitive eating is based on 10 principles (e.g., honor your hunger, make peace with food, and challenge the food police).
  4. Reject any diet or “wellness” lifestyle that comes with rules. Do you have rules floating around in your head constantly about what you can or cannot eat, when you can eat, etc.? Diet culture instills one-size-fits-all rules into us, which goes against the many different factors that contribute to meeting our own food needs, like nutritional needs, taste preferences, cultures, and food access and budgets.
  5. Instead of spending time and energy trying to lose weight, use that space to do things you genuinely enjoy – read a book, learn a new hobby, spend time with family and friends.
  6. Accept that health is complex and nuanced. Health is not an obligation nor a measure of self-worth. Despite what diet culture may have us believe, there is very little about health that is in our control.
  7. Cultivate the belief that your body is worthy of care and nourishment no matter its size.

What do Children’s Fairytales Have to do with ED Advocacy?

What do Children’s Fairytales Have to do with ED Advocacy?

By Andrea Piazza, Primary Therapist at Center for Discovery

Diverse identity and body representation in children’s books is a crucial building block of a size inclusive culture.

The fairy tale princesses and character’s we grew up with have had an undeniably damaging effect on the expectations we set for our bodies. We grew up dressing like these characters for Halloween and pretending to be them in our imaginary games. What did we learn from these characters; that our looks are more important than our intelligence, that we need attractive bodies to have good lives? These narratives do not serve us. We need new narratives that take the good pieces from the classic stories we grew up with and then shift the focus from our bodies as a tool for power and security to our kindness as a tool for growth and happiness.

According to numerous studies, Body Dysmorphic Disorder has a prevalence rate of 2% to 13% in nonclinical adult student samples meaning its relatively common. Characterized in the DSM-5 as “a distressing or impairing preoccupation with slight or imagine defect(s) in one’s physical appearance.” Another to a recent journal article in The Journal of Family Medicine and Primary Care by Himanshu body dysmorphia is on the rise. It’s easy to see how media consumption plays into the way individuals measure their own features against the cultural beauty standards.

As an eating disorder therapist, I am constantly helping clients investigate their own body image development. Characters in the movies and books they grew up watching are nearly universal archetypes for the qualities one needs to possess as an adult… which tend to be physical. Patients will mention dressing up like Hercules or Princess Jasmine and subsequently looking at themselves in the mirror attempting to suck in their tummy or flex their muscles only to be overcome by a child’s sense of inadequacy. In even more heartbreaking stories patient share how they were so excited to dress up or pretend to be these characters with no initial self-doubt, only to have someone say they would need to eat differently to look like that character.

Imagine a world where the characters we grew up modeling ourselves around were diverse with realistic bodies and had goals that were about accepting oneself and or others. How would our dress up change? How would our play have changed? It’s said that we learn just about everything we need to know by age 5 or within a critical period from 5-7. Imagine a world where we learned about body neutrality and inclusion and diversity during our critical period.

The critical period is Noam Chomsky’s idea that language acquisition is learned during a critical period in childhood. It’s the reason it is so difficult to learn a new language as an adult and that its likely that we will always have some challenges speaking it even if we do. It also makes sense why it feels so much more natural to have conversations around the ways we want to change and modify our bodies than the things we appreciate or like about our bodies.

Larger bodies are also villainized in the stories we grew up with. They are the bodies that are drowned in the seas or beat out by stronger more able bodies. They are the bodies that end up alone and bitter.

Even worse than that people of color and people of diverse ability are often completely absent from the narratives we grow up with. In this moment of finally valuing diversity and inclusion we start to realize how intentional we need to be to make change because it’s not something we have been practicing. We need stories that highlight the powerfulness of inclusion and treat it as something normal and basic. Imagine if we saw as many montages about inclusion and accepting ourselves as we are as makeover montages…

Stories like Peter Pan in Everland by Andrea Lynn Piazza and Nicole Warren where tropes are countered on every page from having open discussions on autism and adaptive technology, to women working while the man vacuums, are incredibly important. Even the details in the story can lead to a huge cultural value shift and to an overall healthier and more inclusive society. We need more children’s literature and media, in general, that focuses on body acceptance and inclusion.

By retelling classics with inclusive casts of characters in diverse circumstances we can create a new set of fairytale heroes for our children and therein new healthier expectations for their minds and bodies. It is important to understand the profound impact of seeing characters of all abilities taking part in the stories we already know and love.

Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience, 12(2), 221–232. https://doi.org/10.31887/DCNS.2010.12.2/abjornsson

Himanshu, Kaur, A., Kaur, A., & Singla, G. (2020). Rising dysmorphia among adolescents : A cause for concern. Journal of family medicine and primary care, 9(2), 567–570. https://doi.org/10.4103/jfmpc.jfmpc_738_19

Hartshorne, J. K., Tenenbaum, J. B., & Pinker, S. (2018). A critical period for second language acquisition: Evidence from 2/3 million English speakers. Cognition, 177, 263–277. https://doi.org/10.1016/j.cognition.2018.04.007

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

https://www.amazon.com/Peter-Pan-Everland-Inclusive-Retelling/dp/1955077002