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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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Tag: HAES

10 Feb

How Our Current Approach to “Health” is Failing Our Children

Ideas to Consider No Comments by Ashley @ Nourishing the Soul

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In a paper published this fall in the journal Pediatrics, Drs.

Leslie Sim, Jocelyn Lebow, and Marcie Billings from the Mayo Clinic share two harrowing stories of teenagers who initially met criteria for through various attempts at weight loss developed eating disorders.

And lest you think these were case studies highlighted for their uniqueness, they were not. In fact, the authors point out that over 45% of the adolescent patients that present to their clinic have a history of obesity. The fact that eating disorders can flourish in the context of obesity — and perhaps, obesity intervention — is nothing new, particularly to those of who treat these young people.

Take “Kristin,” the 18-year-old who presented to the study authors’ clinic with an eating disorder. She had been told she was obese at 12-years-old and provided what is all too common for youth of higher body weights — a prescription by her doctor to focus on healthy eating and exercise. Kristin’s weight continued to climb, however, until age 14, at which point she reduced her caloric intake and began running many miles per day. Her weight began to fall, and with it Kristin stopped menstruating, became dizzy, and had difficulties with blood pressure while standing.

When she returned to her doctor, she was simply given birth control pills to address the loss of her period and told to drink more water. Over the next few years, Kristin continued to present with serious issues and lose more weight, all of which was by and large ignored by her various providers, who included her PCP, a sports medicine physician, and even a nutritionist. When her mother expressed to her doctor that she feared Kristin may have an eating disorder, the doctor pointed to her “normal BMI” and dismissed the concern.

We are failing our children.

The current emphasis – obsession – with BMI and weight reduction has locked our culture into a vicious paradigm in which losing weight is the holy grail and the health consequences are simply the price we pay.

It’s not just physicians who are to blame — not hardly: it’s public health advocates who get on soapboxes demonizing fat; it’s state legislators who push for penalizing people for being at what is often their genetically predetermined weight range; it’s school districts who put BMI on report cards; it’s states who think that campaigns like this one could possible be effective. But it’s not all just “them” either. It’s the little things the we do as well — the fat talking we do, the beauty privilege (and thin privilege) some enjoy, the media we support with our hard-earned money.

So how do support our youth in developing health and wellness without sending them spiraling into self-doubt, shame, and disordered eating?

Kathy Kater, LCSW has been working on this issue for several decades. She says, “Children who are anxious about weight begin to view their bodies from the outside-in—objectifying and judging themselves harshly according to external standards.” She’s figured out that the answer is not in addressing BMI or setting up systems of “punishment” for kids.

Instead, it’s about creating healthy kids and communities by teaching kids to connect with their bodies in new ways, challenge weight stigma, embrace healthy approaches to food and activity, and develop positive role models. Her Healthy Bodies curriculum has helped countless kids develop a more grounded perspective on their health. And it’s not just for overweight or obese kids — it’s for all kids.

It might not feel satisfying to some who are still in “panic mode” and arming up for the “war” on obesity. It doesn’t call for weight control or hyper-vigilance about Hershey Kisses. What is does is promote a balanced state of health, one that can be sustainable and non-stigmatizing.

To learn more about Kathy Kater’s work, the Healthy Bodies Curriculum, and how you can help be an agent of change towards health in your family or community, join me as I co-moderate a fun AED TweetChat with Kathy on Friday, February 14th at 1:00pm EST: Connecting Bodies with Hearts: Teaching Kids To Care, Not Compare.

What are you seeing in your community or personal experience? How is the approach to weight and health impacting the kids you know? 

13 Jan

Breaking News: Obesity Causes Head Loss

Advocacy No Comments by Ashley @ Nourishing the Soul

A perusal of headlines in the popular media reveals that being obese causes a host of dire health consequences – everything from diabetes to heart disease to cancer. And now we can add to that panic-inducing list head loss.

Yes, head loss. This frightening condition is apparently extremely common among individuals of larger body sizes, based on the frequency it’s depicted in the media. By my estimation, almost 95% of fat people are headless these days.

If you have a larger body size, beware. You might lose your head at any moment! If you’re particularly unfortunate (or, let’s be honest, really gluttonous – we all know weight has everything to do with what you eat), you might even lose your neck, shoulders, and chest as well. You might be left with only a bulging belly attached to your legs.

