Update: While I stand by this post, I do not currently support Lindo Bacon in light of accounts of a long-term pattern of bad behavior directed towards fat and/or BIPOC individuals that Lindo has not satisfactorily addressed. Basically, their private actions are very different than their public words. Until Lindo takes appropriate accountability for their actions, and makes repairs, I will not give them my support.

In yesterday’s post, I presented observations from Lucy Aphramor, PhD, RD, about how society-wide weight stigma and social disparities contribute to obesity. Social determinants of health, which include income and education level, among other things, are a major focus of public health. Lindo Bacon, PhD, her co-author on the book Body Respect, said she has observed a failure to turn words into actions in the spheres of health education and public health.

Beyond personal responsibility

“On the one hand, there is a really strong awareness of the social determinants of health, and that’s entering into the discourse a lot, but it’s entering into the discourse independent of the personal responsibility issues. It hasn’t been integrated there,” she said. “So it’s a theoretical model that’s not affected applications in any way. That’s blowing me away—the disconnect.”

The adherence to the notion of personal responsibility extends to the healthcare system, which Bacon said institutionalizes the weight stigma that’s pervasive in our culture. “It gives us permission to have our discriminatory attitudes,” they said.

“Even if I knew somebody ate nothing but burgers, it doesn’t give me the right to insult them,” Aphramor said. “My background’s as a dietitian, and I left university thinking it was unacceptable to be fat. There was nothing in my education that helped me to think critically about media messages or the science.”

What is health?

Part of the problem, she said is the difficulty of breaking out of reductionist ways of thinking about health.

“As health practitioners, we’re taught to fix. We’re taught to work within a very narrow paradigm,” Aphramor said, adding that it can be hard to fully accept that the type of science taught is only part of the picture. “It can be a really big thing to recognize that what we’ve been calling scientific practice, if it ignores all the data on social determinants, hasn’t been scientific practice at all.”

Even harder for health practitioners to accept, she said, is the idea that mainstream methods of addressing obesity could actually be harmful. To do so would force them to come face to face with the limits of their own power.

“We’re taught, as health professionals, that we’ve got this power to change,” Aphramor said. “[HAES] is a more real position, it makes us more vulnerable as health care practitioners, and it’s not what we’re taught.”

A weight-neutral approach

Bacon said that when they are training physicians in the HAES method, the first thing they usually say to them is, “Think about what advice you would give someone in a thinner body? Now think about what kind of modifications you want to make given the context of [a heavier person’s] person’s body.”

“We start from a weight-neutral approach, and then the second stage is how do we accommodate this body,” they said. “You don’t tell a fatter person, ‘Go join a gym,’ given the stigma and all that’s involved. You’re going to have to start from their experience, what’s comfortable and safe for them, what’s something they’re going to do.”

In other words, if a doctor would give advice on strengthening and stretching to a thin person with a knee issue, they shouldn’t just tell an obese person with a knee issue to lose weight. But that’s exactly what happens in many cases.

“If what we’re saying is ‘and you should lose weight,’ then what happens then is the person lives in a body they hate, which in itself causes pain, and is more likely to lead to poor self-care behaviors, and shame and blame go along with that,” Aphramor said. “If you’re helping this person to learn to live in a body and accept this body despite the fact it causes pain, it’s a very different thing.”

“Promoting diets promotes weight stigma, and that’s a problem. It’s a human rights issue. It’s not about effective clinical treatment, it’s about human rights.”

Next: Health obsession and “body projects

Carrie Dennett, MPH, RDN, is a Pacific Northwest-based registered dietitian nutritionist, freelance writer, intuitive eating counselor, author, and speaker. Her superpowers include busting nutrition myths and empowering women to feel better in their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute individualized nutrition or medical advice.

Seeking 1-on-1 nutrition counseling? Carrie offers a 6-month Food & Body program (intuitive eating, body image, mindfulness, self-compassion) and a 4-month IBS management program (low-FODMAP diet coaching with an emphasis on increasing food freedom). Visit the links to learn more and book a free intro call to see if the program is a good fit, and if we’re a good fit!

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