healthateverysizeblog

March 27, 2012

the HAES files: How to Photoshop a Research Study

by healthateverysizeblog

[as demonstrated by Rock et al. (2010) on weight loss results of the Jenny Craig® program]

1. Publish in a peer-reviewed, respectable journal like JAMA. The average person has no idea they are willing to publish research sponsored by industry, so the fact that Jenny Craig paid for this will stay buried in the fine print on page 1810.

2. You’re the researcher, so you get to choose who can be in the study. Forget the bother of a representative sample. Make sure you eliminate at least 20% of your interested participants right off the bat, even though you don’t do that with your customers. Who’s going to notice that you don’t have even a representative sample of your customers, let alone a representative sample of the “obese and overweight women” of your title?

3. Don’t bother to test your actual program−too many people would drop out. Instead, pay your participants for showing up to clinic visits, and give away your diet food. Readers won’t realize that you are not really testing your real-world program, which costs $100/week. Don’t report on (or maybe even bother to track) the percentage of people who actually chose to eat the (free!) food−just track whether people showed up at the center or talked on the phone. Don’t report on the percentage of people who would not eat Jenny Craig food even when it is given away.

4. Identify the study participants to your staff, for no discernible reason. Could it be so they can be sure to work extra hard to get the desired results? But report on how you told them to treat everyone the same, as if that is an accepted research procedure.

5. Say your study tests maintenance of weight loss, but don’t ever stop your intervention. Who’s going to notice the difference between a two-year study of continuous dieting vs. a study that actually follows up, i.e., shows what happens two years after the intervention is over?

6. Report in BMI, kg, and means so that readers won’t do the math and translate into what is familiar to them. Who’s going to go back and look at the average baseline weight of 92 kg and multiply by 2.2 then figure out what 5% of that would be (about 10 pounds) to understand that this statement, “By study end, more than half in either intervention group (62% [n=103] of center-based participants and 56% [n=91] of telephone-based participants) had a weight loss of at least 5% …” means that 59% of the people who showed up at clinic visits were at least 10 pounds lighter at two years out, going from an average of 203 pounds to 193 pounds? Who’s going to subtract to figure out that even when they were getting paid and the food was given away for free, 41% of the participants could not maintain even a 10 pound average loss?

And really, who would actually divide to notice that it took an average of $6958 over two years to return an average weight loss of 15 pounds, or $463.87 per pound all while losing your sanity points being on a continuous diet for two years?

7. Count on no one noticing that even when you are paying people over $3000/year in food products and counseling rather than asking them to pay over $3000/year in the real world, the average weight trajectory is on the way back up after month 12.

8. Claim in the results section that the intervention groups reported better quality of life and reduced depression at 12 months; maybe people won’t notice that sure enough, at 24 months there were no significant changes from baseline in physical fitness or psychosocial measures.

9. Make sure to end your study at the point when you stop paying people, but describe the study in the abstract as “conducted over 2 years with follow-up between November 2007 and April 2010.” Who reads the actual article anyway?

10. Make sure you publish your study side-by-side with an independently-conducted study but make sure that one stops at the 12-month point in the process where people tend to have maximum weight loss and benefits, even though studies consistently show this reverses over the next year. That way your sponsoring company can send out its press release mashing everything together and imply all kinds of results no one found in either study, like you had a “two-year independent, multi-site clinical trial” (OK, the independent trial was a only a year and only one site) and “those who took part in the Jenny Craig program adopted healthier eating habits and meaningful health benefits for overall improved quality of life” (OK, the quality of life changes were not significant at 24 months) and “those following the program reduced risk factors that can lead to chronic disease including depression, diabetes, cancer and even stroke” (OK, there were no significant changes at 24 months in total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides, or step test fitness measures, or any psychosocial measures including depression).

Hey, if Vogue can get away with it, why not JAMA?

Posted in Deb Burgard | 17 Comments »

Tags: Deb Burgard, diet industry, industry sponsored research, JAMA, Jenny Craig, weight loss industry

March 20, 2012

the HAES files: De-Stigmatizing Our Workplaces – A Start

by healthateverysizeblog

by Linda Bacon, PhD

Being Linda Bacon, well-recognized for my expertise on weight concerns, author-of what has been called the “Health At Every Size Bible`,” must mean I can use my influence to ensure my workplace is HAES^SM-friendly and stigma-free, right? I wish. Instead, like many of you, I regularly see stigmatizing messages in my workplace. Right now, I am mired in a struggle to sway the organization’s official poster-hangers and “health-promoters” from unwitting campaigns against fat people.

This is in many ways a progressive, open-minded place but, like so many bureaucracies, it reflexively broadcasts misguided policies and messages on body size. From my recent efforts, I draw the following set of suggestions and boilerplate text (borrow at will!) for your own efforts to fight weight stigma, and advance size acceptance and respect in the workplace for people of every shape and size.

With slight tinkering, the principles and language below will adapt for letters, newsletter briefs and face-to-face conversations. I hope they empower you to speak up when you encounter body bias and “hate speech masquerading as health speech,” (in Deb Burgard’s elegant phrasing).

Assume Good Intentions

Even if you’re wrong, your arguments will go further (and you may feel less bitter) if you start from the premise that most people mean well:

Because I [know/believe] you to be caring people with the best intentions for the people with whom we work, I hope you will be concerned to know that actions and messages in [our organization’s recent health campaign/ incentive policy/public service messaging] may be unintentionally harming everyone who comes into contact with them.

Be Clear In Your Goals

Yes, this can be a great teaching moment for the long-term, and we all know changing paradigms is more a marathon than a sprint, one-miler or even a 10K, but know what you want to happen and on what time-table and be plain about it. Is it a meeting you’re seeking, or a series of dialogues? A change in the company health plan? In my case, I wanted a damaging poster removed stat:

For reasons I’ll explain, I urge you to [remove the obesity-campaign poster today]. An issue of prejudice is at stake here, with implications for the health, morale and productivity of our [students/employees].

Put the Stakes in Context

Remember, you are speaking for more than yourself. Only a few people will summon the time, courage and information to advocate on this matter, but no one is immune to body anxiety, and bias in the workplace brings down the entire organization.

I hope you will take this as seriously as you would a claim of racism, because it is parallel. Unfortunately, the [current/proposed company policy/poster campaign/incentive program] encourages weight stigmatization. (It should also be mentioned that this stigma falls especially on minority and disempowered groups, including women and people of color.) I realize the harm is unintentional, but so long as you continue this program, you are hurting people – fat and thin alike.

Question the Premises

This is your chance to point out that obesity “science” is far from proven and that efforts to combat it may be counter-productive, possibly even encouraging the behaviors or conditions they mean to wipe out.

Even setting aside the serious issue of prejudice, the company’s new [program/campaign/policy] is unlikely to have the intended effect of helping people. There is no evidence that educational campaigns like this one, based on fat stigma, yield any long-term benefit for people’s health and lives – rather, the evidence suggests that providing this “education” is damaging. Regardless of whether the information is accurate (and I would argue that it is very misleading), consider that it is delivered in a context where fatter people are regularly pummeled with “news” that their bodies constitute a horrifying health crisis, and the “fat is bad” message is already well-established in everyone’s mind.

Even if fat alone does play a role in an individual’s ill health (social inequity, and nutrition, fitness, and other behaviors actually prove far more significant), studies repeatedly find that it’s nearly impossible to banish. Most every diet fails in the long run for almost all people. Biological mechanisms dictate that the majority of us could no more diminish our girth, lifelong, than make ourselves taller or modify the shape of our ears.

