Thanks to Helen at Food & Nonsense starting the RD book club I finally got around to reading Linda Bacon’s Health at Every Size. Unfortunately, due to time differences, the tweet-up to discuss the book is taking place at 6 am on a Sunday morning for me. I’ve scheduled this post to go live at that time as my feeble attempt at participating in the discussion without waking up ;) If you’d like to check out the discussion just search for the #RDBookclub hashtag (was that redundant? Probably) on twitter.
Helen was also kind enough to post some discussion questions so here goes…
1. Do you agree with the HAES assertion that health not weight should be the focus of nutrition interventions?
Absolutely. The focus should be on health and well being, never on numbers on a scale. That being said, weight management is one of the main reasons that people seek out advice from dietitians. I don’t think that we can just ignore this fact. As health care professionals it’s our job to help people to understand that the numbers on a scale don’t necessarily matter all that much when it comes to health. That being said, weight is often inextricably intertwined with health and nutrition.
2. Is a health approach practical in todays aesthetic focused society?
This is an excellent question and one that I found myself thinking about quite a bit as I was reading the book. It’s all well and good that we know that people can be healthy at many different weights but how do you translate that into acceptance and understanding? As much as we tell someone that they are healthy at their current weight, if they’re unhappy with that weight should we help them to lose weight or help them to accept themselves as they are? Oftentimes, neither of these options is feasible.
3. Do you feel that the main concepts in the book were adequately backed up by the research presented?
For the mist part I did. Although I must confess that I didn’t take the time to seek out all of the research Bacon used to back-up her arguments. A couple of things did bother me: One, I didn’t like how much she mentioned that if you do this or that you’ll probably end-up losing weight. If your book is about being healthy no matter what your size, and you’re preaching fat acceptance, then I don’t think that weight loss should be a frequently touted benefit of your approach. Two, I’m not sure how credible her evidence to support that overweight and obese people generally live longer than their lower-weight counterparts is. Weight loss is an extremely common side effect of many serious diseases. Thus, thinner people may be more prone to dying than larger people as a result of an underlying illness causing weight loss, not as a result of being thin. If we’re talking health at every size we need to be careful not to tip the scale in the other direction. People who are overweight, obese, average, or underweight may all be healthy. Also, death is not the only thing to look at. Obese and overweight people may be living for longer but how many of them are healthy during these extended life spans? Health span may be a more important consideration than life span.
4. How should nutrition professionals use this information in their day to day practice?
I think that nutrition professionals should use this information to help themselves overcome their personal biases and to educate their clients that weight is not the be all and end all when it comes to health. We should also use it to help clients realise that our own weight is not an indication of our health nor of our ability to do our jobs well. I can’t tell you how many people I’ve had tell me that I’m a dietitian they might actually listen to because I’m slim, as though larger dietitians don’t have exactly the same knowledge and education as I do. As with any field, our weight is not an indication of our ability to perform our jobs well.
5. Were there any ideas in this book that you reject or find difficult to accept? Why?
I think I covered this in question three. Oops! I was also bothered with a very small point in which Bacon was advising people on how to choose whole grains (p.79). She says, “Look for the word “whole” in the ingredients list.” Not entirely accurate. This is the point where I pondered whether or not it was okay to write in a library book. You need to see the words “whole grain”. Unfortunately, “whole” on its own is not sufficient. Anyway… This is a very small quibble in the scheme of things.
I did also find it difficult to accept that there is no relationship between obesity and disease states. While I absolutely believe it’s possible to be healthy (and conversely unhealthy) at any weight I do still believe that there is increased risk of developing certain conditions such as heart disease, some cancers, type 2 diabetes when you’re obese.
6. What is the main thing you took from this book? How has it been helpful to you?
The main thing I took from this book is the importance of self-worth and acceptance. We all need to stop aspiring to look like other people and learn to be happy being ourselves. Many of us also need to step away from the scale and stop letting the numbers on it define us. I also really enjoyed the chapters on food and fat politics.
For some more interesting perspectives on the HAES movement check out the following links: