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A Move Toward the Dark Side?

by Dr. Jenny Copeland

“It is better to light a candle, than curse the darkness.”

In this movement, it often appears that we should choose between the two sides of a dichotomy. We must either uphold the HAES principles in their purist form or reside among the fringes of the community, isolated. The decision often feels “either / or,” leaving those who wish to proceed with a choice between belonging and exclusion.

We have among us professionals who have chosen the difficult path of existing within weight-loss centric environments, implicitly participating in the pursuit of weight loss to varying degrees. Rather than choosing the exclusion from this company, which accompanies genuine honesty in these cases, many choose instead to remain silent. To exist in this manner, as a solitary candle within the darkness, is hard. And until very recently, I was one of these professionals.

I am the psychologist on a bariatric surgery team. I perform pre-surgical psychological evaluations, provide psychological treatment as needed, and run a local support group for those pursuing or who have received weight loss surgery. The team I am a part of is made of respectful and compassionate providers – professionals who are not only aware of weight stigma dynamics but are also willing to learn more about them. I am proud to be a part of a team where my judgment is respected and patients have the relieving experience of being treated as a person – not a problem.

The most fascinating, enjoyable, and challenging aspect of my job is introducing individuals in this process to the HAES principles – especially intuitive eating and body respect. These are deeply ingrained in my philosophy, however, and not sharing them is not an option for me. That means from Day 1, my patients are exposed to this approach. Their recommended reading list includes The Fat Chick Works Out, Intuitive Eating, Embody, The Diet Survivors’ Handbook, and Health At Every Size. We talk about not waiting for life to start until after their surgery by learning to recognize the agency they have in their own bodies in the present, shifting from shame and blame to respect and acceptance. For some, the message simply does not resonate for them; they are not ready. They may even be convinced I am off my rocker: of course their weight is a problem and of course they are to blame for it, what could I possibly be thinking by implying otherwise?

The pieces all fall into place for others. And for them, amazing things have happened. One individual noticed recently that not only had she not been binge eating Halloween candy this season, but she had not even purchased a single bag. Another patient encountered feeding difficulties after a series of complications from the surgery. While I was frantically consulting with every expert I could think of and was suggested to me, she progressed from severe anxiety and pain with eating to consuming foods again. All on her own. How did she accomplish that, you ask? Two words: intuitive eating. She discovered “The Body Warrior Pledge” in Beautiful You prior to obtaining surgery and worked to change her inner dialogue to one of acceptance. With a little encouragement, she was able to rely on these principles while struggling in order to continue moving towards health and well-being. How would life be different for patients had they not been exposed to a body positive perspective? What is the result for patients who are only exposed to the HAES principles far after their surgery or, worse yet, who have never had that opportunity?

Research supports that the internalized experience of weight stigma has a tangible impact on an individual’s physical and emotional health. When people accept these stereotypes and prejudices as true, they experience corresponding increases in depressive symptoms, recurrent binge eating behaviors, increased caloric intake, decreased engagement in physical activity, increased cortisol reactivity, poorer weight loss outcomes when engaged in such treatment approaches, and higher HbA1C. Although there is little to no research on levels of internalized weight stigma in bariatric surgery patients relative to other patient populations, I would posit these individuals have significantly higher levels given their choice of intervention to “solve” the “problem” of their weight. We know that for the overall health and well-being of such individuals, internalized weight stigma cannot continue to go unnoticed. What, then, is the solution?

One of the most important facets of the philosophy we espouse is that these principles are valuable for any person, any body, of any shape or size. Should that mean those who are pursuing or have obtained weight loss surgery cannot benefit from them? I do not believe so. I believe we meet these individuals where they are in their level of body hatred, whether they choose an intervention we disagree with or not. It is for this reason I choose to participate in the bariatric surgery process, fully aware of the controversy and potential hypocrisy of such actions in our community. This decision is not for everyone: it can be unsettling and at times, outright disturbing for one who knows the perils of the pursuit of weight loss. Others may choose to work from the outside to dismantle this industry in the future.

I believe this overlooks the well-being of those who pursue bariatric surgery in the here and now. Although I may disagree with their choice, I will not undermine their agency and I do not have the power to change their minds. By the time I meet them, the majority of the individuals I work with are highly invested in this treatment option. Rather, by introducing the HAES principles these patients have the opportunity of full awareness of their options. If they choose to proceed with surgery, they are doing so with greater capacity for their health and well-being than they would otherwise have. The Health At Every Size® approach can be the candle, providing illumination and freedom that would otherwise, not be present. To me, that is worth it.

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