Meanwhile, data show that the repeated loss-regain cycles that result from trying to lose weight) are far more harmful, medically, than maintaining a stable weight, even if it’s high. Yo-yo weights are linked to cardiovascular disease, diabetes and other (“obesity-related”) ailments, so implying that the pursuit of weight loss is valuable is just bad medicine.

Focus on Your Organization’s Goals

Ask your reader or listener to think about practical goals and consequences. Focus on the R.O.I. (return on investment), if it’s that kind of an organization. Issues of stigma aside, if the policy in question won’t yield the desired results, then why bother? Are there other, non-harmful ways the organization could achieve real good?

What does our organization gain by shaming some of us for how we look? How will we measure the success of this [campaign/policy]? Unlikely as it is, suppose stigmatization worked and some people started exercising more as a result of seeing this poster: If they lost no fat (the typical outcome of exercise programs), would the poster have failed? If each managed to lose just five pounds (hard to do but still a medically insignificant amount), would that be a “win”? If the weight loss resulted from disordered eating or had no effect on health, what then? And would results be measured over time (given that most lost weight is regained and sometimes more), or would it be forgotten by the next cycle of [posters/incentives/policy revamps]?

This campaign will succeed in little more than shaming the larger members of our community and making the rest of us feel insecure about becoming like them. The fact is that anti-obesity efforts have been shown to discourage the very types of behaviors –good nutrition and exercise – they try to promote. Fat people already know they’re fat. “Obesity awareness” efforts are not just pointless but counter-productive; no psychologist would argue that shame – or even fear – stimulates positive long-term behavior change. Thin people, meanwhile, may wrongly conclude they’ve got a “free pass,” that fitness and nutritional considerations don’t matter for them.

Propose Alternatives and Offer Information

Here is where you can talk about the missed opportunities in substituting anti-fat campaigns for health-positive messages.

The worst part is, by pursuing a misguided strategy, we may be missing the chance to do good. Evidence increasingly shows that a focus on health and health habits, rather than weight, can do a world of good. The weight-neutral, body-positive Health At Every Size® movement has shown that people who accept the bodies they’re in are far more likely to care for them through good nutrition and exercise. If our organization truly wants to improve the lives of its members, greater acceptance is the way to go, not stigmatization.

There’s more we can do. I would be glad to provide more information about the data and support behind the Health at Every Size approach and happy to brainstorm with you on ways our organization could encourage better health for our [students/colleagues].

Return to Your Goals

Cutting bait time: Are you going to end the harmful policy, or not? If not, this isn’t going away. Obviously, office politics will determine how far you are able or willing to go in setting conditions. But to the extent you can, this is where you ask for concrete change or, short of that, a detailed explanation. This will force your colleagues to consider your concerns and help you to identify further information that may be valuable.

For all these reasons, I ask you to [take the poster down/rescind the policy/change the incentive program]. If you don’t think that’s appropriate, then I would like to meet with you [include colleagues if you have allies] in person and/or hear your justification, addressing the points I’ve made, for perpetuating stigmatizing “education” likely to have damaging results.

Again, please know that I do not question the motives behind this program. I believe we share a desire to benefit our organization and do what’s best for its people. That’s why I feel sure we can work together to more find positive, affirming ways to advance those goals. Thank you.

Provide Follow-Up Information

For more information on weight and health, and Health at Every Size, check out Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon. The HAES Manifesto, taken from the appendix, is a short user-friendly synopsis of these issues. Bacon and Aphramor’s peer-reviewed article, Weight Science: Evaluating the Evidence for a Paradigm Shift, provides academic support.

Humanity Hooks

Consider ending with a personal story of your own. Here is an example of one I use from my experience:

I can never forget these words I heard from a student named Juanita, age 17, tears streaming as we walked down the a hallway emblazoned with messages for Childhood Obesity Prevention Month:

“Can they imagine what it’s like to walk down the hall and see posters essentially blaring, “We don’t want anyone to look like you?”” Do they really think that’s going to motivate me to eat better? Sure, I eat junk foods sometimes, but so do my thin friends. Why am I the only one for whom that matters? The only result I’ve seen from this campaign is that I feel worse and kids are even more mean to me.”

Before Clicking “Send,” Consider the Outcome and Prepare Your Defenses

Choose your battles wisely. Know that walking away is always an option and nothing to be ashamed of. Recognize that you do not have the power to control others’ reactions. Your message may not be heard, and could actually increase your feelings of alienation. Their actions are culturally sanctioned, and yours is a challenging message for others to hear. It will be too easy for them to rationalize what they do and marginalize you. Even I, with all the confidence of my expertise and experience and community support, feel considerable trepidation as I submit this letter to the powers that be.

Being confronted with stigma is painful, and we all experience it. Whether we choose to speak out or remain silent, whether we get the desired outcome or not, we can all benefit from cultivating our defenses and using the community for support. (Not an ASDAH member? This is a great reason to join!) Please take advantage of the comment board to add to the dialogue.

Click here for boilerplate text that you can adapt for your purposes.

Posted in LInda Bacon | 13 Comments »

Tags: employee wellness, HAES, HAES Manifesto, hate speech, health, Health At Every Size, health promotion, linda bacon, stigma, wellness, workplace stigma, workplace wellness

March 13, 2012

the HAES files: what do we mean by health?

by healthateverysizeblog

by Fall Ferguson, JD, MA

What do we mean by the “health” in the Health At Every Size® paradigm?

Let me be clear: I do not think it’s necessary for all of us who advocate for the HAES^SM paradigm to mean the same thing by “health.” I do think, however, that many of us (myself included) have been limiting ourselves and our message by engaging with a limited definition of health, with unfortunate consequences. An unexamined definition of “health” puts us at a higher risk of committing “healthism” in at least two important ways.

The Nature of Healthism

The term “healthism” was first coined in 1980 by sociologist Robert Crawford to describe a “preoccupation with personal health as a primary – often the primary – focus for the definition and achievement of, well-being.” The intervening years have seen only an intensification of this trend, and the term has come to include a moral dimension. These days, we are found morally wanting if we are “unhealthy.” A generation after he first described it, Crawford in 2006 noted how far the healthism meme has evolved, observing that we now tend to use good health as a measure of an individual’s value as a person and a citizen. It has become commonplace to observe that we live in youth-obsessed, thin-obsessed, appearance-obsessed culture; health needs to be included on this list of normative values that we use to measure each others’ worth.

Lest you think I am exaggerating, read this recent blog post (if you have the sanity points to spare). Entitled A Civic Duty to Be Healthy, it’s written by a dietician who asserts that “nobody should consider good health as a purely personal matter that is nobody’s business but his or hers. We all have a civic duty to maintain our health as best as we can and not unnecessarily burden society with the consequences of poor lifestyle choices.” The sorry truth is that this type of rhetoric is all too common. It gets invoked in any discourse around health care reform, health insurance, public health policy, and anywhere else people feel they are entitled to take an interest in other people’s health.

Healthism takes many forms, and we should be worried about all of them. People whose size is perceived as transgressive (whether too fat or too thin) are prime targets of the healthist lens. Fat people who refuse to diet are seen as irresponsible and a burden on their neighbors’ health insurance bill. However, there are two particular forms of this insidious meme that particularly concern me because I think we (and I include myself in this “we”) in the HAES and size acceptance movement unwittingly wield them against ourselves and each other.

#1: The “Perfect Fattie” Syndrome

I participated in a panel on healthism at the 2011 ASDAH conference where I showed this slide identifying what some of us call the “Perfect Fattie” phenomenon as a form of healthism. (Click here to see entire presentation.) Some of us fall into the trap of believing that we need to be in perfect health in order to advocate for the HAES principles or equal rights for people of all sizes. This is just plain wrong: none of us has a “duty” to be any healthier than anyone else. Our work is based on human rights (size acceptance) and proven research (HAES^SM principles), and that doesn’t change if our health changes. By the way, everyone – whether fat or thin – gets sick, and I hate to be the one to break it to you, but we all die too, so we need to get over it.

