Fencing at FNCE: HAES and Weight Management

Yesterday at FNCE, dietitians witnessed an event with a split personality. Was it a debate? Or was it a conversation? The title said it was both – a debate and a conversation on weight management and Health at Every Size®. (People in the HAES movement want you to know, that’s their trademark.)

Whatever it was, it was a good faith effort. The presenters – Christy Harrison and Bob Kushner – did a fine job of offering diverse views on nutrition care. Best of all, no one threw food or insults.

Common Ground

Harrison, a HAES dietitian, opened with a vision that all dietitians share. In that vision, professionals apply solid evidence to support the health of their clients. First and foremost, RDs must commit to a code of ethics. To doing no harm.

Fundamental Difference

Thus, the divide between the weight management approach and HAES can be frustrating. That’s because the divide centers on the impact of obesity on health. The concept of obesity as a chronic disease repels folks in the HAES movement. In fact, many of them hate the o-word.

But Kushner, a past president of the Obesity Society, told the audience that this debate feels like a false dichotomy. Weight inclusivity, health enhancement, respectful care, eating for well-being, and life-enhancing movement are all important for HAES. They’re also important to weight management professionals.

Nonetheless, that fundamental difference remains. HAES practitioners believe treating obesity as a disease is wrong. On the other side of the fence, obesity professionals devote themselves to understanding the physiology of weight regulation.

Shared decision making

Both approaches seek anchors in evidence-based practice. They try to work from the best available evidence, clinical expertise, and patient preferences. Though neither presenter discussed shared decision making explicitly, it’s essential. Especially when working with patients on health behaviors. Practitioners should present patients with unbiased information about options. They should discuss pros and cons for each option. Including the option of doing nothing. At that point, a patient’s values take center stage. Then, and only then, the patient and provider can make a good decision. Focusing on the values of the patient serves to reduce stigma. It respects the patient. And it leads to better care.

In the end, one question remains. When excess body fat is harming health, is that a disease? Or is body fat merely a physical characteristic that varies widely among individuals? Among serious medical researchers, the answer is pretty clear. For HAES advocates, it’s equally clear. But the answer is completely different.

Thanks to Nina Crowley and Eileen Myers for their wise perspectives on this conversation.

Soldier Fencing, Another Reclining; sketch by Georges Seurat / WikiArt

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October 23, 2018