Building Bridges: Interview with Nan Feyler

by Health At Every Size® Blog

by Deah Schwartz, Ed.D., CTRS, CCC

From the ASDAH Blog Committee: Welcome to another “Building Bridges” post, in which we feature interviews with health professionals, academics, and policy makers who are not necessarily identified with the Health At Every Size® movement. While some of our readers may experience our choice of interviewees as controversial figures with viewpoints that are at odds with the genuine promotion of size-acceptance and/or the Health At Every Size principles, we believe that aspects of their work contributes to the overall HAES® conversation and are thus valuable to HAES proponents as we attempt to address issues such as weight stigma, intersectionality, health-care access, research, policy development, and politics, among others. We encourage readers to respectfully ask questions, agree, challenge, and/or share your own ideas on the content of these interviews. Our overarching goal is to engage in meaningful dialogue around differences, in the hope of increasing our overall understanding and effectiveness in moving the HAES approach forward.

Nan Feyler, JD, MPH

Nan Feyler, JD, MPH

This week we feature an interview by Dr. Deah Schwartz with Nan Feyler, JD, MPH. Ms. Feyler has been the Chief of Staff for the Department of Public Health in Philadelphia, Pennsylvania since February 2008.

Dr. Deah: Can you please tell us your job title and summarize your role?

Nan Feyler: My name is Nan Feyler and I am the Chief of Staff of the Philadelphia Department of Public Health. The mission of the department is “to protect the health of all Philadelphians and to promote an environment that allows all people to lead healthy lives. We provide services, set policies, and enforce laws that support the dignity of every man, woman and child in Philadelphia.” I oversee the majority of the Department’s program divisions.

Dr. Deah: How familiar are you with the HAES model? How would you describe this approach to health?

Nan Feyler: It is my understanding that the HAES model states that a person can be healthy at any size and promotes self-acceptance of one’s body regardless of size or weight. In addition HAES questions the validity of research showing weight is a risk factor for disease.

Dr. Deah: What would you like readers to know about the work that you do in relation to the HAES model?

Nan Feyler: In March 2010, the Philadelphia Department of Public Health received a Centers for Disease Control and Prevention (CDC) grant to, in the words of the CDC, “tackle obesity.” With this funding we launched Get Healthy Philly. Working in partnership with community based organizations, the school district, academia, and the private sector, we have improved healthy food access. For example, we created a large network of “healthy corner stores” and farmer’s markets throughout the city, and added physical education resources in schools, recreation centers, and 25 miles of new bike paths. While the funding was targeted to reduce obesity, we have tried to craft a comprehensive initiative emphasizing improved access and opportunities for healthier choices rather than promoting our work to specifically address obesity.

Before working in public health, I worked as a public interest attorney representing low income Philadelphians including eight years representing people living with HIV and AIDS. This work solidified my belief that along with affordable healthcare, the right to live in a safe and healthy environment is a matter of social justice. Everyone is entitled to an equal opportunity to affordable healthy food, clean air, unpolluted drinking water, safe places to play and a safe and healthy home regardless of their gender, race, national origin, age, sexual orientation or body size and shape. In public health we try to address systemic barriers that prevent these equal opportunities with a particular emphasis on improving low income communities.

The challenge is ensuring that our work in public health “does no harm” – that is, in this case, our effort to address the increasing number of people who are obese and at risk of disease not only improves opportunities for healthy choices, but does nothing to perpetuate stigma or undermine self-esteem whether it be in the language we use, the research we support, the policies we develop or the programs we create. Indeed, I believe it is our ethical obligation to work affirmatively against the unrelenting and often unchecked discrimination based on weight and size. In this respect, I believe my work shares many of the principles of the HAES model.

Dr. Deah: Generally speaking, your field of Public Health currently does not have a weight-neutral grounding. What do you see as the benefits and/or challenges to shifting to a weight-neutral approach?

