Friday, December 31, 2010

Interview with HAES (SM) dietitian Sarah Josef, RD

Here's an interview in which Sarah talks about her work and her views on HAESSM.

How did you get interested in Health at Every SizeSM?

As a dietitian, I was trained to work with weight management issues by using a “dieting” or restrictive eating model. I found the model didn’t work and only made people feel worse about themselves. It seemed as if the medical field was too focused on size and not focused enough on health. When Linda Bacon, Ph.D. and UC Davis published their research paper (2005) based on using the HAESSM model to help people become healthier, it made sense to me. The model focuses on size acceptance, intuitive eating, stress management and pleasurable activity. The study participants improved their biomarkers, overall health, and self-esteem without restrictive eating practices. I became hopeful again that my profession might be able to bring greater health and happiness to people of all sizes.

Also, it took years for me to heal my own issues of size perception and acceptance. I did not have the benefit of a model or a community that supported “non-dieting” methods of achieving health. Now that we have a model available to work with, I want to use it to decrease the agony and suffering people have because of weight issues. I want people to feel good about themselves and about their food choices.

Can you talk about some of the popular myths about weight, nutrition, and health, and about research that supports HAESSM instead?

Most health professionals point to weight as the reason for many of the major health issues today (heart disease, diabetes, high blood pressure, and some cancers). While there may be an association between size and health, it is not a direct cause & effect relationship. There are many factors that contribute to poor health and the issue is complex. Weight seems to be the easiest to focus on. A common myth is that all one has to do is reduce their food intake, exercise and they will lose weight. If they lose weight, they will be healthier. Not always true! Weight loss may improve biomarkers temporarily, but in the long run, improvements are not sustained. Instead, greater problems may arise, based on the amount of dieting one has done throughout their life. Dieting comes with its own set of health issues, and this is a fact that many health professionals don’t want to acknowledge.

Is it unusual for people in your profession to use a HAESSM approach?

Yes, it is. Some dietitians are becoming interested in the model because they know that dieting has not produced long term health benefits. However, the medical community is still size-prejudiced and can’t wrap their minds around the idea that a large-sized person could be healthy!

Research supports that a person of any size may achieve improved health by having a healthy lifestyle: daily movement, good nutrition through a variety of “real” foods that are enjoyable, stress management and daily activities that are pleasurable.

A lot of people go to dietitians with weight loss as a goal. What kinds of goals are important to your clients?

My clients are seeking peace of mind and a desire to have a positive, pleasurable relationship with food. They come wounded from dieting and wanting to heal. They want to learn to trust their bodies to know when to eat, when to stop and what foods will be “right” for them as individuals. They want to stop obsessing about food and their weight.

Why did you choose the name Eating with Integrity for your practice?

Eating with Integrity implies that one may learn to eat in accordance with what they feel is “right” for them, that everyone has their own sense of “integrity” when it comes to food choices. Eating seems so simple but actually it is complicated, influenced by many outside factors (advertising, peers and perception of what is “good/bad” food. We have learned to be externally focused when we eat. Eating with Integrity is a name that implies one eats in accordance with internal cues based on needs and desires. We all have a way of eating that makes us feel good, not just physically but emotionally and spiritually as well. My goal is to help others find what “integrity” means to them when it comes to food and eating.

Why do you think it's so hard for some people – women, especially – to trust their own instincts about what to eat and when?

Women in this society are objectified. As “objects” we (women) become externally focused, especially on how we look. We are not taught to trust ourselves or our instincts, we are taught to constantly strive for an unattainable perfection. It seems to follow that we would not trust ourselves to know when to eat and what to eat, that if we “eat what we really want” that will lead to being unacceptable. If we can’t accept ourselves, we cannot trust ourselves – that’s my take on it.

A lot of people recovering from diets and eating disorders feel like it's essential to stop thinking of foods as "good" or" "bad." Others are afraid that if we throw out all the rules, the way we eat will be bad for our health. What are your thoughts about that dilemma?

When people “normalize” their eating and allow themselves to eat what they want, the magnetic pull toward their perceived “bad” foods disappears. The tight rope that draws them to unhealthy choices is cut and they are released. Normalizing their eating entails learning to eat when one is hungry and stopping when one is full/satisfied. It means all food is “just food” and our choices are based on what makes us feel good. It is amazing to see what happens when people begin to trust their bodies, enjoy their food choices and enjoy the experience of eating – they learn that no one food has power over them because all foods are “good.” They no longer have foods they have to eat only in privacy; they may eat all foods in full view of others. They no longer have to climb ladders in the middle of the night to gorge on their favorite treat hidden in the attic BECAUSE they can have their treat whenever they want it. When we learn to trust our hunger and our food choices, we are able to eat what we want when we want it and feel great! I see this over and over again with clients – it is wonderful to witness.

In the workshops you and I have done together, you guided the participants through an exercise in "mindful" or "intuitive" eating. Would you explain what that is?

My private practice is based on teaching people how to get the greatest pleasure from their food while learning to trust their body. Often, people don’t even know when they are hungry and when they are full. Most do not know when they are satisfied. Part of learning to identify states of hunger/fullness/satisfaction is to eat with full presence or consciousness. I teach people how to tune in and listen to their body, so that they may respond “appropriately” and feel good. Eating mindfully or with full presence also allows us to connect with our senses, eat slower and really taste the food. Usually people have greater enjoyment and pleasure when they eat this way. Sometimes people learn that foods they thought they loved are really not pleasurable. Or, they find just the opposite, that they actually love foods they previously thought they disliked. The mindful eating exercises puts people in the moment, in their body and gives them choices they didn’t know they had. A very awesome experience for most!

How can people contact you if they want to set up an individual appointment with you, or learn more about what you do?

I may be reached at: 510-292-1116 or at


  1. I think I have just died and gone to Heaven. I did not know my dear SFSU instructor practiced the HAES model. In addition to her wonderful teaching, this is just another reason to love her.

  2. Sarah is a wonderful co-facilitator in our workshops. I'm not the least bit surprised to hear that her university students appreciate her, too.