Practicing from a HAES® lens: questions with a psychotherapist
1. Please Introduce Yourself.
Hi there! I'm Lauren Linn, LMSW, a psychotherapist working in private practice in the New York City area. I operate from an intersectional, social justice oriented, trauma informed, and HAES®/fat liberationist lens. When it comes to ED/disordered eating, this looks like externalizing the shame the individual feels by calling out the systems and social constructs at play that cause harm, such as fatphobia and ableism.
2. What is HAES® and what led you to embrace this approach to health?
HAES® is super straightforward: it is an approach to public health that seeks to de-center weight loss as a health goal, reduce stigma around bodies, and promote the belief that everyone is worthy and deserving of equal access and regard. Put in an example, it's the belief that someone in a larger body deserves the same medical treatment as someone in a smaller body (versus the former being told to lose weight and the latter receiving legitimate medical care for the same condition). My journey to this work is really complex and begins with ballet class at 4 years old, one of my earliest memories. I stared at my reflection in the mirror as I pointed and flexed my toes during warm ups, looking at the other girls' bodies in the mirror as well and admiring their flatter tummies and feeling so horribly ashamed of mine. That was when a new student joined whose body was larger than mine, and an immediate wave of relief went through my four-year-old body. The point is clear and devastating: fatphobia not only reaches us that young but internalizes. It is potent and destructive. It made me hate my body before I learned I didn't have or deserve to. It took twenty-some years before I finally decided to try and love it as it is rather than forcing it to change by any measure possible. Before then, I went to Weight Watchers with my family as a ten year old. I begged for a treadmill as a twelve year old and would force my prepubescent body to exercise past its limits. I read diet books (The Diet for Teenagers Only sticks out — I highlighted and took notes all over every page, so committed to eating 1200 calories a day of "clean" foods (a diet culture propaganda buzzword) to get the "ideal body". My pediatrician showed me the (completely nonsensical and scientifically unfounded) BMI scale when I was about 7 years old and showed me the range my body fell into at the time and how I couldn't let myself go into the orange and red ranges of the chart. I was taught to fear weight for what it meant in terms of my abilities and access in this world. That's a lot for a child to cope with, and a disgraceful number of children sit with that fear too, right this second. I could go into a million other experiences I had throughout my life with harmful nutritionists who taught me very effectively how to have an eating disorder, endocrinologists suggesting things like phentermine to "speed up" my weight loss, a bariatric surgeon wanting to perform weight loss surgery on my 215 pound body that also has upper and lower GI Crohn's Disease, meaning that procedure could've ended my life. The damage is insurmountable. I sit with clients every day and hear shockingly similar experiences to mine, both in practices and core beliefs. I bear witness to that impact of fatphobia and diet culture, which further propels my dedication to this work. And even better: I have the privilege of supporting and watching people heal their relationship with their bodies and then take these practices with them into their personal networks. It's a privilege and honor that I do not take for granted to be a part of that healing for others.
3. Do you have any advice for those that have been discriminated against for their weight/size in a healthcare setting?
Amazing question. Yes. Firstly, I am so sorry to anybody who has experienced this harm. Your body is just as worthy and deserving of care, treatment, love, and respect as anybody else's and unfortunately healthcare hasn't caught up to that truth. My first piece of advice is to externalize any shame that is present as a result of those experiences. So often we assume the doctor knows best, but if the doctor isn't treating the body in front of them with the same care and expertise as any other then one can argue they are not providing competent care. That is not on you to internalize into shame. So instead of, "They're right. I need to lose weight..." and any continuation of those shaming thoughts, try: "Weight loss is not a medical course of treatment. I deserve to have my body treated equitably and fairly. People in all body sizes have things like high blood pressure, diabetes, heart disease, and other stigmatized conditions..." Take the pressure off of yourself and place it back on the provider that is telling you that you are lesser in some capacity because of your body. Fatphobic healthcare is harmful; your body is not the problem.
4. What is the best way to be assertive with your healthcare provider?
In terms of being assertive, I want to first acknowledge how hard it is to do this. There are inherent power dynamics between healthcare providers and patients (even though I don't believe there should be), and it can feel so intimidating to advocate for yourself. If you do feel comfortable doing so, I find it helpful to say something along the lines of the following upfront: "I want to be transparent that I am not comfortable with any conversations about my weight or body size and would really appreciate if we left those topics off of the table." Hopefully, they will respect this boundary. If they don't, I invite you to re-state it. If it continues to be disrespected, you can name the experience ("I noticed I communicated this boundary and it isn't being respected. I am feeling uncomfortable and would like to end this appointment.") and exit the appointment. Always remember: you are paying for a service when you go to the doctor. You do not need to stick it out with someone who isn't respecting you or creating a safe environment. Building this self-advocacy skill can feel really hard, and I promise you the more you practice it the easier and more empowering it will feel.
5. How have you seen HAES® and size-inclusivity have positive effects mentally and/or physically on people?
On the most basic scale, I see people start to live authentically and with capacity. In other words, when we are so active in diet culture, fat phobia, and disordered eating so much of our bandwidth goes there. It consumes our thoughts. It deters us from certain social experiences. It creates feelings of shame and lack of worth. It is the most brutal and unproductive hamster wheel. When operating from a HAES and body liberationist mindset however, this changes. We learn to de-center our body and food as something attached to our self-worth. We're able to be more present and self-compassionate. We can cope with feelings of shame in ways that don't result in body modification. We allow our bodies to be nourished according to what they need because we learn how to be more intuitive and trusting. All in all, the effects are remarkably healing and empowering.
