I was distraught when I found out the young girl I had been working with had an eating disorder. She was 12. She had dropped to 80 pounds before coming to see me. Her parents found me through a past client I had worked with on weight loss as a personal fitness trainer. Because my client liked that I focused on healthful nutrition that didn't require calorie counting or restriction, she thought, like these parents thought, that I could re-educate their daughter on good nutrition. I was going to help her unlearn whatever was taught in her health class at school (so many now focus on childhood obesity) that seemed to spur this on and return to her normal weight. With the consent of their pediatrician, who also seemed unaware of this little girl's desperate situation, we worked together for three weeks. After we saw no progress, at the parents' request, I asked a physician I worked with closely for a recommendation, and she sent them to a registered dietitian who specializes in eating disorders.
It was this RD who gave me the final push to become a Health at Every Size advocate. I had been aware of this idea that people could be healthy at a variety of weights and what actually mattered was treating concrete physical and mental health conditions, not the weight that might be associated with them. As a nutrition coach in a gym setting, however, my knowledge of clients' health relied on their memory and their own awareness of their health, which was often not much.
It was a relief to get hired on at a medical practice where physicians treated health conditions and I provided practical support — things like translating medical jargon about grams of fiber into real food that real people eat. So when the RD assessed this young girl who was losing weight rapidly and recommended she be hospitalized immediately and join an in-patient program because her vitals were at dangerous levels close to death, I was surprised. I had relied on this girl's doctor to tell me if she had a serious health condition that needed specialized care, something outside my scope of practice. I had had minor disagreements with physicians before about how their weight-loss recommendations and their recommendations to lower cholesterol or prevent diabetes conflicted with each other, but little did I know that the physicians I relied on did not know standard screens for eating disorders, and their understanding of EDs, a deadly condition, was incredibly outdated. It hit me pretty hard. It was one of those situations of "If I had known, I wouldn't have..."
Before healthcare, I had planned on becoming an ecological researcher, but as my career developed, I couldn't stand the lonely months in remote wilderness and the poor pay, and I wanted to do more doing than observing and prescribing. A woman on my roller derby team was a personal fitness trainer and turned me on to the idea. First, I took a certification class in order to at least learn about injury prevention for the many students and seniors who volunteered to set up our research plots, which required intensive digging and carrying heavy equipment in 100-degree Mojave Desert heat. Then, it was during my three-month internship at a local gym when I fell in love with the profession. I coached one team on weight loss — women wanting to lose 30-plus pounds. At the end of the three months, the boutique gym held a celebration for all teams. I was shocked by the outpouring of deep, intense emotions and how happy these men and women were, saying their lives had been changed. I had never had anyone thank me for saving their plants and animals from extinction, so the reward for having touched someone so profoundly in a way that seemed rather simple was powerful.
When I moved to Orange County to move with my boyfriend and become a full-time personal fitness trainer, I was floating on a Mother Theresa cloud of weight-loss goodness. My main interest remained helping people dealing with injury get out of it so they could enjoy the outdoors, but, as you might imagine, most people hired me to help them lose weight. After a year, I got certified in nutrition coaching. But I was no longer coaching people who wanted to lose 30-plus pounds for health reasons; I was coaching people who wanted to lose 10 to look ripped. I, myself, had to refine my already healthy lifestyle so that people would want to hire me and my body. I felt so surrounded by the obsession of my colleagues and gym members that it started to feel like a game I had to play until I found a way out. But I couldn't let go of this idea of helping people because my education, public health knowledge, my employer, my colleagues, and my clients were all in on this idea that weight loss was necessary to achieve health and happiness.
I felt uncomfortable when the young woman broke down sobbing after her free body-fat testing. I ended up remeasuring and lying to her because I didn't want the responsibility of damaging her self-esteem. I felt uncomfortable with the severe depression being expressed in my consultations from men and women whose spouses bought them gym memberships because they were afraid they had given up on life. I grew concerned when gym members who asked me for advice in passing couldn't talk to me about anything else except for food or exercise. I was immensely unhappy in this culture but kept trying to convince myself there was something wrong with me. The only saving grace was meeting some great, down-to-earth clients that I remain friends with to this day.
I found my way out when I was hired into a medical practice to help with consultations for an executive hospital program. I worked directly with 10 physicians and hundreds of executives from multinational corporations. Orders came from the top. I now had a clear understanding of people's actual health as measured and diagnosed by doctors instead of a cheap blood pressure cuff and heart rate monitor. My job was to help with realistic lifestyle goals and behavior change. What I loved about working with executives is they would openly disagree with me, providing me a chance to grow and help better. But even from them I continued to get a fluctuation of feedback about weight loss. One person wept in my office when she had just started re-gaining weight even though she was still following the strict and socially limiting diet outlined by the RD she worked with the entire year before. One person put me in my place and yelled at me when I told him that he needed to do more if he really wanted to reach his goals. Another person returned the following year and was elated after having lost 80 pounds that changed his life. And I had medical experts working alongside me who were incredibly smart and talented and caring tell me when one of their patients needed to lose weight.
What continued to be missed even in this highly regulated environment was mental health. The attitude was that mental health is less than physical health: It could be imagined away, it could be fixed with a made-up form of positive psychology, and it was uncomfortable even for many, but not all, physicians to speak about with patients. It's no wonder that it's required for people to divulge information about heart disease, diabetes, and injuries before starting a health program, but no one gets screened for eating disorders, abuse, addiction, anxiety, or depression before starting a weight-loss program.
After five years in Orange County, I have since moved and shifted my business focus. I thought becoming a HAES advocate might clear things up, tie together mental and physical health, and make my job less confusing. But when people learn of my career path, the first thing they ask me about is weight loss and assume I'm helping with the obesity epidemic. It doesn't matter how much I present the idea with science; for those who accept HAES or weight loss, it's a deeply personal story and choice filled with emotion. As someone trained in research, trained to know everything about their subject and test their ideas before making a conclusion, I see with my own eyes every day that there is something way bigger going on in this American weight story than a bunch of confused people who don't know how to eat right or work out.
There are adverse childhood experiences, there is depression and anxiety, there are underlying and misunderstood health conditions, there are ranges of disordered eating, there is prescription-caused weight gain, there are mistakes in applied research, there is grief, there is relief, there is freedom, there is ability, there is sexuality, there is poverty to plenty, there is image.
What I've started to experiment with is instead of me making the choice for someone else to care or not care about their weight; instead, I leave that choice with the person it matters to most. I help them uncover what their health is, what their values are, and what self-care means, and partner with both therapists and doctors to help with screening and guidelines. But am I OK with helping people lose weight if they choose it? I'm not sure. Choice is something each person rightfully deserves to have — it is their body — so can we come up with a middle ground to safely treat either choice?