A Clinician's Experience, An Advocate's Perspective: Charting a Weight Inclusive Approach to Health
Assistant Professor, Nutritional Sciences; Research Assistant Professor, Center for Human Growth and Development
November 12, 2018, Faculty, Nutritional Sciences, Advocacy, Dietetics, Health Disparities, Nutrition, Obesity
As an undergraduate, I thought I was going to go to medical school. I liked science and that’s what you were conditioned to do if you liked science. When it came time to pick a pre-med major at Michigan State, nutrition seemed more interesting and applied than other pre-med options, so I enrolled as a nutritional science major. As I took those classes, I learned about the field of dietetics and I came to understand what dietitians did. When I started taking dietetics classes, I felt so energized and knew I had found the career for me.
I worked as a cheerleading coach at Lansing Eastern High School and as a Peer Health Educator when I was an undergraduate. Though those jobs felt separate at first—mentoring adolescent girls and doing health programming on campus—I quickly found that whether I was coaching teens or talking with college students, I was speaking a lot about the importance of having a healthy relationship with food. For the first time, I saw that we often talk about people’s bodies in a way that causes harm. I became passionate about non-diet approaches to health and about combating the narrative around weight and dieting in dietetics that I saw hurting so many. The problematic fixation our culture has—the framing and rhetoric we use to talk about weight and body size—harms people.
When I found I could specialize in adolescent nutrition, that was my eureka moment, the culmination of all things I focused on as young student. After completing an Adolescent Nutrition Fellowship at Boston Children's Hospital, I took a job as outpatient dietitian there, working with people with eating disorders and in a weight management clinic. Those seemingly different positions taught me that the patients that I saw were more alike than different. Everyone I worked with had really challenging relationships with their food and their bodies, and they experienced a lot of suffering because of that. They were the “lucky” ones, though, with treatment options and access to care. There were so many who didn’t have access. That observation got me passionate about prevention, and that’s what ultimately led me to public health and back to school. I thought, “How can we prevent these patients from ever getting to this place?” I wanted the people I was seeing to never need to see me.
Right now, I’m working on weight inclusive nutrition and eating disorders prevention. I observed in my clinical work that the nutrition advice we give is often weight-dependent. The fat advocacy community often points out that we prescribe to fat people what we diagnose in thin people. I see this as a major problem, the idea that what we define as a “healthy relationship” with food is dependent on your body size. Informed by my clinical experience and the perspectives of the fat advocacy community, my work looks at weight inclusive approaches to health—how we can promote health in a way that’s independent of body size and how we can promote health and nutrition without inadvertently increasing weight bias, body dissatisfaction, disordered eating, and more.
One of my most exciting projects addresses the way we talk about weight within clinical settings. With funding from the University of Michigan’s Momentum Center, my students and I just completed a pilot study in my lab where we simulated what happens to adolescent girls who are confronted during doctor visits with language around weight that we know is stigmatizing. Though clinicians may talk about weight with the intent motivate their patients, we found that participants felt worse when they left their visits after being told they were “obese” or “overweight.” When we took a more weight-inclusive approach with a focus on health rather than weight, patients left feeling better—their mood was better and they felt more body-satisfied. So what we saw was that changing the way that we talk about things—the words we use—led to better outcomes almost immediately. We’ve just put in a grant to be able to scale the project up with the goal of changing standard clinical practice.
I am first and foremost a scientist, but I’m also very active in advocacy. I have learned so much from my interactions with with activists in the field of eating disorders and fat acceptance, whose voices are not always recognized in academic societies. I feel that my job as a researcher and someone with a lot of privilege is to raise the voices of advocates whose perspectives are under-recognized. There isn’t necessarily a good road map for being an advocate in your scientific field. It is critical that you remain objective in your science and rigidly adhere to the scientific method, so that your interest in being an advocate never bleeds into your role as a scientist.
In general, eating disorders prevention is not a topic we talk about in public health. There are very few schools of public health with courses and faculty studying it, so it’s inspiring to see the students here at Michigan Public Health, and the support I’ve gotten from my department, as we work to put eating disorders prevention on the map in public health. We have a lot of wisdom in the public health field and now we’re pioneering ways we can apply that to something that’s never been framed as a public health issue before. I’m truly fortunate to have a lot of talented, passionate students working with me who have taken on projects related to eating disorders prevention.
I think people come to the field of eating disorders prevention honestly. So many students find me and my lab because they have seen the harms associated with the ways society tends to talk about weight, body size, and nutrition and they know there must be a better way. That’s what’s fun about the area that I study, that people come to it with this kind of passion—it’s people that care about others and bring enthusiasm from personal experiences. The best part of this job is being able to meet students where they are, find out what excites them, and take them along this scientific process of making a contribution to a field they care about deeply.
Ann Arbor is home for me now. Moving back to the midwest after living on the East Coast for many years far exceeded my expectations. I realized quickly this was the best place for me to live, and this is where I could settle in and make my best life. There’s a culture at Michigan of supporting work-life balance. When I’m not in the classroom, I get to do the things restore me—cook, do yoga, and hang out with my dog Sophie. I love all the stereotypical things that are great about Ann Arbor, a walk in the Arb, microbreweries, tailgates—the small town Ann Arbor stuff we sometimes take for granted. Coming to the University of Michigan was like coming back home and I couldn't be happier here.