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 contribute 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.
Dr. Sheila Parker, DrPH, MS, is currently a lecturer in public health at the University of Arizona and participated in the development of the Arizona Graduate Program in Public Health and in the establishment of the Mel and Enid Zuckerman College of Public Health, where she was an Associate Professor. She chaired the Health Education Program for undergraduates and taught in the Masters of Public Health Program in the College of Public Health until her retirement in 2006. She has a long history of working with community agencies to improve the nutritional status and health status of individuals, families and communities. Dr. Parker has special interests and expertise in the role of self-esteem, body image and spirituality in health behaviors and lifestyle choices. Dr. Parker has served in a number of public health capacities for more than 35 years.
Dr. Parker continues to have great interest in public health workforce development in Arizona in health promotion. She has returned to teaching as a Lecturer in the Health Promotion Division to continue her contribution to that process of developing public health professionals in Arizona.
Q: Could you describe your research interests and scholarly work as they pertain to size diversity and health?
As a public health and community health professional my focus has always been on how to improve the health status of communities. However, early on I came to realize that the goal of improved health for communities must actually begin with the individual’s improved health. My personal and professional interests center on how people make their individual decisions for health and their choices that impact their health and quality of life. My research, public health nutrition practice, and health education teaching have revealed the great importance and influence of culture, and individual beliefs and perspectives about what health is and how to attain health through health-enhancing behaviors versus health-diminishing behaviors. My experiences have taught me that individuals will make the best decisions to improve and support their health when they have the best and accurate information, self-supporting attitudes and appropriate skills to make health-impacting decisions that are in line with their belief systems. It is an important professional duty of those in public health to provide the resources, education and support to help individuals make voluntary decisions and take actions that will improve their health. So the leadership must promote this perspective in research, practice, policies, and professional preparation of public health practitioners.
Q: How do you incorporate intersectionality, or the study of intersections between forms or systems of oppression, domination or discrimination, as a prominent component of your scholarly and practical work, and what is its significance?
My approach to this question may be very different from many practitioners in public health. This is strongly related to my understanding and definition of health which is similar to the HAES definition of health. Clearly all practitioners and researchers will profess to helping populations achieve greater health status, but what this actually means will vary among these professionals. The terms of “systems of oppression, domination or discrimination” have nothing to do with health which is a positive experience and tool that helps individuals and communities achieve their personal goals and accomplishments. To the extent that researchers and practitioners use coercion, domination, discrimination or oppression to achieve some ends that are counter to the well-being of our citizens, we do major disservice and harm to our citizens and their health.
These negative agenda and practices do exist in medicine and in public health. In these fields, professionals say that they depend on “evidence-based practices,” but there are agenda, policies, and practices that go against the research and life evidence. For an example, our preoccupation with the thinner body size as an indication of good health status, is not supported by most research and real life experiences. The size of one’s body does not necessarily align with positive health choices, health behaviors, and quality of life. We are using measures such as BMI and body weight to determine individual health status and these are not supported as the best ways to determine body composition, body fat, and body size for health status. Unfortunately, in using such methods and questionable associated standards, many professionals in public health, medicine, and education have moved forward with policies and actions that may do harm to the health of children and adults and cause much economic and personal waste. In my research in body image and body weight and in public health nutrition and health education practice, individuals and families often reject standards that have little to do with their cultural, physical, social, spiritual and psychological realities. They do hear and apply those principles and behaviors that help them achieve their personal health goals with the assistance of those who understand and support their goals. Health professionals must know their clients and communities from the clients’ perspectives.
