Praising Adele’s Weight Loss Is Fatphobic

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The following is a guest blog written by “Sarah,” a nurse practitioner in the Boston area, who strongly believes in utilizing Health at Every Size (HAES) and anti-diet approaches in both her personal and professional lives. She has been Joanne’s patient for about six years and is in recovery from an eating disorder.

It is no secret that our current society is obsessed with physical appearance. The perceived attractiveness of a person very much determines how they are valued, respected, and treated. This is especially true in regard to women, and to an even further extent, celebrity women. 

At this point, I am sure most of you have come across recent media stories of renowned singer Adele’s dramatic weight loss. After an Instagram post from Adele of herself in a form-fitting dress, with a caption giving a mention of her birthday and a shout-out to the first responders in the midst of the COVID-19 pandemic, comments swarmed in that had nothing to do with what she actually wrote. Now there were some comments that highlighted the fact that we should be praising Adele for her immense talent and not her appearance. Five or ten years ago, some of these comments would probably not have existed, and therefore that does highlight the progress we have made in rejecting diet culture and in the public knowledge of this movement. However, the majority of the comments praised her new, thinner, more “acceptable” body. 

Now I want to make it clear that I know absolutely nothing about Adele as a human, including her diet or exercise regimen. It is truly none of my or anyone else’s business what Adele decides to do or not to do in regard to her body. Even as someone who fully believes in HAES and is very anti-diet, if Adele did intentionally seek a smaller body, I can’t say that I blame her. Our world is a hostile place for those of us living in marginalized bodies. If you are fat, disabled, trans, poor, non-white, or any iteration of these, you are subjected to discrimination and othering. Therefore, it is no wonder why one would want to attempt to fit into a more socially respected body. 

I would normally say that it is unfair to assume anything about Adele’s means of attaining this new look, but in recent articles, she does discuss a particular diet of a VERY scary low number of calories (*trigger warning) and a rigidly structured exercise plan. Again, it is no one’s business how Adele decides to treat her body, but by the DSM standard, there is no question that she would be diagnosed with an eating disorder. I recognize that this is more of a systems issue, and those who mean well by praising her new body are operating under a fat-phobic structure. While eating disorder behaviors are considered concerning when the individual is thin, these same behaviors are encouraged for those who are in larger bodies. It is what we are taught and how we operate as a culture; it is no wonder that full recovery from eating disorders is so challenging (and oftentimes unachievable).

Now let’s get down to the real issue and meaning behind Adele’s weight loss (which really has not much to do with her at all). Body autonomy is part of the HAES movement, and I fully stand behind this for Adele or anyone else. It is the mere fact that a single picture can prompt so many comments (positive or negative) about one’s body that is the core issue here. 

The focus by others on a changing body, in a positive or negative way, often keeps people from recovering fully. If we lived in a world where a body was just a body regardless of how large or small it became, this would not even be a topic of conversation. Although it is an inevitable fact that bodies fluctuate for various reasons throughout the lifespan, we cannot seem to accept this as a society. Naomi Wolf stated: “A culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history; a quietly mad population is a tractable one.” Diet culture and fatphobia are the prime examples of this. We are taught that our worth depends on other people’s evaluation of us and that how our body looks to others matters more than how it feels to us. Especially as women, we are taught that making others happy is more important than making ourselves happy and that the most important thing is that others will like and approve of us, and therefore it is no wonder that we constantly rely on external validation to prove our worth.

Being fat and/or gaining weight is seen as the ultimate failure, and there is countless evidence of this belief expressed throughout history. We see and hear examples of this in our everyday lives, whether we recognize it or not. It is more common knowledge these days that “diets don’t work,” but we have yet to make significant progress in the idea that one’s body does not determine their worth. That is not to discredit all of the amazing progress that the HAES community has made, and as someone in a straight-size body, I cannot speak to the true experience of someone living in a larger, marginalized body. However, as a woman living in constant recovery from an eating disorder, I can say that the fear of weight gain has held me back in so many ways throughout this journey. Fatphobia truly affects everybody (whether they realize it or not) but is much more pervasive for women. 

I now know that these are reactive thoughts stemming from decades of diet culture brainwashing and the instinctual need to belong as a human. These messages have become even louder throughout the COVID-19 pandemic. Not only are we separated from many of our in-person support systems, dealing with real threats to our health and vitality, but we are relatively stuck at home with our thoughts. Although I do truly believe sitting and ruminating in these thoughts and fears can lead to growth in so many ways, it is also extremely triggering. We have less access physically and maybe financially to certain foods, and this can be triggering in itself.

To add to this, those who suffer from eating disorders and also live in larger bodies are especially vulnerable given the extreme fatphobia that knows no boundaries. There have been countless news articles claiming that people living in larger bodies are more susceptible to COVID-19. Not only is this untrue, but it is incredible healthism and just another example of diet culture profiting from our fears. Attempting to change one’s body size in the hopes of health and immortality has never worked in the past and scientifically never will. It is disappointing that these messages of blame and shame are being touted instead of compassion, inclusivity, and actual scientific facts, especially during this time. 