Nan Feyler: I agree with HAES that everyone can adopt healthy habits regardless of size and the soundest way for an individual to improve her health is to honor her body. I do not believe that public health policy should be framed around an individual’s weight loss. I do not believe that obesity is a disease. But I think research has shown that weight can be a contributing factor to health problems whether someone is overweight or underweight. And I believe the increased numbers of children and adults who are obese is a public health concern. So if weight neutral means denying the role weight plays as a risk factor of disease then I have not adopted a weight-neutral approach to my work.

Instead I believe the public health approach should address the societal factors which have contributed to increased numbers of adults and children whose weight puts them at risk of disease – factors such as the ubiquitous advertising and availability of cheap junk food and sugar sweetened beverages; the lack of access to affordable healthy food; unsafe or rundown neighborhoods without safe places to play; lack of gym and recess in school; weight-related bullying and discrimination; and the weight phobia in the media.

Dr. Deah: How might organizations like ASDAH work more effectively to promote a better understanding and the adoption of the HAES approach within your profession?

Nan Feyler: First I’d like to say how proud I am to be a part of this blog and how great this idea is. Facilitating this kind of cross communication is one way to promote a better understanding of HAES and for practitioners and proponents of the HAES approach to get to know more about what people in the field of public health are doing.

Perhaps a place to begin is identifying shared principles or common ground. What do ASDAH and public health professionals see as the goal of improving health? While there may not be agreement on whether there is an “obesity epidemic” or even if weight is a risk factor for disease, can we create a shared agenda that supports all people regardless of size or shape allowing for equal opportunities to healthy choices? Can we join together to fight discrimination laws and anti-bullying policies and to promote size acceptance and inclusion? There is a wide discrepancy in interpreting research on the contributions of weight and disease making dialogue difficult. Is it possible to create a shared research agenda and plan?

Ultimately I believe that the voices and opinions of people who are overweight or obese should be vital to creating and evaluating public health strategies. While working in the AIDS field, I learned the importance of people living with HIV having leadership positions in shaping the response to the AIDS epidemic. Similarly, there is a history of including people living with mental illness in leadership positions in addressing mental health services. We have taken a small step in Philadelphia in creating a consumer advisory board, but more work needs to be done, not only locally but at the national level, where I think ASDAH could play an important role if dialogue was possible.

But first we must find common ground and put aside suspicion and mistrust. I think that ASDAH and people who support HAES principles have information, experience and rich insight which would make public health efforts better informed, more compassionate and ultimately more effective in encouraging healthier environments without blame or harm. I welcome more conversation about this possibility. Thanks again for including my thoughts.

11 Responses to “Building Bridges: Interview with Nan Feyler”

  1. I appreciate that Nan Feyler participated in this interview. Every journey starts with a first step.

    Even if it is true that weight does confer different (or greater) health risks, so does my gender (female). For that matter, so does a man’s gender. The associated health risks are different, not better or worse. There are no campaigns to get rid of unnecessary testes on the theory that women (without testes) live longer than men, so testes must be the problem and eliminating them would solve it. I see campaigns to rid “the country” of “excess weight” similarly to how I would regard a campaign to rid the country of “unnecessary testes.” My veterinarian does in fact put forth the view that neutering can prolong both life and quality of life in cats and dogs, and recommends it. But I have never seen this seriously proposed for humans.

    Likewise, I think public health would be much better served if it got away from the recommendation that humans should push their bodies into preferred weight categories. I’d rather see research on how people at every size can achieve optimal health. For example, research has recently shown that fat cancer patients may be undertreated because their treatment is not scaled to body weight. I’d like to see more research into areas like that, more emphasis on meeting the individual human as they are and working with them to achieve optimal health given that some things (like weight, gender, or the presence of testes) — while they MAY be changeable for some people some of the time — are not likely to change for most people most of the time, and that should not even be an underlying social goal.

    • Thank you for your comments. I share your concern that the serious health conditions of overweight or obese patients – unrelated to weight — are often ignored. The pervasive anti-weight discrimination by medical care providers is well documented and should be a priority issue for medical organizations and clinicians alike. And I agree there needs to be better understanding of how people of every size can achieve optimal health. I don’t think, however, public health can ignore the risk that obesity plays for some diseases. While it may be true that some disease risk factors, such as gender are largely immutable (though not always) this doesn’t mean that men should not be aware of their heightened risk and make choices accordingly. Similarly some people have increased health risks due to genetics. They can’t opt out of their gene pool but may get more frequent screening tests and make health related decisions taking that risk into account.

