As the alarm bells have grown louder and more piercing over the last several years, warning us that Obesity kills! and Fat is the devil!, a quieter voice has been breaking through the noise. If we can allow ourselves to turn down the volume on the anti-fat rhetoric for a moment – and I recognize that’s asking a lot – we learn from this voice that, oh… maybe, it’s possible, perhaps… we got it all wrong?

It’s one thing to challenge the diet and weight-loss industry, but to also rock the entire medical community’s entrenched belief system about what healthy means… Well, that’s a big job. Fortunately for us, there is another, strong community fighting this battle. The movement is called Health at Every Size, which I’ve told you about before here, and it’s founded on the idea that fat does not equate to unhealthy.

Even those of us for whom this concept doesn’t sound totally bizarre sometimes find ourselves falling into fat stigmatization, even in subtle ways. We accept the fact that our workplaces are hosting a weight-loss competition among employees or we complement a friend who’s slimmed down, often without even knowing the circumstances.

To do the work required of us – which is to fight and defeat these untrue assumptions about weight – we need resources. That’s why I was so thrilled when the Association for Size Diversity and Health launched the Health at Every Size Blog.

Since it’s first post last June, the blog continues to grow in the complexity and richness of ideas. It offers a space for a thorough look at some of the issues that crop up when thinking about weight and health (which we all too often think about in these days of disgusting and shaming campaigns).

One of the strengths of the site is that it is a collaborative effort of some of the most talented and brilliant minds in the HAES field. Deb Burgard, PhD, Linda Bacon, PhD, Jon Robison, PhD, and Michelle May, M.D. are all on my totally nerdy idols list (the list is nerdy, not them!), and they have each contributed incredibly thought-provoking pieces to the site.

Some of my favorite have included whether BMI is a good measure of health, if it’s possible to love your body and still want to lose weight, and whether we have it all wrong when it comes to treating binge eating.

If you haven’t had a chance to take a look, I urge you to check out what HAES is all about. Just remember that I warned you that it might turn your current paradigm on it’s ear. If you’re cool with that, click here.

{image credit :: haescommunity.org}

Having lived sans cable for the past five years or so, when I’m in the mood for some network entertainment I usually turn to Netflix and usually delve head first into a series. Mad Men, the hit AMC series about advertising men in the 60s, is my latest vice, and I’ve been going gang-busters through the first few seasons recently. I never knew I would be so fascinated by the lifestyles of the 1960s, but I can’t get enough! While keeping in mind the fact that everything is amplified for television, I’m riveted by the complicated gendered relationships between men and women, the parenting styles, the political climate, and, of course, the portrayal of mental health. Oh, and the hairstyles. I love those.

What’s so fascinating about Mad Men is that it offers a glimpse into how far we’ve come – and haven’t come – in our social development. Mental health is no exception. When Betty Draper notices numbness in her hands and discovers that this could be psychosomatic, she urges her husband Don to allow her to attend therapy. Don is at first incredulous about the idea of his wife confiding in a stranger to solve her seemingly physical ailment, but when the problems continue he relents. What we soon discover, however, is that Don is keeping close tabs on his wife’s sessions, getting a full report from her psychiatrist after each meeting.

My jaw literally dropped when I saw this exchange transpire, but then I reminded myself just how long fifty years is in the world of mental health. It was only in 1996 that former President Clinton enacted the Health Information Portability and Accountability Act – HIPPA – that provided protection for individuals’ health information being communicated. Just to be clear, in today’s world, one would need to give explicit permission for a partner to receive information about one’s treatment. And detailed information about one’s sessions would virtually never be revealed.

In fact, a lot has changed in the world of mental health since the days of Betty and Don Draper. To put in context, here are some of the developments in the past fifty years:

1966 – Alcohol abuse and dependence were finally recognized as a major public health issue, and federally-funded organizations were developed to research these illnesses. We’re still trying to establish the the exact causes of alcoholism, and genetic research is helping us understand it’s biological roots.