Don’t get me wrong. It’s important for us to acknowledge and publicize the fact that many fat people do enjoy excellent physical health and are very fit according to the traditional health indicators. This is powerful anecdotal evidence that the known correlations between “obesity” and various chronic health conditions are just that, and not proof that being fat causes these conditions. The danger is that when one of us declares, “Look at me – I’m fat and I have perfect blood pressure/cholesterol/blood sugar, etc.,” some of the rest of us get worried because we don’t. Does one individual’s health condition change what we know about HAES science? Of course not; my point is that we are all entitled to speak up, whether or not we have health conditions that the medical establishment and the public associate with fatness.

#2: Limiting the Reach of the HAES Approach

We spend a lot of time talking about the fact that it’s healthy habits and lifestyle that matter for health, and not body size or weight. Sound familiar? I have read that in many writings by HAES advocates. I have said it and written it myself. And I am not saying we’re wrong, just that this is an incomplete picture of health.

Emphasizing the evidence that healthy habits and lifestyle rather than weight loss are what have the power to improve everyone’s physical health is an excellent strategy, especially when we are dialoguing with health professionals and others who are caught up in the weight loss paradigm. But by not talking about other aspects of health, we risk alienating many whom we want to reach, namely, the victims of that same paradigm – chronic dieters and disordered eaters, folks who loathe their own bodies, and anyone who has ever been lectured by a health professional to “just eat better” and “just start exercising” in the pursuit of weight loss. And for anyone who has been stigmatized as unhealthy in our healthist society, our emphasis on how to achieve physical health may sound like more of the same.

I am not saying there’s a problem with the HAES principles as defined by ASDAH – far from it. I am actually suggesting that we need to re-read them and especially to take more seriously the second of those principles:

Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.

When we are faced with the complexity of the human experience in a one-on-one setting, most of us readily apply the above-quoted principle. We see each other and our clients as complex and fascinating human beings with all these dimensions to their experience of health and well-being. But is this recognition reflected in how we talk about HAES issues publicly?

Health as a Cultural Construction

Despite my conviction that we are applying this idea of multi-dimensional health in practice, I don’t often see it reflected in our rhetoric about the HAES approach. It’s not that we never bring it up, but this part of our message too often goes unnoticed or unmentioned. I worry that allowing that to happen is tantamount to engaging in physiological essentialism – talking about health as if physiology is all that matters.

Health is a cultural construction, not a “fact” that can be defined in terms of science. Yes, we are engaged in a debate over the scientific evidence, but there is a deep cultural divide that needs to be bridged as well. If we tacitly accept a concept of health that focuses almost exclusively on physiology, then we may be subtly participating in healthism and supporting the very paradigm that we are seeking to change. Linda Bacon has suggested that the HAES approach is “the new peace movement.” This is a brilliant reframe of the rhetoric of the “war on obesity.” Maybe we need a similar type of reframe around physiological essentialism and the definition of health.

Can we bring a recognition of the multi-dimensional nature of health to our rhetoric without losing our clarity around the physiological evidence that supports a HAES approach? Is there a way to do it without alienating the health care professionals we would like to convince to abandon the weight loss paradigm for a health-based approach? I don’t have all the answers to these questions, but I am going to try to continue to sort them out. I have already started working on another post about some of the other dimensions of health. Meanwhile, I would love to hear what you all think.

Posted in Fall Ferguson | 9 Comments »

March 6, 2012

the HAES files: the other white powder – sugar and food addiction

by healthateverysizeblog

by Jonathan Robison, PhD, MS

Gary Taubes was at it again recently, responding to “The Fat Trap” by Tara Parker-Pope spouting the same old rhetoric about how carbohydrates are poison and how the “obesity epidemic” is the result of too many carbs. As usual, his response was short on confirming evidence for his claims other than mentioning several clinical studies (no names or references) and the fact that severely restricting carbs has evidently helped him to lose weight.

The latest round of sugar bashing probably traces its origin back to an article by the lawyer (not nutritionist) Jon Banzhaf in the New Scientist in 2003 in which he argued that “fats and sugars can act on the brain in the same way as nicotine and heroin.” In a piece in The New York Times in 2011, Dr. Robert Lustig summed up the latest attack on the sweet tasting white powder from the health professionals perspective saying:

“Sugar is not just an empty calorie…It’s not about calories. It has nothing to do with calories. It’s a poison by itself.”

Of course the sugar as “empty calorie” concept makes no sense at all. A calorie is a measure of energy and carbohydrates are a nutrient – sugar has both. But that aside, the supposed dangers of sugar have certainly become legendary. Its damaging effects have been compared to those of another white powder and an entire industry – non-sugar sweeteners – has grown up around the fear produced by the legend. Experts have claimed that “most Americans are addicted to sugar” and a quick Google of sugar addiction will bring up almost 11 and a half million hits, more than 5 times the number for cocaine addiction!

What is it about this wonderful tasting stuff that inspires such trepidation? Well, the argument by the naysayers goes something like this. When people ingest sugar, it lights up the same nerve pathways in the brain that get lit up when people take cocaine. Therefore sugar must be addictive just like cocaine. In fact, the effect of virtually all drugs of abuse is largely dependent on activation of the body’s reward circuit or pleasure center – the mesolimbic dopamine system. While there are undoubtedly other mechanisms involved as well, all of these drugs exert their influence primarily by increasing the release of dopamine, which makes us feel good. So, what about sugar? Actually, it is true that eating sugar and sugary foods also increases the release of dopamine through these pathways and makes us feel good. Does this mean we are addicted to sugar? The biggest clue to the answer for this question is that sugar is only one of many factors besides addictive drugs that lights up these pathways. Here are a few others:

Music

Humor

Winning a prize

Expecting to win a prize

A mother recognizing her child

Attractive Faces

Smiling Faces

Oh yes, and being in love!

Are we to claim a pathological undercurrent for the enjoyment of all of these? Writing in 2010 in a review article in The Journal of Clinical Nutrition, Dr. David Benton, professor of psychology at the University of Swansea, Wales summed up the reality this way:

“That such a wide range of pleasant phenomena activate these mechanisms suggests that rather than seeing the stimulation of these pathways as something unusual or worrying, it can be viewed as one of a wide range of positive experiences that routinely stimulate a common circuitry.”

Interestingly, a closer look at the details unearths other discrepancies in the comparison between sugar and drugs of abuse when it comes to mechanisms of action. In fact, although these substances all do share some common pathways, sugar actually influences different populations of nerves in the brain, causes different patterns of firing, and induces different timings of the release of dopamine. As Benton explains:

“reward response is highly dependent on the substances tested, demonstrating that multiple reward mechanisms operate that can encode for different stimuli.”

In spite of the evidence, the sugar as evil mantra is not likely to disappear anytime soon. You only have to go to the bookstore to see that – Beat Sugar Addiction Now, Break Out of The Sugar Prison, Lick The Sugar Habit, The Sugar Addict’s Total Recovery Program, How To Break Your Sugar Addiction Today, Little Sugar Addicts, Suicide By Sugar and of course Freedom from Obesity and Sugar Addiction – to name only a few titles. Even more unfortunately, many so-called experts are stuck in the food as addiction paradigm, leading to outrageous recommendations to an already confused and anxious population. In his recent book, The End of Overeating: Taking Control of the Insatiable American Appetite, physician and former Food and Drug Administration Commissioner David Kessler focuses on the alleged addictive qualities of highly palatable ( sugary and/or fatty) foods. He claims that the only way to deal with these foods is to banish them. He suggests that

“the enduring ability to eat differently depends on coming to view these foods as enemies, not friends.” The solution according to Kessler is to retrain the brain to think “I’ll hate myself if I eat that.”