  2. I enjoyed this interview, and felt that Dr. Deah and Nan Feyler did a fine job of discussing areas of agreement and differences. I believe that there is something to be gained in the concept of “building bridges” with people who are not necessarily 100% on board with HAES® precepts.

  3. Like Bill, I enjoyed reading this interview and appreciate both Deah’s and Nan’s willingness to engage in this interaction. Nan, you state that you “believe the public health approach should address the societal factors which have contributed to increased numbers of adults and children whose weight puts them at risk of disease”. I agree that the specific issues you list after this statement (along with poverty, discrimination, economic disparities, and other factors) are among those that are critical to improving the public’s health. However, it is because these factors, in and of themselves, put ALL sizes/shapes of adults and children at greater risk for negative health outcomes. A focus or framing based on weight is actually exclusionary and reinforces size bias and stigma. It seems that the broader framing would much better serve public health across the board. What do you think?

    • You may be interested in reading Dr. Thomas Frieden’s Framework for Public Health Action: The Health Impact Pyramid available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/. As noted in his article, socioeconomic determinants of health such as inadequate public education, lack of safe and affordable housing, and poverty are strong indicators of health both within and across countries. These are however, difficult issues to address through public health. Instead the Philadelphia Health Department has focused on the second tier of Dr. Frieden’s pyramid: “Changing the Context to Make Individual’s Default Decision Healthy,” with some of the initiatives I included in my blog – e.g. access to health food and increased opportunities for physical activity — hoping to make them the default and easier option for all. In this way we are trying not to frame our work on weight – I hope successfully.

  4. Ms. Feyler, I really appreciate your willingness to engage in dialogue with ASDAH. Your compassion for people and desire to make it easier for people to make health-enhancing choices is clear. I hope you continue to explore HAES, because this approach does not promote the idea that an individual’s weight never contributes to their risk for disease or illness – although in my experience that’s a common misperception. HAES does recognize that pursuing weight loss to reduce possible health risks makes the overwhelming majority of people trying this less healthy in the long run. And I think HAES practitioners are also more able to put any possible weight-related health risks in context with the whole person and their environment when thinking about what will help an individual improve their health and well being.

    I wonder if you would share what you think are some of the “suspicions” or “mistrust” that non-HAES oriented public health or other practitioners might have? . .

    • Thanks for your comments. My sense of mutual suspicion and mistrust stems from discussions I’ve had with HAES proponents and their feeling of being excluded or judged by public health practitioners and feedback I’ve gotten from public health practitioners who have had negative experiences in seeking out HAES proponents to participate in their work. I think there has been defensiveness on both sides and an unwillingness to listen and try to understand each other’s point of view. I know that integrating people living with HIV into work addressing HIV/AIDS was, in the early years, not easy – but because it was mandated in federal funding guidelines – after much advocacy by people living with HIV — everyone had to learn to collaborate. I hope we are moving in this direction here.

  5. I appreciate the interview and can see a great deal of common ground. I wonder about two things: 1) the use of weight stigma to motivate changes that are good for the whole community – I have heard many people doing policy say that the argument for better environments doesn’t get traction without the obesity hysteria angle, and 2) the empirical question of whether villifying higher weight and pressuring people to lose weight actually leads to better health in the longer term. I want to thank Ms. Feyler for recognizing the lack of input from our community and how this violates basic principles in public health. I agree with other commenters that one of the most common misunderstandings of the HAES model is that it somehow insists everyone is always healthy.

    • Thanks for your comments. Let’s be clear: there is absolutely no value whatsoever in weight stigma. In fact the opposite is true – stigma is harmful, with a range of negative consequences for people including depression, social isolation, unhealthy eating and avoidance of health care. Dr. Rebecca Puhl from the Yale Rudd Center on Food Policy and Obesity and others have documented what every reader knows – stigma against people based on their size is tough to avoid – whether in a doctor’s office, a classroom, a job interview, in one’s family or in the media – and always hurts.

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