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Confessions of a Radical Registered Dietitian
By Joanne Ikeda, M.A., R.D.

From Radiance Spring 1995 Issue

"A woman is calling on line one with a question about dieting. Can you take it now?" my secretary asks.

I'm the Cooperative Extension nutrition education specialist and a lecturer in the Nutritional Sciences Department at the University of California, Berkeley. If you call UC Berkeley for nutrition information, chances are you'll end up talking to me. That's because one of my myriad job responsibilities is to provide research-based nutrition information to those who need it. Most of my work is with health and education professionals and the media, but occasionally a layperson manages to find me.

I pick up the phone. "Can I help you?" I ask.

"I hope so," responds a mature female voice. "Do you read Woman's Day magazine? Did you see the article on Oprah Winfrey and the diet she went on to lose all that weight? I want to send that article to my daughter in Oregon. You know, my daughter has been fat all her life. I did everything I could to help her. I never let her eat ice cream, potato chips, candy, or other junk food. I always portioned out her plate at meals and never let her have seconds. I bought her special diet foods and made special low-calorie meals just for her. I told her over and over again she was never going to have a boyfriend if she didn't lose weight. After she graduated from college, she didn't come back to the San Francisco Bay Area. Instead, she settled in Oregon. I rarely see her anymore, but I know that she's still fat. Maybe if she goes on this Oprah Winfrey diet, she'll finally lose weight. I wanted to check with an expert before sending her the article. What do you think? Is this the right diet for her? After all, she's thirty-two years old, and it's about time she did something about her weight."

"Hmmm," I say as I think to myself. No wonder your daughter moved to Oregon: you're lucky she didn't move to Australia! Yet you persist in harassing her about her weight. Well, I refuse to give you permission to continue this. I am going to steer you in a very different direction.

"I can think of a couple of things you might send your daughter that would be a lot more helpful to her than that article."

"You can? What are they?"

"The first is a book entitled Great Shape, The First Fitness Guide for Large Women. It encourages large women to be physically active in ways that are safe and fun. This book can help your daughter learn to enjoy moving her body and become more physically fit if she isn't already doing this.

"The second thing I highly recommend is a subscription to Radiance magazine. Radiance is a wonderful magazine that encourages large women to live life to the fullest. It features stories about large women who are successful businesswomen, actresses, lawyers, psychologists, athletes, and so on. I think your daughter would enjoy it."

"Well, I might send her that exercise book, but I'm certainly not going to send her a subscription to that magazine!" responds the woman huffily.

"Why not?"

"I wouldn't send her that magazine because then she might feel good about herself the way she is now and not want to lose weight."

I could feel the explosion coming. "Look, lady, if making fat people feel badly about themselves helped, they all would have been thin a long time ago, because people like you have done a terrific job of that!"

End of phone conversation.

I have told this story over and over again. To the dietetics students enrolled in the nutrition education and counseling course I team-teach every fall semester at UC Berkeley. And to the registered dietitians, nutritionists, nurses, doctors, psychologists, coaches, physical education teachers, home economists, and many other health and education professionals who attend the Cooperative Extension workshops I present on Children and Weight: What Health (and Other) Professionals Can Do About It. I tell them this story after I show them a series of slides featuring very large men and women in various settings and poses. While they view the slides, they are supposed to write down three adjectives describing their personal feelings about the people they see in the slides. They usually think I intend to rant and rave about the terrible health risks of obesity. They are quite surprised when this turns out to be an exercise in self-examination - an examination of their personal attitudes toward large people.

I tell my students that no one but me will see their adjectives. Throughout the past five years I've noticed a shift away from overtly negative adjectives such as "gross," "lazy," and "stupid":toward more clinically oriented negative descriptions, such as "obese," "unhealthy," "physically unfit," and "high chronic disease risks."

Clearly negative attitudes toward large individuals are still common, even among those pursuing careers they hope will "help the obese client reach a healthier weight through good nutrition and increased physical activity." So I discuss the work of the esteemed psychologist Arthur Combs, who investigated the differences between effective and ineffective helping professionals.

"What did Dr. Combs find to be the major difference between professionals who are very good at helping others versus professionals who are not?" I ask my students.

"Giving more practical advice rather than talking in vague generalities?" says one. "Using better counseling techniques," suggests another. "Motivating them by telling them all the terrible things that might happen to them if they don't do what you tell them" says a desperate third.

"No, Arthur Combs found that the most important characteristic of an effective helping professional is the way the professional views his or her client. If you believe that the person you are working with is worthy, able, dependable, internally motivated, and friendly, you are much more able to help that client than if you view him or her in negative ways, that is, if you feel that he or she is unworthy, unable, undependable, externally motivated, and unfriendly. Now, look at your adjectives. How do you view large people?" Most of the students have guilty expressions on their faces.

Next I play a tape that Judy Freespirit, an activist in the fat liberation movement, made for me. She reads her essay "A Day In My Life." It poignantly describes the discrimination she endures on a daily basis because she is a very large woman. Many of the students cry while listening. That's okay. It indicates they are mature enough to confront their own prejudices and deal with them. I play the same tape for the health and education professionals attending in-service training meetings.

