A call to action.

Hey! All you fat-friendly, size diversity-supporting, amazing social workers! Get at me.

I want to create a collective. I'm not sure what it's going to look like yet, but I think it's needed. There are reasons I fell in love with social work: its dedication to social justice, teaching about privilege, eradicating and confronting all the-isms in the world that most people would rather sweep under the rug. There's just one -ism social work has avoided: sizeism.

Fortunately, social work is a profession where I think the people in power are willing to listen. But first, we need something to say and we need people to say it.

If you are interested in organizing with me, email me at fatsocialworker (at) gmail dot com. Why can't social work schools teach about size? Why can't we talk about Health at Every Size as being THE ethical way to approach working with *all* clients? NASW has begun to speak on obesity issues. They recognize the "multifaceted" nature of "obesity"--why not recognize the ethical way of viewing obesity, the one that honors self-determination?

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?

Reference

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

The New Year's ReVolution

As I grow older, it's sort of hilarious how laughable New Year's Resolutions have become in my life. They are always, without fail, body related somehow. I think it's that time of year that we all resolve to become more in control of our lives, as if the New Year is some kind of Saturn Return and that our goals *must* be accomplished within a certain amount of time, or else we are unsuccessful and doomed to repeat our failures indefinitely. And honestly, if dieting is your New Year's Resoultion? Yeah, that's probably what's gonna happen.

The last time I made a weight-loss related New Year's Resolution was in 2008-2007. I wasn't "dieting"--no, I was a good fattie and I was going to make better *LIFESTYLE CHOICES*. I was going to eat fresh fruits and vegetables and go to the gym more often, because that was surely going to help me shed 60 lbs. Getting my thyroid medicated? Oh, that wasn't a priority at all. I was going to look like a Fitness Mag cover model by 2009, and my life was going to be oh so much better. My relationship wouldn't be in the crapper anymore, and I would have a better grip on what I was doing in life, all because of a good ol' NYR to LOSE WEIGHT.

It didn't work. I stuck with it for awhile. And honestly, I do still use a lot of the habits I learned, such as eating more whole grain foods and getting more fiber in my diet. But I think I maybe lost 5 lbs and my boyfriend and I broke up by year's end, and it still took me a whole year to figure out what I was doing (you know, without dieting, and the answer to that question changes every day). All in all, everything turned out okay though. But you know what I won't get back? All of that time spent anguishing over calories. All that time standing in front of a mirror pinching my belly fat and imagining it melting right off. That never happened, and I actually gained weight.

I feel better than ever; I eat what I want when I want, and the only times I don't feel healthy is when I don't do that. I've considered myself interested in fat acceptance for years now, but I think it was my last New Year's Resolution ever in 2008-2009 to stop torturing myself over my weight and to enjoy it that I actually FINALLY stuck to a resolution. Resolving to no longer resolve hatred towards my body was the best decision I ever made.

It's not to say resolutions are bad. But why do we frame them the way we do? Why are we always fixing something bad about ourselves, instead of resolving to continue to nourish what is already amazing about ourselves? I currently am a case manager at a domestic violence shelter. I think about what my biggest gripes are with how the system works--it's so punitive. It's so focused on what clients are NOT doing instead of celebrating the amazing things they accomplish every day (um, duh, they left an abusive relationship!!!). I am so unabashedly confidident in my clients and positive. I always frame goals in a way that they are obtainable and positive.

This is where the idea of weight loss and social work intersect. As I close out, I ask, if we as social workers are to present obtainable goals for our clients, can we recommend weight loss? Should a social worker ever recommend weight loss (especially considering by and large we are not medical experts)? What damage could be done by a social worker recommending weight loss to a client?