Fatphobia Part 3: Some Thoughts about Diet Culture and Talking to Patients

Guest post by Ellen Vincent

I need to preface Part 3 of this series by saying that I had read the Fatphobia blog posts (Part 1 and Part 2) before, I had read Lindy West and Roxane Gay and completed the POCA Dept. of Education Fatphobia CEU, and more, but somehow none of that prepared me for what listening to the Food Psych podcast did to me. For some reason, it was a completely life-altering paradigm shift for me; a veil was lifted, the angels sang, and all of the previously unconscious or subconscious ways that I was restricting food all of the time, diet-bonding with other people, using movement as punishment, and colluding with diet culture without realizing it became hyper-visible to me, and I knew I had to stop all of that immediately. I wanted out. More than I wanted to spend one more second of time and energy trying to change my body, I wanted to be free of those thoughts. And I wanted everyone else to be free of those thoughts. I went really deep into that podcast and the whole anti-diet world of body and fat liberation.

In that process I realized some of the harm I had done to patients. I had fucked up many times with them despite my good intentions. And I know I will most likely fuck up again and say the wrong things. Maybe even in this blog post. So before I really get started here, I need to steal some disclaimers from Melissa Toler’s post and acknowledge my thin privilege. I have never experienced discrimination based on the size of my body. I am also not an expert on this topic. I’m not speaking for people who have been and are victims of fatphobia. If I use the word ‘fat’ it’s as a descriptor, not as judgment of another person’s worth or character.

I started talking to other punks about how they actually respond to patients who come in for weight loss, and I didn’t like the answers I was getting. The answers were not much different than what I had been saying to people (before), and I think we can all do better. Lisa Baird’s first part of this series did a great job of talking about how we as practitioners can be ethical by being honest about what acupuncture can and can’t do for patients looking for weight loss solutions. Please go read that first. And then, let’s go deeper with it and talk about what this really looks like in our clinics.

How are practitioners responding to all of the various clinical scenarios that show up in the context of diet culture?

How can we avoid colluding with the harmful idea that it’s better (or healthier) for people’s bodies to be smaller?

And how do we, as practitioners committed to delivering trauma informed care, respond to patients who come to us looking for help with their “emotional eating,” or with “food as an addictive substance”?

It’s not our job to tell patients that their goals are ill-founded, but because acupuncture is widely marketed as a magical tool for weight loss, it is our responsibility as members of the profession to acknowledge that even if we ourselves don’t espouse sizeist views, we are members of a class that has played an oppressive role. “When weight loss is casually laid on the table, weight bias continues and eating disorders persist.” Just yesterday, I saw a “community” acupuncture clinic’s fatphobic post on Instagram, an image of a thin white woman flexing her biceps, with the hashtag #WeightLossService. There was a dedicated Weight Loss page on their website that listed all of the horrifying statistics about the “obesity epidemic.” You know the one, the epidemic that’s not actually a thing.

The primary way that it’s “worse” to be bigger in this world is because our society stigmatizes and discriminates against large bodies (not to mention the fact that the world — just think about airplanes, restaurants, clothing stores — is not constructed with larger bodies in mind). “The number one medical complication in those with BED (binge eating disorder) and/or larger bodies is the poor medical and surgical care that those patients receive at the hands of doctors. It’s not diabetes, high blood pressure, or high cholesterol. It’s harm – both psychological and medical – that comes from often well-meaning medical professionals.” 

 “There happens to be a lot of evidence out there (scientific, peer-reviewed studies and everything) concluding that being fat is, actually, not bad for a person’s health. But the actual evidence doesn’t matter here, because the argument that fat is bad for one’s health is never made out of concern for fat people’s health. It is instead an argument made to justify being explicitly weight stigmatising and fatphobic. And because the ‘fat is bad for you’ myth is so accepted in our society, it is an extremely effective method of justification.” (https://thebodyisnotanapology.com/magazine/weight-stigma-101/)

Maybe it’s partly because of a fight I had with my mother a few years ago, but what I really find myself wanting to do these days is to just never come across as thinking that weight loss is ever a good idea — I don’t want to do or say anything that could contribute to the harm of fatphobia and diet culture. I want to stand as much in opposition to it as I can (without “social justice shaming”). I had been to the doctor that morning and made the mistake of looking to see how much I weighed, which was enough more than it had been 6 months prior that it was bugging me. My mom and I sat down to dinner and I told her about the few extra pounds bumming me out. “Oh,” she said, “you’ll lose that again, don’t worry.” I don’t know why I expected any kind of different response — I know my mom and her bias, her own history with dieting, her constant body talk — but I was so disappointed and angry. I realized that the response I really wanted was what I couldn’t even give myself — the permission to be any weight at all without it being a big deal. And that’s what I want to give to anyone coming to the clinic thinking that they should lose weight  —  basically, the kind of response that I had been looking for from my mother. Acceptance that doesn’t depend whatsoever on the numbers on a scale.

I made a list of some decent responses to different clinical scenarios for anyone interested in nurturing a size-friendly clinic that serves to acknowledge and counteract the pervasive harm that diet culture does to everyone (but mostly to people in larger bodies).

There will be no shortage of opportunities to practice responding well to the multiple ways that patients’ internalized weight stigma expresses itself from the recliner, and this list I made will not even begin to cover the nuances. Nor will it, or is it meant to, tell them they are wrong for wanting to lose weight. It is meant to show them that you are not colluding with “the part of their brain that believes they are unacceptable… You do not have to agree on everything in the body liberation movement to be a part of it, but if you are part of this movement, you must include all bodies. In order to include all bodies we must use language to question and denounce the levity we bring to weight loss conversations.” (from Be Nourished, Wanting to Lose Weight Isn’t Shameful.)

Every workday, I am surprised by the different ways people can ask to have their fat removed, their cravings erased, their appetite deadened. And every workday, I am excited to be able to answer them differently than I used to. I still lay in bed at night shuddering at all of the things I used to say to people (and I made another list of all of the wrong things to say).

I know that for a lot of people, this is a loaded subject. The media is highly effective at reinforcing the thin white ideal and the “fat is bad for you” myth, I know. And lots of people are super-attached to their “healthy” diets — from first-hand experience, I know. This list is a work-in-progress, and more than anything I want to continue this conversation and collaborate with all of you. What did I miss? How did I fuck up? What do you have to add? How are you going to talk to your punks about this? In case you missed the link above, here’s the document; I hope it’s a start.

p.s. POCA members, please share your thoughts here: https://www.pocacoop.com/forums/viewthread/9218/

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