by Health At Every Size® Blog

by Linda Bacon, PhD

Woulda, coulda, shoulda. And now, did! Drowned as we are in pronouncements from the fat-fighting world, how much do we long to take the fight to their door? How often do we wish we could hash it out in public, and test the Health At Every Size® model against baseless claims about the perils of obesity?

Well, at long last, I did enter the lion’s den (backstory in a recent post) to face conventional weight loss advocates and make a public case for a HAESSM approach. I did poke holes in studies that supposedly show evidence for sustained weight loss (link to excerpt), did show the evidence behind why intuitive eating works and dieting doesn’t (link to excerpt), and did explain the social psychology that underlies resistance to the HAES message. Did lay out the evidence that the War on Obesity has done more harm through collateral damage to its own side than through vain attacks on the “enemy,” fat.

My debate with John Foreyt, PhD, a prominent anti-obesity researcher, took place before an audience of well over 1,000 dietitians and other professionals on September 25 at the Food & Nutrition Conference and Expo (FNCE) in San Diego, the annual meeting of the American Dietetic Association (recently rechristened the Academy of Nutrition and Dietetics). (An audio recording is available from the ADA for $15.)

Just a couple of good things to come out of the session were stronger bonds in the nutrition-HAES community, a petition for the ADA to form a HAES dietetic practice group (please sign if you’re an ADA member), and a promise from ADA staff to tighten FNCE conflict of interest disclosure requirements for speakers. Above all, though, the event represented one more breakout for the HAES message from behind the longstanding “obesity sound barrier.”

A recap follows, my take on where points were scored for the HAES side and lessons and fixes to take with me to the podium next time.

(“Next time” is already on the calendar, by the way – in June, vs. leading Canadian obesity expert Arya Sharma, as blogger Quantum Acceptance describes. And more “next times” undoubtedly will follow. As for Quantum’s suggestion that the two sides “hug” and make up, however, read on for my response.)

THE DEBATE

It won’t surprise practiced HAES defenders to hear that my presentation covered evidence belying the myths around “obesity=death” and other unsupported claims. I discussed confounders and the difference between association and causation. I reviewed CDC and NIH data that undercut the agencies own advisories on BMI. And I delved into the wash of corporate money that unavoidably seeps into common beliefs, research, academic publishing, and public policy decisions in the obesity field.

Dr. Foreyt reprised familiar lists of the “health detriments due to obesity.” His response to my challenges on the data consisted, essentially, of this: Everyone knows fat is bad for you. It’s a no-brainer. When confronted with data showing pursuit of weight loss to be ineffective, he again trotted out canards drawn from Popular Wisdom. Sure it’s difficult to maintain weight loss, yet it’s always better to keep trying, he insisted illogically, even if you regain it. (Say it with me:) It’s a no-brainer.

Seems he’s right: There is a decided “brainlessness” to the arguments for an international war on fat.

STRENGTHS AND “NEEDS IMPROVEMENT”

I managed to anticipate all of Dr. Foreyt’s arguments. Rather than rebut him directly on BMI, for instance (sigh, what’s the point – he was on the government panel that lowered the BMI standards, and I can’t imagine he’ll ever publicly admit the politicking that went into this decision, in which NIH adopted guidelines favored by the diet industry in the face of evidence suggesting that raising BMIs might have made more sense. The backstory is in my book.), I took the occasion to address the relentless barrage of misinformation and understandable self-interest that can make it hard to hear and internalize the HAES message (link to excerpt).

I do hope those points were heard by many audience members. The data supporting a HAES approach are strong. It’s the ability to consider it that is the limiter.

Think about what it would take for an audience of conventional health providers to really challenge themselves. After all, they probably chose their professions because they care about health and are committed to helping people. A HAES approach suggests that what they have been doing is not only unhelpful, but actually harmful. Who wants to believe she or he has hurt people?

It would be the most natural thing in the world to resist this message.

If I had to do it over again, and of course, if I could have found more time than was available in our limited format, I would have spent more time engaging the audience on the emotions they felt as I spoke. The more public speaking I do, the more I recognize that emotional connection matters more than a thousand facts and data points.

My task next time will be to draw more on my experience as a psychotherapist and work more empathy into my presentation. Suppose I asked my listeners to consider the idea that they have hurt their clients and watch what that evokes, noting how hard it must be to stay in that emotional place. I could ask them to tune into the feelings that arise when they realize that they may not be able to deliver the fantasized weight loss, and what it must feel like to share that with clients. (Too touch-feely for an audience of professionals? Something to think about.)

If they recognize the cost to giving up the old ideas, the thinking goes, they may better understand where their own resistance comes from. And that could help them see the tremendous power they have to make substantive change in people’s lives if they face up to their resistance and adopt the HAES model.

Lastly, I am glad to say I managed my tone. I was calm and respectful throughout, something Dr. Foreyt (who is, it should be said, a generally genial man) didn’t always manage. At one point, he sneered:

Thank you, I appreciate you have published one paper, so thank you, on that. There was no weight loss in your study, but thank you.

Of course, how telling was it that he dismissed the study as a failure because there was no weight loss, when its very point – and success – was to demonstrate that health improvements can result without a focus on weight loss? That one line really exposes the hypocrisy when fat-fighters profess their concern for health, but betray an obvious focus on weight over everything else.

