Thread by @HelenlouWest

A few discussions I’ve had on here recently have turned to Intuitive Eating and HAES (non-diet approaches) with other professionals raising doubts about the usefulness of IE and non-diet in healthcare - with some going so far as to call it ‘anti-science’ 1/

Critical thinking is obviously important - it helps us move forward, learn more and answer questions. This is a relatively new area of research, with gaps and so (as someone who is still learning), questions are valuable 2/

However, after some reflection, I feel that there is a “us vs them” sentiment occurring between professionals unfamiliar with/in opposition to the principles and application of non-diet approaches, and people using this framework. Which is unhelpful 3/

I think this stems from a lack of familiarity of what HAES/IE involves from a clinical standpoint & miscommunication, in part due to the spectrum of views that occur under a HAES banner, not all of which are (or need to be) coming at it from a scientists/clinicians perspective 4/

The main reason for this is that HAES/non-diet is a framework (set of guiding principles) borne out of a social justice movement. It’s an acronym used by a number of groups, from health care professionals (in a range of disciplines), to individuals to activist groups 5/

Note: ‘HAES’ itself is a trademark of the Association for size diversity and health - a social justice movement committed to tackling size discrimination in healthcare. Not at all non-diet practitioners practice under the HAES banner 6/

Understanding these views, means taking a look at systems of privilege and power within our healthcare system and understanding ‘who’ and ‘how’ we are letting people down with our current approaches and narrative about weight and health (Weight centric or BMI base healthcare). 7/

The first way we can learn more about this is by listening to the people who have experienced harm from the way we currently approach and talk about weight and health 8/

For example:

https://twitter.com/yrfatfriend/status/1069771082855399425

However, many people interested in these approaches from a clinical and scientific perspective are not denying that people with larger bodies statistically have a higher risk of disease. Or that weight loss is always ‘wrong’. Or that every body is healthy at every size 9/

What this approach is trying to figure out, is how we, as professionals can make our care structures better. 10/

It’s doing this by challenging assumptions about size and disease, particularly the cultural discourse which labels people as ‘unhealthy’ based on BMI alone (ignoring health behaviours and physiological marker of health). 11/

It’s looking cross disciplines, to social and psychological theories about weight, health and disease and recognising how complex systems influence risk e.g. social determinants of health 12/

e.g. ncbi.nlm.nih.gov/pubmed/30428717

It’s thinking about at how we can improve our practice by minimising the risk of dietary interventions; looking more closely at ‘risk vs benefit’ (& not assuming diets/weight loss is harmless); Identifying more clearly who would benefit from e.g intuitive eating 13/

It’s considering how factors which we don’t currently take into account in weight studies, such as weight bias, stigma and even health behaviours can influence disease risk in larger bodies 14/

Recognising that the words we use, shape our identity and status within society - and that the words we use as professionals in care and health promotion can strip people of autonomy, power and respect as individuals and human beings 15/

Okay, so this thread is way longer than I intended, but essentially I wanted to share two thoughts/suggestions 16/

The first is to people skeptical of this approach. Please continue to be critical - but also be curious. Unpicking all of the different ways our current approach may be harmful takes a long time, and often is uncomfortable. 17/

Please be mindful that although we don’t yet have all the answers and these things are hard to study, this does not invalidate them as lines of enquiry or make them a ‘fad’. An absence of evidence is not the same as evidence denial 18/

If you work in weight loss services, you may be surprised - much of what you already do with your clients is probably included in non-diet interventions (it’s the focus on weight loss as the ultimate ‘goal’ that differs most often on a practical level) 19/

The second is to clinicians and scientists working in the HAES non diet space. Be kind. Give people the space and room to ask questions (many will be useful in plugging holes in understanding) - phew -END/