Transcript:

The Pursuit of Weight Loss: More Harm Than Good? (Episode 4)

The following is a transcript of The Pursuit of Weight Loss: More Harm Than Good? with Ayana Habtemariam.

Melissa Toler: Welcome to Hearing Our Own Voice, the anti diet weight inclusive podcast that centers black stories and experiences. I'm your host, Melissa Toler. I'm going to start out today's episode with a question. When you think of what dietitians do, what comes to mind? You probably think that they are the people that you turn to, to tell you what you should eat to lose weight, or to be "healthier". I know that's what I always thought dietitians did. And I'm sure a lot of other people have that same thought. In the past several years, though, I've become friends with quite a few dietitians. And I've learned just how weight loss centered that the field of dietetics can actually be. But many of the dietitians I know are working actively to change that. And today's guest Ayana Habtemariam is one of those dietitians. Ayana is a nutrition therapist, a certified Intuitive Eating counselor, and macro social worker based in Arlington, Virginia. She is the owner of Truly Real Nutrition LLC, which is a private nutrition practice, where she empowers clients to give up dieting in exchange for trusting their bodies and breaking free from food rules that result in feelings of failure and shame. She encourages her clients to embrace the beauty, power, connection that their food traditions and personal experiences and values add to their lives. She provides nutrition therapy for clients with disordered eating and those who are recovering from an eating disorder. She is committed to increasing awareness of weight inclusive philosophies in Black communities and believes that weight-centric approaches to health and wellness only serve to exacerbate body image issues, stress and anxiety, which all contribute to increased rates of chronic diseases often seen in Black communities. Prior to transitioning to her private practice, Ayana owned a community based nutrition company in Philadelphia, where she worked with community leaders and local politicians as a nutrition policy advocate and community nutrition educator. In this capacity, she wrote legislation that was introduced in the Philadelphia city council, testified on nutrition policy issues, and she developed and implemented community nutrition programs for nonprofit organizations. And finally, she is the co-founder of Reclaiming Our Plate, which is a collective of Black Registered Dietitians, empowering our community, centering our stories and creating a world where we are free to be, eat, and live in peace. And in this episode, Ayana talks about why and how she's taken a more weight inclusive approach to her work and the resistance that she faces from both clients and fellow practitioners. And we talked about how the pursuit of thinness and fitness can be really dangerous to our physical and mental well being. And she recounts her own journey of unlearning. So let's get into the episode today. I hope you really enjoy it. Hi, Ayana. Welcome to the podcast.

Ayana Habtemariam: Thank you, Melissa, how are you?

Melissa Toler: I'm really good. I am so excited to talk to you today. And before we get into it, I just want to start off our conversation by recounting the first time you and I connected. And it was late in 2019. Marci Evans, another dietitian, you had met her I think at a conference, and she connected us over email. And we actually don't live that far from each other, which is awesome. But we hopped on the phone, and I remember we had a great conversation. And I remember you talking about the challenges that you face as a dietitian and bringing a weight inclusive approach to your clients to your community and social circles. And so that led us to talking about how messages that we hear in the traditional health and wellness paradigm can perpetuate really harmful ideas about Black people around health and weight and weight loss, and how a lot of us have internalized those messages, especially messages about higher rates of obesity and heart disease and blood pressure and all of those things and I just want to say it was that conversation that led me to make the decision to do this podcast because you have real life experience and information around how those messages can be harmful. And we'll get into that. So I just want to say thank you. And so it's really great to have that conversation come full circle. And you know, as I mentioned, it can be easy for us to internalize those messages, which then makes it difficult to reject the current paradigm and actually consider something different. So with that, I want you to tell us, or can you tell us: What is a weight inclusive approach?

Ayana Habtemariam: Yeah, so weight inclusive approach is,I practice from a weight inclusive approach. And it just means that I don't believe that health, in whatever way we're defining health is contingent upon a "healthy weight". So people of all body sizes deserve nutrition therapy, counseling and treatment that is specific to their unique individual experiences, and not just the size of their bodies. And so a weight inclusive approach is the opposite of a weight centric or weight normative approach. So for example, a weight centric or a weight normative leaning provider will probably prioritize weight loss for a condition like high blood pressure. So you go to the doctor, they say your blood pressure is high, or dietician or whoever. And it's like, okay, lose weight. Research shows that when you lose weight, because you're this weight, it could impact your blood pressure in a positive way. The thing is, people of all sizes get high blood pressure. So when you're practicing from a weight inclusive approach, you're not focusing on the weight. A weight inclusive provider will provide recommendations to manage controllable stress, because we know stress contributes to hypertension, they might confirm that the client has access to consistent meals before saying, hey, restrict this, this and that. They might explore realistic and sustainable movement choices, and suggest foods that research shows supports a normal blood pressure, or normal blood pressure range.

