#WakeUpWeightWatchers (and keep your marketing away from our children … and adults for that matter)

What do you remember about being 8 years old? 10 years old?

Do you remember playing tag in your neighborhood, adrenaline running through your veins while you ran as fast as you could, trying to avoid becoming “It”? Jumping in the lake on a hot summer day and eating popsicles with your friends? Snuggling up on the couch with a bowl of popcorn while watching a Disney movie?

Thanks to Kurbo Health, a new app for kids and teens created Weight Watchers (now “WW”), some of today’s children as young as 8 years old will remember logging their meals and snacks day after day, receiving either praise or warnings regarding their choices.  They will remember messaging with “health coaches” on the Internet about how to “budget” their “red foods” (aka foods to avoid as much as possible) for “special occasions.” The app tells children (whose brains aren’t close to being fully developed) that they can eat all the “green foods” (fruits and vegetables) they want!, but be careful with the “yellow foods” (examples include: chicken, eggs, 1% milk, whole wheat bread, rice, and beans).  They will remember being encouraged to have fruit instead of butter with their eggs (and to be careful about how many servings of eggs they have in the first place).

Eight year olds.

They will remember taking a “before” and “after” photo documenting their pursuit of weight loss.  The Kurbo Health website includes “Success Stories” of children ages 8-17 showcasing these before and after photographs. CHILDREN. I felt sick to my stomach looking at it.

Let me make a few things clear early on in this post: I am all for healthy eating (though my definition does not label foods as “good” or “bad”). I am all about encouraging children to move their bodies, and to eat what feels good to them, and I am all about promoting health.  Preaching weight loss to children – yes, even children who are “overweight” or “obese” according to a BMI* chart – does not promote health.  It focuses on a number which children, like it or not, learn to equate to their worth.  It promotes dieting and obsessive thinking. Shaming someone for their weight or size does not “motivate” them to lose weight (they might initially, but 95% of the time they regain it); it leads to worsened self-esteem, disordered eating, and chronic stress – which has worse negative health outcomes than being a particular weight.

*BMI was invented by a mathematician, not a physician. Fortunately, the CDC website does state, “[BMI] is not diagnostic of the body fatness or health of an individual.” … If only everyone kept this in mind!

My favorite study is the Health at Every Size (HAES) study from the early 2000s.  I would encourage anyone who finds themselves thinking, “But what if someone needs to lose weight? What about health?” to read up on it. The study took a group of women, all of whom were considered “obese” on a BMI chart, and all of whom endorsed desire for weight loss, and split them into two groups. One group met with a “top obesity expert,” and focused on dieting and exercise with the goal of weight loss, and the others practiced a HAES approach.  The HAES approach was, essentially, a non-diet approach focused on self-acceptance, intuitive eating, and moving in ways that felt good. There was no focus on weight loss, but instead on self-compassion and health.

The findings were notable – the diet group, as predicted, did initially lose weight. That said, 41% dropped out of the study because dieting is restrictive, hard, not enjoyable, and not natural.  But at two-year follow-up, those who remained – despite the initial weight loss – had regained all of the weight they had lost, and many had regained even more (if you’ve ever dieted, I’m sure this sounds familiar – that’s because this is the rule, not the exception).  Their health markers were worse than they were when the study began, and their self-esteem had worsened, as well.  The HAES group did not lose any weight, however, improved all of their health markers and self-esteem at two-year follow-up.

I realize that this is completely counter to what most people, myself included, have been taught most of their lives.  It takes time to shift your thoughts and beliefs to align with this. But the evidence is there.

… Now let’s get back to this atrocious childhood dieting app.

As one might anticipate, childhood and adolescent exposure to dieting (e.g. in the household and socially), let alone actually engaging in dieting behavior, is a significant predictor in the development of disordered eating and eating disorders.  An eating disorder is not something anyone is immune to, it is not simply “taking a diet too far.” It is like any other illness – while there is not one single factor that contributes to the onset, many are biologically predisposed due to their genetics.  For example, having a family member who has experienced an eating disorder, anxiety, depression, obsessive-compulsive disorder, or substance abuse puts you at risk for an eating disorder. Environmental factors – such as weight stigma and early exposure to dieting, among other things – only increase your odds.

Many eating disorders begin with a diet; unfortunately, in many of these cases, the diet was recommended by a doctor.  Early dieting predicts lifelong dieting (since diets generally don’t work long-term; see HAES study above), and Kurbo Health, of course, is hoping to lock kids in at a young age so they always seek guidance from the Weight Watchers (read: so WW can take their money).  They want them to believe they have failed, and need the points and the diets and the apps to help them be more in control because they just have no will-power, when in reality, biologically, our bodies are not designed to diet.  Our bodies believe they are in famine when they are restricted, which leads to slowed metabolism (often leading to weight gain, which is counter to the dieter’s original goal), increased thoughts about food, and often binge eating. This is not a lack of self-control, it is an evolutionary response trying to keep you alive, fueled, healthy, and safe. 

Not only does a focus on weight increase the likelihood of developing an eating disorder, it reinforces the message that being above a certain weight is “bad” and below or at a certain weight is “good.”  This leads to obsessive thinking, and poor self-esteem, which often leads to depression, anxiety, self-harm, suicidal thoughts and behaviors, early sexual behavior, and substance abuse disorders … to name a few.

Weight itself is not a health concern. Let’s say two people walk into a doctor’s office – one is in a thinner body, one in a larger body.  Both recently had bloodwork indicating high cholesterol. The doctor will likely recommend to the thinner person to be mindful of their eating, encouraging them to choose lower cholesterol foods more often.  This makes sense. They will likely not mention their weight at all.  

What will the doctor likely prescribe to the larger bodied person? Weight loss.  (Actually, even if the larger bodied person was not presenting with high cholesterol, or any health concern for that matter, the doctor would likely preach weight loss to them.  I hear about it and read about it all the time. It is real, and it is harmful.) 