We know only too well that far from moving us towards that End Of Overeating, this approach is one that has led and will continue to lead to exactly the opposite – more confusion, more anxiety, more shame and more overeating. My friend and colleague Dr. Karin Kratina has been treating disordered eating for many years. She shared the following with me about her experiences with the concept of food as addiction. She asks her clients “if I gave you a bag of sugar and a spoon, how much would you eat?” She says they look at her like she is crazy! I’m guessing this would be an unlikely response from someone offered the other white powder.

We in the health professions (and lawyers as well, evidently) seem to be constantly in need of pathologizing some food or another. I plan to write more on this soon,

Posted in Jon Robison | 28 Comments »

February 28, 2012

the HAES files: can you tell anything at all by a person’s weight?

by healthateverysizeblog

by Deb Burgard, PhD

If you have grown up in this culture, you probably associate quite a few things with fatness and quite a few of the opposite traits with thinness. Almost every audience comes up with the same lists:

Fat:	Thin:
Lazy Depressed Sick Out of control Loser Bad	Productive Confident Healthy Disciplined Sexy Good

Even though these associations are not something people from other cultures (or other times in history) believe, they are so strong and unquestioned in our own time that they form the basis of our weight stereotyping, bias, and stigma.

To test your own associations, go take the Weight version of the Implicit Attitudes Test. The test does not measure whether you inflict weight bias on people, but rather how strongly you have been taught to associate certain concepts with weight.

It might be surprising to know that weight stigma hurts both thin and fat people. In my work with people of all sizes who are struggling with disordered eating, it is clear that a huge factor in their misery is almost always the worry that they will be humiliated and rejected because of their weight – no matter what their weight is. I have had people sitting in my office who look like they walked straight out of a fashion magazine who are convinced they are not thin enough, not perfect enough, and not good enough (and some of them are absolutely accurate about the impossible standards of their world of ballet or modeling or a really bad relationship). Others have endured a lifetime of negative stereotyping and discrimination as fat children or adults, and can’t imagine loving the bodies they blame for the meanness of other people. Still others have witnessed the humiliation of a friend, a parent, a sibling – and are petrified about such a thing happening to them.

So some of them have had actual experiences of weight stigma, some of them give themselves the experience of stigma within their own minds, and some are convinced that it is only a matter of time before the axe falls unless they perfect their bodies to some mythical state. No one feels safe, because everyone has times when we feel something from the “fat” column. Busted!

When I work with clients, we have to figure out a way to handle both the real and the self-inflicted experiences of weight stigma, so that they can get unstuck and recover. Part of this work is for the client to change his/her own mind about what fat and thin means. Part of it is to change other people’s minds.

And so today in the spirit of changing other peoples’ minds, I ask that we stop for a moment and question this weight stigma stuff, and why we keep it around.

It seems obvious that the diet (i.e., the weight cycling) industry wants to keep it around, because how else would you sell a program that never works, over and over again, and not worry about the consumer getting hip to the fact that it is useless? But even though it is a big honking industry (most recently estimated at over $60 billion), most of us are not making money from it and would be fine if it suddenly went out of business. In fact, most of us would be much better off economically with our $500-1000/year safe in our own pockets rather than handing it over to Weight Cyclers.

So what about the rest of us who aren’t profiting off this industry? Why would we perpetuate weight stigma? When you look at the lists of traits associated with “fat” and “thin,” what strikes me is that they are such normal human states and traits. Is there a week that goes by when you don’t feel like some of Column A and some of Column B? But the “fat” traits are painful to experience – they are the things we feel when we miss the deadline, can’t get motivated, find ourselves rejected, or are diagnosed with a health problem. We would prefer not to feel them at all, and when we are promised that just by losing weight, we will become a Whole New Person (free of all the “fat” traits!), we think that would be a pretty great deal. That promise sucks us in. We cave to the illusion that life does not have to sometimes feel bad, and we perpetuate the myth that by changing our bodies, we can avoid feeling bad. In fact, according to the myth, if you feel bad, it must be your own fault for not working hard enough to get the right body.

The truth is, few people live only in the “Thin” column. And actually, when you think about it, doing so might make you pretty insufferable. It may be the reason some people can be so immensely clueless about the weight stigma they are inflicting on others – being cut off from your own human vulnerability makes it more possible to justify “punishing” other people. Only someone who refuses to identify with the person across from her who is suffering, would add to that suffering.

There are people who understand that weight stigma is causing suffering but feel like it is somehow going to make people care about their health. Like a person will start exercising to lose weight, but not to become more healthy, so we have to keep trying to stigmatize higher weight and promote weight loss.

It is true that people are social animals, and are very punished by being stigmatized. But punishment is famously unpredictable as a motivator. The things people do to leave the stigmatized group are often not at all conducive to their health. Injecting poison into your skin, slicing up healthy body organs, starving yourself, taking drugs, and even repetitive weight loss attempts, are things that make people sicker. Even though I don’t think people would go through half of what they do in the name of weight loss just to have lower blood pressure or better triglycerides or a lower risk of a stroke, I would argue that the net effect of the attempt to leave the stigmatized group is actually less health. Weight loss is not like trying to quit smoking. Weight cycling makes you sicker and fatter. And if your weight loss takes the form of an eating disorder you have a one of the deadliest psychiatric illnesses to battle.

And what about the health burden of weight stigma itself? Historical studies of cultures where higher weight is not stigmatized show that people at higher weights were just as, or even more, healthy than the thinner members of the community. And perhaps the most robust finding in all of epidemiology is that social support is the holy grail of health. How can removing social support – and making people sicker – be a path to making people healthier? How can the US government telling people that we are trying to eliminate them in a generation make them healthier?

The truth is, there is no reason to demonize people of certain weights. The far more effective message is that people can find things to do that support their health at whatever size they are. After all, the same practices and environments support health for thin or fat people. If the same cafeteria feeds the thin kids and the fat kids, why can’t we talk about what is on the menu that supports the health of all the kids? Why do we have to argue that the food has to change so we can have no fat kids? Why can’t we argue that the food should be healthy for the kids – period? We can work to create environments that support people in their efforts to thrive and make lasting efforts to take care of their bodies. Part of creating that environment is ridding it of the pollution of weight stigma.

I grew up during times of great social upheaval, and I have seen a lot of change when it comes to social stigma. Though the world is far from perfect, it is a very different place now than it used to be if you live together without being married, or get divorced, or have a baby as a single parent, or work as a female airline pilot, or get around in a wheelchair, or raise kids as gay parents, or love someone of a different race or religion. Stigma is a kind of fashion. We can change what is fashionable. We can make weight stigma incredibly uncool. Because it is.

So what are you going to do today to end weight stigma, in your mind, and in the world?

National Eating Disorder Awareness Week

is February 26-March 3! Get involved!

Everybody Knows Somebody. Visit the NEDAwareness Week homepage to register today and learn more about how you can do just one thing to help raise awareness about eating disorders and become part of the solution. NEDA’s Helpline number is: 800 931-2237

Posted in Deb Burgard | 7 Comments »

February 21, 2012

the HAES files: you gotta have heart!

by healthateverysizeblog

by Jeanette DePatie, ASDAH Vice President, in consultation with ASDAH member Sandy Dixon, RN, MS, Cardiopulmonary Rehabilitation Manager

Valentine’s Day has just passed us by and February is American Heart Month. So it should come as no surprise that this blog post is going to talk about the Health at Every Size® approach to a healthy and happy heart.

