Where’s the competency in the new “Provider Competencies”?

The recently released “Provider Competencies for the Prevention and Management of Obesity” requires our attention.

Two doctors, with the support of 27 agencies including the Academy of Eating Disorders (face palm!), the Academy for Nutrition and Dietetics, and the American Psychological Association, have attempted to describe provider competencies to prevent “obesity” and manage the size of people’s bodies.

The minimal eight citations and bare bones text is more of the same anti-obesity rhetoric that causes more harm than good. Higher body weight is not the enemy to be eradicated. We know the hustle to lose weight is causing more harm than good with all of the short-term unsustainable efforts that have enormous impacts on the emotional and physical well-being of our populations.

Frankly, it is disturbing to think of the funding that supported the creation of this document.

Be disturbed. We certainly are.

Deb Burgard, in her recent blog for The HAES Files asks this:

Are we trying to police the bodies of a diverse population with an aim to make everyone the same size? Or are we trying to support the health of a diverse population who face many barriers to competent and complete health care, only one of which is weight stigma?

Are we trying to fight a war with fat cells or are we trying to impact a health disparity?  Are we fighting for weight normativity, or weight inclusivity?

We are increasingly overdue for a new conversation about body size that actually includes the needs and experiences of the people who are being “treated”. We are overdue for the acknowledgement of what truly contributes to health disparities, and more of the same will not do it.

This “Provider Competencies” document, with only eight bare bones citations, did not include the voices, opinions or needs of the people most impacted by its suggestions. It is time for medicine to stop treating fat people as if they are in a temporary and correctable state. Healthcare has yet to offer interventions for high body weight that are reliable, life-sustaining and minimally invasive. There is no evidence-based treatment for high body weight that leads to long-term maintenance of weight at five to 10 years out. NONE.

We are failing people. People are not failing.

The competencies did include language about weight stigma that reads as lip service when we turn our attention to the ways these standards are inherently stigmatizing. We cannot alter the impact of stigma simply by increasing our awareness of it or by naming its presence “in the room.” The course of discrimination and stigma is altered when the people with the most privilege address and reduce the power-over relationship that silences the voices and experiences of the people who are being marginalized.

What happened to meeting people where they are at with respect and curiosity?

To achieve competency, we could start with an apology for the ways higher body weight has been iatrogenic (caused by the cure). We could acknowledge how little we know and name our own internalized fatphobia. We could avoid labeling other people’s bodies. We could invite our clients to educate us as primary dwellers and historians of their own bodies and lived experience. They could tell us what they need, especially when we slow down and show we are listening. We might acknowledge how their resistance to our interventions is rooted in wise and intuitive distrust of our unnamed biases. We could be honest and reject our shoddy, biased weight science. We could focus more on how to support living instead of worrying about dying.

These are the competencies that are needed to “do no harm” and provide ethical care.

As Deb Burgard says, Question every idea that assigns greater or lesser worth to certain human bodies. Question every process that claims expertise that fails to center the voices of the people living those lives. Question the motives of people – mindlessly or deliberately – carrying out the imperatives of the corporate DNA to monetize bodies.

Together we must resist.

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