If someone is presenting with a health concern that can be remedied by changes to their eating, doctors and family members can promote and give guidance regarding these concerns without ever mentioning weight. Because the weight is not the problem! Might this person lose weight as they begin eating lower cholesterol foods? Perhaps, and that’s fine! Being anti-diet does not mean I am anti-weight loss; it means I do not advocate for weight loss as a goal for the sole purpose of weight loss, or in the pursuit of “health.”  What is important here is that it is possible that someone can improve their health markers without ever seeing the number on the scale decrease. Their body may not change, even as their health improves. 

The first thing you’ll see on the Kurbo Health website is “Reach a healthier weight with Kurbo.”  It is all about weight.  I hope I have made it clear that you cannot tell whether someone is healthy based on their weight or shape alone, and we have got to stop trying to sell kids – or adults for that matter – this idea that weight loss will automatically improve their health.  

Instead of entering all of your food – or having your child enter all of their food – into an app, cook and eat dinner as a family if this is possible given your life circumstances.  Go for family walks and find what kinds of sports and exercise feel good to you, rather than the ones that burn the most calories. Do not label foods as “good” or “bad;” this will stick with kids more than you think – hasn’t it stuck with you?  Be mindful of the language you use about your own body in front of your child, but also when you’re all alone because you matter too. Challenge yourself to adopt a new perspective by reading Health at Every Size and Intuitive Eating (both also available as audiobooks!).  Use the Intuitive Eating Workbook – there is a teen edition of this book, as well!  Follow @feedinglittles for guidance on how to use positive language and incorporate all foods when raising babies and toddlers. Let yourself live and enjoy all foods and loosen the association between weight and worth, and weight and health.

And please, do not give Weight Watchers or Kurbo Health any of your money or time or energy. Your children (and you) are so much more than before and after photos. I promise you they are doing much more harm than good.

Additional Resources:

New York Times Parenting: https://parenting.nytimes.com/feeding/healthy-eating-habits

Nutrition Journal: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

 

The Importance of Hobbies

I recently caught myself during a conversation I was having with one of my clients, who is a college student. She was telling me about a volunteer opportunity she has, and I shared my excitement, ending the statement with, “… and that will look great on a resume!”

While my statement is accurate – any type of volunteering will certainly look wonderful and make for a great interview topic when applying for jobs after graduation – I instantly became aware that I had inadvertently perpetuated the idea that things are only worth doing if they serve a secondary gain in terms of either professional growth or profit.

Professional growth and profit are important, can be incredibly empowering, and are key building blocks of self-esteem. That said, it can be easy to forget that some things are worth doing just because they make you happy.

Sometime around high school, I stopped doing things for enjoyment and started doing them to pad my college applications.  While I enjoyed many of these activities, the primary motivator was certainly more about preparing for my future than on enjoying the present. That mindset only continued as I prepared to apply to graduate school and to get a job in the real world … so much of what I did became more about how it would look to potential admissions counselors or employers, rather than about whether I was enjoying the activity itself.

There are a few exceptions to this. When I was a senior in college, I decided I wanted to learn how to play piano – so I signed up for lessons at school, bought a keyboard for my dorm room, and annoyed my roommates by repeated and often butchered renditions of “Comin’ Round the Mountain.” After senior year, I never played the piano again and do not remember a single thing from that year of lessons. But I had fun, and it oddly became a fond memory from that time in my life.

This past year, I began taking improv classes. I was sure I would walk into the room that first night and be the oldest person there – that everyone else would be in or fresh out of college, and have years of experience having started this hobby during their time in high school. I was surprised to find that I was somewhere in the middle; the age range of my classmates spanned about 35 years, and most of us had absolutely no experience with improv!  Turns out I wasn’t the only person looking to try something new just for fun. After eight weeks of classes, I learned a new skill, made new friends, and found a hobby I plan to continue.

It is so easy to get sucked into the ‘black and white’ or ‘all or nothing’ thinking pattern: If I’m not going to become a professional singer, why take voice lessons? I have no desire to work in a restaurant, so why take that cooking class? Sure that sounds like a great idea for a novel, but why write a manuscript if I’m never going to submit it for publication? I definitely had the thought “Maybe I will open my own improv studio someday!” before I had even attended my first class … so I had to keep this in check, and remind myself I was doing this just for fun.

(Side note: It is possible that in exploring your hobbies, you will end up finding that you do want to make a career out of something at which you never thought you’d be good! But if that doesn’t happen, that is totally fine too – the ‘point’ of doing it is that you’re enjoying it. That’s enough.)

For me, I know when I get stuck in this mindset, it is reflective of my type-A personality – if I have free time, I want to be productive, and it does not feel like doing something just because is productive. But when I actually sit back and think about this, this is completely contrary to everything I preach as a therapist. Pleasure is such an important part of our lives, and life is meant to be enjoyed. Relaxation and fun are good for mood regulation and quality of life. Building mastery* of a skill or hobby is good for building self-esteem. Therefore, if we find the hobbies that make us feel our best, we will most likely be more productive in other areas of our lives. This means that we may actually achieve more professional development and profit if we are carving some time out for the things we want to do, rather than if we are spending 100% of our time doing the things we think we should be doing.

I challenge you to reevaluate how you are spending your time, and be sure you have at least one thing that you regularly do just for fun. What have you been wanting to do, but have been putting off because it seemed ‘pointless’? Remember when you were a child and did things just for fun? Playing tag with the kids in your neighborhood likely wasn’t listed on your college resume, but it was fun for you, so you did it, and this is just as important – possibly sometimes even more important! – as adults.

*’Building mastery’ does not mean you have to become a ‘master’ at something. It simply means you are improving your skill over time.

