Include Health at Every Size® principles in the Obesity & Weight Management certification

 

To the Commission on Dietetic Registration:

I would like to express my concern, and offer some alternative education, for the new certification for Obesity and Weight Management.  I am compelled to write about these concerns after reading through the definition of a Certified Specialist in Obesity and Weight Management (CSOWN) practitioner, the content outline for the course, and the reference list to study for the exam.  I am hopeful that these remarks will make it to the Task Force and have some impact on coursework selected for this certification, and therefore an impact on those practitioners choosing to apply to take the examination.  Hopefully, you will hear from a lot of professionals, like myself, who practice dietetics with a Health at Every Size® (HAES®) mentality.  Like-minded dietitians like myself, who believe in the HAES® movement, passionately want our voices to be heard in the Academy of Nutrition and Dietetics and would support more education on the HAES® principles for dietitians, nutrition students, and healthcare professionals.

Ironically, as a Registered Dietitian, I always said I hated the word “diet” and preferred to talk to clients about a healthy lifestyle.  In the beginning of my career 10 years ago, I was a Certified Diabetes Educator and advocated for weight-loss plans through “dieting” even though I didn’t think I was educating clients about the diet mentality at the time.  Through clinical practice and experience, I learned that I was wrong to put clients on diets and focus on weight loss.  A weight-loss diet has a 99% chance of weight regain and an increased likelihood of disordered eating behaviors.  I started to find my way as a non-diet dietitian when I started to see eating disorder clients and became an eating disorders expert, especially in the area of Binge Eating Disorder.  This is when I discovered the Health at Every Size® movement, and the Association for Size Diversity and Health (ASDAH).

According to the description of this new certification, “Over half of American adults are overweight or obese. In order to better assist individuals in their weight loss endeavors, the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics, is unveiling a new specialist certification in Obesity and Weight Management.”  The main issue I have with this description is the reference to “weight loss endeavors”.  A diet for weight loss does not work long-term and the focus on weight can steer a client in the wrong direction.  It can have a negative impact by leading to weight cycling, weight stigma, in addition to the risk of disordered eating and developing an eating disorder.  Rather, health should be looked at as a puzzle and each piece is important.  It’s not WEIGHT that needs to be addressed, but rather a person’s relationship with food and exercise, positive behaviors around food, eating for well-being, exercise that feels good, and emotional, spiritual, environmental, social, and intellectual well-being.  There’s no question that nutrition and exercise are important pieces of the puzzle.  However, positive behaviors in these areas do not necessarily result in weight loss.  In fact, some positive behaviors are associated with weight gain.  The HAES® approach is weight-inclusive, meaning that clients with diverse body weights and sizes should be respected equally.

When I read through the content outline and recommended research for this certification, so much of the content is focused on weight-specific recommendations.  Many dietitians pride themselves in being evidence-based practitioners.  The evidence shows that weight is regained after a weight loss program, no matter the approach (see this study from Mann, T. 2007 https://www.ncbi.nlm.nih.gov/pubmed/17469900  Why should the CDR train dietitians to promote weight loss if there is no evidence to support that weight loss efforts actually result in long-term weight loss?  Rather, it is known that positive behaviors around food and a healthy relationship with food will make a huge impact on a person’s health, regardless of weight.  A Registered Dietitian Nutritionist is the perfect professional to help clients on the journey to a healthy lifestyle, regardless of weight or the number on the scale.  RDN’s have the unique ability to use science, psychology, and physiological knowledge of the human body in order to help clients with weight concerns.  I would love to see HAES® concepts included in the content for the certification, or better yet, an entire section dedicated to the HAES® curriculum.  This would be helpful, not only to increase awareness among professionals, but to help clients who have weight concerns be taught the HAES® principles by those who receive this credentialing.