1970 – The FDA approved the use of lithium to treat mania. This revolutionary drug drastically reduced the number of days spent in inpatient hospital. It’s also credited with sharply reducing the number of suicides in areas where it was prescribed.

1976 – The number of people in psychiatric hospitals was dropping dramatically as an emphasis on treating individuals in their own communities developed. While giving individuals tools for community-living was important, many patients were pushed out on to the streets still ill-equipped to manage their illness. Some became victims of trauma – individual and institutionalized.

1978 – Many people still claimed that autism was caused by refrigerator mothers, parents that offered a “genuine lack of maternal warmth.” While we still aren’t clear on the causes of autism today, we’re generally agree cold moms are not to blame.

1986 – Homosexuality was removed from the Diagnostic and Statistical Manual (the Bible for mental health practitioners) as a diagnosis. It took this long despite compelling research in the 1940 and 1950s by the likes of Alfred Kinsey, Evelyn Hooker, and others. No one ever claimed that the American Psychiatric Association was speedy on these things.

1989 – Former President Bush signed a proclamation establishing the 1990s as the Decade of the Brain. The 90s saw an enormous boon in research on genetics and the brain. By 2000, genetic researchers had finished mapping human genes. The goal is to help identify specific genes and how they are associated with various illnesses. [Are eating disorders brain disorders?]

2002 – New Mexico allows psychologists (not, psychiatrists – click here if you’re not sure of the difference), to prescribe psychotropic medication. Hotly debated, but the future may hold more prescription privileges for appropriately trained psychologists.

2008 – The Mental Health Parity and Addiction Equity Act was passed. This landmark legislation required  insurance companies that offer mental health benefits to provide coverage on-par with medical coverage. Unfortunately there are still many insurance companies that are trying to sneak around this, and eating disorders are often not covered.

2010 – Nourishing the Soul was born! (Sorry, had to add that in there!)

As you can see, while advances in mental health may seem to progress at a snail’s pace in real time, in the context of our history we’ve made great strides in this field. And what has universally propelled this forward movement has been the willingness of invested parties to speak up. Whether as a clinician speaking up on behalf of your patients, as a concerned family member advocating for your loved one, or as a consumer of mental health services sharing your struggle, putting these issues at the forefront has meant everything.

So on World Mental Health Day 2011, I urge you to use your voice to keep the momentum going. This week, write a blog post about the role of mental health services in your life, share your story with a friend who might need to hear it, or even lobby in Washington. Whatever you do, remember that mental health is health, and it takes our voices make sure it gets the respect and recognition that it deserves.

For more World Mental Health Day posts, head over to PsychCentral. How are you recognizing the importance of mental health in your life today?

{image credit :: ChrisCofer}

While Kerry Washington’s history of an eating disorder may seem to make her live up to the stereotype of the young Hollywood actress, it also shatters that of the powerful black woman.

The critically acclaimed star of Ray and The Last King of Scotland has talked candidly about her struggles with her body and food. In one interview, Washington revealed the ways in which her eating disorder kept her locked into an agonizing cycle.

She recalled, “I’d eat anything and everything, Sometimes until I passed out. But then, because I had this personality that was driven toward perfectionism, I would tell people I was at the library, but instead go to the gym and exercise for hours and hours and hours.”

Washington’s sharing of the details of her battle with a food obsession is, unfortunately, a rare exception. While memoirs and media spotlights of young, white women with eating disorders are seen with increasing frequency, portrayals of black women who struggle are harder to find.

The notion of eating disorders as only affecting affluent, Caucasian women is undergoing a revolution as we recognize how these illnesses impact all sectors of society. Black women are accounting for a larger proportion of those seeking treatment for disordered eating.

Like in other diverse communities, eating disorders in black communities often go unrecognized. Marna Clowney-Robinson, an eating disorder survivor, recalled, “Within my family I don’t think they actually saw it as a eating disorder. I am one out of six siblings and we all use food as a way of coping with stresses and stressful situations that came up in our lives at the time. What I was doing was pretty much normal with my siblings. So to us it was normal behavior.”