So how do we begin to change as a culture? By recognizing that beliefs and facts are not the same. By rejecting diet culture and recognizing that our body size or health status has nothing to do with our worth as humans and by treating others with respect and dignity just because they exist. As the wise Ragen Chastain said best: “Health is not an obligation, barometer of worthiness, or entirely within our control,” and this could not be more relevant in our current climate.

Emotional Eating in Quarantine

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Despite the major life disruption that the coronavirus quarantine has been for us personally, Jonah and I are lucky enough to be able to still work, as we are telehealth providers. While all of my patients are struggling in different ways with quarantine, one theme keeps on popping up consistently: “I feel like my emotional eating is out of control.”

Many of my patients are working on becoming intuitive eaters, and the current pandemic is making it extremely difficult for them to heal their relationship with their bodies and food. Living in these strange times is like nothing we have ever experienced before – being confined to our homes, socially distancing, and the near constant underlying fear of illness are exhausting and emotionally draining.

Some of my patients are working on the front lines of the corona crisis, taking care of patients who are severely ill. Some of my patients have lost loved ones to the virus. Others are struggling with the loneliness of isolation. In short, the past couple of months have been really, really rough. And the fact that there is no definite end point for this pandemic, that this state of limbo could continue for months on end, leaves many of us feeling hopeless and trapped.  

So when my patients tell me that they are emotionally eating, I am not at all surprised. Emotional eating in times of stress and uncertainty is normal and, honestly, to be expected. From the time that we are born, food is a source of nourishment and comfort. Food is a basic human need. From the very beginning, whether we start out nursing or bottle feeding, drinking breast milk or formula (or both), food is necessary for survival. It is designed to make us feel satiated and safe. Food is one way that our caregivers take care of us when we are babies, providing comfort when the feeling of hunger arises. This is all to say that turning to food for comfort is a completely normal thing for humans to do – it is programmed in our DNA. And feelings of comfort and safety are paramount to developing love and attachment.

The phrase “emotional eating” has been around for many years, and it always seems to be presented as a negative thing. Many of my patients characterize themselves as emotional eaters and wish that they could stop. In most cases, these patients feel as though they have “no control” around food, that they will overeat on certain comfort foods, and they inevitably feel shame after they do this. Of course, many of these patients are consumed with fears around gaining weight and feel that by engaging in emotional eating, they are likely to become larger.

To me, “emotional eating” is a phrase that was created by diet culture because at the root of it is fat phobia. Our culture is a completely fat phobic one, and one of the underlying themes is that engaging in emotional eating is a dangerous habit; if one emotionally eats regularly, they will gain weight, become fat and be unhealthy, unattractive, and unlovable. Emotional eating is seen as problematic by diet culture, and those who engage in it are deemed weak-willed and less than.

In my work, what I have found is that the amount that a patient engages in “emotional eating” is almost directly proportional to the amount of restriction (both mental and physical) in which they also engage. In other words, my patients who feel like they are emotional eaters and cannot control themselves around food are often the ones who are the most restrictive with their intake.

If you think about it, it makes sense on a biological level. Our early ancestors were often subjected to famine and food scarcity, and in order to survive during those times, their sole focus became about finding food. It is one of our most basic survival mechanisms, and it is deep within our genetic code. When we are deprived of food (whether it be deprivation imposed on us by others/circumstance or self-imposed), our primal brain is designed to focus solely on procuring food. And not just any food, mind you, but food that is calorically dense and will give us quick and lasting energy, specifically foods that are high in carbohydrates and fat. Is it any wonder that many of our “comfort foods” are often comprised mainly of carbs and fat? It is our ancient genetic code’s way of keeping us alive.

This is all to say that when we are in times of stress, anxiety and fear (like during this pandemic), it makes perfect sense that we might turn to food for comfort more often. This behavior in and of itself is not problematic; it is one of the many ways that humans cope during difficult times. Add on top of that feelings of deprivation around food (with many grocery stores running out of supplies and access to restaurants reduced), and it is no wonder that we have food on the brain more often as well. The most important thing we can do right now is not to judge ourselves for “emotionally eating” during this tough time, but to have some compassion for ourselves. We are all just trying to take care of ourselves in the best way we know how.

No Bargaining Needed

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About a month ago, I was watching one of my usual TV shows when a commercial came on for Ore-Ida French fries. Normally, I would skip ahead using my DVR fast forward button, but something made me pause. The commercial starts with a young girl and her father sitting at the family dinner table. The girl has a plate with broccoli on it. She pushes it away with a look of disgust on her face, her father pushes the plate back in front of her, and this gets repeated a couple of times until dad whips out three crinkle cut French fries in his hand. Immediately, the girl smiles, takes a bite of her broccoli, and then happily grabs the French fries. Meanwhile, the voiceover narrates: “Is mealtime a struggle? Introducing Ore-Ida Potato Pay. Where Ore-Ida Golden Crinkles are your crispy currency to pay for bites of this [broccoli] with this [French fries]. When kids won’t eat dinner, Potato Pay them to. Ore-Ida. Win at mealtime.”