Melissa Toler: Ah, yeah, thank you for that. I think your point about how many clinicians and health care professionals go right to weight loss as the solution. And one of the things that you just mentioned is practicing a weight inclusive approach should also entail investigating what foods a person has access to or doesn't have access to before telling them to restrict. And I think I have never encountered that. And I think that's something that is pretty, I guess, revolutionary in terms of the health, the traditional health and wellness approach. And so, because of that, I think there's a lot of resistance on the side of the practitioner, but also on the side of the client, because we've been taught that health and wellness looks a certain way, and that you have to do certain things. And oftentimes, weight loss is one of those things, you have to do certain things to achieve, "optimal" health and wellness. So can you talk about some of the resistance that you've received from clients or other practitioners when you are talking about your approach?

Ayana Habtemariam: Yeah, so I think so first of all, with clients before, when they hear that I'm a dietitian, or not just with clients with anyone, they usually assume that my job is to help them or help patients achieve a thinner, more muscular or leaner body by putting them on a restrictive diet or by saying: "hey, you can eat this, you can't eat that". Because people always say, "Well, what should I be eating? Am I eating the right thing?", and it's so so it can be annoying. but my but just research in my personal experience, and my professional experience, and general observations just living in the world have shown me that, time and time again, restrictive diets, they lead to weight cycling, body dissatisfaction, abnormal lab values, everything that people want to avoid, but people are constantly pursuing the weight loss. And so I like to give people, clients, random people that spiel. But still, even when clients know what my background is, and even when they know my philosophy and my approach, there's still that level of resistance, or still some level of resistance to putting weight loss on the back burner. And I see this in the form of clients saying something like they still have a small desire to lose weight, or they walk past the mirror, and they didn't like what they saw. So those thoughts of weight loss came up. I would say that's the most common form of resistance of clients, if you want to call it that. But I would also say that with us living in such a weight obsessed world, the weight obsessed world that we live in, it's also normal to have those thoughts and those thoughts can also occur while you're still strongly rejecting dieting and diet culture. I would say other things that have come up like during the first few sessions with clients, before they really started working on rejecting the diet mentality, and before we really start digging into the root of their beliefs about how their body should look, and why, because that's a really important part of giving up that dream body or that fantasy body that they might have. So they might have told me that they still plan to use a scale, and so that they're making sure they're not getting too heavy, and they're controlling their weight. Some people even share that they fear what people might think of them, if they gain weight. So there are people who, who get it, they're like, "Listen, I'm done weight cycling, I'm done dieting, I'm completely finished with this, but my family is going to judge me. My friends are going to say Oh, so and so has given up so and so has gained so much weight." And so there also comes resistance with adopting an anti diet weight inclusive approach with that, because we're worried about what people are thinking of us. But then I see really strong levels of resistance, not just from clients, mostly from people who still very much tie their self worth and their value to the size of their bodies, or how their bodies look. And an anti- diet approach feels threatening to them. And when I've had conversations with people who are just like, "I can't get with that, it'll be bad for me, I'll get fat, I'll get sick. And no matter what you tell them, those, those are people who you won't be able to get to, and they'll have to come to the realization on their own or to a realization, they'll have to come to some point when they realize that this isn't working for me.

Melissa Toler: Yeah. And you know, I'm glad that you validated that these concerns or the resistance come from, a...It's reasonable to think these things after living in such a weight obsessed culture that is, I mean, we're surrounded by images of fitness or quote unquote, fitness that looks a certain way. And there's the attachment of this thinness and fitness to not only health, but also eliteness and superiority for lack of a better word. And so it makes sense that we would want to achieve that. Right? It totally makes sense. So I just want to I'm glad that you said that. Because I don't want to vilify folks who still have thoughts of losing weight or looking a certain way. Because we live in a certain because we live in a culture that we do, it just makes sense to think that and it takes a lot of work to shift that thinking.