Many of us have had our poor hearts broken by medical professionals who have railed on us to lose weight for the sake of our cardiac health. Fat and heart disease are associated–meaning that people who are fat may be somewhat more likely to experience heart disease. But does this mean being fat causes heart disease? Can you effectively prevent heart disease and maintain a healthy ticker using a Health At Every Size Approach?

There is a lot of new evidence indicating that healthy behaviors have a far greater impact on heart health than weight. In fact a significant study recently published in Circulation magazine (The Journal of the American Heart Association) indicated that healthy behavior—specifically exercise had a far greater impact on heart health and mortality from heart disease than body size. This was not a small or isolated study. It followed over 14,000 subjects for over 11 years. But the outcome was clear—fitness trumps fatness in terms of longevity and heart health.

So, there are a variety of Health At Every Size® behaviors that we can adopt to keep our tickers in tip top shape. Here are five good ones to get you started:

Exercise Joyfully: As indicated by the study referenced above, fitness is one of the most important factors in maintaining heart health. You don’t need to be a marathoner or a professional athlete. We’re looking for a total of 150 minutes per week or 30 minutes on most days of the week. Even as little as 75 minutes per week can have a positive impact on heart health. It doesn’t need to happen all at once, it doesn’t need to be hard core and it doesn’t need to happen at a gym. Work in the garden. Walk the dog. Park a little further away from your favorite outlet mall. Find pleasurable and manageable ways to work fitness into your life.
Manage your Mood: Some studies indicate that your emotional outlook on life can significantly impact your cardiac health. People with Type-A personalities, depression and unexpressed anger seem to be more prone to heart problems than those with a happy-go-lucky approach. Luckily there are positive steps you can take to cope with that stress. One step is mentioned above. Exercise enhances mood and helps cope with both depression and anger. Other techniques include relaxation techniques like breathing exercises and meditation. And if you’re having difficulty managing stress, anger or depression your own, seek the services of a qualified mental health professional.
Care for your Teeth: There is a lot of recent evidence linking dental health with heart health. Gum disease can lead directly to heart disease, infecting the inner lining of the heart (endocarditis). Some research also suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation. So do like your mom told you—brush, floss and see your dentist regularly.
Know your Numbers: It’s important to be aware of your key cardiac indicators including your cholesterol and blood pressure levels. That means seeing your doctor regularly. And since you’re seeing that doctor regularly, it’s smart to pick one that doesn’t raise your blood pressure through the roof. White coat hypertension is a well documented phenomenon which causes some people to exhibit significantly elevated blood pressure in their doctor’s office. So try to pick a doctor you can respect, who respects you and with whom you can communicate effectively.
Eat Colorfully Close to Nature: I’m not suggesting the dreaded “D-word” here, (You know, the one that starts with “die” and ends in agony and frustration.) But there is a lot to be said for eating a variety of delicious foods, from both land and sea, that are close to a natural state. Heavily processed foods tend to be very high in sodium and other chemicals. For some (but not all) people, high sodium levels lead to higher blood pressure. Fruits, vegetables, whole grains and seafood can help maintain a healthy heart and can also be quite delicious. So make your heart happy while you pump up the variety in your diet with a colorful plate of fabulous foods.

A downloadable version of this Health At Every Size Tips for a Healthy Heart is available here.

Posted in ASDAH, Jeanette DePatie | 12 Comments »

February 14, 2012

the HAES files: journey to acceptance

by healthateverysizeblog

by Judith Matz, LCSW

Remember me?” Beth asked following my presentation at a community-based hospital. “Of course I do!” I responded. Beth had been in my Diet Survivors group about 7 years ago, and had come a long way in breaking the diet mentality and developing a healthy relationship with food. In fact, I was surprised to see her at this event, since the purpose was to introduce participants to a non-diet, Health At Every Size® approach, with the option to pursue an eight-week program.

Beth explained that she had loved my group, and had felt much calmer in her relationship with food at the time that she left. But, she told me, she “just couldn’t handle” the acceptance part of the HAES^SM approach. In the years that had intervened, she went back to Weight Watchers, losing lots of weight, and then, inevitably, gaining it back.

It made me sad to hear Beth’s story. I don’t have illusions that I can help move everyone from the culturally induced body hatred to a feeling of being at home in their body, but I couldn’t stop thinking about the amount of energy wasted by this talented, smart and kind woman as she continued the yo-yo diet cycle.

There’s a term in the field of psychology called disavowal, which means that you know something – but at the same time, you don’t let yourself know that you know it! In other words, you disavow the thing that’s too hard to consciously acknowledge. When it comes to the failure of diets, disavowal occurs not only for individuals, but at the cultural level as well. Think about how many times we hear a report that diets don’t work, “but it’s still good to keep trying,” or a finding that people can be healthy in higher BMI ranges, “but it’s still probably a good idea to lose some weight.” These cultural messages to lose weight despite the lack of evidence for efficacy seep into the individual’s psyche, making it all the more difficult for people like Beth to move toward acceptance.

In coining the phrase diet survivor, my co-author (and sister!) Ellen Frankel and I hoped to encourage people to come out and openly declare that they’re done with dieting. But, we also recognize that people go through a process of loss and grief as they let go of all of the fantasies associated with dieting and weight loss. Here is a summary of how we describe that journey in The Diet Survivor’s Handbook:

Denial

You may find yourself questioning whether you must truly give up on the idea that diets can make you permanently thinner. After all, research shows that diets fail in the long term about 95 – 98% of the time. That still leaves a tiny percentage of people who have lost weight without regaining it back. You might imagine that you can become one of those people, even though experience says otherwise. Dieting is seductive, and you may be in denial about the inherent failure of diets. You may need to engage in another cycle of dieting before being convinced that this is true for you.

Anger

You may lament, “Why me?” You may turn your anger against yourself by berating your body, or you may direct your anger at others. It may seem unfair that some people are naturally thin no matter what they do, while you’ve tried so hard to achieve that body size. As you come to understand the physiology of dieting and body size, you may also become angry when others continue to judge you based on size.

Bargaining

Even though the concepts related to diet failure make sense, you have a wish to diet one more time to lose weight before incorporating principles of attuned eating and acceptance. Your attitude is, “Let me just lose weight first, and then I’ll quit dieting.”

Depression

You’re being asked to live your life without the goal of weight loss when, up until now, your life was focused and organized around this premise. The sadness of shifting beliefs about the merits of dieting and the requisite of thinness is a difficult challenge. You may feel that you’re being asked to give up on yourself when, in fact, the opposite is true. You have the opportunity to live an authentic life based on principles that contribute to physiological, psychological and spiritual well-being.

Acceptance

This is the point where you accept the inherent failure of diets and no longer choose to diet in an effort to become thinner. At this stage, you understand that dieting wreaks havoc on your ability to find your natural weight. You see the cost of dieting in both physical and emotional terms, and you’re no longer willing to pay the price. You’re committed to taking care of yourself the best way you can and allowing your weight to settle in its natural range as a function of attuned eating and engaging in physical activity that suits both your body and your lifestyle.

Last night I met with Karyn, a client that I’ve been working with for about six months. Even as she’s come a long way in breaking the diet mentality and becoming an attuned eater, she’s been struggling with her body image. “Something came to me this week,” Karyn announced with a smile. “I’ve been reading more books and googling for Health At Every Size information. I really get that I need to just accept my body as it is and stop focusing on trying to change my weight. When I can do that first, my eating will really fall into place.”

