Monday, January 3, 2011

Clients and weight loss. How is the HAES approach appropriate for social work?

I was going to reply to some comments left on the last article, but the reply became so long, I thought an entire post would be appropriate.

Here's the scenario: A client comes in and wants to lose weight. Simple enough, right? Except for the fact that the client wants your help in losing weight. The client's goal is to lose weight and is looking to you for support. How do you give that in the case that you do not believe in diets and you fundamentally believe the client would be putting themselves in harm's way by going on a diet?

I wanted to make this post in order to brainstorm up strategies for dealing with this situation. Here's a few scenarios. Please comment your own ideas, or if you have an objections/improvements to what I am posting here. Please only comment suggestions if you believe in the Health at Every Size (HAES) philosophy. Learn more about HAES here at the Association for Size Diversity and Health's page on HAES Science and also with this excellent PDF by Dr. Jon Robison, PhD, MS.

Strategy #1: Support them fully on their diet quest.
The NASW Code of Ethics states: "Social workers respect and promote the right of clients to self­determination and assist clients in their efforts to identify and clarify their goals." One way of interpreting this means we give referrals to weight loss clinics, and provide them with any tools they need to lose weight. We word the goal as "weight loss."

Strategy #2: Discuss and explore thoughts on weight loss and body image
I think this needs to happen regardless of what strategy one decides to take. Why does this person want to lose weight? What is it that they expect to happen if the weight loss goal is achieved? Many people who are trying to lose weight are actually wanting to improve other parts of their life, such as romantic love, friendships, family relations, employment, or overall satisfaction in life. It is important that the client have realistic expectations about what would result in weight loss. Weight loss is not a magic wand.

Strategy #3: Assist the client in reworking the goal to something more obtainable
De Jong and Miller wrote in an article about the solution-focused approach that best practice is starting with small, concrete goals. Rather than listing weight loss as a goal or focusing on that, begin with a smaller goal such as learning how to cook a healthy meal or finding an enjoyable, affordable exercise routine. I think this will help reinforce healthy habits or help the client find joy in facilitating health into their lives.

Strategy #4: Explain what may happen if the client goes on a diet
Is it unethical to tell the client that diets typically don't work? Would it be promoting one's own agenda too much to say, "Look, I am more than willing to support you on your weight loss goal. But first, let's talk about how weight loss actually works." Granted, we are not nutritionists. But it's not like this information isn't out there, confirmed in peer-reviewed articles that we've all read (or should read... maybe I will post some recommendations in the next blog post). I don't think the purpose here should be to discourage the client at all! I think it should be giving the client the same information we have so that they can make an informed decision and so that we are providing the best tools for them to enact their self-determination.

Strategy #5: Make HAES referrals
This won't be easy in most places. HAES professionals are not always easy to come by. ASDAH can help, but if you don't live in NYC like me, but rather somewhere like Iowa, you may not have as many referrals. I would suggest though that there are HAES professionals out there that don't even know they are HAES professionals. Let's pick up our phones and directly talk to nutritionists and therapists who specialize in dealing with food issues. I think we'd be surprised how many professionals would a take a HAES approach with a client without even calling it that. Referring to a nutritionist and a therapist (if you are not one yourself) who specializes in these concepts is supporting the client in his/her goals. I think this is putting them in better hands than a referral to Weight Watchers would be. Referrals to YMCAs for exercise are always a good idea for clients, weight loss goal or not, IMHO.

So I'm dying to know what you all think! Would you use these strategies or try something else? Am I saying something completely unethical or am I being too conservative in my strategies?

De Jong, P. & Miller, S. (1995). How to interview for clients strengths. Social Work 40(6), 729-736. Available for download here.


  1. You could introduce them to The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, from the US National Institutes of Health (NIH) guidelines on "obesity treatment", which recommends trying to lose 10% of baseline weight as a "starter goal" and cautions "Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not." It might serve as a reality check. And hey, it's what the NIH recommends...!

  2. You might also look at why the overeating (their decision) happens. I have yet to see an overweight person (including myself, of course) that does not have a psychological reason(s) for their relationship with food. In fact anyone with any form of eating disorder. Not familiar with HAES, will have to look into it.