Um, what now? Wow. Now, as the mother of a toddler who isn’t the most adventurous or enthusiastic eater, I get that parents often struggle at mealtimes with their kids. As parents, especially parents of young children, we are the “gatekeepers” of meals and snacks, deciding what food will be served and when. There is a lot of pressure on parents to make sure their kids are getting just the right amount – not too much, not too little – of nutrient-dense foods to ensure optimal health. Even prior to birth, mothers are reminded to eat as nutritiously as they can to give their developing baby the best chance of being healthy. This concern continues with infants, as many parents struggle with figuring out if breastfeeding, bottle feeding, and/or formula works best for them. And as these infants grow and eventually start eating solids, the worries about getting enough nutrition while avoiding “empty calories” commence. It’s stressful to be in charge of what your kids are eating (or not eating)!

As Jonah and I have written about previously, we believe that Ellyn Satter’s Division of Responsibility (DOR) is the best way to help one’s children become competent intuitive eaters. In short, the DOR states that parents or caregivers decide what food will be served, at what intervals food will be served, and where food will be served. Children, on the other hand, are in charge of eating (or not eating) the offered food and how much they eat of said food. Parents/caregivers are encouraged to offer a wide variety of foods at meals and snacks, including not only “nutrient dense” options but also foods that the general public might consider to be “fun foods” that are high in sugar, fat, and/or salt. When using these strategies, children learn to trust their hunger and fullness cues, develop their palates, and learn to eat in a satiating and enjoyable way. They also learn that foods don’t have moral value; for instance, broccoli isn’t inherently superior to French fries, and all foods fit.

Clearly, bribing your child to eat their vegetables (or other foods they don’t want to eat) with “fun foods” is the exact opposite of the DOR. This teaches kids that they can’t trust their own bodies to tell them what and how much to eat. It teaches kids that the only way to eat broccoli is to choke it down in order to earn French fries. It takes all agency away from the child and turns the parent/caregiver into the food warden. Instead of helping kids try and figure out what foods they enjoy (which could include broccoli!), this technique basically punishes kids for having preferences. It can and will create even more stress and power struggles around mealtimes.

Look, I get it. I, myself, have had to curb my instinct to try to push more “nutritious” foods on our daughter when all she seems to want to eat are the high fat, salty or sugary foods. I want her to be healthy! I don’t want her to have nutrient deficiencies! But I also have to remind myself that intervening in her side of the DOR is overstepping my bounds and that by putting some foods up on a pedestal and pushing them on her, I would be teaching her that foods are either “good/healthy” or “bad/unhealthy.” Instead, I want her to know that all foods fit and that I trust her body to tell her when it is feeling more in the broccoli mood or in the French fry mood. I know that she will eventually get plenty of messages around food from her peers, teachers, and TV, but I hope that by instilling the principles of intuitive eating and DOR early on, I can prevent her from getting sucked into diet and wellness culture.

Stop Complimenting Weight Loss

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On the surface, complimenting someone’s weight loss seems like a benign and positive affirmation, but there are a number of reasons why doing so is problematic.

First and foremost, unless we have been told by the individual that their weight loss was intentional, we really have no clue as to why someone is losing weight. It could be due to illness, grief, or depression. It could also be as a result of an eating disorder (ED). Many of my patients say that comments about their weight loss when they were in the throes of their eating disorder fueled the disorder and made them feel like they had to keep up their disordered behaviors in order to keep their body “in check.” This goes double for patients with anorexia who are in larger bodies. These individuals often go undiagnosed with an ED because their weight loss is seen as a positive thing, never mind that they are engaging in extreme restriction and over-exercise to achieve this loss.

While I was never formally diagnosed with an ED, I myself remember when I was a teenager and engaged in very disordered eating and exercise habits and ended up losing a significant amount of weight in a short period of time. Despite the fact that I had lost my period, had very little energy, avoided going out to eat for fear of having to eat “junk” food, and overall felt awful and obsessive, I got compliment after compliment from family, friends, and even from my doctor. I even remember my doctor saying to me, “I don’t care what you are doing to lose the weight, just keep doing it!” I cringe just thinking about it!

Another reason to stop complimenting weight loss? It inherently implies that there was something wrong with the person’s body before they lost the weight. Think about it – do we ever comment on someone gaining weight in a positive light? Nope. These weight loss compliments also imply that being smaller or skinnier is better than being larger. The truth of the matter is that bodies come in all shapes and sizes, and they all deserve respect. Placing smaller bodies on a pedestal reinforces the idea that people in larger bodies are less than. This is weight stigma, and it has been shown to negatively affect us not only psychologically, but physically as well. Furthermore, since we know that 95-98% of intentional weight loss attempts result in weight regain, the silence when someone regains the weight they lost can be deafening.