It’s a wonder that all these headless fat people are walking around. Based on the media images, it would seem that most of the headless spend their time sitting at greasy diners with overflowing plates of burgers and fries in front of them. There are a few that are apparently able to walk, however. These are the ones that we see on the news reports shuffling down the busy street, dressed in either baggy frocks or too-tight shorts. Either way, their lack of a head clearly prevented them from seeing what they were putting on this morning.

This is public health crisis, people! We can’t let one more fat person lose their head due to their crappy eating habits and complete unwillingness to engage in physical activity. We have to save the headless fat people!

I wonder what would happen if the media was no longer allowed to disembody individuals of a larger sizes by cutting off their heads? Would we realize that these “diseases” that we are discussing are actually people? People with hopes, dreams, careers, families, and… faces?

Depicting larger people as nameless, faceless blobs is one of the most dehumanizing acts that the media perpetrates on these individuals. The world internalizes these images in developing our perception of reality, and thus these headless fat people are bred into our consciousness. They become what we equate with the idea of “obesity.”

It follows that if the obese don’t have faces or, well, humanity, then we can treat them however we choose. These manufactured blobs become un-real, almost cartoon-like characters, and suddenly we are dealing not with a person, but with an image of what we have been taught to fear.

We ought to be both afraid and outraged. Afraid of the implications of dehumanizing one another. We don’t have to look far behind us in history to see the horrific consequences of seeing other human beings as less than human. Outraged because this is one of the least contested forms of discrimination.  This affects not just those of us who are larger in size or love those who are, but us as a community, as a society.

09 Aug

Should We Really Be Calling People “Overweight”?

Advocacy 7 Comments by Ashley @ Nourishing the Soul

I write about weight every single day. Whether it’s a blog post, a patient’s progress note, a journal entry, or a conference proposal, I’m constantly putting pen to paper on the topic of weight.

And without fail, every single time I write the word “overweight” – which let me tell you, is often – I internally cringe. It just doesn’t feel right in my body or my mind. And I think I know why.

It’s not even so much that I think the word is mean or hurtful, though it most certainly can be. It suddenly lumps an individual person into a category of people whom have been stigmatized at every single turn. I think that there are plenty of people who, like myself, use the word clinically to describe a person of a certain size, but do not have any intention of harming someone.

Of course, there is also a large sector of people who use the word with little regard for the person who is tied to the other end of it. They say it with disgust, disdain, or dismissiveness. It’s used as invective and meant to imply something about the individual.

So those things are true. But what I actually don’t like about using the word “overweight” is that it implies that there is a normal weight at which this individual should be. Plenty of physicians might argue with me (and I’d tell them to read Health at Every Size and get back to me next week), but after years of observing people managing eating issues, I can assure you that there is no one right weight.

In the eating disorders field, we often talk about a “healthy weight range,” and many suggest that range to be within maybe pounds. But the truth is that a healthy range is much, much larger than that.

And in fact, research shows that the underweight are at higher risk of premature death than overweight or even obese (the extremely obese are also at higher risk). Scientists believe that a little extra weight can actually be very protective. So if we’re really concerned about the health of this nation, why do we focus on “overweight”?

How often do you hear the term “underweight” thrown around? I’ll tell you. A quick non-scientific review of google search results shows 8,520,000 results for “underweight” and 54,200,000 for “overweight.” That’s almost 6.5 times as many results.

So in all this talk about achieving a healthy weight, the idea of what a healthy weight even means often gets lost. The National Institute of Health defines it through Body Mass Index (BMI). This measurement has inherent flaws, however.  For one, BMI makes no distinction between weight from muscle and weight from fat. That means that people like Tom Cruise, George Clooney, and Tom Brady are all in the “overweight” range.

Drs. Yoni Freedhoff  and Arya Sharma have a definition of what they call “best weight” that I really like. They say that one’s best weight is, “whatever weight they achieve while living the healthiest lifestyle they can truly enjoy.” Got all that?

What I like about this definition is that it incorporates the most important factor in this entire equation – living a healthy and enjoyable life. If you’re in the “ideal weight range” but sedentary, depressed, and/or have poor health indicators (e.g. blood pressure, cholesterol), what’s so ideal about that?

