By Alex Raymond, RD, LD
The majority of health professionals do not have eating disorder knowledge and do not align themselves with Health at Every Size (HAES) © values. Although there is a huge movement and a huge anti-diet community, we still have a lot of work to do.
HAES-centered providers, including myself, do a ton of advocating on behalf of their clients. Which is just so important. One of my goals as an eating disorder, anti-diet dietitian is to teach my clients how they can advocate for themselves if I can’t be there. As much as I LOVE my clients, my end goal is to help them so they don’t need me anymore, which is totally bittersweet 🙂 . Advocacy is especially important in a physician’s office. I am speaking generally here, but, many doctors are not well-versed in EDs and HAES. It can be extremely difficult to find a doctor who “gets it.”
This blog is about how you can advocate for yourself in a doctor’s office when the topic on weight comes up. This blog was inspired by a recent trip to my ob/gyn.
She commented I gained weight since our last visit and seemed concerned about it. She proceeded to say it was “fine” though because my “BMI is normal.” At the moment I could place myself in some of my client’s shoes who have had doctors comment on weight in the past. I followed up our appointment with a note (you can read it at the bottom of this blog as well as on my instagram… follow me at @empoweredeatingrd !!).
Read on to learn more about how you can advocate for yourself at a doctor’s (or other health care provider’s) office.
I would like to preface the rest of this post (and my letter to by obgyn) by saying that I do recognize the privilege I have (thin, white, cis, heterosexual… and others) lead me to having different experiences in doctors’ offices in the past. The comment my ob/gyn made on my weight is not at all similar to what those in larger bodies experience daily. I used the “o word” in my letter to comment on BMI. I do not use that word regularly. Lastly, if you are seeing a health care provider that makes your body feel wrong in any way you have the right to terminate care and see someone new.
1. Come prepared.
You may want to consider having the conversation at the start. Perhaps the first conversation you have with the doctor (or NP or PA). Meeting a new provider can be really intimidating, especially if you’re worried about how they may broach the topic of weight. It may be a good idea to send an email or letter to your provider before your first meeting. I really like this blog by Ragen Chastain. If you scroll down to the end of the blog, you can find cards she created. These cards include… “Helpful Phrases at The Doctor’s Office,” “Helpful Research for the Doctor’s Office,” and information on Health at Every Size… the cards have links to various research studies your doctor may be open to reading. I also LOVE this HAES letter from EDthirdwheel.com. This letter is an amazing resource for doctors to read prior to the appointment.
2. Bring support.
If you’re able, bring a support person with you to the appointment. Ideally, someone who understands your journey so far. They can be that person who may speak up when you feel you can’t use your voice (if you’re okay with that!). Or someone you can vent to if needed after the appointment. You may want to even consider seeing if your dietitian or therapist can be on the phone while you’re in your session. At least for a few minutes to explain more about HAES and intuitive eating.
3.See someone new.
Remember: Your body is NOT wrong. This may feel emotional to read, especially if you have gotten those messages your whole life. If your health care provider makes you feel wrong in any way, you are allowed to terminate care and see someone new. I can’t say this enough.
Letter to obgyn.
“Firstly, I wanted to thank you for the time you spent with me at our appointment a few weeks ago.
As you may remember, I am a dietitian that specializes in eating disorders. I also work with clients who have dieted their whole lives and are now working to make peace with both food and their bodies. One comment you made in our appointment hasn’t been sitting right with me. I just felt I needed to say something as I often encourage clients to advocate for themselves and I should do the same. .
You mentioned that I gained about Xlbs over this past year. When I said that sounded about right and didn’t bother me, you said it was fine because my BMI was “normal.” What happened in that moment is I was able to place myself in my clients’ shoes who often hear comments about their weight and body size.
What the comment insinuated to me, whether that was your intention or not, was that the weight gain was bad and alarming and that I should be concerned about it. The opposite is actually true. I feel healthy, energetic, and content with my body. Hearing the comment made me feel as if my body was wrong (probably not your intention, but that’s how I felt nonetheless), and for a brief moment I did question my eating and exercise habits. .
Additionally, you mentioned my BMI was “normal.” Using BMI as a measure of health is, well there is no way to sugar coat it, completely outrageous and terrible science. My BMI could be “normal” and I could be struggling with an eating disorder or have other diseases that might go missed because a doctor saw my weight or BMI was “normal.” Or I could be perfectly healthy and be in the “overweight” or “obese” category
Putting an emphasis on weight in terms of health is something that can trigger eating disorders and/or dieting for almost all of my clients. Some of my younger clients (like middle school age) go to their doctor and are told they need to lose weight, and that triggers the development of anorexia. Or it triggers dieting, and they wind up yo-yoing their whole lives. Neither are healthy.
This note is not written with anger or to question your professionalism. It’s unfortunate because our medical training is hyper-focused on weight for health outcomes. But it’s too narrow of a lens. I know you’re busy and I would encourage you to read research regarding weight stigma as well as Health At Every Size ©. Here are 2 links to get you started if you feel so inclined. I understand these studies offer widely different perspective, but I have found that this perspective greatly benefits my clients who have been treated with a weight normative view for their whole lives”
Advocating for yourself at the doctor’s office can definitely be uncomfortable. It can overwhelming or scary. But if your health care provider says or does something to make you uncomfortable, you absolutely have every right to say something. Speaking up might feel weird. Calling someone out is never easy. But you have every right to respectful and good care. This includes feeling respected.
Going to the doctor’s office in general can also be overwhelming or uncomfortable. You have every right to take the steps you need to take to make it a more comfortable experience. Email your doctor ahead of time. Have your dietitian give your MD a call beforehand. Bring a friend or family member. Whatever you need to do.
If you want any support or to talk more about advocating for yourself in the doctor’s office, email us! Or call us! We would love to speak with you, about going to the doctor’s, or anything else. Email us at firstname.lastname@example.org and call us at 240-670-4675.