Finally, and possibly the most important reason, is to stop modeling this behavior for our children. Little ones are like sponges, and from a young age, they are acutely aware of our society’s dislike of fat people. One study found that children aged 6 to 11 hold considerable negative attitudes towards their heavier peers, being more likely to describe these “overweight” peers as “mean, stupid or dirty” than average-weight peers. Other studies found that “nearly a third of children age 5 to 6 choose an ideal body size that is thinner than their current perceived size” and that “by age 6, children are aware of dieting and may have tried it”. When we compliment another’s weight loss, we are telling our kids that to be smaller is better and that being fat is a bad thing.

What can we do instead? Don’t comment on another person’s body. Full stop. If you feel compelled to give a compliment, try complimenting the person’s kindness, humor, intelligence, or other attributes not related to body shape or size.

The Kids Are Alright

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Weight Watchers, I won’t call you by your new convenient moniker “WW” designed to try to fool the public that you aren’t all about the weight. You might try to kid yourself into thinking that you are just about “wellness” and that the goal of weight loss is just a byproduct of a “healthy lifestyle change.” Nope. It’s just the same crap in a slightly different package. Any way you slice it, the only thing you care about is your bottom line, not helping your customers get healthy. If you really understood health, you would realize that a lifetime of weight cycling, weight stigma, and self-loathing are far more damaging than just staying fat. 

Weight Watchers continues to spread the lie that intentional weight loss is attainable if you just try hard enough. And if you fail at maintaining your weight loss, you, not the diet, are to blame. Bull. If your program worked, you’d be out of business. Even your former financial director Richard Samber stated as much in an interview, explaining that repeat customers are “where your business comes from.”

Where is the evidence that Weight Watchers “works” anyways? The company is famously close-lipped around their long-term success rates. In fact, they cannot demonstrate that anyone, save for a measly tiny percentage of dieters, can keep off the weight they lose for more than five years. And those who do manage to keep the weight off often use disordered eating and exercise behaviors to do so.

Intentional weight loss endeavors, whether they are through Weight Watchers or any other diet or “lifestyle change,” fail 90-95% of the time. Yet our medical community continues to push weight loss on fat patients, telling them that they are at risk of death if they don’t lose the weight. For myself and many other fat people, going to the doctor can be an anxiety-inducing experience, as we are often met with weight stigma and advice to stop eating so much (even if that’s not what’s going on). Many fat people I know just avoid going to the doctor altogether to avoid this weight shaming. Is that health-promoting behavior? I don’t think so.

The notion that weight loss is achievable and maintainable is one of those common beliefs that is put forth by diet culture. Diet culture tells us that being fat is inherently unhealthy and unappealing, that those of us who cannot lose weight are lazy, inept, unintelligent individuals who just aren’t trying hard enough. Diet culture glosses over all of the research that shows how and why our bodies fight like hell against losing weight. Diet culture ignores the facts that repeated dieting and yo-yoing is actually much more physically harmful than just maintaining a higher weight and that shaming fat individuals is not helping anyone but is taking a toll on all of our health and well-being.

Weight Watchers’ latest endeavor, launching an app that targets children aged 8-17, makes my blood boil. In the iconic words of John McEnroe, you cannot be serious, Weight Watchers. Never mind all of the eating disorders that this app will help to create and/or encourage; this app contributes to the weight stigma that plagues our society. It reinforces the idea that being fat is a bad thing and that it must be avoided at all costs. It fosters a feeling of shame in heavier kids, a feeling of being “less than.” 

As a chubby (not fat) child, I was repeatedly told by my pediatrician and my family that my body was wrong. These messages and the messages I got from diet culture led me to develop disordered beliefs around food, exercise, and my body. It wasn’t until I found Health at Every Size that I finally figured out that my body is not to blame. My body doesn’t need to change. Our weight-shaming culture needs to change. And I am honestly scared for the legions of kids and teenagers who are exposed to this toxic culture.

Weight Watchers’ app will teach kids that they cannot trust their own bodies, that their own bodies are damaged or ill-equipped to tell them what and how much they need to eat. This app will create lifelong struggles for these kids, who likely will have a disordered relationship with food and their bodies for the rest of their lives. I cannot even wrap my mind around the amount of psychological and physical damage this program will cause. 

I don’t know if it’s the fact that I have a daughter myself now that this is striking such a chord with me. I fear for her. I don’t ever want her to feel like she needs to make herself smaller to be loved, accepted, or healthy. I don’t want her to spend her life trying to change her body and fear its appetites. I want her to be confident in her body, to trust that it will tell her what it needs, and that her weight is not the measure of her worth. 

So, Weight Watchers, I hope this program fails and you disappear into the ether sooner than later. 

Intuitive Eating and Infants

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It’s been a number of months since I last wrote for the newsletter (8.5 months, to be exact!). As most of you know, Jonah and I became parents last June to a wonderful baby girl named Lorelai. I’ll be honest, the first few months with Lorelai were a blur of diapers, bottles, and swaddles, but once she reached about six months old, things started to settle down a bit. Around this time, on the advice of her pediatrician, we started introducing solid foods. It has been such an eye-opening experience to watch her begin to navigate food, and it has given me a front row seat to what purely intuitive eating really looks like.

