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A Dietitian’s Road to HAES

by Joanne P. Ikeda, MA, RD

In the early 1990’s, it became apparent to me that we had no successful treatment for obesity. I came to this conclusion because I was very conscientious about reading the scientific literature. One of my myriad job responsibilities as a Nutrition Education Specialist in the Department of Nutritional Sciences at UC Berkeley was to keep abreast of the research and to extend the findings to health professionals if the conclusions had practical application. “If we can’t help large people lose weight, is there anything we can do to help them?” I asked myself.

One of the things that bothered me about research on “obese” people was that it always focused on weight loss. It was as if that was the only thing obesity “experts” cared about. For sure, they didn’t give a damn about the people they were treating. They hardly knew them. These experts would design a program and then would write a grant to obtain money to fund their program. Once the funding arrived, the researchers would hire staff to do the recruiting, the screening, the intervention, and the collection of data. Oh, they might appear at the first meeting of the patients so they could inform the group as to how knowledgeable they were and how lucky the patients were to be treated by such an esteemed obesity scientist. After that, interactions between experts and patients were pretty minimal. In fact, in my interactions with these experts, I sensed that they really didn’t like fat people; thought they were lazy and out-of-control; and they often made prejudiced statements about the people they were supposed to be helping.

Another thing I noticed was, they were totally preoccupied with only the physical health indices of patients. They collected data on their BMIs, their blood pressure, cholesterol, HDLs, LDLs, hematocrit, etc., but not one of them administered an instrument that evaluated the patient’s psychosocial health. Most of them got very nervous when this discrepancy was pointed out, and they usually said that the patients felt so much better about themselves when they lost weight. Not a word was said about what happened when the patients didn’t lose weight or regained the weight. Most studies lasted a year. There were 6 months of treatment and 6 months of follow-up. The success rate was based on the number of patients who remained in the program for a year. Dropouts were not counted, which skewed the data in the researcher’s favor. Even today, it’s easy to get the results of a one year weight loss program published in a scientific journal even though the data is meaningless. The gold standard used to be following people for 5 years after they completed an intervention. Now researchers talk about 3 years being ideal, and even with this change, people start to regain weight by the 2nd and 3rd year.

Along with changing the gold standard for what constituted “effective” treatment, the experts changed the goal. In the beginning, people were supposed to lose incredible amounts of weight to get to a BMI under 27. Then it was reduced to a BMI under 25. When the experts realized their programs were failing, they changed the goal. It became losing 10% of body weight. When they couldn’t even achieve that, they reduced it to 5% of body weight. Can people lose 5% of their body weight and keep it off? The results of the Look AHEAD study that went on for over 10 years found that the average person, after years of treatment, managed to lose and maintain the loss of 2% to 3% body weight. Is anyone clapping? No, and in fact, these results have not been widely publicized and the obesity experts are calling for more money for more research on treatment!!! Talk about a waste of taxpayer’s money – this is a real example.

In the meanwhile, many of us who had been brainwashed into believing that weight loss was the only goal worth pursuing, began to wake up! Someone actually asked, “How can we tell if someone is healthy?” Doctors had been assessing their patients’ health for years…how did they do it? They did it by taking a patient’s blood pressure, getting lab values for cholesterol, HDLs, LDLs, blood glucose and insulin, hematocrit, etc, and by examining and interacting with the patient. “Perhaps we should evaluate the health of fat people this way rather than just determining their BMI,” suggested some of us. But the obesity experts were not keen on this. “Why bother?” they would say, “we already know those people aren’t healthy. Look at all the studies showing that obesity is a strong risk factor for chronic disease!”

From the mid-1990’s onward, there was more and more research published that hinted at the fact that many larger people were healthy. None of it was given much attention. I thought the results of the National Health And Nutrition Examination Survey (NHANES) published in 2008 by Wildman would put an end to the debate when the data showed that over half of people categorized as overweight and nearly a third of those deemed obese were actually healthy! Again, no one appeared to notice. “Am I the only dietitian in the world who read this research?” I asked myself. It certainly appeared to be the case since my own professional organization, the Academy of Nutrition and Dietetics, endorsed weight loss as an achievable goal.

And then came bariatric surgery. Dietitians had even more patients to treat since this surgery causes havoc with the digestive tract. I am convinced that someday it will be viewed in the same way we now view lobotomy.

Finally, the results of the Look Ahead study were published in 2012 with no fanfare because after all the years of treatment and support, the average weight loss was around 7 pounds. “Why? Why?” I ask myself, “Why does the scientific community refuse to admit this approach has failed?” There are a lot of reasons. The so-called obesity experts are still with us. Many of them are in their 80s and 90s, but they don’t dare retire and give up the influence they have on the public and the government. After all, if weight loss is not possible, then they have wasted their entire careers trying to achieve it. Then there is the aspect of “following the money.” What would happen to all of these obesity experts, diet programs, diet products, diet books, and diet gurus if we gave up trying to get people to lose weight?

The group I feel sorriest for are the public health professionals. For years, they were underfunded. No money went into the prevention of chronic disease while billions were spent on treatment. The “obesity epidemic” finally persuaded politicians to loosen the purse strings and spend money on environmental changes that are much more supportive of healthy lifestyles for people of all sizes and shapes. Now there is an excuse for schools having quality physical education, for selling nutrient dense foods at lunch, and for not signing contracts with soft drink companies. Is doing good for the wrong reasons still doing good? Would politicians spend money if they were told it was to improve the health of the populace? Well, they’ve always had that choice, and they didn’t choose it until there was an “epidemic” declared.

I retired from UC Berkeley in 2007. My husband and I travel, do volunteer work, and some occasional paid consulting. I still keep up with research. I am active in NAAFA, ASDAH, and the Society for Nutrition Education and Behavior. I keep promoting the HAES approach and fighting size discrimination. My hope is that we will get a bill passed at the national level that will ban discrimination based on body size. My worry is that someday scientists will be able to genetically engineer human fetuses to be a specific size and shape as adults. Fortunately, if it does happen, I probably won’t be around to witness it.


Joanne Ikeda, MA, RD is a HAES pioneer and also a nationally recognized expert on pediatric obesity and the dietary practices of ethnic and immigrant populations. She co-founded the UC Berkeley Center for Weight and Health, and though she retired from UC Berkeley in 2006 as a lecturer, Joanne remains very active in the field of nutrition education. Joanne is the current Vice President of the Society for Nutrition Education and Behavior (having formerly chaired their Weight Realities Division) and also serves as a nutrition consultant to the Cartoon Network.

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