The HAES® movement may have a reputation to some people as being “healthy no matter what”.  This is simply not true.  Taken directly from the Health at Every Size® curriculum website (https://haescurriculum.com Health at Every Size® principles help us advance social justice, create an inclusive and respectful community, and support people of all sizes in finding compassionate ways to take care of themselves. HAES® is about respect for body diversity, including those bodies classified as “obese” according to the BMI chart.  Respect is so important because these bodies should be celebrated no matter what size they are.  These people have been “shamed” so many times and we all know that shame never helps behavior change toward health.  The HAES® movement is all about health, not weight, because people at any size can be healthy.

With that being said, I encourage the task force to read Linda Bacon’s book Health at Every Size: The Surprising Truth About Your Weight, as well as Body Respect.  I also encourage the task force to read the HAES Manifesto (http://lindabacon.org/HAESbook/pdf_files/HAES_Manifesto.pdf which includes many links to research articles and more explanation of their position.  This article, “Weight Science: Evaluating the Evidence for a Paradigm Shift” (http://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9 evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.  https://haescurriculum.com/ and https://haescurriculum.files.wordpress.com/2013/07/haes-curriculum-resource-list.pdf also have many resources for professionals to learn more about the HAES® principles.

Thank you so much for your consideration of this information.  I appreciate your time to read my letter and hope you will consider including information about the HAES® principles in the new certification program.

Sincerely,

Jennifer McGurk, RDN, CDN, CDE, CEDRD

www.eatwithknowledge.com

Health At Every Size® and HAES® are registered trademarks of the Association for Size Diversity and Health and used with permission

 

In my efforts to spread the word about my concerns for this certification and to hopefully include the HAES® principles, many of my colleagues came forward with their support.  These practitioners have agreed to add their names to this letter as individual signatures to show their support.

Valery Kallen, MS, RD www.valerykallen.com

Jamie Dannenberg, MS, RD

Josée Sovinsky, RD

Julie Duffy Dillon, MS, RDN, NCC, CEDRD

Darice Doorn, RD, LD

Aaron Flores, RD www.bvmrd.com

Michelle Kuster, RD, LD

Maggie Danforth, RDN, LD

Lindsay Stenovec, MS, RD, CEDRD www.nutritioninstincts.com

Beth Rosen, MS, RD, CDN http://www.goodnessgraciousliving.com

Erica Leon, MS, RDN, CDN,CEDRD  http://www.ericaleon.com

Christy Harrison, MPH, RD, CDN http://christyharrison.com

Lauren Fowler, RDN

Crystal Vasquez, MS, NDTR, Dietetic Intern

Rachael Hartley, RD, LD, CDE, CLTwww.avocadoadaynutrition.com

Annie Goldsmith, RD,LDNwww.anniegoldsmithrd.com

Ursula Ridens, RDN, Certified Intuitive Eating Counselor www.ursularidens.com

Dawn Clifford, PhD, RD www.motivatechange.net

Bobbi Hitchcock Boteler RD LD CEDRD Www.empoweredeatingblog.com

Julie-Anne Seale, RD

Mary Dye, MPH, RD, CEDRD, LD/N

Lauren, MS, RD, CPT

Alison Kouba, MS, Dietetic Intern

Brandi Olden RD, CSP, CD www.creatingpeacewithfood.com

Shanon Armfield, MEd, RD, LDN

Hillary Getty, RD

Julie Bowman, MS RD LMHC

Marci Evans, MS, RDN, CEDRD, LDNwww.marciRD.com

Danielle Miyazaki MS,RDN, CD www.creatingpeacewithfood.com

Elizabeth Saviteer, MS, LMHC, CN

Jill Sechi, MS,RD, CEDRD Www.jsechinutritiontherapy.com

Kelly Martin, MCD, RDN, CD www.creatingpeacewithfood.com

Julia Patterson, MS, RDN, CD

Cassie Barmore, MS, RD cassiebarmorenutrition.com

Megan Hadley MS, RDN, LDN www.simplenutritioncounseling.com

Aleta Storch, MS, CN, LMHCA

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