the HAES® files: The Expert Stance

by Health At Every Size® Blog

by Hilary Kinavey, MS, LPC

I met with a new-to-me physician to talk about some challenging symptoms I had been experiencing – unprecedented fatigue, changes in my cycle and sharp mood fluctuations that were outside my norm.   I was ready for someone new to take a look at my symptoms and my history with fresh eyes.  I searched for this new provider and was told that she was experienced with a curious, scientific mind, which was exactly what I was looking for.

I have Polycystic Ovarian Syndrome or PCOS. Sometimes getting helpful and empathic information about PCOS feels like a challenge.  Lots of the info out there is geared towards improving fertility, which is a challenge for some who are diagnosed, but has not been my primary concern.  PCOS shows up with a varied presentation from person to person.  I was diagnosed 7 years ago and have, over time, become one who listens to and trusts my body despite the challenges this syndrome presents.   In fact, I am the only accurate historian of my body’s idiosyncrasies, nuances, and patterns.  A big part of learning to live in my body with my hormonal challenges has been learning to love and care for myself as I am.  I do not focus on my weight (as a problem) and in doing so have become more tuned into what are the best ways to take care of myself and my body.  Body trust and acceptance has been far more valuable to me than any dietary protocol, recommendation or medication that has been offered so far.

As the physician and I began to talk the day we met, it became clear our goals were different for the appointment.  I shared some challenging history with her, as well as ideas about what has and hasn’t helped over the years and asked the many questions I had.  She seemed to bypass what was most important to me rather quickly.   She began recommending a protocol that was specifically orientated towards weight loss, recommending an enormous amount of “things that I need to do and should never do.”  She admitted this would be difficult to pull off (particularly with my young children, she noted), but it didn’t deter her from writing it up.   Instead, she gazed at my body with pathologizing eyes (at a minimum), missing the fullness in my story and my own body knowledge, cooking up a plan to remedy her judgment instead of my request for help.

The shame. The rising, hot shame of being seen as a problem to be solved was right there, front and center.  It tore me in two. I knew her recommendations were not going to meet my true needs, but I did not want to be any more vulnerable in front of her, so I found my presence becoming much more quiet and small. It was painful to find myself acquiescing just to get out of there. Honestly, I can’t think of anything more costly to me than following her protocol and bypassing my need to be heard, seen, and responded to. But I had years of pain that rose to the surface that said otherwise.

When my body was named as the problem, it was as if her “expert stance” meant I should assimilate her limited, biased view of me into my sense of self. You know, take it “on board” and make some changes because she knows best. Her invitation was to jump into hypervigilance as if it was a health behavior, to dump the enormous amounts of self-care I already engage in to follow an unsustainable protocol (that did not address the concerns I vulnerably brought to her in the first place). Her eyes saw something in me that was not truly there – that I could and should change the body I live in – the one she cannot accept. In an effort to build rapport with me, she made efforts to bond over how tempting cupcakes can be, or how difficult movement is to fit in. But these weren’t MY concerns or thoughts – not mine at all.

I’m guessing she and I would tell very different stories about this appointment. But weight discrimination is commonplace in health care even if providers don’t own it as such. We also know that weight loss prescriptions aren’t working either.  Why aren’t providers more cautious about the way in which they address weight in their offices, especially when the failure rate and emotional consequences are so high? Likely because the dieting culture has made us all so afraid to let go of our focus on weight over whole person health.  What I wish I had asked this doctor is, “What would you recommend for a patient with similar concerns to mine that lives in a smaller body?”

It took a little while to regain my footing after this appointment.  The judgment was hard to shake and it took many reminders of my core truths – and of my love for and care of myself – to recommit to eating normally without restriction or backlash.  I remind myself I am not a problem to be solved, even if weight discrimination is a possibility again.

I hold hope that health care can evolve.  I believe providers can learn to address their own internalized weight bias – especially the more we talk about it.  Regarding the encounter I had with this physician I say:

If you can’t SEE me then you can’t treat me.

Kinavy.U02Hilary Kinavey, MS, LPC, is a licensed professional counselor and cofounder of Be Nourished, LLC. Her work encourages movement toward a compassionate model of radical self-care to heal internalized body shame and associated patterns of chronic dieting and disordered eating. She is the co-creator of Body Trust Wellness, a Certified Daring Way facilitator, and a transformational workshop leader. Hilary is a popular speaker on topics such as Health at Every Size®, intuitive eating, and body respect in health care communities, and a regular contributor to the Huffington Post. More information about her work can be found at http://www.benourished.org or on Twitter @BeNourished.

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