The #MeToo Campaign

This post contains language related to sexual harassment, assault, and rape.

My heart both breaks and fills every time I see a #metoo post.

It breaks for the people who have been targeted, for the survivors. In 2010 I began my work with sexual assault survivors, and every story breaks my heart.

At the same time, my heart fills with compassion and gratitude for the people who are coming forward, speaking their truth, assuring others that they are not alone, that they are not the only one (particularly as many survivors aren’t in a place they feel comfortable, safe, or ready to come forward).  This inspires resilience. It creates a more open culture, increasing awareness, and shedding light on an issue that some feel is taboo, should be discussed behind closed doors, kept in the darkness.

I’m not going to pollute this post with his name – the famous man whose lewd crimes sparked the resurgence of the “me too” campaign.  I don’t want to give him any attention; I want to remember the survivors’ names, the ones who are innocent and who were targeted for no reason.  I wish we practiced that with any crime – remembering the victims/survivors, not the perpetrator.

I do think there is one incredibly important thing we tend to miss.  Some of the language I’ve read (not just in this campaign, but in general) continues to be about women standing up against men who rape. Who assault. Who harass.  I can understand why – as I said, this campaign is in response to a man targeting too many women (too many = any number above zero).  The purpose of this campaign is about empowering women to come forward and to know they are not alone.

At the same time, we must remember that this is not exclusively a male versus female crime.  It can be. Most of the time, statistically, it is.  However, women can assault men. Women can assault women. Men can assault men.  Any gender can assault another gender.  This does happen, it happens often, and it is generally under-reported.  It is so deeply important to bring this into the conversation because when we make it about men versus women, we ignore a huge part of the population: a group of people who often feel silenced because their circumstances were different, who sometimes feel like their assault didn’t count, didn’t matter.

Not only is this true for men abused by men, women abused by women, and men abused by women, but for many others:

If you didn’t report your harassment or assault to the police, that’s okay – it still matters.

If you didn’t go to the hospital, it still matters.

If you didn’t tell anyone, if you’ve never spoken a word about it, it still matters.

If you said yes then changed your mind and said no, it still matters.

If you were a child and didn’t know what to say and said nothing, it still matters.

If you were dating or married to the perpetrator, it still matters.  

If you were drinking alcohol or using drugs, it still matters.

If you were wearing revealing clothing, it still matters.

If you have been called “promiscuous” before, if you have a long list of sexual partners in your history, it still matters.

If you’re not ready to post “me too,” or are never ready to post about your history of harassment or assault, it still matters.

Nothing gives anyone the permission to hurt or to shame another: nothing on this list, and nothing I haven’t mentioned because the list could go on forever.

To everyone posting – you are incredible for speaking your truth and helping others to work through theirs. To everyone not posting – it is okay to process your experience without going public, and please know you are not alone. To everyone who has not experienced harassment or assault – please continue to be supportive of those who have.

If you are looking for support regarding your own or a loved one’s sexual assault, the BARCC hotline is open 24/7 and is completely confidential: 1-800-841-8371.

Thoughts on “To The Bone”

2017 seems to be the year for controversial Netflix releases – first “13 Reasons Why,” and now “To The Bone.”  Like many other mental health providers, come July 14th, I was prepared to cozy up on my couch and watch the new Netflix movie that promised to tell the tale of a young woman navigating the challenges of anorexia treatment.

I have a lot of thoughts about the “To The Bone” which I will detail below; but first, I want to add the disclaimer that I am speaking to my experience, which likely differs from the experiences of others.  For just over four years, I worked at a well-known eating disorder treatment facility in various levels of care, including Intensive Outpatient (IOP), Partial Hospitalization (PHP), and Residential.  I have never worked inpatient, but have spent time with clients on an inpatient eating disorder unit.  In my outpatient private therapy practice, I focus on the treatment of eating disorders, and have spoken with clients who have participated in various treatment programs across the country.  While I am an eating disorder expert, I certainly do not know everything about every program in the world, or what everyone’s individual experience of an eating disorder is like.  That would be impossible.

Before I go into detail, there is one point that I really want to sink in, whether you choose to continue reading past my spoiler alert below or not.  While “To The Bone” certainly works to break down some stereotypes about eating disorders (e.g. featuring a straight male and women of color as individuals struggling with eating disorders), I believe the film perpetuates the [unfortunate] stereotype that you have to look emaciated to have an eating disorder and to necessitate treatment.  While some of the women in the home are [likely] at a higher weight than Ellen/Eli (the protagonist), the majority are strikingly thin.  Sure, many people who are affected by anorexia and other eating disorders do lose a lot of weight and have that “skin-and-bones” appearance, but here’s why this has my feathers ruffled: Several of my clients have shared that they do not believe they are “sick enough” because they are not “skin-and-bones.”  Or because their eating disorder never landed them in the hospital.  Or because someone didn’t believe them when they reached out for help because they “looked fine.”

You can lose weight and have an eating disorder. You can lose no weight and have an eating disorder. You can gain weight and have an eating disorder.  This is one of the single most important things for people to understand about eating disorders: You cannot tell if someone has one by looking at them; weight does not have to be an indicator (though it can be); in fact, the DSM-V got rid of the specific ideal body weight percentage requirement to be diagnosed with anorexia (Woohoo! Go DSM-V!).  If you have an eating disorder, or disordered eating, or any mental health issue, you deserve help. Period.

Lily Collins, the actress who plays Ellen/Eli, lost weight for this role; she also has a history of an eating disorder in real life.  The energy imbalance that weight loss of any kind requires (even if under medical supervision) heightens the risk of relapse for someone with an eating disorder history.  I have seen this firsthand in my work, and I do not support the decision (though I am unclear who made it) for her to lose weight for this part.  It is also worth noting that her appearance in the movie was likely exaggerated with camera angles, Photoshop, make-up, and possibly mannequins in place of her actual body in some scenes.  This is key for someone who is triggered by her appearance to remember as they watch.