Of course, Lorelai was an intuitive eater from the day she was born. When she was hungry, she would cry and would eat until she was satiated. Some days she was seemingly ravenous, and other days she was not so hungry, but she steadily gained weight and thrived. Since she only had one source of food (first breastmilk and then formula), there was no real choice about what she was eating. That’s what happens when there is only one food on the menu! But introducing solid foods increased her options, and that’s when things got interesting.

Lorelai’s first solid food was baby rice meal mixed with formula. When we initially tried to feed it to her, she pursed her lips and seemed truly offended by the spoon. We didn’t want to force anything on her, so we waited before trying again, and eventually she allowed the spoon into her mouth. Her puzzled face spoke volumes as she could not fathom what was in her mouth, never mind how to eat it! She opened and closed her mouth and then proceeded to push the food out with her tongue, causing the food to land on her bib. She didn’t cry or seem upset, just genuinely perplexed about this new development. None of this food made it past her mouth. We were assured by our pediatrician that this was totally okay and normal, as the introduction of solids for the baby is mainly about teaching her food comes in forms other than just liquids. The baby learns to taste and manipulate the food in her mouth and may or may not swallow it. During this time, her formula continued to be her main source of fuel.

As the weeks went by, we continued to try introducing new solids, moving next to baby oats and then adding things like mashed banana and pureed pear. With each feeding, Lorelai became more and more interested in food and started not only to mouth and gum it, but swallow it, too. Her food preferences started emerging at this time as well. From the get-go, she was not a fan of white potato, which she made evident by promptly vomiting it up after a few reluctant bites. Similarly, she votes “no” on pureed peas. Pretty much all fruits are her favorite foods, especially pureed blackberries.

But even in this short time, some of her preferences have changed. When we first tried to give her avocado, she looked at us like we had three heads. She pursed her lips and pushed it away and was not having it at all. We wondered if maybe she could try feeding herself avocado, she might like it better. And that is exactly what happened! Instead of giving her mashed avocado and spoon-feeding it to her as we had done previously, we gave her avocado slices with the peel on so she could hold it herself. To our surprise, one day she picked up an avocado slice and joyfully started chewing on it. It is now one of her staples, and she loves it. The same thing happened when we introduced her to Bambas, crunchy peanut butter snacks that are very popular in Israel. At first, Lorelai was not at all interested in them, but at some point, she began to pick them up and hold them and put them in her mouth, and now she eats them every day and loves them.

Even with her ever-growing repertoire of foods, Lorelai has maintained her ability as an intuitive eater. If we present her with food, even if it’s one of her favorites, and she is not hungry, she won’t eat. And if she is hungry, she will eat until she is satiated and then stop eating, even if there are a few bites left. I have always spoken with my patients about how we are born intuitive eaters, and as we get older, we often lose that ability for numerous reasons (dieting, being told to clean our plate or that some foods are bad for us and aren’t allowed). Much of my work with these patients is around rediscovering their inner intuitive eater and getting back to the time when they explored and enjoyed their food and made choices based on whether they were hungry or not and whether they liked what they were eating. It has been such an amazing experience to watch Lorelai’s intuitive eating up close, and I truly hope she will maintain this ability throughout her lifetime. Of course, I know that I won’t be able to shield her completely from diet culture and its toxic messages around “good/bad” foods, weight, and appearance, but I hope to foster her intuitive eater and help her develop a joyful relationship with food and her body.

Thoughts on Body Image and Pregnancy

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I want to preface this installment of pregnancy thoughts with this: the biggest lesson I have learned regarding pregnancy and body is that not only is every woman’s body different, but every pregnancy is different for each and every woman. What I am writing about in this piece is my own personal experiences, and it is not meant to be generalized to other women’s experiences. There is no wrong way to have a pregnancy and/or a pregnant body!

Thoughts on Body Image and Pregnancy

Some of the earliest advice I got from female friends and family members when they found out about our news was around making sure that I did not gain “too much weight” over the course of my pregnancy. Of course, I feel that these sentiments are rooted in fat phobia and diet culture, but many women also told me that they themselves ended up gaining “huge” amounts of weight during their pregnancies (much more than the medically recommended amount), which led to complications. While I am not a doctor and do not know the intricacies of these women’s pregnancies, part of me wonders if perhaps this “extra” weight gain might have resulted from the rebound bingeing I described in the previous newsletter feature, although it could just be how their bodies responded to pregnancy.

The other thing I have wondered in these situations is if these women give this advice to all pregnant ladies or just fat ones. Given that I have been living in a larger body for a number of years now, I am curious to know if these women are worried about potential medical complications for my pregnancy or, instead, how much fatter I will get. I have not asked these women questions about their intentions, but it definitely has crossed my mind.

