Chapter 2 in Treatment of Eating Disorders: Bridging the Research-Practice Gap, “What’s Weight Got To Do With it?” by Deb Burgard makes some powerful points. As a dietitian, weight is obviously a topic I end up discussing with all of my clients in some manner. Most of them are troubled by their weight, and often think that is The Problem to be solved. A sentiment I hear almost daily in my office is, “If I could just be thin I would be happy.”
Most of my clients believe is that being fat means they are unhealthy. This belief literally starts at birth when everyone wants to know the weight and length of the baby, and continues into childhood and adolescence when doctors or parents often make comments about weight, particularly after weight gain. Sadly, what most parents don’t realize is that the average female gains 40-50 pounds and grows 10 inches between the ages of 10-14 (Friedman, 1997). It’s not uncommon for clients to report that they were put on their very first diet by either their mother or doctor. Many doctor’s offices now have programs designed to “fight the war on childhood obesity.” Even schools have gotten involved, sending home BMI report cards.
As Burgard points out, there are no existing methods that are proven effective at achieving long-term weight loss to a “normal” weight for people classified as “obese.” The assumption that the BMI is a useful tool for assessing health isn’t accurate, so it’s not fair of us to rely on the BMI categories of “normal” and “overweight” or “obese” to begin with.
Another issue is weight cycling. Despite recognizing that the diets weren’t working people keep doing it, only to keep gaining more weight with each rebound. What is also fascinating is that people will keep going back to the same diet, knowing it’s unsustainable. When pointed out clients often chuckle and bow their heads in shame. “I just don’t know what else to do.” I share with them that the weight yo-yo’ing is more detrimental to their health than simply maintaining a higher weight. This is hard to accept, because it means acknowledging that their efforts to be healthier and happier have actually done the opposite.
Challenging a client’s strong assumptions about weight and health can be difficult. Compassionately exploring what s/he really believes weight loss will do takes time and requires a strong rapport, especially for the dietitian since weight loss is often the reason clients come to us in the first place.