So, as someone who truly hates spoilers, here is where I will insert a big SPOILER ALERT!!! in this post for anyone who has not yet seen the movie.  Granted, it may be helpful to know what you’re in for, but if you want to appreciate the film without knowing plot twists and details, I would stop reading now.  I commend the filmmakers for starting with a warning that the movie may be challenging for viewers, particularly those struggling with eating disorders, or those in recovery.  If you wish to know what specific triggers you may encounter, I have listed them below:

Potential triggers include, but are not limited to: Specific calorie counts, specific weights, emaciated bodies, water-loading, purge behavior, discussion of laxative use, secretive and compulsive exercise, chew & spit behavior, passing out, miscarriage, NG tube, body checking, cutting food into tiny bites, and discarding of challenging foods/components of meals.

One of the biggest criticisms I saw about the film before it was even released was the concern that it “glamorizes” eating disorders.  This was, I assume, based on the trailer, released several weeks before the film became available.  The trailer shows a group of patients, both male and female, living in a cozy, well-decorated home, working on recovery together.

My take away? I do not feel the film glamorizes eating disorders, per se, but perhaps does not accurately portray what a typical treatment center experience is like.  To be fair, they do refer to the doctor (played by Keanu Reeves) as having “unusual methods.” That being said, I think I owe it to readers to explain how a typical treatment facility works (again, based on my experience in the field):

Many Residential programs are quite nice, possibly in a well-kept home (as in the film), or in apartment-style living.  During mealtimes, patients generally come together and eat as a group.  Depending on the program and the age group of the patients, food is either prepped by the patients themselves, or by a chef or counselor in the program.  There are generally one or more staff members sitting with the group to provide support if a patient is struggling, and to redirect eating disorder behaviors (many of which are evidenced in the film) or topics that may be triggering at mealtimes (e.g. calories, comments about food, weight, etc).  It is unlikely that patients would be eating without staff support, or that they would not be expected/encouraged to eat during a meal, as portrayed in the film.  It is also unlikely that they would be able to choose their own food, and eat just hard-boiled eggs, or peanut butter, or a candy bar for a meal; meals are generally balanced containing components from each food group.  If a meal or snack is not completed, the patient would likely be coached individually by staff, and ultimately offered a supplement (such as Ensure or Boost), or possibly a nasogastric (NG) (i.e: feeding) tube if they were not properly nourished.

In “To The Bone,” the program is referred to as an inpatient unit, which is confusing, as an inpatient facility is generally more like a hospital, and less like a group home.

So, back to the idea of whether or not the film glamorizes EDs: Ellen/Eli had to drop out of college due to her eating disorder.  She has been inpatient several times, and many of her housemates share that this is true for them, too.  One of the women is 12 weeks pregnant and suffers a miscarriage, which is assumed to be related to using eating disorder behaviors such as restricting and purging, as compromised fertility is one of the many serious side effects of eating disorders.  Ellen/Eli’s sister speaks about how she does not get to have the full experience of having a sister due to the eating disorder. Ellen/Eli has lanugo (excess body hair grown to keep her warm due to not having enough body fat) on her arms, passes out at a train station, has bruises along her spine, and is constantly cold.  She is near death by the end of (and presumably throughout) the movie.  All of these things – multiple admissions, serious medical consequences, family issues – are very real when it comes to eating disorders, and I, as well as many of my clients who have discussed the film in sessions, do not feel this glamorizes the illness.  In fact, I am glad it shows so accurately how much an eating disorder can suck the life out of someone – both physically and mentally.  (That being said, if you have not experienced any of these specific consequences, you are still deserving of help.)

Going back to how treatment is not necessarily accurately portrayed in the movie, let’s talk about that bottle scene.  This was a significant topic of conversation with many of my clients afterward.  Toward the end of the film, Ellen/Eli’s mother begins to lose hope about her daughter’s ability to recover given the long, arduous road they have been down since the onset of her eating disorder.  One day, her mother has a premonition that tells her she should feed her daughter the way she did when she was a baby, and she encourages her daughter to try this approach.  Initially, Ellen/Eli says ‘No way,’ but shortly thereafter, she comes around and allows her mom to feed her … sitting in her lap and drinking rice milk from a baby bottle.  This is definitely unexpected, and certainly not a typical form of treatment.  Methods like the Family-Based Treatment (FBT) approach, also known as Maudsley, focus on the parents temporarily taking over food preparation in order to renourish their sick child, but certainly not in the way that is shown in the film. In fact, some of the teens I work with were quick to say they were concerned that peers of theirs watching the film might think that’s what their ED treatment was like. I was initially a mixture of both shocked and a bit uncomfortable watching this scene, and it was actually my husband who provided some great empathy for the characters, commenting that most parents would do anything they could think of, even if strange or unconventional, to help their sick, dying child.  I thought he offered an interesting perspective on an otherwise unusual scene.

I loved some of Ellen/Eli’s therapist’s quotes, such as “What you crave is the numbing of the thing you don’t want to feel,” “Feel the fear and do it anyway,” and “Bad things are going to happen, that’s non-negotiable; what is [negotiable] is how you deal with it.”  Eating disorders are often about pushing away uncomfortable emotions by using disordered behaviors (e.g. when Ellen/Eli does sit-ups in her bed after a particularly emotionally challenging day), and often recovery is about confronting and sitting with these emotions.  He also says during a family therapy session that “Fault and blame have no place here,” which is so consistent with the Family-Based Treatment (FBT) approach, and can help families move forward in treatment.

