Updated: May 1, 2020
I am a fat registered dietitian. And no, I do not mean that in a negative way. To me, “fat” is simply a descriptive word for my size 20 body. It does not define who I am as a person. It does not add or take away my worth. However, it does often influence the actions of the people around me.
I have experienced my unfair share of weight discrimination and stigma. Frankly, the resulting feelings of shame and discouragement suck. It can feel even worse when coming from your doctor or other clinicians. I became a registered dietitian for this reason. I wanted to be the type of clinician to empower my patients, no matter the size or shape of their body, to help them reach their health goals.
My journey to becoming a registered dietitian has been challenging to say the least. I have a Master of Public Health degree in Nutritional Sciences from one of the best public health universities in the country. Throughout my education, it was ingrained in my brain that there are so many factors that play into a person’s health. I was trained to keep an open mind and to deliver the best client-centered care possible.
In all honesty, I am disappointed my higher education was unable to do the same. Do not get me wrong. I feel so fortunate to receive the prestigious education, to have access to so many opportunities, and to meet the many wonderful people that I did during graduate school. However, as a public health university, I think they could have done better to be more inclusive of their students in larger bodies.
Most of the classrooms were not designed for those in larger bodies. For three semesters in a row, I had a class in a large auditorium with a layout much like a theater. The seats were so small, I could barely lower the desk over my stomach. Imagine taking an exam in those desks. Through trial and error, I was able to determine the seats in the very back of the auditorium and those along the aisles were slightly larger. (The desk was only at a small angle during tests when I lowered it over my stomach.)
As part of a public health university, the conversation in many of my classes turned to how we as health care professionals can tackle the “war on obesity”. For a solid two years, the message I heard over and over again was, as an obese individual, I am going to die from my weight. It did not matter if I exercised regularly during the week, ate a nutritious and well-balanced diet, or attempted to sleep seven hours nightly. Even though there are so many determinants of health, my weight would ultimately kill me.
This is the message I heard for two years from many of my public health classes. It frustrated me to no end, because I did not feel welcome in my own school. I no longer felt like a unique individual. I was the example of the “health crisis” our field was in war against.
I will say, my nutrition classes were a breath of fresh air. I had the opportunity to take classes specializing in eating disorders, weight stigma, and motivational interviewing. It was in these classes I first learned of the Health at Every Size (HAES) approach. Most importantly, I met like-minded future registered dietitians who fully believed in this HAES approach.
I no longer felt like a unique individual. I was the example of the “health crisis” our field was in war against.
Fast forward to my next two years as a dietetic intern and (finally!) a registered dietitian. Overall, I have met amazing clinicians and supporting staff who genuinely care about the well-being of their patients and work hard to deliver patient-centered care. However, I still believe the healthcare system has a long way to go to eliminate weight discrimination and stigma.
I have witnessed clinicians joking in private because a patient was unable to lose weight since their last visit. I have heard clinicians stating they could not imagine how their patient manages moving around with a body mass index (BMI) of 40 kg/m². As someone with a BMI of 40 kg/m² who regularly exercises, I wanted to scream at them for being so ignorant and disrespectful.
As a fat registered dietitian, I also experience weight discrimination and stigma from my patients. On a pretty regular basis, patients will often look my body up and down and incredulously ask if I follow my own recommendations (mind you, I always use a HAES approach with my patients). My time working in a bariatric clinic was particularly challenging. I was asked on a regular basis why I had not already undergone weight loss surgery.
Overall, the journey to becoming a registered dietitian has been challenging. Do I regret it? Not in the slightest! Health care needs registered dietitians in larger bodies to help shift the conversation. We need to be more inclusive and empowering with the goal of eliminating weight discrimination and stigma in the care of our patients.
I am a fat registered dietitian and I am determined to change the conversation in my field. No matter the shape and size of your body, you deserve to live a life and receive care void of weight discrimination and stigma.