In my role as a Cooperative Extension nutrition education specialist at UC Berkeley, I travel all over the state, providing up-to-date nutrition information that professionals can put to immediate use on the job. These professionals are on he front line; they are the ones working directly with large people. Their attitudes will make a critical difference in whether they help or hurt in their interactions with those patients/clients/students. Most of them report that my training has helped them feel more empathetic toward large children and adults. They tell me that they expected to learn about counting calories and were surprised and delighted by my innovative yet practical approach.

After twenty-five years as a registered dietitian, I am familiar with my profession's "party line": that large people can lose weight if they permanently alter their lifestyle, that all they need to do is eat a low-fat, low-calorie diet and exercise every day for the rest of their lives. That if they persist long enough, and try hard enough, it will happen. My response is, "Bullshit," and I'm brave enough to say it out loud in front of my colleagues, which makes me a renegade. But someone has to stand up and publicly say, "It's time to accept responsibility for the harm we have done." We have done large people a great disservice in keeping alive the myths that it is possible for them to become permanently slender and that unless they become slender they can never be healthy and fit. Yes, "obesity" is associated with an increase in a number of health risks, but a search of the scientific literature reveals that no study has ever compared the risks of large people who have healthy lifestyles and are physically fit with the risks of those who do not have healthy lifestyles and are not fit. A telephone conversation I had with an "obesity specialist" at the National Institutes of Health (NIH) illustrates the problem.

"You mean to tell me there are large people who have healthy lifestyles and are physically fit?!" asks the specialist incredulously.

"Yes, there are. And I believe these individuals probably have fewer health risks than those who have given up on themselves because health professionals have reminded them again and again that they can never be healthy unless they lose weight. Instead of continually harping about weight loss, why doesn't the NIH adopt the slogan, Healthy at Every Size, and just promote a healthy lifestyle?"

"Well, that's an interesting thought," replies the specialist."I'll share that with some of my colleagues."

Another frustrating attempt to influence those who seem to be "in charge" of the national agenda with respect to weight and health. Unfortunately, power comes with numbers, and even though I am affiliated with a prestigious nutrition department at one of the world's greatest universities, I am a single voice in the wilderness.

Fortunately, more and more RDs are beginning to question the party line, especially the ones who actually work with large people. We are supported by recent articles in our professional journal, The Journal of the American Dietetic Association, entitled "Why Treatments for Obesity Don't Last," "Obesity Treatment: The High Cost of False Hope," and "Weight Loss Programs: Failing to Meet Ethical Standards." But even these articles suggest that we must try harder to motivate large people to devote themselves to a lifetime of eating right and exercising daily, as if none of them were doing it already.

As a health professional, I do have a strong commitment to helping all people adopt a healthy lifestyle - not in a way that is compulsive and constraining, but in a way that helps them enjoy their bodies and take responsibility for their care. That's why I was delighted to discover AHELP, the Association for the Health Enrichment of Large People. This professional organization represents members of the medical, mental health, health education, and scientific communities who accept the fact that people come in a variety of sizes and shapes and who are not really interested in changing that situation.

At the third annual AHELP meeting at Mountain Lake, Virginia, last April, I renewed my commitment to promoting size acceptance and to discouraging "dieting." These meetings rejuvenate me; all of a sudden I am not alone. There are others eager to fight the good fight. I will join them! Together, we can make a difference! We can end size discrimination! We can enlighten our colleagues and help them realize that if they really want to help large people, the first thing they have to do is accept them!

Upon my return to Berkeley, I send out an e-mail message to more than fifty university nutrition departments, announcing "May 5th is International No-Diet Day" and explaining why I support this event. The next day I receive a message from one of my colleagues in mid-America.

"Are you saying that obese people can be healthy? Now, Joanne, you've seen all those statistics about the strong relationship of obesity to noninsulin diabetes, heart disease, hypertension, cancer . . . ."

I write a long message in response, saying many of the things I've said in this article, and send it to everyone on our nutrition network. This is yet another opportunity to open people's minds and get them to question the way we have always approached this "problem of obesity."

I do other things, too. While attending a California Nutrition Advisory Council meeting, I suggest that "acceptance of size diversity" be incorporated throughout the revision of the nutrition education curriculum used in California schools. Back at my desk, I finish writing a pamphlet for "Big Kids" that will be published by the National Association to Advance Fat Acceptance. There is a lengthy phone conversation with a staff member from the Human and Civil Rights Division of the National Education Association who is investigating size discrimination in public schools. The book I coauthored with Priscilla Naworski, "Am I Fat - Helping Young Children Accept Diversity in Body Size" receives a rave review in the Journal of Nutrition Education.

I love my job as the University's Cooperative Extension nutrition education specialist! It gives me the freedom and flexibility to put my time and energy where I think it counts the most.

"Good things are happening!" I exult one morning to my husband. Then I open the Oakland Tribune and see the front-page article, "Fourteen-Year-Old Starves Self to Death." I read the sad story of a Chinese-American girl who thought she was too fat. She stopped eating, only to drop dead on the living room floor of her home one morning.

Two days later, I am working late in my office when the phone rings. I pick it up. It's a reporter with the San Diego Union Tribune., who says, "Today a fifteen-year-old girl in our community killed herself because her mother kept pressuring her to lose weight. Her uncle told us that she was awfully fat, as if that justified the mother's actions. Do you have any comment on this?"

"Yes, I do. We have a long way to go, don't we?"

JOANNE IKEDA, M.A., R.D., is a nutrition education specialist at University of California, Berkeley, and a size-acceptance activist.

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