Ayana Habtemariam: Yeah, it does. It does. And I know you mentioned superiority and eliteness. And I would say even power and respect and access to jobs. And it's just comes with, I guess for some people a better life, unfortunately. And it's really sad. And we really do have to work on it. And I tell my clients all the time, I know we're doing this individual work. But we have to hit this from every angle, we have to change, there needs to be a paradigm shift, like you said in the opening, it needs to be a whole entire paradigm shift, because even as individuals, it's important to do that work on an individual level. But we can't function in a fat phobic society forever, because it's hurting us especially with with the health care model and the in the traditional medical model, you still have physicians out there recommending weight loss, and you still have, I don't know, I don't want to, I was going to say people getting bariatric surgery, which is like a stomach amputation. And I don't want to say that that's a bad thing. Because like we just said, sometimes people feel like it's their only option. But we really have to change this at the higher level at a systemic macro level, as well.

Melissa Toler: Yeah, I agree. Because you can and I know a lot of people, including myself, who have done a lot of work over the years and are still doing work to think differently and to treat ourselves differently and also treat others differently outside of that traditional health and wellness paradigm. But we're still in it, though, like we're, we're still surrounded by these messages, these messages Don't go away. So that brings me to my next question. In order to get to this point, I'm sure you've had to do a lot of unlearning yourself. And I know a lot of dietitians and I know that the training you guys receive is usually, and this may be changing, but it's usually very heavily aligned with the traditional way of thinking about health and weight. It often tends to not be weight inclusive, and can actually be super fat phobic. So can you tell us how you've like a little bit about your journey and how you've unlearned those harmful messages that you not only learned through the culture, but also through your formal training? How have you unlearned those harmful messages to get to where you are today?

Ayana Habtemariam: Hmmm So I, I gave this question some thought before we started and I was trying to like like backtrack and figure out years, but like you said, just living in this world and also being trained traditionally as a dietitian, 100% of my training was very fat phobic. It was very weight normative, weight centric. And I honestly don't know how I've unlearned so many years of that training. I've been a dietician for 13 years now. And I've been weight inclusive, I don't even want to admit it, just for about two years now. The thing is, my journey started longer than two years ago, prior to that. So I've been dieting. I had been dieting for a very long time, I started dieting when I was 16. And even as a dietician, I never liked giving weight loss advice. It just never felt right to me, I felt like it felt like a fraud. I felt like it was fraudulent. And part of the reason is because I knew how bad I struggled with my own weight. And so me telling other people to do this, this and that, and you'll lose weight, and you'll be happy, it just didn't feel right. So when I came upon HAES and weight inclusivity, and Intuitive Eating, I just felt like I found where I belong as a professional. I was like, "This is what I've been missing. This is why it never felt right." And I almost immediately stopped dieting. So maybe a year before that I stopped working out, I did a lot of weight lifting. I had been always in the gym, running, doing everything. And one day I said, I'm done with this, I don't feel like doing this anymore. I was beginning to force myself to do it. And so maybe a year later is when I came upon Health at Every Size, weight inclusivity, Intuitive Eating, and I immersed myself into everything anti diet. I became an Intuitive Eating counselor, and that training comes with a lot of research. And I read a lot of the research, not even all of it. I read the books, but it was kind of like an organic process for me. Everything just happened naturally. I don't know. It's just a really tough question. Because I really went from thinking that everybody should be exercising and eating the right things, to hitting diet rock bottom, and saying this is not working for me. It's not healthy for me, and changing the way that I practice. It was also important for me to surround myself with like-minded professionals, because this can be a lonely space. And it can be especially in the beginning stages, you can easily say, "Well, you know what it's easier to practice as a dietitian, as a weight normative dietitian". And it is, because that's what everybody wants, you know, people don't get it. But because of my own personal experience and my journey, there's just no looking back. I can't look back, and I can't ever see myself dieting, I can't ever see myself recommending a diet to anyone because I don't think it's ethical. And I think it's harmful.

Melissa Toler: Hmmm, yeah, over the years as I think about my own journey. And I agree with you Like when I'm asked this question, I'm like, Well, I don't exactly know when it started. It feels like a gradual process. But it seems like it follows the same trajectory as you where you just are like, Well, why am I doing this? And then you encounter other folks who are practicing Health at Every Size and a weight inclusive approach. And you're like, Oh okay, this makes sense. This feels right to me. And so when I think about my own journey, it was over a number of years, and I'm still on it. To be perfectly honest, I don't think there's a place where we kind of get to the end, and that gets all done. But over that time, I realized how dangerous the emphasis on weight loss and dieting can be, especially when we tie it to health. And I think it's really dangerous to Black folks. And I'm not using the term dangerous lightly, like I don't think it's hyperbolic to say that. I think it can be downright destructive. So in what ways do you think, or have you seen, the traditional paradigm be harmful to folks?

