NEDIC Conference Journal 2018

For reflection:
What would a body inclusive environment look
like or feel like?
What would be different at your workplace,
classroom, gym, at home or in the community?
How would you deliver service differently?
3.2 Respectful care
The next tenet is respectful care. This means that
all staff have the opportunity to learn about weight
bias, risks of dieting and HAES® principles. The clinic
environment includes chairs and medical equipment
that meet the needs of a wide range of body sizes.
Health education, promotional materials and other
communications use inclusive, diverse images and
non-stigmatizing language when discussing weight or
health [2].
At WHC, we pay attention to the details. For
example, if there are magazines in our waiting room
they will not include messages that are contrary to
our values (i.e. nothing that promotes diets or
weight loss). Another way we practice respectful
care is to avoid stigmatizing language such as
“overweight” or “obese”. These are medical terms
with arbitrarily shifting definitions. In 2013, the
American Medical Association defined “obesity” as a
disease, going against the recommendations of its
own Public Health and Science Committee [16]. The
Canadian Medical Association followed suit in 2015
[17].
At WHC people simply have a weight which is not
used as a measure of their current health status or a
future health goal or expectation. Even with clients
who may be at an artificially low weight due to an
eating disorder, their body shape or size is not
identified as the problem nor as a proxy for the
illness itself. Weight change, in itself, is not seen as
an indicator of restored health and wellbeing.
WHC clients are rarely weighed as this is
unnecessary for most general community health
clinic visits. Weighing may be necessary in
diagnosing specific conditions such as malnutrition
or to prescribe certain medications. We have
observed the adverse effects of weighing which can
include embarrassment, anxiety, and clients
reporting that they avoid seeking medical care.
If weighing cannot be avoided in your practice,
then we suggest you adopt the recommendations
from the Rudd Centre’s on line Tool Kit: Preventing
Weight Bias: Helping Without Harming. This
includes asking for permission to weigh, offering to
have the person face away from the scale and
ensuring that weighing takes place in a private
location and is recorded without comment or
judgement [18].
3.3 Eating for wellbeing
Another important tenant at WHC is to
encourage eating for wellbeing. Healthy eating
includes eating for energy, nutritional needs and
pleasure. We encourage regular eating that is
balanced as well as flexible. Dieting for weight loss is
not recommended [2].
WHC dietitians and other care providers use a
variety of strategies to encourage eating for
wellbeing. We encourage families to share food
together and attempt to make meal times pleasant
and an opportunity for positive connection. Adults
are encouraged to model a balanced relationship
with food, which includes eating regularly and
enjoying all types of foods from all food groups. We
discourage diet talk and labeling food as “good” or
“bad”. In school or community settings, we
discourage food shaming and teaching about food as
“healthy/unhealthy” or “good/bad”. We encourage
educators to teach about nutrition as eating for
energy and pleasure and without connecting it to
weight. In classrooms, children can make soups, visit
a greenhouse, plant and harvest a garden, try new
foods or share traditional dishes made at home.
These activities help children enjoy food and learn
about nutrition without fear of judgment about what
is in their lunch box.
We recognize an important part of eating for
wellbeing includes learning how to nourish the body
adequately and, at the same time, avoid treating
food choice as a moral issue.
People of all shapes and sizes deserve to eat and
be nourished. We encourage clients to eat at regular
intervals and eat enough throughout the day. We
emphasize how this fuels the brain as well as the
body. We use an add in approach when clients are
missing basic nutrients. Even when client goals
include reducing their intake of pop or low-nutrition
snacks, we start with adding in other fluids or the
missing elements such as protein or complex
carbohydrates. Typically, clients begin to make the
desired changes themselves as they notice that they
crave the pop or low-nutrition food less often. No
food is labeled “good” or “bad” as we are also
working towards moving away from all-or-nothing
thinking. Nutritious foods are promoted because
they help to reduce the risk of chronic disease (high
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