I still get tingles when my clients have their “aha” moments, and I hope that Karyn will be able to sustain the feeling she had in my office. It’s clear to me that the HAES culture makes a transformational difference in people’s lives as it permeates the larger culture. I don’t know whose website she went to, or which blog she read, but I do know that our collective voices and activism, whether it’s in public forums or private conversations, is significantly breaking through the cultural disavowal of diet failure. Perhaps if Beth were in my group now, she would find that burgeoning support for the Health At Every Size approach in the greater culture would help her to finally feel comfortable in her own skin. I like to think so.

Posted in Judith Matz | 3 Comments »

February 7, 2012

the HAES files: a tale of two billboards

by healthateverysizeblog

by Jeanette DePatie, (the Fat Chick), MA, ACE

Lately the Strong4Life campaign in Georgia has received a lot of publicity and a LOT of pushback. For those of you who aren’t familiar, this is a group of ads that depict fat children in black and white photography and seeks to convey how miserable it is to be a fat child. They claim that this is a “wake up call” for parents who apparently don’t know that their kids are fat and have somehow missed the message in our culture that being fat is a “bad” thing. They insist their goal is not to make kids feel bad (even though the images look like shots of hardened criminals). But it’s hard to imagine that chubby children encounter these ads via magazines, the web, television and even giant billboards and feel GOOD about themselves.

But ASDAHonians should take heart. This week I’ve interviewed two amazing women who are involved in specific pieces of activism aimed at counteracting the negative effects of this ad campaign. Both of these activities are extremely easy to join and both have used new technology and social media to create a groundswell of publicity around and support for the Health At Every Size® approach to health.

ASDAH Member Marilyn Wann has initiated an amazing campaign called “I STAND against weight bullying.” In this campaign, Marilyn has created a design template that imitates the Strong4Life ads and invites people to submit pictures of themselves and positive statements to represent themselves. Marilyn’s amazing design team takes the photos, cuts out the images of the people and puts them as well as the positive statements into the I STAND design template. These photos are then shared via facebook, twitter, tumblr, flickr, and other social networking tools. You can see some of the images submitted by your very own ASDAH leadership team here in this blog post. So far well over 200 images have been created. I caught up with Marilyn in the midst of this extremely popular project and she agreed to an interview:

What gave you the idea for this project?

I’ve been aware of these awful billboards since they went up last year. I always thought they were a hateful blight on the Georgia landscape very much like the 1-800-GET-THIN billboards are a blight on the California landscape. I tend to think visually and so I was aware of how much damage these negative images can do. But I started to wonder about how I could take the negative charge of their images and turn it into a positive charge for people of all sizes. What if we could create and share positive images of people of all sizes who are comfortable and happy in their bodies? How powerful would that be?

How did the project start?

The project started with a single STANDard. (I call these images STANDards.) I just wanted to create one of me with a powerful image and statement. I had a friend snap a few quick cell phone pictures of myself, and then Nicole Peirce helped me create an image that looked very similar to the Strong4Life versions. But the image had large red letters on it. Those letters made me feel tense. I realized that the color red usually implies warning or danger or fear. This is the opposite of the feelings I was hoping to convey. So we changed the red to hot pink, which to me symbolize health and happiness and joy. Once we did that, we realized that we had a very powerful image and we posted it.

So then you invited others to join you?

Yes! The moment I posted the picture, I realized it was something other people could do too! Almost immediately people started asking if they could submit images too. So we just developed it as a “meme dream” and put out invitations. And I want to say something about those invitations. They are open to EVERYBODY. I have had people email or call and say they want to do an image, but they have a health issue or they are in a wheel chair or they have some other reservation. This is an open invitation. If you have a picture and something positive to say, you’re welcome. And the images have just been pouring in!

Why do you think this has been so popular?

There are plenty of us that are good and angry. But we want to express our anger while doing something good. This effort unites people in our movement. It’s hard to feel powerful when you feel like you are completely alone. But when you see hundreds of images of people of all sizes standing up and saying, “hey I love myself and I love my body and my life rocks!” well, how powerful is that? We take the finger pointing and finger wagging and blaming of Strong4Life and turn it on its head. Instead of spreading fear and prejudice, we stand AGAINST bullying and FOR joy and life and health.

How do you think the “I STAND against weight bullying campaign” represents the Health At Every Size® approach to wellness?

I think this represents the HAES^SM model mostly in terms of its positive approach. It takes the approach of the pleasure principle as opposed to the punishment principle. It’s the difference between motivation and eagerness. When we are asked to do something we may not really like (which for me might be to go to the gym and get on an exercise bike) then we have to be continually motivated. But when we do something healthful we like (which for me is going for a fabulous bike ride outside) we feel a sense of eagerness. When it comes down to it, people are eager to like their own bodies. They are eager to engage in pleasurable activities. They are eager to eat delicious and sustaining foods. A HAES approach is about connecting with this eagerness. These images from dozens and hundreds of people are coming from their own hearts and express the eagerness experienced in a Health At Every Size life. People end up avoiding exercise or nutrition when those goals are motivated by shame. Enjoying eating well and exercising can come from loving one’s body and not hoping to change one’s body–core values, I imagine, of these photos and of the HAES principles.

ASDAH Member, Blogger and Fat Activist Ragen Chastain has worked with several other members of the size acceptance community to create a campaign to raise money for billboards that feature a size-positive response to the Strong4Life ads. She spearheaded the Support All Kids Billboard Project and kicked off the fund raising last week. Since last week’s launch, she has raised over $12,000 for size-positive billboards in Georgia. She only needs about 250 more donors to make a contribution (at any size) to unlock a $5,000 matching grant from More of Me to Love. You can help by making a donation. I caught up with Ragen this past weekend and she graciously agreed to an interview.

How did you come up with the idea for the billboard campaign?

I had been thinking for a while about how powerful it would be to have positive images of fat people on billboards as a way to give people of size a chance to see ourselves positively represented in the media. I talked about my frustration about Strong4Life on my blog and someone from wellroundedmama.blogspot.com left a comment saying that she wished we had enough money for our own billboards. I felt that this would be an amazing response to the Strong4Life campaign. The next day did a poll of my blog readers and people were excited about it. The only negative comment I got was that I shouldn’t bother because there was no way we could raise the money (which the commenter estimated to be $3,000). I felt like our community was ready to do something big, and I didn’t want to be held back by the notion that we shouldn’t try something big because it’s difficult or because we might fail.

Who else is working on it with you?

This has been a massive team effort. Marilyn Wann from Fat!So?, Shannon Russell of Fierce Freethinking Fatties, and Rachel Adams who did our web design were absolutely instrumental in this effort. Jay Solomon (ASDAH member) and the folks from More of Me to Love also extremely generous in offering a $5,000 matching donation that was half of what we needed to raise to put our billboard up, as well as getting the word out.

Why is this important to you?

They are kids. They are kids and they are being shamed and stigmatized by an organization that purports to care about their health. All the while that organization is taking hundreds of thousands of dollars in donations from corporations of which they claim to be critical (Pepsi, Coke, Golden Corral etc.). They are kids standing on the front lines while adults humiliate them and call it healthcare, and we need to get their backs.

What has surprised you the most about the campaign so far?

I was most surprised at the speed of the response. I believed we would hit our goal of raising $5,000 in the first day but I thought that it might be a mad dash at the end of the 24 hour Big Fat Money Bomb. Then, as I prepared to get everything posted at midnight people were e-mailing me asking for the link so that they could donate. Once we launched it the support literally poured in – we raised $1565 in the first hour, when I went to bed (at 4am!) we were at $3,290. By the end of the 24 hours we were just over $12,000.

