Today on the podcast I have Vincci Tsui, a former bariatric dietitian turned Certified Intuitive Eating Counsellor, yoga teacher, and Health At Every Size® advocate. In this episode, we talk all about Health At Every Size, intuition, mindfulness and how it’s been taken over by diet culture, and so much more. 

This is such a big topic that has so much room for exploration- so I hope you enjoy the episode! 

In this interview, we talk about: 

  • Vincci’s journey to Health At Every Size 
  • My opinions on Health At Every Size professionals in bariatrics 
  • Practitioners who straddle the line 
  • Coming out as Health At Every Size 
  • Informed consent in bariatric surgery 
  • The biggest misconceptions people have about HAES 
  • What intuition is

Vincci’s Journey To Health At Every Size 

In her early days of being a Dietitian, Vincci worked at a bariatric surgery clinic for over 5 years. It wasn’t necessarily planned out that way; she didn’t become a Dietitian because she was passionate about bariatric surgery or weight management. At the time, she was trying to grow her private practice and needed a part-time job on the side. So when she saw the position come up at the clinic, it made sense to take it. 

Vincci went into the world of bariatrics straddling the weight neutral and weight centric paradigms. When she learned about Health At Every Size, she initially felt as though she could apply those principles into her practice at the bariatric clinic. As a surgical Dietitian, she wanted to make sure her clients were going into the surgery well nourished and prepared to meet the restrictions associated with the surgery. 

The turning point for Vincci was when ASDAH (Association for Size Diversity & Health) published a blog by a clinician who was also trying to straddle both sides. The association received a huge pushback; people were upset about the fact that this person was ultimately still making money from oppressing fat people. They were saying they wouldn’t be able to trust someone who was working in bariatric surgery and in Health At Every Size. That was the wake up call that lead her to go all-in and leave the bariatric clinic.

A Side Note 

At the time of this interview, I had the opinion that Health At Every Size Dietitians should work in bariatric clinics. In those clinics, you have to go see a Dietitian anyways. I thought that it would be great to have someone introduce the idea of Health At Every Size for the sake of informed consent. 

Informed consent is a big problem in these settings; we’re sending people in for surgery who don’t know that they don’t need surgery to be healthy in a bigger body, which is a huge reason why many pursue that procedure. Introducing Health At Every Size is not the solution, but I do believe that if you’re going to get bariatric surgery you should be informed about what Health At Every Size is. That needs to be a part of informed consent- the fact that it’s not highlights the fatphobic bias in medicine. 

As I’ve gotten deeper into this field, I’ve realized that it’s not really possible for a Health At Every Size professional to work in a clinic setting like that. Firstly because of cognitive dissonance, but also because it makes it SO confusing for people, which can be so problematic and harmful.

Practitioners Who Straddle The Line 

One thing Vincci has been working on is supporting those who are straddling the line and sharing their work while keeping in mind her audience and what triggers them. Everybody is at a different point in their journey; no one is born without prejudice or perfect or knowing about privilege. 

When we’re talking about conversations within the dietetics community, there is nuance. You have to look at the full spectrum and realize there’s a reason why the Health At Every Size bubble is such a bubble. There are so many who have never heard about it because we don’t have people in the middle of the road, and we shame those who are. I also see the downsides of having people in the middle- it’s really confusing for patients. 

It’s about respecting the fact that we’re all people, we’re all at different points in our journeys, and sometimes it is important to reach out to bring people into the movement while being conscious of not causing confusion.

 Coming Out As Health At Every Size 

When Vincci took the leap into Health At Every Size, she still worked at the clinic for the first year. Partly because of the ASDAH blog post lashback, she was very quiet about the fact that she did work in bariatric surgery. She ‘came out’ as both a Health At Every Size practitioner and a bariatric dietitian at a body image workshop she attended. 

What she found was that Health At Every Size clinicians were very supportive and didn’t shame her for working in bariatrics. Clinicians who are new to Health At Every Size can feel a lot of shame for not being perfect, or they hold back because they’re worried about saying the wrong thing. 

 In this situation, what’s more important is putting yourself out there and showing you are an ally. You’re not going to get it perfect, but it’s more important to get out there and take up space rather than sit out and wait until you’re perfect before you start. 