I thought the movie did a nice job showing how the house members could be supportive of one another through their eating challenges at meals, even though they were struggling themselves.  That being said, I did not like the storyline about Luke and Ellen/Eli falling for each other, as relationships formed in treatment can often create challenges regarding recovery, particularly when they are romantic relationships.  At one point, Luke asks Ellen/Eli to stay in the home because he “needs” her, given his fear that he may relapse after learning some bad news.  People need to make decisions for themselves, and not feel guilted into being there to assist in someone else’s recovery.  It is okay to focus on yourself during treatment; in fact, you will be better at helping others (eventually, if you so choose) if you have first given yourself the time and attention you deserve.

I wish the film had shown successful treatment – while still acknowledging that it may take several admissions – to give hope that recovery is possible.  I wish it had not ended with the idea that you have to hit “rock bottom” in order to recover; for many people, hitting rock bottom can be fatal, which is a gamble that is not worth taking.

I found myself wondering what the purpose/goal of the film was.  Was the goal to show what it is like to have anorexia?  To that, I would say that while Ellen/Eli’s experience certainly may be relatable for many people, the film runs the risk of being incredibly triggering due to the use of specific numbers/behaviors (as listed above), and featuring someone so visibly underweight.  I also wondered if it might turn viewers off to treatment if they hadn’t yet sought it, believing that they would not be able to receive proper support, particularly at meals, while living in a home with other patients.

If you have not yet watched the movie, I hope this helps guide whether you choose to watch, and helps inform you about potential challenges the movie may bring up.  If you have watched it and are feeling triggered or emotional, or just want to process it, I would encourage you to reach out to someone you trust when it comes to discussing eating disorders – a friend, family member, therapist, dietitian, or doctor.  Support is out there.  Remember that you are not alone in this illness, and although recovery can be incredibly challenging, it is absolutely possible.

Body Diversity & Fat Assumptions

Earlier today, one of my friends posted this photo to his Facebook page:

[This image no longer available, however, here is a description of what it was: a woman wearing yoga pants and a top typically associated with exercise clothing. The woman appears objectively larger bodied than the women we typically see in advertisements, particularly those regarding exercise equipment or clothing]

His caption was as follows: “This ad makes me so … HAPPY. Health at every size. Skinny doesn’t mean healthy and overweight doesn’t mean unhealthy. Way to go TARGET!”

As I have come to expect, a post like this stirred up a bit of a debate.  Many people were caught off-guard by his statement that being overweight does not necessarily mean one is unhealthy.  I want to summarize my thoughts, some of which I commented on the post, as I cannot seem to stop them from racing through my mind.

♦ First of all, just the same as skinny does not equal healthy and fat does not equal unhealthy, skinny does not equal unhealthy and fat does not equal healthy.  Everyone’s individual health is influenced by a number of factors, one of which may or may not be weight, and many of which may be simple genetics.  Some people do improve their health by decreasing weight, while others improve their health by increasing weight (we just tend to hear about them less).  

This can also be connected to happiness.  If someone finds that food is controlling them – perhaps they are engaging in overeating and binge behavior, or emotional eating, on a regular basis – seeking help around this may lead to weight reduction due to behavior change, and regaining control over this aspect of their life may lead to increased happiness.  Similarly, breaking free of the prison that is anorexia nervosa, or restrictive eating in other forms (“disordered eating”) aka dieting, may lead to a newfound sense of happiness stemming from the freedom one finds in normalized and intuitive eating.  We focus so much on health – of course, physical health is important, however, mental health and happiness are as well, and none of these things can be deduced by looking at someone.

There is an article outlining multiple studies which found the following:

In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease.”

So much of our tendency to see a larger-bodied person and assume they are unhealthy comes from these aforementioned “long-held assumptions.” (Let’s not forget that the diet industry was formed as a way to make money – which it certainly has, not necessarily to improve health – which it often does not.)

♦ This morning before my friend’s post inspired this storm of thoughts, I had seen an ad featuring several women of various body sizes posing in their bathing suits. The ad read, “Chic styles and incredible fits for every body.”  Most of me loves this. I think it’s great. This is a great step toward incorporating body diversity into ads and helping more women (and men) see models who reflect their own natural body size.  There is, however, a piece of me that feels frustrated that ads need to point out that they are including various body sizes.  The ad my friend posted is perfect.  It does not feel the need to state that it features a larger-bodied person.  That is, afterall, what the woman in the ad is – a person!  The ad does not need to acknowledge “Hey look, we included a more diverse body!” By the lack of acknowledgment, it helps to normalize the body type.  The ad just … is.

(Side note, I realize that by writing a blog about this ad, I am acknowledging that this is not a typical body we see in media; I struggled with whether to even write about this, but until things become more normalized, I will likely continue to discuss it.)

♦ Finally, let’s take the health piece out of the discussion.  I can understand that for many people, it is very hard to read an article about how being overweight may actually be a protective factor and suddenly buy into the health at every size approach.  Let’s set that aside, and take a moment to just celebrate a larger woman being in an ad. Isn’t she as deserving of wearing these clothes as anyone else?  (Not to mention, so often fat-shamers assume larger men and women are “lazy.”  “Just exercise!,” they say.  Well here ya go – a larger-bodied woman exercising!  Yet many fat-shames will still be angry about this ad. You just can’t win.)

One final thought: even if this woman is unhealthy – whether it be weight-related or simply that she happened to have a nasty case of pneumonia on the day of the photoshoot … unhealthy people wear clothes too!  They need to go shopping, and they deserve to see people who look like them in the media.  