Being a fat pregnant person is an interesting experience. For me, my baby belly did not become all that visible until relatively recently. This is partly due to the fact that I tend to dress in loose clothing (that is just my style), so my baggy sweaters and sweatshirts do camouflage my bump. But I also think that starting out as a fat woman, I was not going to have the stereotypical pregnant body that we all see on TV and in the movies. When I used to envision a pregnant woman, I would think of a slender woman who is “nothing but bump,” i.e., lean all over except for the “perfect” round tummy. I feel that we rarely see representations of fat pregnant women on TV or in movies, so that what the “typical” pregnant body looks like has been skewed for many of us. I was big before my pregnancy, and now I just look bigger in my belly area; if you did not know I was pregnant, you might not assume as much.

This “untypical” pregnant body has its pros and cons. On the one hand, I do not like to have a lot of attention focused on me, so not appearing obviously pregnant has helped me fly under the radar a lot, which I appreciate most of the time. One of my good tennis friends told me that she had a tough time during her pregnancies as she is a very private person, and her protruding baby belly made her quite conspicuous. She described how people on the street would approach her and touch her belly and give her a lot of attention that made her uncomfortable. I am sure she would have preferred to have had a bit more camouflage at the time!

But there are also times when I wish that it were more obvious that I am pregnant. In our society, pregnant women are (for the most part) treated lovingly and with respect. If a pregnant woman gets on the T, people will give up their seat for her. Her baby belly garners smiles and warm greetings. I am missing out on that as my baby bump is not prominent, and sometimes that makes me sad. When Jonah and I went on our “babymoon” vacation in March, no one could tell I was pregnant. They knew we were celebrating something, so they assumed it was our honeymoon, and as such, they kept on trying to give us champagne! I was able to laugh at it at the time, but there was also something a bit disappointing about not having my pregnancy celebrated by others.

Another thing that has been super interesting to notice is how friends and family have commented on my pregnant body. While all of the comments have been positive in nature, it also makes me feel uncomfortable when people comment on my body at all. On many occasions, these friends and family members have said, “Wow, I can’t even tell that you’re pregnant!” or “Good for you for not gaining too much weight!” A few weeks ago, the tennis pro at my club actually said, “You look great – you look like you’ve lost weight!” I know he was trying to be nice, but his comment implied that losing weight would be an improvement for me (as in my pre-pregnancy body was flawed). Never mind that pregnant women are indeed supposed to gain weight over the course of their pregnancies; so any weight loss would not be healthy during this time. These types of comments are fat phobic in nature and reinforce the idea that it is okay to comment on others’ bodies. People, please stop doing this! If you must, saying something like “You look great – how are you feeling?” is a much better sentiment to express rather than commenting on a woman’s specific body changes.

I feel like my pregnancy has given me a new appreciation for my body. I had thought that being “advanced maternal age” and fat would have not only made conceiving nearly impossible, but that my pregnancy would be rife with complications. Incredibly (knock on wood!), everything has been going well! I hesitate to write this, but honestly, being pregnant has been much easier than I thought it would be. Aside from some tooth/gum pain (hello, root canal!), hot flashes (sweating up a storm), and fatigue, I have had very few negative pregnancy symptoms. Of course, this could all change in the final month, but for now, I am amazed that my “old” and fat body is handling pregnancy so well. When I think about the fact that I am actually growing a tiny human right now, it seriously boggles my mind! It truly is incredible!

I am sure that my thoughts about my body will change once I deliver and continue to evolve after the birth and as the years go on. I hope to impart to my daughter the idea that our bodies are truly amazing and are capable of so many wonderful things and that appreciating what our bodies do for us on a daily basis is one of the cornerstones to a happy life.

Thoughts on Food and Pregnancy

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As some of you may know, Jonah and I are expecting our first baby (a girl) in June. While we just recently started sharing this news with our patients, we both have been experiencing the myriad of emotions, including excitement, anxiety, and joy, about the major life change that is about to occur. But in addition to this, I have been acutely aware of both my relationship with food and my feelings around my changing body. I had often wondered how my body would react to pregnancy. Would I feel sick as many of my friends and family members did during their first trimesters? Would I be excited as my bump grew and feel a new sense of appreciation and joy for my body and what it is doing? How would my appetite change? So I thought that I would write a two-part newsletter feature on some of my observations around food and body image in relation to my own personal pregnancy experience. This month, I will focus on my observations around food and pregnancy.

Thoughts on Food and Pregnancy

I am sure I am not the only first-time pregnant person to have had preconceived ideas about how my relationship with food would be during pregnancy. We all have heard about the strange cravings (pickles and ice cream, anyone?), insatiable appetites, and odd aversions that pregnant women are supposed to have. Interestingly, almost none of these applied to me! While of course I had to change certain things in my diet, such as cutting down on the caffeine in my morning cup of coffee (I now do ½ caffeinated and ½ decaffeinated.) and avoiding raw fish (i.e., no sushi tuna rolls), I really did not have to change much at all. Most of all, I have noticed that more than anything, I am slightly more conscious about making sure I get enough vegetables into my day. I have always been a reliable veggie eater, but there are days when I only have one serving for whatever reason, so I have been making an effort to make sure I eat at least 2-3 servings per day. Sometimes that is in the form of cooked broccoli or raw snap peas or baby carrots, and sometimes it comes in a smoothie.