If you had your dream come true, what would the outcome of this campaign be?

If my dream came true every kid who has ever been bullied or made to feel less than because of their weight would find this campaign and realize that they are worthy and valued and deserving of respect in the body they have now. Their new understanding would be supported when First Lady Michelle Obama stood at a microphone and said “I had the best of intentions when I focused on the weight of kids as a way to improve their health, but I now know that was a mistake, I was wrong and I’m sorry to all of the kids who were hurt when I confused their weight with their health. We are going to support developing healthy habits and high self-esteem in kids of all sizes using a Health At Every Size® approach. This is Dr. Linda Bacon, she’ll explain the research and talk about our new campaign…”

What one thing do you most want people to know about this campaign?

Right now I want people to know that we have raised enough money to put up our billboard and we are now raising what we need for other media including bus shelter signs, smaller billboard in downtown Atlanta etc. following the model created by Strong4Life to make sure that we get this message out. The More of Me to Love Matching grant is a challenge grant and to unlock it we need to get 1,000 individual donors. We are currently running a Solidarity Dollar campaign and if people want to support what we are doing. No donation is too small!

Do you think this is a good way to spread a Health At Every Size message?

I think that this is a great way to spread the message. Since CHOA’s controversial billboards have made it into National Media, our response is has the opportunity to earn National Media as well. In fact we’ve already been contacted by a major network news program, BBC News, and we’ve had an article in SF Weekly. We are getting the message out that shaming is bad for children’s health, and that we can be for developing healthy habits in kids of all sizes without stigmatizing any kids at all. The Health At Every Size paradigm is an evidence-based way to do just that.

Is there anything else you’d like to share?

Thank you. I’m reticent to start listing people lest I miss someone but thank you to Marilyn, Shannon, Jay, Rachel, everyone at More of Me to Love, NAAFA, ASDAH and everyone who is involved in this campaign. I’m so excited about what we can do for kids in Georgia and the reverberation it could have. We have accomplished something huge and we should be incredibly proud of ourselves.

This is a remarkable time in the Health At Every Size movement. Ragen, Marilyn and their amazing partners (and that includes many of you!) have created unique opportunities to create positive, HAES messages for kids, parents and other people of all shapes and sizes. I encourage you to take a moment to contribute just a little of your time, money, energy, voice, creativity, publicity or other resources to these amazing efforts!

ASDAH President Deb Lemire blogged about the Strong4Life website video campaign that accompanied the billboards.

ASDAH’s Leadership Team Supports the I STAND project!

Not pictured: Jennifer Copeland, Education Co-Chair; Paul Ernsberger, Research

Posted in ASDAH, Jeanette DePatie | 3 Comments »

January 31, 2012

the HAES files: the nocebo effect – belief and biology – part III

by healthateverysizeblog

by Jon Robison, Phd, MS

Decades of research on the placebo effect support that people’s perceptions and expectations about their health can positively influence physiological parameters as well as the course and outcome of treatment. But, is the opposite also true? Can negative expectations adversely affect our biology? The answer to this question is yes and the phenomenon is called the nocebo effect.

The word nocebo comes from the Latin nocere (to do harm) and is defined as “the causation of sickness or death by expectations of sickness and death and by associated emotional states.” People most commonly equate the nocebo effect with Voodoo, a concept well-documented in so-called “Traditional Societies” throughout the world. There is, however, substantial scientific evidence that the nocebo effect is alive and well in contemporary Western Cultures. Here are a few examples from the research over the last 4 decades:

When individuals with asthma were told they were taking a drug that would make their breathing more difficult, airway resistance increased even though the drug was composed simply of saline solution.

People who were susceptible to poison ivy developed rashes when given a harmless look-alike plant and told it was the real thing

25% of people with food allergies developed symptoms when injected with a benign substance and told that it contained the foods to which they were allergic.

The suggestion that a mild electric current was being passed through the head of healthy volunteers caused headaches in about 2/3 of the people in spite of the fact that there was actually no electric current.

A recent study in the journal Pain clearly demonstrates the power that people’s perceptions can have on their physiology. The authors reviewed 73 clinical trials from 1988 through 2007 involving comparison of the efficacy of 2 different anti-migraine medications (non-steroidal anti-inflammatories, and anticonvulsants) vs. sugar pills (placebos). Non-steroidal anti-inflammatory drugs are known to cause stomach problems. Side effects from anticonvulsants include paresthesia (burning, itching, and numbness) and memory loss. In each study, participants were told they were going to be taking either one of the two drugs or a placebo. In all cases, people who were taking the placebo had side effects that were related to the drugs they thought they might be taking. No one who thought they might be taking an NSAID reported tingling or memory problems, and only people who thought they might be taking NSAIDS reported experiencing stomach problems.

Negative thoughts, feelings and expectations on the part of health care professionals can translate into potentially dangerous and even life threatening consequences for the people they are trying to help. In his excellent book, The Placebo Response, Dr. Howard Brody says that anytime a patient “feels less listened to, without a good explanation, uncared for, and less in control, then we’d predict that a nocebo effect is possible.” He goes on to say: “in our complex and often too impersonal health care system, nocebo effects must be rather common.”

In fact, the literature is replete with stories of individuals who appear to have suffered serious untoward consequences as a result of nocebo effects or what Dr. Andrew Weil refers to as medical “hexing.” In Spontaneous Healing, Dr Weil relates the story of a woman in her early 40’s who came to see him from Finland after being diagnosed with multiple sclerosis. Although the symptoms to that point had been limited to muscle weakness in one leg, she was depressed and related her story almost without emotion, as if it was all happening to someone else. It turns out that, as can be the case with this type of disease, the initial diagnosis had taken a long time to make and involved many tests. After finally sitting her down in his office and delivering the bad news, her neurologist excused himself and left the room only to return a moment later with a wheelchair that he invited her to sit in to “practice” for when she was totally disabled.

In a study at Massachusetts General Hospital, patients about to undergo surgery were randomly assigned to control and experimental groups that were matched for age, gender, underlying disease, severity of disease and type of operation. Those in the control group were addressed by anesthesiologists in a cursory manner. The anesthesiologist gave them his name and told them that he would be giving them the anesthesia the next day and that everything would be fine. The same anesthesiologists spoke warmly and sympathetically to those in the experimental group, sitting on the bed, holding the patients hand and discussing exactly what they should expect in the way of pain and suffering. The operations were performed the next day by surgeons and nurses who were not aware of which patient belonged to which group. The patients who experienced that simple 5-minute act of compassion needed only half the pain killing medication and were released from the hospital 2.6 days sooner than those in the other group!

Contrary to the traditional dogma of the separation of the mind from the body and of psychology from physiology, the literature on placebo and nocebo clearly demonstrates that thoughts, beliefs and emotions can powerfully affect our physical health. In all therapeutic encounters, treatment is delivered within a psychosocial context based on the expectations of the patient which is strongly influenced by her/his relationship with the involved provider. Every interaction has the potential to detract from or promote the healing process. Furthermore, the beliefs that people hold prior to entering into the therapeutic process can influence the outcome in either direction.

For the work that we do around size acceptance and weight and health, this information has particular significance. It helps us to begin to understand the devastating damage that can result from oppression, weight stigma, discrimination, marginalization, labeling, bullying, etc. even when they are done in the name of health. With the accumulated knowledge of the powerful effects that perceptions and expectations can have on our physiology it is time to realize that it is not only sticks and stones that can hurt us.

