How to Start A Conversation about Intuitive Eating/Health At Every Size

How to start a conversation about Intuitive Eating and Health at Every Size - Dietetic Interns @thewellful thewellful.com

Being a dietetic intern is hard. I don't think many people will disagree with you there. You're unpaid, working maybe your first full-time job, and changing rotation site, responsibilities, location, preceptor, and expectations every few weeks - or days! I feel you. I actually wrote this post when I had 2 months left of my internship so I totally get where you’re at if you’re struggling - but you’ll get through it!

For my internship I had at least 13 main preceptors and at least twice as many RDs who I shadowed and worked directly under during the internship. Which means you have endless opportunities to learn from so many people and see different perspectives, techniques and approaches. It also means, it's very likely that there will be some who you don't agree with or see how you would approach a situation differently. This is OKAY. In fact, that’s awesome - how lucky are we to be able to have so many teachers and opportunities to grow and learn. But it can be difficult at the time.

I don't believe there is ever a time to belittle someone else's work or beliefs - because nobody is all right or all wrong, we each have something to bring to the table and something to learn from someone else. But as the imperfect humans that we are, it can be hard to navigate these feelings and passions and figure out the most productive way to express them, especially within the dynamic of being in the position of being the "learner" as a student or intern.

Which brings me to HAES® Health at Every Size. If you're a HAES informed intern or even if you're a HAES informed RD practicing in an area where your colleagues or supervisors are not, it's a tough spot. Like anything that you’re passionate about or well researched on, it’s important to learn how to become a strong communicator on that idea or passion so that you can share it and clearly express it to others. Remember, sharing and advocating for something you’re passionate about is different than a ‘my way or the highway’ attitude (we’ve all seen that before). We all have so much to learn, none of us have all the answers, and I find it most productive to assume that everyone has good intentions and is doing what they believe or were taught, is best. Just like you. Especially if you are in a position as a dietetic intern or where you are being trained by other more seasoned professionals, know that you are there to learn, and at the end of the day you will incorporate what you learn in a way that aligns with your passions. So if you are in a situation where you would go about something differently, ask questions, bring up what you’re thinking and get curious! Ask “would you ever do XYZ with a patient like this?” You are bringing up your thought AND sharing a possible new perspective with your preceptor. As you do this, it may invite conversation - maybe they’ve tried that in the past, maybe they never thought that way before - your preceptors will learn from you too!

Finally, it is NOT your job to convince anyone of anything - when’s the last time someone tried to force you to believe in something? How did that go?…When something is forced on us, we resist. So, whether you’re trying to navigate advocating for HAES, Intuitive Eating or something else you’re passionate about - it’s easy to get swept up and blinded by your passion and how you wish things were different. I’ve had lots of conversations over the past year about incorporating non-diet approaches into traditional programs in school and healthcare and these have been some of the best tips and techniques myself and others have used to not only ‘get through it’ but feel like your voice is heard too.

If right now you’re thinking “…what is up wit all this HAES/IE talk in nutrition and online recently? I don’t even know what this article is talking about.” check out this post for resources and a breakdown of HAES.

SO…what do you do?

1. Take a breath and try to gain perspective. Remember how you would have acted in the situation before you were HAES informed. Also remember that we don't all agree and our past experiences inform our future practice. So it is amazing to want to share all that you know about HAES and the harms of dieting but just like when you're counseling a client, the other person needs to be ready and open to hear it. 

2. “Know your current position is temporary.” Kathleen at @TheRDNutritionist actually gave me this advice on a particularly tough day, which was so helpful and a good reality check. I had a patch a few months ago where I was really struggling with what the knowledge I had learned from other RDs and resources about HAES and how it can be incorporated into the MNT and in/outpatient settings, but was living a very different reality during a rotation where patients were very much primarily interested in weight loss.  (If you’re there Fiona Willer AdvAPD has incredible resources for this exact situation!) The internship is your opportunity to learn and see and practice. Afterwards, you will decide what parts of it and in what way you will implement them into your actual work as an RD.  You won't like or agree with everything you see, but remember that it is a chance to see and learn a lot, and that it is not permanent. 

3. Bring it up! As I've gone through my rotations, I've developed more of a knack for talking about HAES, Intuitive Eating a the non-diet approach (but always improving!). In the beginning I would brush over it because I was nervous about starting a conflict or getting a question I wasn't able to answer. But then I realized that just like I didn't learn about this in school, neither did many of my peers or preceptors! So this information, resources and research needs to be shared by us - the people who are educated and passionate about it! Or if you are not yet comfortable speaking about it, refer to credible resources who can offer some info.  Personally, I struggled the most as I went through my outpatient rotation - because many of the patients were on such a hamster wheel of chronic dieting and extreme weight loss goals. So I started to bring it up.  My preceptors already knew what I was interested in (because I was working to develop a course for the hospital on Intuitive Eating - more on that another time!), and when I would meet with a preceptor to chat and recap after a client session, I would ask general questions about counseling and nutrition goals but also ones aimed more to a non-diet approach and if that would be something that the preceptor ever does with clients.  I experienced a lot of encouragement when I first brought these topics up to some of my preceptors and I left my first week feeling like I was going to be the ONE to re-vamp our outpatient office. I was going to make handouts, create a training guide, and even was approved to give a talk on IE to the outpatient RDs Some conversations will be easier than others. But don’t count any win as too small!

4. Discussion and Critical Thinking are Important! Remember how you felt the first time you learned about HAES. Uncomfortable? Guilty? I was lucky to learn about HAES and IE while still in school and even though it contradicted certain aspects that I had been taught in school, I had not been in practice yet. I'd imagine and from speaking with other RDs who have gone through the transition later in their career - it's a tough pill to swallow. If this sounds like you, I’d encourage you to read some of the stories of RDs who transitioned from a weight-centered approach to non-diet during their career and the obstacles and lessons they learned along the way. (Alissa Rumsey, Rachael Hartley, Haley Goodrich + Christy Harrison) To learn about research and techniques that are unfamiliar to you even after going through our intensive nutrition curriculum and training can be hard. So put yourself back into that person’s shoes and think about planting a seed rather than plowing down the forest.

Lastly, if you’re reading this article, you’re already doing the work. You’re looking into the best way to approach and bring up these conversations, you’re curious about how others have done and if you’ve never heard of Intuitive Eating or Health at Every Size yet - then you were welcoming enough to open up this article and learn more! There is so much work to do but we need to acknowledge the small steps along the way.

If you’re a dietetic intern and wondering how to incorporate Intuitive Eating or HAES into your internship experience feel free to email me brenna@thewellful.com. I had so many amazing people willing to give me guidance along the way and am happy to pay it forward!

Two other articles that are helpful on this topic:

What it’s Like to Be A HAES-Informed Dietetic Intern - Lauren Newman via Rachael Hartley, RD, LD

HAES + My Education - Amy Hanneke, RDN, LD