Food Psych #207: Doctors Without Diet Culture with Louise Metz

Louise Metz.jpg

Medical doctor and Health At Every Size advocate Louise Metz joins us to discuss why weight management has no place in evidence-based medicine, how our current medical system can get in the way of providing compassionate care, why it’s actually not necessary for doctors to weigh their patients, how physicians can shift their practice to be more weight-inclusive, and so much more! Plus, Christy answers a listener question about dealing with digestive symptoms. 

Louise Metz is an Internal Medicine Physician who has expertise in the medical management of eating disorders and gender-related health care. She is the owner and founder of Mosaic Comprehensive Care, a medical practice in Chapel Hill, NC offering primary care and specialty care that is inclusive and affirming of all bodies. After receiving an undergraduate degree in Biology and Women’s Studies at Duke University, she attended medical school at the University of North Carolina. She completed her internship and residency in Internal Medicine at the University of California at San Francisco. She has previously held academic positions at NYU’s Bellevue Hospital and Duke University, and has published research on heart disease in women. She created Mosaic using a unique model of individualized and collaborative care with a focus on body diversity and complexities of health. She is passionate about providing weight-inclusive medical care, and committed to helping to change the paradigm surrounding the way we address weight and health. Find her online at

We Discuss:

  • Why Louise thought her parents’ “hands off” approach to her picky eating as a child was helpful

  • When she became aware of diet culture and started engaging in disordered eating behaviors

  • Physical symptoms of polycystic ovarian syndrome (PCOS), and how they can affect body image

  • The differences in how larger people and thinner people are diagnosed and treated in healthcare

  • How social justice and feminism motivated Louise to pursue medicine

  • The lack of training in nutrition and eating disorders in medical schools

  • Complexity Theory, Chaos Theory, and how they can apply to medicine

  • Louise and Christy’s experiences with “fence-straddling” between weight-inclusive and weight-centric paradigms

  • Why medicine can be more of an art than a science

  • How Louise was introduced to Health At Every Size® (HAES®)

  • How our medical system can get in the way of providing appropriate care to patients

  • Why it’s actually not necessary for doctors to take your weight most of the time

  • The few circumstances where monitoring weight is appropriate

  • The overemphasis on weight in pregnancy

  • The lack of evidence for weight as a proxy for health

  • The contradiction of recommending weight management in evidence-based medicine

  • Louise’s experience educating medical students and providers on HAES

  • The importance of compassion and lived experience in healthcare

  • Why medical care can be traumatic

  • How physicians can shift their practice to become weight-inclusive

  • Why NOT offering weight loss services is still patient-centered care

  • How weight-inclusive providers can work with people who want to lose weight

  • Why it should be easy for physicians to shift to a weight-inclusive practice


Resources Mentioned

Some of the links below are affiliate links. Affiliates or not, we only recommend products and services that align with our values.

Listener Question of the Week

How can a person live less rigidly when a change in daily routine is a trigger for digestive symptoms? How does disordered eating intersect with digestive issues? What are some non-food approaches to managing digestive symptoms? What are some of the ways that wellness culture has heightened our concerns with digestion? Why does avoiding certain foods sometimes worsen digestive issues? How can someone get help for their digestive symptoms without worsening their disordered eating? Is it possible that a person’s fear of having digestive issues is worse than the symptoms themselves?

Resources Mentioned:

  • Food Psych episode #175 with Marci Evans

  • Food Psych episode #94 with Alan Levinovitz

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