This is not an “either/or” issue, it is a “both/and.”  This is not a debate of fat versus skinny; it is about including all body types and sizes in media to create body diversity, which can in turn improve the self-esteem of consumers, and reduce poor body image and disordered eating behaviors.  (Fun fact if you are still of the mindset that fatness is bad and that fat people deserve the shame they so often receive: one study found that overweight teenage girls with negative body image were more likely to gain weight. Some people believe that shaming overweight people will help motivate them to lose weight, when this study found just the opposite. {Also, why are we still shaming people for existing?})

If you find yourself seeing an advertisement, or any other form of media, including a larger-bodied individual, and your reaction is “but health!,” I would encourage you to take a moment to check what’s really coming up for you.  Are you possibly making an assumption?  Are you genuinely concerned about that person’s health? Does your reaction, perhaps, stem from the fat-phobia our society has developed over many years? Remember: both/and, not either/or.  For all things.

Scale It Back

If you are someone who “watches your weight,” you may find that you put more value in your scale than in many other things.  

Think about it.  You may wake up one day feeling great; you got a good night’s sleep, are in a great mood, and the first thing you do is step on the scale.

It’s higher than yesterday. Instantly you feel like crap.

It’s the same as yesterday. What am I doing wrong? you may think. Like many people, perhaps you have been conditioned to believe that weight loss is the only way to feel good about yourself.

The only difference between the moment before you stepped on the scale and the moment you saw the number the scale produced is that now you have new information.  Nothing has changed. Your body is the same. Yet suddenly, you see it from the perspective of the scale, rather than from the perspective of your mind.

Again, the only difference is that you have new information.  You were feeling like a rockstar, and suddenly, because of seeing a number, you feel like a failure.

I cannot tell you how many times I have seen this happen, particularly when I was working at an eating disorder clinic.  One of the protocols in the program in which I worked involved showing the adolescent clients their weight twice weekly.  I fully supported this, as many of these kids needed to weight-restore as part of their recovery, and viewing their weight was a form of exposure therapy.  I saw kids bounce into program, smiling, chatting with their peers in the group … but once they saw their weight increase (or stay the same), their mood did a complete 180. 

Let’s take a second to define body image.  Not surprisingly to anyone who knows me, I talk about my corgi … a lot.  This is a story I often share with my clients.  After I’d had him for one year, I took him to the vet for a check-up.  When I’d first adopted him, he was in rough shape, as he’d been living on the streets for a while.  After a year of rehabilitation, he was doing great!  When the vet saw him, she smiled and exclaimed, “He’s got great body image!”

I started laughing, as I talk about body image pretty much all day every day, and instantly thought, “How does she know how my corgi feels about his appearance?!”  

What my vet meant was he was growing appropriately given his age and history.  However, that is not actually what body image is.  Body image is how we see ourselves.  You cannot actually tell anyone’s body image from looking at them.  Body image is an interpretation, a form of self-evaluation.  You may see someone completely different from how they see themselves.

With the summer approaching, weight loss ad are everywhere – arguably moreso than they are the rest of the year.  Everyone is advocating for a new you!, sharing tips to get a smaller body, promising ways to lose those stubborn 10 lbs!  What if instead of listening to a scale, we listened to ourselves?

Are you having a great body image day? That’s all the info you need.

Are you having a not-so-great body image day?  Off days are normal. Take some time to think about what’s going on. Have you spent a lot of time on social media comparing yourself to others?  Have you not been exercising when you’re used to doing so?  Maybe some endorphins could do you good.  (Note: Just because you have not exercised does not mean your body looks different – I am not talking about how you look, I am talking about how you feel, as defined above.)

It’s also possible that something else is going on, completely unrelated to your body image, yet because we’ve been conditioned to connect our self-worth to our appearance, we accidentally morph one problem into another.  For example, maybe you’re in finals.  You’re really stressed, and instead of understanding the thought as, “I’m really worried I’m not going to do well on my exams,” you think, “I suck, I’m unattractive, nothing is going well.  If only my body were smaller/more toned/thinner, I wouldn’t feel so bad right now.”  

Perhaps you have gained weight. And perhaps that can be okay.  Contrary to what (almost) every magazine tells us, weight gain does not have to make us miserable.  Maybe you’ve finally relaxed your expectations around eating and have become more flexible, allowing yourself dessert when you used to be stuck in the prison of restrictive eating. Consider that this can make you mentally healthier and happier, and yes, it is possible your weight may shift a bit in the process.

There are so many other ways to evaluate how you are feeling without using a scale.  Weighing yourself and focusing on the number enables you to avoid your intuition and feelings, and instead tells you that you should feel a certain way based on what a $30 battery-operated machine tells you.  

Also, scales can be so different – I have a scale at my office for the kids who, as I mentioned above, are weight-restoring and using this as a form of exposure therapy.  Often, they come to my office immediately following appointments with their doctors, and their weight is about 3-6 lbs. different on my scale.  Does that mean they gained 6 lbs in the 15 minute car ride? No.  It means scales aren’t perfect, so we need to stop treating them as the be-all and end-all.

If you can’t kick the habit, try this: Before you weigh yourself, ask yourself some questions: How are you feeling about your body? What factors contribute to that feeling (e.g. are you more stressed than usual, have you been sick, are you out of your element or routine, etc.)?  After you get off the scale, ask yourself how you’re feeling now. Did anything actually change? Does it make sense that your mood may have drastically changed even though the only thing that changed is that you got new information?  What factors are contributing to this mood change (hint: numbers numbers numbers)?

And if you’d like a daily reminder about why dieting and the scale generally make you feel worse, check out Jenna Free of You Ain’t Your Weight (@youaintyourweight on Instagram) who is amazing at helping with intuitive eating, moving away from the diet mentality, and moving toward positive body image.

 

“I Wish I Had an Eating Disorder”

Earlier this week, I went on vacation for a few days. Many other vacationers were very friendly, engaging, and talkative, so I got to hear some beautiful love stories, travel experiences, and all sorts of interesting things.

During one of these conversations, one woman asked what I do for work. “I’m a psychotherapist,” I said, “I primarily work with eating disorders.”

“I wish I had one of those!” she exclaimed with a snide laugh.

I froze.