While I have noticed that I have days during my pregnancy when I am super hungry, it is not too much different from my appetite fluctuations as a nonpregnant person. As an intuitive eater pre-pregnancy, I knew that there were some days when I felt like a bottomless pit, and then there were some days when I just did not feel that hungry. This pattern has continued throughout my pregnancy. Just to see if what I felt was going on was accurate, I asked Jonah one day if he noticed that I had been eating much more than usual, and he said, “No, not really.” Don’t get me wrong; there have been some days when I have been ravenous, but honestly, it does not feel that much different than my normal (nonpregnant) hunger cues. One interesting observation that Jonah had was that I seemed to be having less dessert than usual. Let’s be clear – I am not consciously trying to eat less dessert! It just seems that these foods have become slightly less appealing to me than usual for whatever reason. Perhaps the developing baby needs more other stuff!

A number of my friends and family members have described how they felt that pregnancy gave them the green light to eat whatever they wanted in unlimited amounts and that they took full advantage of “eating for two.” One woman recounted how she would have an ice cream sundae every night of her pregnancy. My thought on this is that I bet that many of these women prior to pregnancy were eating in a restrained or diet-minded way (as many women in our culture do). As such, they would not allow themselves to eat certain forbidden foods prior to becoming pregnant, or if they did, they had to do so in very limited amounts. I would be willing to bet that much of their overeating during pregnancy was likely a direct reaction to the restriction they had exercised pre-pregnancy. As we have heard time and time again, one of the biggest contributors to binge eating is prior restriction.  Once the constraints are lifted, the body and mind go all in with the previously off-limit foods. Given that I haven’t eaten in a restricted manner in many years, there was no rebound bingeing for me. I have always given myself permission to eat whatever, whenever in any amount that feels good to me. And that has not changed!

I have not had any strange cravings or strong aversions to certain foods or odors. Once I began to be able to feel the baby moving (around week 19), it was interesting to notice that she would be much more active after I had eaten certain foods. To this day, when I eat foods that are more carbohydrate-based, the baby gets busier in my belly! She also seems to really enjoy breakfast, which I guess might be due to the fact that she has not “eaten” since the night before and therefore is hungry. So apparently, she is tuned in to her hunger cues!

I guess the bottom line to all of this is that my relationship with food has not changed markedly since I have become pregnant. I still eat intuitively, and I still eat a wide variety of foods. I feel very lucky to have been an intuitive eater prior to pregnancy because I feel I am much more relaxed around food than many pregnant women I have known. Of course, over the next two months, things might change; but for now, eating in an attuned manner is working for me.

Next month, I will discuss my thoughts around body changes in pregnancy. Stay tuned!

Holiday Survival Guide

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It’s November, and that means the holiday season is upon us. Many of my patients have mixed feelings about the holidays. On the one hand, these celebrations can be a joyous time with one’s family and friends, full of tradition and connection. On the other hand, these same gatherings can be highly triggering and lead to serious anxiety. Of course, the fact that most holiday celebrations are centered around food can complicate matters even more.

While I love my family and cherish the holiday celebrations we have together, it can still be challenging at times. As I have written about previously, my family does not really understand the principles of Health at Every Size® (HAES) and Size Acceptance. In addition to this, my sister is Oprah Winfrey’s personal Weight Watchers coach and firmly entrenched in diet culture. Needless to say, my family gatherings can be seriously difficult at times!

Over the years, I have accumulated some practical strategies for dealing with challenging family situations, so I thought I would share them with you. Keep in mind that not all of these strategies will work for you, but, hopefully, one or more of them will aid you in navigating these tricky situations and permit you to enjoy the holiday season.

1. Create Safe Spaces

One way that I have found to help my family gatherings be less triggering is to ask my family to refrain from talking about dieting, weight loss/gain, or judgments about weight or food choices during our time together. This can be achieved by sending an email to the main holiday participants ahead of time or making a few phone calls. Another way to achieve this would be to send along some HAES materials to explain the basics. Finally, if you feel uncomfortable reaching out to everyone yourself, you could ask your significant other or trusted family member to relay this information to everyone else.

2. Have an Ally

While this might not always be possible, bringing a supportive friend, partner, spouse, or family member to a holiday gathering can be tremendously helpful. Ideally, this person would be someone who understands/is open to HAES and Size Acceptance and could advocate for you if needed. If your ally cannot be with you at the actual event, making a plan to talk, text, or Skype with them before and after the gathering can also be helpful and make you feel more supported.

3. Take Space

Sometimes despite best efforts, family members or friends will talk about dieting, weight, and/or moralizing food choices. Unfortunately, this is common practice in our society, and many people (especially women) use it as a way to bond with each other. If the conversation turns to these triggering topics, you have every right to get up and leave the table, room, or conversation. Take a walk outside, hang out with your nieces and nephews, play with the family pet, or just find another space and take a few minutes. Sometimes all you need is a few moments alone.