I do admit to taking one cheap shot, but this one was just too hard to resist…

Eating in HAES is not about monitoring your weight or counting calories or fat grams. It’s not about drinking Slimfast, vegetable juice, or carrying a plastic module that supplies a whiff of vomit to help you maintain your diet… [Audience laughs.] Oh, be nice. Don’t laugh. Dr. Foreyt has actually done research on all of these and can tell us the advantages to that whiff of vomit.

It’s true! He published research on “Aromatrim,” which apparently impressed him since he also appeared in advertisements plugging its benefits. (I assume it goes without saying that Aromatrim funded his research.)

CONFLICTS OF INTEREST (COI)

Before we leave that topic of COI, I should add this. The ADA requires that we provide a disclosure of interest. (Follow links to view John’s disclosure and mine.) In the speaking contract, the ADA specifies that “While an interest or affiliation with a corporate organization does not prevent you from making a presentation, the relationship must be made known to attendees.” The ADA even provides us with a disclosure slide as part of the template we are instructed to use.

I used no slides during the debate but voluntarily described my potential conflicts of interest in the course of my talk. (Really, I disclosed the lack thereof, since, as a matter of principle, I accept no corporate funding for my research.) Dr. Foreyt did use slides, but omitted the required COI disclosure that had been inserted by ADA staff. When this omission was brought to the attention of ADA staff after the fact by me and journalist Pattie Thomas, who is examining these issues, we received the following response from the ADA Director of Professional Development:

We will follow up directly with Dr. Foreyt regarding the lack of the disclosure slide and verbal acknowledgement at the educational session. Additionally, we have already made notes for FNCE 2012 regarding enhancing the language in the speaker agreements indicating this new mandatory slide in each speaker slide deck.

This is a major development. Perhaps audiences would hear information about weight loss differently if they know a speaker is a paid Slimfast representative?

THE RESPONSE

Q&A, Twitter and the Press

I am (the HAES community is) forever indebted to stalwart HAES backers in the ADA, who agitated to help get this debate on the map in the first place. They and other supporters also turned out in force at the event itself, which drew a crowd that easily topped 1,000.

The sizable HAES presence did more than just bolster me. It sent a powerful message of conviction and numbers to the HAES-hostile, -agnostic or merely -curious in the rest of the crowd. The 500 HAES stickers that ADA/ASDAH members Dawn Clifford and Michelle Neyman Morris brought were quickly snapped up, and it was way fun to see it on lapels all over the convention later. I’m sure it inspired many important conversations.

Also, several people amplified the HAES message in the Twittersphere. Other notable HAES advocates posted to their blogs: check out smart commentary by Marci, a dietitian, and dancer Ragen Chastain (Dances With Fat). (Great to meet the two of you personally, by the way!)

THE PAYOFF

Initially, I refused payment from the ADA for this appearance. I assumed offering a gratis appearance would make it more likely that I would get a spot, and, later, when I was pushed into a debate format, was the best way to assure my interlocutor and I approached the issues on a high professional plane, with deference only to the research. I also disliked the idea of accepting fees that come, indirectly, from the many food, diet and pharmaceutical companies that pitch their goods through the ADA; it feels like tainted money to me.

But when I learned Dr. Foreyt would be receiving $1,000 for his appearance, I renegotiated my contract for the same. (How come they offered me only $500 at first?) I will be donating my stipend to ASDAH.

“KISS AND MAKE UP”? NOT SO FAST…

One of my few regrets in this debate was the way it ended. Audience member Julie said something to this effect:

The health risks are real and undeniable. I want you to kiss and make up. Linda, stop saying the health risks of obesity are exaggerated. John, stop saying that intuitive eating doesn’t work.

Well, sorry Julie, but no can do.

Most every objection to the Health at Every Size model (that it’s “giving up;” that never-mind-the-data-we-”know”-fat-is-bad-for-your-health, that obesity impedes an active lifestyle, etc.) relies on a paradigm that the HAES approach itself rejects. The HAES model has an answer, is an answer, to every one of these concerns, but you can’t pursue a HAES approach as long as your health model revolves around weight.

There’s no question of “making up,” really, because there’s no fight. What there is is a vast and unbridgeable difference in opinion and outlook. It’s not just desirable but required of us – as professionals and thinking people – to tolerate such differences, weigh the evidence and reach our own opinions.

We don’t ask climate change researchers to “make up” with global warming deniers, do we? Should flat-Earthers have “made up” with Christopher Columbus? This is where the broad acceptance of the obesity paradigm proves so pernicious: How can we consider evidence that counters what we “know” to be true? (Copernicus’s opponents “knew” that the sun circled the Earth.) It seems to take time for evidence to build and sink in before a paradigm shift can happen. For the majority of Americans who struggle with weight and weight paranoia, change can’t happen soon enough.

I have no personal beef with Dr. Foreyt or any weight-control advocate. But that doesn’t mean our ideas are, or ever can be, compatible. A HAES perspective works when and only when we disregard weight and focus instead on attaining the best possible health.

If the goal is just to make everyone skinnier, good luck with that. But if the war on obesity’s true aim is to help all Americans achieve greater health, a HAES approach will get us there.

The HAES model is not an alternative in the arsenal against fat. It exists to disarm that arsenal. It’s a fundamental paradigm shift in the way we think about fat, disease, and our bodies. A HAES path is the only route towards a more compassionate – and healthier – culture.

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