Ayana Habtemariam: Ah, it's so harmful, especially to Black folks, we already have these pervading cultural and stereotypical myths that paint us as being unhealthy, and like, larger than average, and as people who eat foods, just naturally that are high in fat, sodium and sugar. And as Black people, we've drank this Kool Aid, it was not just people saying this about us, we are now saying these things about ourselves. And that in order to be healthy, the only way that we can be healthy is to reject our cultural foods, and to be smaller, or be as small as we possibly can be. And it doesn't help that you have statistics that constantly say how we're at a higher risk of high blood pressure and heart disease and other chronic diseases like diabetes, but those statistics never say why.

Melissa Toler: Yeah Yeah. And connection. Yes.

Ayana Habtemariam: Yeah. And so, yeah, I see it in so many different ways. And I just think that now, we're going on these diets. And we're restricting. And we're choosing veganism. And I'm not saying that there's anything wrong with different diets, but I think we're doing them for the wrong reasons, a lot of them and we really need to get back to ourselves, we really need to know and understand our history in this country, our access to health care, or lack thereof, and how all those things, how compassionate care, and how access to health care impacts our health, and understand that it's not just our individual choices. Yes, individual choices are important. But that is not the only piece of the puzzle. It's not the only piece of the equation. And so in even the conversations that we're having with our health care providers, it's like, well, you're heavy. And so it's associated with your weight. And there's so much more associated with these chronic conditions besides weight. These providers aren't looking at the bigger picture. And the statistics don't look at the bigger picture. It doesn't look at stress and racism, and issues with housing, it just doesn't look at the whole entire picture. And then we as individuals carry the burden of making ourselves healthier. And I don't believe that this is an individual issue. So yes, I know, hypertension, and high cholesterol, and diabetes can be genetic. But they can also be due to stress. And they can also be due to systemic racism and other systemic issues, and the physicians aren't talking about that. You don't hear anybody talking about that. And so as Black people, like you said earlier, we internalize these messages. And we think that there's something wrong with us, as individuals as people, and we try to, again, reject their cultural foods, which make up a big part of our identity and who we are.

Melissa Toler: Yes, yeah, I totally agree. I think we've seen that recently with the COVID-19, and pandemic and early on in the pandemic, the news that it was disproportionately affecting Black folks in, in the US. And it followed the same trajectory as all of the conversation, or most of the conversation, around Black people and health. And it almost always paints us as, like you said, inherently defective, like there's something wrong with us, and/or people who consistently make bad choices. And neither of those things are empowering at all. And it's just so hurtful and harmful to hear people saying them. And the perfect example is the black Surgeon General of the United States who gave his little spiel, back in April or May. And so like it just is enraging, it really is enraging how those messages get perpetuated without going into like real systemic issues. And I suspect this because 1) it's very difficult to change systems, but also, 2) people think it's just easier to just blame it on personal irresponsibility and like just keep it moving. And that's the danger in these messages. Right? It puts all the the blame and responsibility back on the individual as if that's the only cause. And it just not fair. Yeah.

Ayana Habtemariam: And the other thing too, that I'm seeing, I know there are health care providers and dietitians and even ourselves, perpetuating this idea that we have to be smaller, we have to change our diets. But I also think it just has to do with with cultural beauty standards as well. Like we've assimilated into a dominant culture that values thinner bodies, and that wasn't always a value of ours. And no one should have to aim to achieve a certain body type. But at one point that just wasn't, those weren't our standards.

Melissa Toler: Yeah.

Ayana Habtemariam: And so I feel like the health piece of this is also an excuse, like, Oh, I want to lose weight, or I want a smaller body so that I can be healthier. But honestly, a lot of things that people are doing aren't healthy, it's just to achieve a certain aesthetic. So I think they're like two, two different pieces. I think it's this health piece, but there's also these these beauty standards that have changed, and everybody wants to be a certain size or look a certain way or have like a coke-shaped bottle or be "thick".