I also love all of the amazing reader responses to the question of “How do you define a healthy weight?”

As I’ve said at least a hundred times on this blog, language is crucial. Words create our realities, and so throwing around terms like overweight that may not mean, well, anything, seems dangerous.

What do you think of the term “overweight”? If you have been called this, what is it like for you? If you use this term, why?

 

23 May

Are skinny women shamed as much as fat women? [And, does it matter?]

Advocacy, Current Events 55 Comments by Ashley @ Nourishing the Soul

For the “What I Wish You Knew” series over on Rage Against the Minivan, a blog I lovelovelovelovelove (in case you wondered), a reader submission addressed the topic of discrimination against thinner women. [Please note, the author makes explicit mention of weight, and the post could be triggering for some. Use your best judgment.]

Megyn shares her personal experience with food allergies that have caused her to be underweight and the subject of others’ critical stares and scathing comments. She makes some excellent points:

There is so much out there about loving your curves and accepting your body if you’re not thin. But what about us thin women? Is it ok to belittle and begrudge us? To make snide remarks and disgusted looks? Speaking badly of someone’s weight seems more socially acceptable of thin women than of heavier women. It’s hard to love my body when everyone else tells me I too should hate it and be disgusted. That I am wrong and not ok.

Megyn’s right. Discrimination against thinner women is not something that’s talked about very often. Society does seem to think that it’s okay to pour it’s commentary on how skinny women should “eat more” or “put on a few pounds” without a second thought. In fact, one of the very first posts on NTS addressed this issue, because I think it’s so important.

We all too often forget that creating a world in which weight stigma doesn’t exist means creating a safe space for people of all shapes and sizes. The truth is skinny women don’t all want to be that way. Some struggle with food allergies. Others with illnesses that have wrecked havoc on their bodies. Others may have been the victims of neglect or malnourishment in youth. And still others do struggle with eating disorders, but are no less deserving of respect. So, I understand Megyn’s frustration, dealing with health issues that not only cause her to have to eat differently, but to then be scrutinized for it.

Perhaps the comments she bears are born out of jealousy, discomfort, or simply our hyper-focus on others’ bodies. Whatever the reason, there’s work we need to do culturally and personally to address weight shaming.

So here’s where I disagree with Megyn:

I want you to know thin women are prejudiced against just as much as heavier women.

Perhaps I’m splitting hairs here, or playing right into the Pain Olympics (Waaa! We have it worse!). But I think that this statement is 100% untrue. To me, it’s like a white person saying, “I want you to know that I am just as prejudiced against as a black person.” I just don’t buy it. [Am I opening myself for a firestorm here?]

Everything that I know from reading countless research studies, following the HAES movement, working with patients across the full weight spectrum, and living as a person in a weight-focused world tells me that fat people have it worse. Period.

Larger folks are shamed at nearly every turn – in the workplace, at the grocery store, on the internet, at restaurants, on the playground, in the voting booths, and in their own families, as a start. While perhaps (and I say that tentatively), the comments are more underground when it comes to people we consider overweight or obese, the effects (in salary, opportunities, respect, etc.) are profound.

I think it’s important that we take a cold, hard look at the discrimination happening against larger people. We have to recognize privilege as it exists, or we are doomed to live blind and biased. That’s all.

Now that I’ve stated that fat people have it worse, I recognize that it’s not all that helpful to pit one side against the other, and that’s not what I mean to do. Really. It doesn’t make what’s happening to Megyn better. I just think that making the comparison doesn’t have to be part of her argument.

This actually shouldn’t be a battle of who is more shamed, because the real victims here are women in general. When fat people or thin people are shamed for their weight, we are all hurt. If we grow up fearing being anywhere but in the dead center of the weight spectrum, we perpetuate the stigmatization and we become terrified of letting our bodies find their natural rhythm.

My heart aches for Megyn and her struggle, because no one deserves to be stared down for their size.

What do you think?

[Speaking of not pitting people against one another, one of the best posts I’ve read recently also appeared on Rage Against the MinivanWhere Is the Mommy War for the Motherless Child? Go check it out.]

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