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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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10 Jul

Where are the fat eating disorder therapists?

Ideas to Consider 5 Comments by Ashley @ Nourishing the Soul

A few weeks ago, a wanted-to-be scientist name Rachel Fox, bravely shared the fat-shaming she’s endured during her years as an undergraduate science major at a prestigious university. The overt and covert discrimination by the scientific community has led her to make the decision to say goodbye to the field altogether.

Her story should make us angry. Not only on her behalf for another human to have to endure insensitivity and harassment based on size, but also for ourselves. We’ve just lost a potential brilliant scientist because our society is so bigoted that we can’t see talent beyond a jean size. She could have been the next scientist to cure a terminal illness or discover a new planet. What if Jonas Salk or Stephen Hawking were told to avoid milkshakes and made to feel less than?

Fox’s op-ed piece left me reflecting on where else larger people are missing. I started to look around at my own field and wondered… how many aspiring therapists have changed course because they didn’t feel welcomed by the community?

In the field of eating disorders, I’d anecdotally suggest that there is a disproportionate number of clinicians with smaller bodies, as compared to the general population. I can take educated guesses as to why this might be. One reason might be that of fields in psychology, those with histories of their own eating disorders are perhaps drawn to working with this population. And while the vast majority of clinicians with their own histories of eating disorders are fully recovered, they may continue to be more aware of their own body size and possibly engage in some weight-control practices. More optimistically, it could be argued that these clinicians may be disproportionately smaller because they tend to be more mindful about their eating, practicing what they preach and not using food in unhealthy ways.

But the cynic in me wonders if there is not something more disheartening going on. Are we losing therapists of larger body sizes because they are not feeling welcomed into this field?

There is some research to suggest that this may have some validity. For starters, patients with eating disorders are often considered to be much more highly attuned to others’ weight and shape, including those of their therapists. While some with eating disorders claim that they “judge” only their own bodies, many others acknowledge feeling hyperaware of others’ bodies and even making assumptions about their therapists based on body size. A recent study (Rance, Clarke, & Moller, 2014) examined patients’ perceptions of therapists bodies and found that some patients assessed a fat therapist as less trust-worthy and more likely to lose control. This study asked patients to report on their experiences, but often the beliefs, assumptions, and feelings are less overt and conscious. It’s not difficult to imagine how a patients’ weight bias, particularly in the midst of an eating disorder in which weight and shape’s importance often gets elevated, can create a seemingly hostile environment for a therapist.

I wonder, though, if more of that hostility and distrust doesn’t actually come from within our own ranks, however. A study by Puhl, Latner, King, and Luedicke (2013) reveled weight bias among eating disorder professionals. In fact, 56% of us reported having observed our colleagues express negative comments about obese individuals. If more than half (and I’d suggest it’s actually much more than half) of us observe these behaviors occurring — and are we addressing them? — it’s easy to imagine how uncomfortable a fat therapist might feel in that setting.

Just as in the STEM field, the eating disorder realm is full of assumptions about what professionals should be doing with food. Insiders and outsides, explicitly and implicitly, seem to assume that someone who treats eating disorders should be of a middle-of-the-road weight, or even thin. If someone deviates from this, the assumption becomes that they must not really know how to manage a relationship with food. Thus, how in the world could they teach or inspire someone else to do the same?

Obviously — or, apparently, maybe not so obviously, these assumptions are unfounded. But they permeate our experience in this field and it’s easy to see why we don’t observe as much diversity in body shape and size among therapists.

Perhaps the best thing that we can do to avoid losing talent and diversity is to become ever more aware of own stereotypes and biases. Once we can acknowledge these, we can take more conscious steps to not allow them to guide our decision making and treatment of others in our field.

Do you think people of larger sizes are underrepresented in the eating disorder field? Why or why not?

 

**Please note that I don’t believe that there are not fat eating disorder therapists. I personally know many. I do believe that there aren’t as many as one might expect and that there are reasons for this…

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.

12 Nov

Can we treat binge eating and anorexia together?

Ideas to Consider 3 Comments by Ashley @ Nourishing the Soul

If I had a nickel for every patient with anorexia that has told me that their doctor has remarked, “I wish you could teach some of my overweight patients your tricks,” well… I’d have more nickels than I’d know what to do with.

Unfortunately, physicians aren’t the only ones who often see these two groups as opposite. Many of us think of the  underweight and overweight as existing on opposite ends of some wide spectrum: one group has an eating disorder and consumes too little, the other consumes too much. The fat can learn something from the thin, they surmise. Just don’t take it too far, of course.

In reality, people who eat too much or too little likely share space on one end of a different spectrum, with those who have a balanced relationship with food on the opposite side.

As a recent New York Times article points out, the recent inclusion of binge eating disorder (BED) in mental health’s diagnostic manual may help bridge the gap in how we think about these two groups. As we begin to recognize and understand BED, we start to see the many similarities the disorder shares with its more familiar counterparts, anorexia nervosa and bulimia nervosa.

But what happens when you treat these disorders together?

When I first started treating eating disorders, I thought it was important to have more diagnosis-specific programming. Would a larger person really want to sit in a room with someone underweight and talk about their body shame? Would someone underweight panic to face a person that they fear they will look like if they begin eating properly? Like some others in our field, I worried that the anxieties and differences in these groups would be a barrier to them really being able to benefit from treatment.

I felt that each population deserved their own specific programming that would target their specific eating issues. We could work on refeeding those who needed to regain weight and we could help those who overeat to learn how to feel comfortable eating less.

And then I learned a thing or two.

What I discovered was that the work was incredibly similar. Both groups were using food in a way that was not in line with their health, well-being, and values. They were using as a tool to manage their difficult experiences and feelings – whether they were restricting or binging wasn’t really the point.

Similarities in their personalities and struggles emerged quickly too. Both groups tended to be perfectionistic and have high standards for themselves. They both were known as caretakers and supporters to others among friends and family. In the midst of helping others, both groups tended to forget and deny their own needs. And both groups tended to be very critical of themselves and place a really high value on weight and shape.

The research tells us that those who continue to place a high value on weight tend to relapse, and I realized that lessening the power that weight wielded was the work that all of these patients needed to do.

Further, they all needed to eat. While the assumption might be that those who binge eat or are of a larger size just eat all the time, that isn’t the case. In fact, most of those I see who binge eat cycle between eating too little food and then eating a large amount. So, like the patients with anorexia, those with binge eating need to learn to eat full, satisfying meals regularly.

Perhaps most importantly, treating these two groups together allows for some really powerful work to be done and connections to be made. Having patients to come face to face with their hopes and fears allows them to discover that their is a real person on the other end of those stereotypes and assumptions. They discover that their expectations about what it means to be fat or thin are hardly the case, and they can begin to challenge their own beliefs. Sharing treatment allows us to combat weight stigma in a powerful way, and that’s an issue that we all face, regardless of size.

If you’ve been in group treatment, did you have mixed groups? Did you find it helpful or not? If you haven’t, what do you imagine the pros and cons or combining treatment might be?

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