Like many, I feel like I always have the perfect response … just ten minutes too late. But what is the perfect response to this?

I think I said something like, “Ehh, it’s not what you think,” but she started talking over me, saying something about how her daughters are always saying they think they’re fat.

I couldn’t shake it for awhile. My husband and I stood there talking to her for a few minutes about her most recent vacation, her kids, etc, but I was already shut down. I stayed (unusually) quiet.

Once the time was right, we ended the conversation and walked away. I took a moment to vent about her comment. How could she think that?! Doesn’t she realize that’s an awful thing to say? What a terrible thing for a mother to believe!

Then I realized she is not the problem.

I’ve been reading Brené Brown’s book “I Thought It Was Just Me (But It Isn’t),” which is all about shame. One of the most important things she says is that there is no evidence that shaming someone (telling someone they are bad) leads to change. There is, however, evidence that guilt (acknowledging that someone did something bad/wrong) can lead to change. Announcing to this woman that what she said is abhorrent and she should really think before she talks won’t change anything – in fact, it likely would have made her more defensive and shut off to what I had to say.

In fact, perhaps this woman is lucky in that she has not been directly affected by an eating disorder – either by having one herself or by watching a loved one suffer through the downward spiral of the illness. The problem here is that there is a societal misconception about eating disorders, and not enough education about the topic. Looking back, I wish I had given her more information, and said something like, “Yeah, the media sometimes makes it seem like eating disorders are just a quick way to lose weight, but really they can lead to deep anxiety and depression, and actually kill 10% of the people who have them. I have definitely learned a lot from working with people suffering from the disease – things I’d never realized before.” That way, I could have educated her, while also avoiding shaming her for what she’d said.

If you have ever thought “a little anorexia” could do you good, or heard someone joking that they have an eating disorder because they just “love french fries so much they could eat them all day!”, here are some reasons why an eating disorder is not something to be desired:

  • Eating disorders have the highest mortality rate of any mental illness. This means more people die from eating disorders than from any other mental illness, often due to cardiac arrest, failure of other vital organs, or suicide.
  • People with eating disorders often experience significant hair loss, dry skin, growth of lanugo (a fine layer of hair covering the face and body), weakness and fatigue, premature osteoperosis or osteopenia, stress fractures, tooth decay, low heart rate and blood pressure leading to heart failure, dehydration leading to kidney failure, swelling of the face and limbs, tears or even rupture of the stomach and esophagus, and many more uncomfortable and extremely dangerous medical side effects.
  • Those struggling with eating disorders often experience substance abuse at a rate about 4x higher than those without eating disorders, as well as comorbid depression, anxiety, and suicidal thoughts and/or behaviors.
  • Although I do not have a formal statistic to back this up, in my work over the past several years with people in recovery from their eating disorders, many have stated that their body image (perception of their own appearance) was worse when they were at their lowest weight. In other words, many actually felt worse about themselves when they were at their “thinnest” than when they were weight-restored (i.e. at their natural, healthy weight). This is often because the stronger the eating disorder becomes, the more it can hijack one’s brain into believing they aren’t good enough – or in this case, thin enough.

When someone says they “want an eating disorder,” they likely mean they want to lose weight. It is important to remember that those are two different things. That being said, 35% of “normal dieters” progress to pathological dieting, and, of those, 20-25% progress to partial or full-syndrome eating disorders. On top of this, 95% of all dieters will regain their lost weight in 1-5 years – so really, what is the point!? Instead of focusing on changing your body to feel better about your appearance, remember that there is a less common, yet much more effective option to improving your body image, which is to change your mindset. Find body positive role models in your friend group or community, talk to a therapist about your self-worth, do what makes your body feel best rather than what will burn the most calories, and eat foods that give you both nourishment and satisfaction.

It is also important to remember that not everyone with an eating disorder loses weight – some maintain or gain as a result of their behaviors. You cannot tell from looking at someone if they have an eating disorder. Instead of glorifying or dismissing the severity of eating disorders, remember that they are serious, life-threatening diseases that hold people’s minds captive, forcing them to obsess about food, weight, shape, appearance, calories, compensatory behaviors, and rigid rules all day. Rather than wishing we had eating disorders or could just lose a little weight, let’s focus on wishing away eating disorders – or better yet, fighting society’s obsession with weight loss and dieting so eating disorders can become a thing of the past.

 

Note: Although one of the diagnostic criteria for an eating disorder is fear of weight gain or of becoming fat, eating disorders are not only about weight and appearance.

Reference: http://www.nationaleatingdisorders.org/get-facts-eating-disorders

 

 

Rapid-Fire Gratitude

Last week, my yoga teacher ended class in a way I had not experienced before. Right before we ended with a synchronized “Om,” she asked us to participate in a round of “Rapid-Fire Gratitude.”

I loved it.

Essentially, this was an approximately one minute period in which we were to think of as many things as possible for which we are grateful. I think the fact that she specifically stated that we were to do it “rapid-fire” style triggered my brain to run through as many things as possible in that time period. It’s amazing what comes to your brain when you’re challenged to thinkfast.

Gratitude doesn’t have to be about big things. Gratitude can be for anything. Life. Recovery. And if you’re not there, for having a strong team to help you on your hard days. For the unrelenting love you receive from your dog. For the 10, or 16, or 3 years you had with your dog who recently passed. For the ability to afford delicious food, something too many people in the world cannot do. For yoga. For your limbs and moving your body. For living somewhere with access to hospitals when your body is struggling. For your friends. For friends who are comfortable enough with your relationship to tell you how they feel, even when that leads to arguments. For music. For coffee. For decaf when your body cannot handle caffeine. For a beautiful day. For a rainy day that makes you want to lay around and watch a movie. For your first grade teacher for believing in you.

The list can include anything you want – past or present. Maybe even future.

