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.
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.