Posted in Jon Robison | 1 Comment »

January 24, 2012

the HAES files: notes to myself – finding hope in difficult times

by healthateverysizeblog

by Linda Bacon, PhD

My new year nearly began on a depressing note, because of the way I ended the old one. Right around December 31, I read an article in the Environmental Nutrition newsletter, The Fit vs Fat Debate, written by the dietitian who moderated my September debate with John Foreyt before members of the Academy of Nutrition and Dietetics (formerly American Dietetic Association, or ADA).

This article was hardly the first to bring me down with mindless assertions of conventional thinking on fat, disease and dieting. But as a total misrepresentation of my long-sought ADA platform, it cut particularly deep. It also seemed to undermine my confidence and sense of progress after a year that included many Health at Every Size®(HAESsm) highs, like favorable press, a spirited, community-building ASDAH conference, a successful summer workshop, and the emergence of this blog. If this one article could bring me down, I wondered, how could I find the courage to go forward into 2012 and the years beyond, still pushing against all the odds for a paradigm shift on weight and health?

I know I’m not alone in sometimes wondering how to go on advocating fat-acceptance in a fat-phobic world, so I’m using this first blogpost of the year to share with my HAES homies the resources that pulled me out of the rut. Hopefully, they can help all of us reinforce ourselves and one another when we need to. First, though, some background on the article.

She Just Didn’t Get It

The ADA, as you may recall, insisted that HAES belonged on the conference dais only in a debate format, faced by a counter-argument. It was the job of this article’s author, Christine Palumbo, to moderate, and she informed me beforehand that she would be writing a journal article based on the panel. At her request, I suggested numerous HAES resources to support her learning, including my book and the article I co-authored in Nutrition Journal (Weight Science: Evaluating the Evidence for a Paradigm Shift), as well as a partial transcript of the debate.

So why was none of this information in the article that emerged? How could she have heard so little of the HAES case – missed, in fact, the entire debate aspect of the debate? Her article merely recapitulated conventional thought and either ignored or misinterpreted the HAES perspective. “If you’re overweight or obese,” she wrote, ”There’s no argument that your goal should be to get fit through diet, exercise, and slow, steady weight loss,” Really, Christine? What were you moderating, if not an “argument” about that very point?

Ms. Palumbo takes as gospel the standard statistical fear-mongering that “two-thirds of Americans are overweight or obese.” (That we even take those numbers seriously astonishes me. Set arbitrary definitions and you can create any fraction you want.) She ignored substantial evidence I presented on the influence of commercial interests that played a role in creating and then benefit from BMI-based definitions. She then parroted unquestioningly the notion that fat leads to death and disease. I mean, even Dr. Foreyt conceded that mortality data show fatter people living at least as long as those in the “normal weight” category. And even he conceded that confounders muddle epidemiologic associations.

I was even more disturbed– stunned actually – by Ms. Palumbo’s sidebar on HAES, which she labeled an “alternative weight loss approach.” Was she even there at the September debate? How could she have missed the central thesis of every piece of writing I supplied her with? HAES is decidedly not about the pursuit of weight loss. To the contrary, HAES shifts the focus from weight to health. Reducing it to a movement for overweight people was yet another rather egregious missing of the mark.

To too many in the dietetics community, HAES qua HAES is just too threatening. They want to co-opt it into just another weapon in the anti-obesity arsenal when in reality, HAES exists to disarm their war against obesity.

What We’re Up Against

On reading the article, though, I felt more than ever like a victim of that war. I found myself in a dark place, where I felt disillusioned and hopeless, and my life work suddenly felt meaningless. I had presented Ms. Palumbo with my best stuff. She was, she assured me in an e-mail, “trying her best to capture both points of view.” She seemed, in fact, to be a kind person who wants to do the right thing. Yet, despite all this, all my efforts at education failed even to dent her armor.

For anyone with a HAES perspective and committed to social justice, it’s easy to get discouraged this way because the truth is, this a HAES-hostile world. Our greatest efforts can seem like droplets in an ocean of conventionally accepted thought; especially when our opponents find so much buoyancy in that sea of ideas.

What happened that rendered Ms. Palumbo so unable to consider a new perspective? I don’t know. But I would like to take advantage of this platform to contemplate the challenge we’re up against. Consider a generic woman with her traits: a white, middle-class dietitian in North America, whose BMI places her in the “normal” range.

She lives in a world where her thinness is currency, conferring attention, respect, jobs, and quality health care, among other advantages. She avoids the daily humiliations heaped on fatter people, the looks of disgust, the blame, and the news reports that her shape constitutes a public health crisis. Everything in her training reinforces this posture. It is likely that she was even drawn to her profession because she has absorbed these cultural values more deeply than others and fears becoming fat, herself, and subject to the stigmatization she perpetuates.

She stands to lose a lot by challenging the mainstream paradigm: the self-righteousness and sense of entitlement that many “normal weight” people feel for having “achieved” their weight; the female bonding around food and weight anxieties, the support and respect of the professional community she is invested in, social approval, even her career. Moreover, she would have to reflect on her history and come to terms with the fact that her beliefs and actions, however well-intended, were actually quite hurtful to others.

In light of the tremendous penalty that could come from engaging with the HAES challenge, I expect it isn’t always conscious choice to avoid it. Many of us have strong defense mechanisms that keep us rooted to the safe and familiar and protect us from hearing information that might threaten our identity and worldview.

Letting Go as a Way to Hang On

Putting all this in context made it easier for me to understand why change is coming so slowly despite all my efforts. My next step was to reach out for support from other HAES advocates who I respect tremendously. That they experience similar resistance reminded me that the outcome may have little to do with me and also lifted some of the pressure I was feeling to break through. Given what we’re up against, I need to just do the best I can, I realized, learn from it, and then let go.

My best defense, I remind myself, is to take good care of myself and stay happy, despite the pain and injustice that surround me, and to maintain my strength to carry on. Only by cutting myself a little slack on the results, can I keep up the strength to keep trying. And I have to try because it is only if I stop trying that I give up any chance of winning.

I have never forgotten a conversation with my father in the last months of his life. He reflected on how he had done everything right, obeyed the rules, gone from “rags to riches” and created a lucrative business, created a good marriage, and fathered children who made him proud. His life was “a success” by any conventional measure. Yet why, he wondered, did he feel like a failure?

It’s a shame that he waited until so late in life to recognize that what matters is feeling pride in who we are, as opposed to placing value solely on our accomplishments. I inherited this to some extent – the constant drive for achievement, never feeling like what I do achieve is enough. (Did I really need three graduate degrees!?!) But that late in life conversation reminded me to think hard about what I need to achieve success. I have achieved the conventional kind of success, involving wealth and standing and prestige (and thinness). But by itself, it leaves me feeling the same emptiness my dad did.

No. My efforts to make a good life for myself heed my father’s lesson rather than his example. I do what I do – making the case for HAES in the face of almost overwhelming opposition – because it’s the right thing to do, regardless of outcome.

And, finally, I can console myself with the hope that change does happen. Many dietitians are already championing a HAES perspective. HAES did make it to the agenda of the ADA conference. Some dietitians were able to hear the message and are converts or at least opening to a HAES perspective. Mainstream news outlets have been asking if all anti-obesity efforts are such a good thing.

It helps to remember how often we have been astonished by the sudden crumbling of institutions and extraordinary paradigm changes: the American Revolution, the March on Birmingham, the Stonewall riots, Tahrir Square… And let’s not forget that it is now scientific consensus that the earth is round.

Change happens because ordinary people organize, insist on challenging the system and speaking their truths, and do not give up. So, as hard as it can be to feel I’ve tried and failed, I take comfort knowing at least I’m still trying.

Posted in LInda Bacon | 33 Comments »

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