Health At Every Size: Recognizing Momentum in Every Encounter

We are pleased to share a segment from Registered Dietician Kori Kostka that was recently published on The Association for Size Diversity and Health. For the full piece, please visit the Health At Every Size blog here.


Sometimes we all need a little R&R (what I like to call rest and rejuvenation,) taking a break from the work we do so that we can come back with a fresh perspective. Over the last several months I have had the opportunity to attend conferences and visit people working towards a health approach. Currently, I work as a registered dietitian in a Family Health Team just outside of Toronto, Canada where I have been practicing Health At Every Size® (HAES®) for the last several years. A Family Health Team is a unique place to work because of the extended resources available and coverage offered by the Ontario Health Insurance Plan (OHIP) that go above and beyond the traditional family doctor’s office. Our Family Health Team is fortunate to have an amazing group of social workers, a pharmacist, doctors, nurse practitioners, and nurses.

Implementing a HAES approach at our Family Health Team has been exciting, challenging, energizing, exhausting, and everything in between. I am ever so thankful that I can reach out to the people who “get it”—like colleagues on various HAES networks, which fortunately seem to be plentiful these days! Recently I have had the pleasure of organizing one of these, a local Greater Toronto Area HAES Professionals Network, which includes a range of participants beyond registered dietitians, like social workers, nurses, teachers, moms, exercise physiologists, and personal trainers. So far, we have held three meetings to work on building and developing the network, and showcase various speakers and topics such as: the National Eating Disorder Information Centre (NEDIC), The Difference between Fitness and Fatness, Intuitive Exercising, Mindful Eating and Marketing a HAES Approach. We have also explored several challenges and gaps within our communities that would benefit from the development of local subcommittees, for example, on how to prevent and manage the increased prevalence of disordered eating and eating disorders in the youth population. […]

Our visit at OPC was packed with a full day of visiting the grounds, various buildings, residential apartments, eating yummy food (of course!) and meeting almost the whole OPC team who function very cohesively. Most impressively, they utilize and share common language and messaging no matter their role, and complement and reinforce each other’s work with the aim of coaching patients back to intuitive and mindful eating habits. Part of a patient’s treatment includes visiting restaurants and eating once “forbidden” foods with the accompaniment of the therapist and/or dietitian to provide extensive coaching and support. Together, the patient and team member work through the experience of dining in a social environment and overcoming the fear of food while addressing other emotions or anxiety that accompany the dining experience.

As a registered dietitian, I most enjoyed meeting with Mary Dye, the Director of Nutrition Services, and the other registered dietitians at the center. I asked Founder and Executive Director Wendy Oliver-Pyatt a question that I recall being asked at the ASDAH conference in 2013 on whether or not we should be so focused on a patient’s weight during treatment for an eating disorder. Her response involved the many side effects of patients who are not adequately nourished as evidenced by being severely underweight: the inability to concentrate and make conscious decisions, altered moods, increased anxiety, weakening of the cardiovascular system and the inability to respect hunger and fullness cues. The best tool we have to identify if a patient, particularly one with anorexia nervosa, has restored his/her nourishment is to compare current body weight to “ideal” body weight. The nutrition team added to this response later in the day by explaining how at the patient level, rather than focusing on calories and weight, they coach patients using intuitive and mindful eating practices, which works well regardless of an individual’s eating disorder type and degree of illness. Part of this coaching involves the use of beautiful laminated, colorful cards, which list hunger and fullness levels on one side and various emotions on the other. At each meal, patients sit with a team member to help identify their hunger and fullness levels and how they are feeling before and after. In the beginning, it can often be difficult to feel these cues and connect them to emotions, but patients are encouraged to take part in this exercise no matter where they are in the recovery process. Mary commented that often, as patients progress through their recovery journey, these cues change and become easier to sense, especially once detangled from the emotional component.

I went to OPC hoping to simply learn about the program, but I came away with a focus on how we could use a similar approach in primary care. Last month, I and one of our primary care physicians shared our experience of implementing HAES principles to the Peterborough Family Health Team. One of the physicians in the audience commented that dietitians need to be consistent with their messaging. He’s right, but not only do dietitians need to be consistent, there is a need for all of us working within nutrition to work intersectorally and to share the same language. It excites me to think that we are on the horizon of integrating Health in All Policies in Ontario, which may be the evidence-based solution to an intersectoral approach or perhaps a universal Canadian nutrition policy that just might parallel the Health At Every Size approach. We can always learn from the frameworks used in other practices, like how Oliver Pyatt Centers works collaboratively in healing eating disorders to ultimately promote a healthy lifestyle and minimize unintended consequences. Many of us encounter daily challenges of practicing HAES, whether it is resistance from our clients, our colleagues or society. Sometimes we need to take a step back from our individual HAES settings and look at the good that is going on in the world. If you were to look back a few years ago, would you have known as much about the HAES model as you do today? Would you have heard as many success stories? I sometimes watch Dr. Ivan Joseph’s TED talk on self-confidence and he recommends to write your own “brag sheet” so that you can look back and read all of your HAES successes, big or small. Maybe it does not have to be as much of a “brag sheet” as a way to show the HAES movement is growing and gaining momentum. And I am thankful to have each of you on my team!