This applies to any social justice conversation. The only time it can get harmful is if you say something harmful, get called out for it, then get defensive and double down on what you said. As long as you’re open to learning and being wrong, then you’re in a good place to start. 

Informed Consent in Bariatric Surgery

 People reach out to me on Instagram all the time saying they are thinking about bariatric surgery and want advice. I don’t give out personalized advice on Instagram, but what I tell them is that body autonomy and informed consent is key. If that’s something you want to do for your body, that’s fine. But being told that surgery is the best thing for your body and your health is just not true. There are other options out there.

If you’re reaching out through a DM, you’re probably having doubts about the surgery on some level. A good starting point is to name those doubts- what’s actually going on there? Name that ambiguity and sit with it. The person needs to ultimately be the one making the decision; it’s not the practitioners role to tell them not to have surgery.

At the end of the day, it’s about informed consent. One of the biggest problems with healthcare today (other than the fact that the weight-centric approach is stigmatizing) is the fact that patients aren’t even given another option. They’re not told they don’t need to lose weight and given other treatment options. That’s not informed consent. 

We need to be completely informing the patient about the surgery and what the research shows instead of just funnelling people into it. 

The Biggest Misconceptions People Have About HAES

The biggest misconception people have is that Health Every Size means healthy at every size. They think it’s saying that everyone is healthy no matter what size they’re at. 

Saying people are healthy at every size is not what HAES is about. At its core, Health At Every Size is about pursuing health (if that’s a value for you) regardless of your size. It’s not a statement about who is healthy or unhealthy. It’s saying that health is something people can pursue if they choose to, regardless of what size they are now and what size they end up being over time. Size shouldn’t have anything to do with health. 

People misunderstand what it is and then think that it’s not based on evidence. They use it as a way to discredit Health At Every Size and say it’s anti-health. It’s really just saying that no matter what size you are, you can pursue behaviours that are health promoting. 

What Is Mindful Eating?

I remember when I was dieting, I put all of these restrictions on myself to make me more mindful and eat less. That’s not true mindfulness. 

What makes mindful eating and intuitive eating so easy for the weight loss industry to co-opt is the fact that they didn’t start off as exclusively weight neutral practices. It’s only been in more recent years that they have been that way.

Vincci refers to mindful eating in relation to the Buddhist practice of mindfulness. Mindfulness is about awareness of the present moment without judgement. When we talk about mindful eating, it’s about bringing that practice of mindfulness into the act of eating. It applies to eating, cooking, and choosing what you’re going to eat.  

If we’re talking about the present moment, then weight loss is a future outcome. You’re taking away from the spirit of mindfulness if you are focused on this future outcome of weight loss. Mindful eating is about focusing on the present

The second piece of non-judgement is huge as well. With weight loss, you’re expecting a specific outcome, so there will be judgement whether or not that outcome happens. Mindfulness is about being in the present moment, not focusing on the future. In its purest form, it’s impossible for mindful eating to ever have the goal of weight loss.

What Is Intuition?  

Intuition is hard to describe, and there are so many ways that our culture encourages us to pull away from it. The best way to describe it is the idea of gut feeling.

Within the dietetics field, we talk so much about evidence and science that we ignore the importance of intuition. 

There’s not always a should and shouldn’t when it comes to listening to your intuition. If you didn’t go in the direction of your intuition, that’s okay. There’s no point in saying you ‘should have’ done something. It’s already happened! You don’t know the outcome had you gone in another direction. You went in the direction that you did, and you learned from that. There are no bad decisions as long as you learned from it and you’re growing from it. 

About Vincci 

Vincci Tsui is a former bariatric dietitian turned Certified Intuitive Eating Counselor, yoga teacher, and Health At Every Size® advocate. She is the author of The Mindful Eating Workbook: Simple Practices for Nurturing a Positive Relationship with Food. Vincci is passionate about helping people find freedom in their relationship with food and with their body, so that they can confidently step away from diet culture and live life on their own terms.

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This post was transcribed and edited by Brittany Allison, Intuitive Eating Counsellor. You can find her on Instagram @thefoodfreedomlife.