Clowney-Robinson’s experience is unfortunately common. In black communities, food often takes on seemingly sacred qualities and is used to demonstrate a range of emotions in families. Since food is often used as a means of communicating things deeply felt, it’s easy for a disorder to develop.

In fact, a 2000 study by Ruth Striegel-Moore and her colleagues suggested that recurrent binge eating, which is part of both Bulimia Nervosa and Binge Eating Disorder, is actually more common in black women than in white women.

The lack of awareness of eating disorders in diverse populations jeopardizes the treatment of these individuals. Without recognition, research funding is extremely limited and disorders go untreated for too long. When our health care system and communities already fail to acknowledge the seriousness of these illnesses, further ignorance is deadly.

Stephanie Covington Armstrong offers a compelling look inside her own eating disorder in a memoir, Not All Black Girls Know How to Eat, that shatters the notion of the “rich, white girl disease.” She notes that the black women are underrepresented in the statistics, “Because we don’t flock to traditional therapy, we are not counted.”

Like Washington and Clowney-Robinson, Armstrong is determined to make sure that eating disorders in the black community don’t go unnoticed. She said, “It is the silence that makes this disease possible. “

Do you think that eating disorders are under-represented in some communities? How have you witnessed this?

Could seeing images of individuals with larger frames be bad for our health? The answer is yes, according to University of Bologna researchers, Davide Dragone and Luca Savorelli.

In a recently published paper, “Thinness and Obesity: A Model of Food Consumption, Health Concerns, and Social Pressure,” the study’s authors claim that societal attempts to increase the ideal body weight could be harmful rather than helpful.

Drs. Dragone and Savorelli focus on the governmental interventions in Europe – Spain, Italy, and Germany, in particular – to increase the culturally defined ideal body weight through regulations on modeling. Recent bills and policies throughout the world have sought to address the prevalence of very thin models on the catwalks. The goal of these initiatives is to counter the damage done by portraying unrealistic and unhealthy images in the media.

But now these researchers are telling us that such policies serve to hurt us. They claim that if we are surrounded by images of people who look heavier, it “induces people to become more overweight,” and thus impairs their health. They warn that this trend will only worsen the “obesity epidemic.”

Interestingly, the authors do make the argument that increasing the ideal body size would be good for our pocketbooks and mental health. They recognize that our “welfare” would be improved if we could avoid the negative feelings associated with feeling the ideal is out of reach, and that discrimination might decrease as well.

The authors remark, “Since the healthy weight and ideal weight do not usually coincide, [people] have to trade off the health and social consequences of their food intake.”

Well how’s that for an awful choice to have to make?

Fortunately, we don’t have to buy into the idea that we really have to make that decision between our social health and our physical health.

For one, there isn’t the one-to-one ratio of physical health to weight that the popular media would sometimes have us believe. In fact, it is possible to be healthy at many different sizes and shapes, and it’s our own internal bias that prevents us from considering that a larger person could be healthier than a smaller one. Studies indicated that most health indicators, such as blood pressure and insulin sensitivity, can be improved through changing health behaviors, even if we don’t lose weight.

In addition, if we believe that seeing images of larger people breeds over-eating and resultant poor health, than perhaps we need to focus on the triggers for our eating. It would be naive to say that our eating habits aren’t impacted by social cues, but if a plus-size Vogue cover girl is going to impact my waistline, then I need to be thinking about whether I’m eating based on my body’s needs and my hunger and fullness cues. If we are truly eating based on the signals of our body, with the occasional influence of a night out with friends, then our bodies should stay at or around a weight that is healthy for us. That weight not be the “ideal” as defined by society, but it will be healthy.

This study is concerning less due of what it actually says and more due to the way that it is already being interpreted and disseminated in the media. My own fear is that hearing that images of larger women will make someone fat, without understanding the intricacies – and fallacies – of the article will serve only to reinforce the weight-bias that the authors lament in their paper.

What are your thoughts? What impact do you think seeing images of larger people in the media would have on your health and welfare?

{Image Credit :: Pocket Rocket Fashion}