In class, we practiced this individually and silently, however, I think it could also be great to practice out loud and with others – around the dinner table, in a therapy group, on a long drive with friends, anywhere.

Rapid-Fire Gratitude can be practiced when you’re happy, sad, or anywhere in between. In DBT, the IMPROVE skill includes “Prayer,” and for many people, their head jumps to religious prayer when this skill is taught. That helps many, however, some people do not identify with a particular religion and seek other kinds of spiritual involvement. Rapid-Fire Gratitude is a great example of how to open yourself to something powerful as a way to get through a challenging moment, to deal with life’s inevitable struggles, or to celebrate and reflect on the present.

While, currently, we tend to designate Thanksgiving as the day to give thanks and reflect on our blessings, imagine the mind- and mood-shift that could happen if we practiced Rapid-Fire Gratitude on a more regular basis. It could be a calming way to end your day, an energizing way to start it, a pick-me-up when you’re in a rut, a way to pass the time in moment of distress, anything. Let’s make it a habit and see what happens.

(Note: If you are struggling with depression, this may be challenging, especially at first. Start small, be patient with yourself, and ask for help when you need it.)

Normalizing Differences

“That lady has a baby in her belly!” Max exclaims, pointing at the building employee walking by.

I’m 14-years-old, volunteering at a camp with my best friend. We are sitting with 4-year-old Max, whose mom is late to pick him up. My friend and I meet eyes and swallow our uncomfortable grins in response to how awkward the situation is. The lady isn’t pregnant, she’s in a larger body.

Shhh, no she doesn’t, Max,” the camp director says. She laughs out of her own discomfort and everyone moves on.

I’m sure you’ve experienced this with regard to many differences we recognize in people. One of my graduate school professors told this story that, to this day, has never left my mind. He was teaching Multicultural Issues, a core class for my degree. He explained how so often, at the grocery store, mall, or other public place, a child will make an observation, and, as many children do, he or she will announce it as loudly as possible: “Mommy, that man is BLACK!!”

And what does the parent usually say in response?

Shhh, don’t say that!” … and then pushes the shopping cart away as quickly as possible to escape the now uncomfortable situation.

“Why do we shush them?” my professor asked us. “What do we teach them by shushing them in response to them noticing a difference?”

I think a light bulb may have literally appeared above my head.

I hadn’t realized how – unfortunately – normal it is to respond in that way to that situation. I hate to admit it, but, prior to this professor’s lecture, I may not have thought twice if I saw someone shushing their child for announcing that someone was black. Or a minority in any other way. Or maybe-pregnant. We as a society struggle to accept differences. I think we have somehow been trained to combat racism by being colorblind AKA not acknowledging differences, when in reality, that is not effective at all.

Shushing a child – or anyone – in a situation like this teaches them that what they observed (because truly, that’s all they did: observe) is shameful. Shhh, skin color is private, so don’t announce it! Shhh, it’s bad to be in a larger body, keep that to yourself! And in addition to that – imagine how it makes the observed person feel! Should they feel bad for the way they look?

Imagine what it would be like to normalize – or celebrate – these difference.

“You’re right, honey, that man is black. People have all kinds of different skin colors!”

“Actually, Max, that woman is not pregnant. People come in all shapes and sizes.”

These responses acknowledge differences in a non-shaming way (especially because shame is not warranted in this situation).

I’ve done a mindfulness activity with some of the kids I see in which I ask them to describe different celebrities using only facts (e.g. his shirt is blue, she has glasses), rather than judgments (e.g. she is pretty, he has a good singing voice). More than once, when describing President Obama, someone has said, “Not to be racist, but he is black.”

But that isn’t racist! It is true! I wish there were more clarity in our society around when something is racist versus when it is a simple observation, an adjective. (This, of course, is not the fault of the kid I am working with. It is a product of this lack of clarity.)

The same summer that I took that Multicultural Issues class, I remember reading to a group of 3 & 4-year-old children at another camp where I worked. The book featured children of different ethnicities. One of the black children in the group sat up really tall, smiled the widest grin I’d ever seen, pointed to the book, and said “Hey! He has black skin and so do I!!”

Some of the other counselors instantly appeared very uncomfortable, unsure of how to manage the situation.

… But nothing needed to be managed! It was the coolest, most progressive thing I have seen among preschoolers. All of the kids got involved. One girl looked at him and pointed to her arm, “I have white skin!” Another: “And mine is brown!” Suddenly the discomfort faded from my co-counselors’ faces. These children were so much more comfortable with differences than many adults!

This can be applied to so many other things – race, physical ability, sexual orientation, the list goes on. At some point in history, people of color have been (and sadly, far too often still are) marginalized and oppressed. The same is true for those with disabilities. And for people of different body sizes.

While going up to someone and calling them ‘fat’ is not necessarily the nicest thing given the way our society views issues of weight, when a child makes a comment about body size, they likely are not saying it with the same judgment that we as adults have developed over time.

I realize that with body image, we as a society are not there yet. Unfortunately, if someone were to say, “That lady is fat!” – even a child – the person they were describing would likely be offended. ‘Fat’ is still a word we use as an insult, in some ways similarly to when we used to use other words that I will not dignify here by listing them (however if you’re reading this and still using those words, please remember that there are so many other words that you can use to express yourself and your feelings). Perhaps someday, as I have written in a previous blog, we will be able to accept that ‘fat’ is just an adjective just like skinny, black, white, tall. It is an adjective that does describe some people, and does not have to be a negative thing.  Truly, the only negative thing about it is the other adjectives (lazy, bad, less than) with which we, unfortunately, have come to associate it. (I could write an entire separate post about this.)

Differences are normal. They make us who we are, and they make us unique. Sometimes, they tell a story. We have the ability to make sure every new generation knows and appreciates that. Let’s embrace differences with the excitement of a child, and not make differences taboo.