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I Stopped Working for Weight Loss Programs Decades Ago. Here’s Why.

Writer's picture: Beth Kitchin PhD RDNBeth Kitchin PhD RDN

Almost two decades ago, I vowed that I would never again work for a diet program. Nor would I put a client or patient on a weight loss diet. Ever. I would not be a party to the damage that diets can do. I had seen the damage firsthand, and I just couldn’t be a part of it anymore. It was a relief to step away from the crazy world of diets where the latest, greatest weight loss diet was just one new issue of Good Housekeeping or New York Times bestseller away. But my road to enlightenment was long and meandering.

Early in my over 30-year long career as a registered dietitian, I worked for quite a few weight loss programs. My first was in the late 1980’s as an intern at the University of Tennessee Hospital in Knoxville. Being an intern meant that I got the jobs the full-time dietitians didn’t want. I worked on the cancer floor where I saw young men with testicular cancer, bald headed from chemo, walking around the floor pushing their IV poles. I watched one of my patients, a woman in her 40’s, dying of ovarian cancer. I cried the day I went to her room, and it was empty. I counseled outpatient non-violent prisoners who came in for medical care. The other dietitians were happy to hand that over to me and I loved it. I was young and enthusiastic and willing to take on the work that others found emotionally difficult or unsettling.

In the 80’s, commercial liquid weight loss diets became all the rage thanks to Optifast and Oprah with her red wagon of fat. Even hospitals jumped on board that red bandwagon and rode it to what they hoped would be big weight loss for patients and big profits for them. However, medical staffs and clinicians were not all onboard. Many had doubts about safety and the profiteering appearance of selling a gimmicky weight loss program. UT Medical Center joined the crowd and started a program whose name was filled with hope and a future of skinny jeans: New Horizons. Or was it New Directions? I can’t remember – or maybe I’ve excised it from my memory. The other RD’s spurned the idea of working for such a program, so guess who got that assignment?

I would again be one of the clinical dietitians for my next diet program gig at UAB’s audaciously named Slim for Life liquid weight loss program. My colleague was another young RD. We shared an office and one of our friends, also a dietitian, would call us up and say, “Hello, is this Slim for a Day?” Yes, she was joking but there was a lot of truth in her jest. Who were we kidding? Slim for life? No diet can truthfully make that promise. Yet we did.

One day, before our evening group meeting, I was walking down the hall as one of our participants was coming in. “Hi! How are you today?” I said. She replied, “I’ll let you know once I weigh in”. That gave me pause. I saw that with many of the people in the program. How they felt, their mood, their happiness depended on the number on the scale.

After months of working in the program, I discovered that many people didn’t have a problem drinking the three to four liquid meals a day with no “real” food. Some people thrived on it. They told me how easy it was to not have to think about what and when to eat. The strict regimen was a relief and a respite from the enemy that food had become with all its alluring, tasty temptations: no thinking required and rapid weight loss to boot! What’s not to love? Plenty. Eventually, after losing weight, it was time to transition off the liquid diet to real food. This is where things got tricky.

I found that people generally fell into two categories. There were those who made the gradual transition relatively smoothly. They looked forward to eating food again. Then there were the people who didn’t want to come off the supplement. They asked me if they could stay on the liquid diet for the rest of their lives. And here’s the really bad part. When they started to eat real food, some lost all control and started binge eating.

So how did these two groups differ? The people who adapted to eating food had been regular “cheaters” when they were on the liquid diet. For instance, if they went to a party or other social event, they would come in the following week for the group meeting and say “Yeah, I went to a party and had a few appetizers and then got back on track with the liquid diet the next day”.  They didn’t feel bad or like a failure. The people who never strayed, who adhered rigidly, and followed the directions to a tee, were the ones who struggled with food.  They described feeling out of control in self-deprecating, punishing self-talk after one bite of food - a bite that sometimes led to extreme overeating. This was not run-of-the-mill overeating. We all overeat at times. This was different. This was emotional eating. “I feel completely out of control.”  “I want to stop but I can’t.” “I hate myself when I do this.” Some describe an almost trance-like state when they were in the throes of bingeing. These were just a few of the things people would tell me.

I thought that maybe it was the rigidity of the liquid diet. I thought that maybe other, less extreme diets would not be harmful. As I continued in my career, I would often hear people say, “this or that diet worked for me, but I gained most (or all) of the weight back”. But my definition of a weight loss diet “working” is not whether you lose weight, but whether you were able to keep at least some of the weight off long-term. As it turns out, few people can keep weight off regardless of the type of diet. And chronic dieting is the worst. Chronic dieting can really mess with your mind. Rigid, rules-based eating can lead to feelings of deprivation, to binge-eating, and full-blown eating disorders. The roller coaster of losing weight and then regaining it is bad for your psyche. I’m guessing some of you reading this can relate in a deeply personal way. You are not alone.  

After years of trying to help people lose weight, the nagging question that would not leave my head was “Am I causing harm to this person by claiming expertise and putting them on this diet? Am I helping or hurting?”  I felt inept and useless. So, I stopped. Luckily, in my last and longest career move, my clinical practice shifted to bone health. As the UAB Osteoporosis Clinic educator I felt like I could make a difference – not only through counseling on nutrition but also helping people understand the role of medications and body movement. It was infinitely more fulfilling, and it made me happy.

Now, I have mostly banished the word “diet” from my vocabulary. Even though the word simply means “what a person typically eats”, the connotation is first name “weight loss”, last name, “diet”. I now say, “eating pattern” or “eating style”.

Two summers ago, I took a training course in intuitive eating counseling for nutritionists. It really struck a chord in me. The main themes of intuitive eating are ditching the diet mentality, getting in tune with your hunger cues, making peace with food, and respecting your body. Food, calories, and carbs are not enemies to fight – but rather a part of nurturing our bodies and minds. The goal is not to help your client or patient lose weight, but to collaborate with them to develop a healthier, adaptive way of eating. As you can probably imagine, once you do that (and yes you can!) you can achieve better health – both physically and mentally. It's not an easy path to take, especially with all the food and nutrition noise of social media. But I think it's worth it.


Beth Kitchin PhD RDN

 

 

 

 

 

 

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