4. Set Boundaries

If a friend or a loved one consistently makes comments about your weight or food choices, you have the right to tell them that this is unacceptable. In the moment, it can feel very difficult to stand up for yourself, so it might be helpful to think of some replies ahead of time. Some examples could include “Please don’t talk about my weight,” “I would prefer it if you didn’t make judgments about my food choices,” or “My food choices are none of your business, so please do not comment on them.”

5. Practice Regular Self-Care

While of course I would recommend engaging in self-care activities year-round, the holidays are an especially important time to do so. Practicing intuitive eating and physical activity, getting enough sleep, and managing stress are some basic ways to take care of yourself. If you are in therapy, it can be helpful to prepare for challenging situations with role-playing, i.e., have your therapist help you practice your responses to difficult family members or friends.

In the end, sometimes holiday gatherings are just about getting through it with as little scarring as possible. Inevitably, Aunt Edna will start talking about her latest cleanse, or cousin Fred will comment on how much weight someone has gained/lost. In some cases, there really is nothing you can say or do to change a family member’s or friend’s thoughts about weight/dieting/food, so the best thing you can do is agree to disagree and move on. Remember that these events are time limited, meaning that they will not last forever. I hope that some of these strategies will be helpful for you during the upcoming months – you can do it. Happy Holidays!

Real Reality

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Some of you may or may not know, but I am a reality TV fan. I know, I know, it definitely isn’t doing anything for my IQ points, but watching these shows is one of my favorite ways to unwind and relax. The ridiculous scenarios and personalities are entertaining and help me suspend my own reality for 52 minutes. Now, while I am not a fan of all reality TV, I have been known to watch some of the “Real Housewives” shows on Bravo, and lately, I have been watching episodes of the “Real Housewives of New York City” and the “Real Housewives of Orange County” (RHOC).

This season of RHOC, one of the storylines is about how Shannon, one of the housewives, has gained weight since the last season of the show. Shannon cries to the camera about how ashamed she is of her body, how “disgusted” she is with herself, and how she cannot believe that she has let herself go. Shannon attributes her weight gain to eating to cope with numerous stressors in her life. In addition to this, the camera shows her family (her husband and daughters) making fun of her weight and urging her to eat less.  Some of the other housewife cast-mates also make snarky comments about Shannon’s weight gain to the camera, saying how she should only be eating steamed fish and vegetables.

On last night’s episode, Shannon goes to see her chiropractor/health guru to help her get her body back to where it was previously. From the get-go, this charlatan, er, um, health guru, is brutal to Shannon about her weight. Without missing a beat, he asks her to step on the scale and berates her when the numbers show that not only has she has gained a significant amount of weight, her body fat percentage is “dangerously high.” He warns her that these numbers are dreadful and that she has nothing to look forward to other than cardiovascular disease, diabetes, and an early death. If this wasn’t bad enough, he then insists that he take photos of Shannon in just a sports bra and capris from all angles to show her how much weight she has gained. With every turn, you can hear this guy mutter “ugh” when Shannon turns for each pose, clearly vocalizing his disgust. And, of course, Shannon ends up in tears, not because she is upset with the chiropractor, but because she is angry with herself for her weight gain.

I found myself literally screaming at the television screen during this above scene – I was horrified and sickened by it. If this is not one of the most blatant examples of fat shaming that I have ever seen, I don’t know what is. This “health guru” told Shannon that she is less than human for having gained weight, that if she doesn’t “shape up,” she will end up dead before the end of the week, leaving her in tears. And then he made sure she knew how “gross” and “unappealing” she looked while taking her “before photos.”

I think the thing that most upset me about this scene was how it portrays an actual reality for many people living in larger bodies and how they are treated by “health professionals.” I can’t tell you how many of my patients who are “overweight” or “obese” have been subjected to ridicule and abuse from their providers. Several of my patients have been denied fertility treatment until they lose weight, while others have been told that even though their labs and vitals are perfectly normal, their weight will “catch up” with them and lead them to inevitably develop diabetes or heart disease. Even though there is a mountain of evidence that supports Health at Every Size®, that behaviors are more important in determining health outcomes than the number on the scale, doctors, nurses, chiropractors and the like still believe in the weight-centered paradigm and beat their patients over the head with it. Not surprisingly, these fat shaming instances make people of size reluctant to get medical treatment, and in turn can result in even worse health outcomes. Fat shaming is never okay and when perpetrated by health professionals, it’s honestly a form of malpractice.

In any case, after watching the scene with Shannon and her “health guru,” I had had enough. I am no longer a RHOC watcher and I hope that eventually the show will catch on that this storyline is doing so much more damage than good. It is teaching millions of women that they should be ashamed of their bodies if they gain weight, that weight and health are synonymous, and plays into the “obesity epidemic” rhetoric we have been subjected to for the past two decades. Not only that, it could inspire eating disorders in many of its viewers as they will learn that the number on the scale is the most important thing and eating only steamed fish and vegetables is acceptable behavior. Please, Bravo, get your heads out of your asses. This reality show is too real in the worst possible way.