This makes it even more important to define health and to elaborate on some “intersections” that are central to the health of every person, but are seldom discussed. Could it be that many that work in the health field have not properly defined what health is? Unfortunately in our society, the discussion of health often centers on physical health. Physical health is a focus, because we can often observe or measure certain aspects of physical health. Perhaps we can feel more comfortable in determining someone’s health, if we can measure it and compare it to certain acceptable ranges. However, health is so much more than these physical measurements and observations. I define health as the combination of the physical, psychological, social, and spiritual dimensions of life that can be balanced in a way that produces satisfaction and joy in life.The definition implies that humans are not one dimensional, but multidimensional. They are not static, but dynamic, constantly impacting or being impacted by their environments. The concept of balance in these dimensions of health implies that one can compensate for the lower level of health in one dimension by improving the levels of other dimensions of health. The definition implies that the intersection and balance of these dimensions will result in satisfaction that brings a sense of fulfillment and joy that is evoked by well-being and success as the individual lives a full and healthy life, supported by their health –enhancing decision-making. The joy that is produced is more than momentary happiness; it is both the result of and the perpetuation of hope, faith, and love. Healthy people are joyful people who can weather the storms and the sunshine of life’s circumstances and conditions.
Health is more than body size, it is the multidimensional life-sustaining tool that will impact every aspect of one’s life and also be impacted by many factors in life, within the physical, social, spiritual, cultural, and political environments that surround every individual and communities. Health is not an end unto itself, but the means to an end or the means to the life goals of the individual, family or population. Some in the health field do seek to disrupt this understanding of health through distortion, oppression, discrimination, because their focus is the control or manipulation of individuals and populations. People who do not have balance in these multiple dimensions of their lives, who do not use health to achieve joy and satisfaction in their lives, will never experience the power in true health and how to achieve their goals and better quality of their lives.
Q: Generally speaking, the field of Public Health is not grounded in a weight-neutral philosophy. What do you see as the benefits and/or challenges to shifting to a weight-neutral approach?
I believe that I may have answered this question in my previous comments. As professionals in public health we should be the first to recognize the great diversity in human beings – not just diversity in races and ethnicities, but also in body types, sizes and shapes. While people have some limited control over body weight, many do not have such control due to genetic make-up, disease experiences, lifestyle experiences, etc. My research and the research of many others clearly document that there are cultural and personal preferences for body size and definitions of beauty that support larger body sizes. Our job in public health promotion and health education is to know our clientele and to make sure that people have factual information, resources and the appropriate skills to keep themselves healthy in every dimension of health. People must be able to voluntarily make their own choices for health. Public health professionals can assist them or facilitate their health-enhancing choices. We cannot be in the business of forcing our citizens into some rigid standard for body weight, just as we are not in the business of forcing people into one monolithic belief system in this country. Freedom of choice must be the philosophy of public health as it is for our country, recognizing that choices will bring benefits and positive or negative consequences. If public health professionals are to seek and do what is best for their populations we must get to know them and recognize the great diversity of our populations and individuals in all dimensions of health. Using that knowledge, we can develop resources and policies that actually help people make the most health-enhancing choices and fewer health-diminishing choices.
Q: How might organizations like ASDAH work more effectively to promote a better understanding and the adoption of the HAES approach within your profession?
Currently, the majority of my focus and efforts are committed to the development of health promotion professionals who can assess the needs of individuals and populations, plan programs, services, policies, and provide leadership in meeting the needs and concerns of diverse populations (by age, sex, ethnicities, spiritual beliefs, etc.) I do support that individuals can choose to be healthy at every size, if they know and choose behaviors that support their individual health concerns and life goals. I find that my students, both undergraduate and graduate, have had little to no exposure to the work of ASDAH and the HAES approach. Perhaps one of the most important things that ASDAH can do is to increase their visibility in public health programs at universities and colleges. Most students are oblivious to the harmful messages that promote “one size” must fit all people. Once I have introduced the HAES approach to my students, they begin to see the harm that is done with the “smaller is better” message. They begin to explore more effective ways to support people in making healthier choices.
ASDAH could have a greater role in the training of health professionals. This may happen through greater communication and information for academic and professional training programs. More of our new and experienced public health and medical professionals need to hear ASDAH’s message. If individuals and communities are to choose to be healthy, they must be able to choose the lifestyles that work for them without the pressures of the biases, prejudices and dictates of those in public health and community health that are ill-trained, insensitive, lacking relevant knowledge and lacking concern for what matters to the people and their society.