Melissa Toler: Yeah, yeah. And yes, you're right. There has been an intertwining of the aesthetic with being healthy, right like the images when you think about the images we see magazines, social media, TV, wherever the images of optimal health and wellness, you can guarantee that it is a thin-ish young ish, conventionally attractive white woman who almost always is doing some sort of yoga position. So like, that's the idea of health, like, that's what is sold to us. So it's really difficult to dissociate those aesthetics from what health actually means.

Ayana Habtemariam: Yeah, and I just think that trying to achieve that, like you said, it's dangerous, it's unhealthy. It's not good for our mental health, either, because a lot of people are trying to achieve something that they won't ever achieve. And so it's constant, "I'm worthless, I'm not good enough, because I can't I can't achieve this". And it's not it's not realistic, it's not achievable. And so it's devastating, it has a devastating impact and, and people are constantly exercising, and it becomes their lives, dieting and exercising, it becomes like a religion. And I think so many important pieces of our lives are missed out on because we're so hyper focused on our body image.

Melissa Toler: Yeah, it's like a never ending chase of something that you just will never get your hands on. And it's really frustrating to be in that space. So you do a lot of work to bring concepts like you mentioned Intuitive Eating and Health at Every Size to marginalized communities. How can people who are still struggling with the idea that losing weight is the only path to wellness, how can those folks start to think, and maybe even act differently?

Ayana Habtemariam: One thing, well a couple things I would say: if they're on social media, even any kind of media, watching TV, it's so important to expose yourself to a wide variety of different bodies, and people enjoying their lives and loving themselves and doing the things that they want to do when they choose to do no matter the size of their bodies. I think too often we're looking at people who have these unrealistic, unrealistic bodies, and who look different from us or just are images of things that aren't really achievable. And so I think we need to diversify what we're looking at and what we're consuming. And so diversifying your social media feeds, because I have clients who say, "Well, I won't do this until I reach this size". Well, maybe you need to see somebody else your size, or somebody else's similar size, enjoying their lives and having fun. So you can see that it is possible and you don't have to put anything on hold until you get to a certain size. The next thing I would say is just be compassionate with yourself and understand that it's okay if you, if you don't feel like you are good enough, tell yourself you are. "I am good enough. I'm living. My body has done a, b and c for me." Be kind to yourself, don't be harsh to yourself, don't speak harshly to yourself, speak to yourself like you would a loved one or a friend. Then I would also say, just start start doing some of the work if you have internalized fat phobia, or if you think low or negatively of people who are in larger bodies, start changing that, start challenging those thoughts.

Melissa Toler: Hmm, yes, thank you. And we definitely want to recognize that it's not easy, but those are some really great places to begin your journey. So with that, Ayanna, I just want to say thank you so much for spending time today sharing your story as a dietitian with us. So before we close out, why don't you go ahead and tell the listeners where they can find you?

Ayana Habtemariam: Sure. So I'm on Instagram mostly. And my handle is at the trill rd, T-H-E, T-R-I-L-L R-D. And also you can go to my website to find more information about me or book an appointment. And that's Truly Real Nutrition dot com. And one other thing I also started a collective for Black people with a couple of other dieticians, there are six of us total for people who want to divest from diet culture, in a safe space away from outside gazes and have questions and want to learn from dietitians and other like-minded people. So the Instagram for that is @reclaiming our plate. And we also have a private Facebook group for Black folks. Melissa Toler 29:09 Oh, thank you. That sounds great. I didn't I didn't know that. But I'm glad that you mentioned that. Well, thanks again. And I look forward to connecting with you sometime in the future. Take care.

Ayana Habtemariam: Thank you for having me, Melissa. Take care. All right, bye bye.

Melissa Toler: I love the work that Ayana and other Black weight inclusive dietitians are doing in the world. I think it's really important to have people like her using her skills and her expertise and her voice to not only help individuals but to also have a positive effect on the community overall. I hope that you'll visit Ayana's website and connect with her on social media. And all of those links will be provided in the show notes. And I also just want to say as always, thank you for being here today. I appreciate the time that you've taken out of your schedule to listen to these important conversations. And if you enjoyed this episode and the other episodes of Hearing Our Own Voice, please let me know by rating, following, and reviewing wherever you listen to this podcast. And also if you want to support the podcast to keep it going, please visit my website Melissa Toler dot com forward slash podcast, and click on the link to donate. contributions as little as $1 are greatly appreciated. And as always, I thank you again for listening to Hearing Our Own Voice.