Author Archives: Joanne Soolman

“As long as you’re healthy . . .”

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“Health.” It’s a simple one-syllable word with a deceptively simple definition: “the state of being free from illness or injury.” What I have come to realize over the decade-plus that I have been practicing nutrition therapy as a registered dietitian is that health means many different things to different people. Health is not black or white, but a million shades of gray. But the wellness industry (diet culture’s shapeshifted cousin) would have us believe that health is not only easy to define and simple to identify, but also easy to achieve, if we just try hard enough. Well, sorry, it’s not that simple.

When I was a preteen, I remember feeling like my body was wrong, too big, taking up too much space. My mother and I would go to my pediatrician appointments, where my doctor would hem and haw about my weight. I had always trended on the 95th percentile on growth charts, and every year my pediatrician would comment on it in a concerned way. My mom would echo these concerns at home, gently reminding me that my doctor was worried for my health. When I would cry to my mom about being in a larger body than my peers, she would always come back to this statement: “You are a beautiful girl. We could make some changes to how you eat and exercise. I just want you to be healthy.”

“I just want you to be healthy.” These words ring in my ears as they have been spoken to me in different iterations throughout my life. From concerned college friends after I had gained a significant amount of weight during my freshman year (post diet, of course): “We are just worried about your health.” From my first adult PCP when I was 22 years old: “We just want to make sure you are healthy.” From my mom when I announced that I would be going on a low-carb diet at age 25: “as long as you’re healthy!”

Everyone seemed to say that my health was the most important thing and that being healthy meant being in a “healthy-looking” body. When I actively engaged in dieting, restricting, tracking every morsel, weighing myself multiple times a day, exercising even when I didn’t feel like it or was sick or injured, eschewing lunch outings with friends, losing my period – during these times, everyone marveled at how “healthy” I was. “It’s so nice to see that you are finally taking care of yourself!” my family would crow. “Keep going, get healthy!” my doctor cheered. Little did they know the personal hell I was living in. But at least I “looked” healthy. Or at least my body fit the social norm for what we collectively believe is healthy, i.e., it was no longer considered fat. But inevitably as the weight would come back on, the concerns for my health would resurface.

When I finally gave up on dieting and learned about Health at Every Size® and intuitive eating, I was ready to hear the message. At last, I didn’t need to micromanage my intake and output. I didn’t need to obsessively count and weigh and measure. I didn’t have to give lunch outings with friends a second thought. It was like a freedom I hadn’t felt since I was a child, before I was told that I had a body that was “wrong.” I began to realize that health is not one-size-fits-all and that it looks different for different people. With individuals who have chronic illnesses such as celiac disease or cystic fibrosis or those with physical disabilities such as paralysis or amputation, they would never be able to achieve a state of being “free from illness or injury.” How about the millions of people who deal with depression or anxiety? Are they unable to achieve health as well?

I feel that we need to change our beliefs and expectations around health. In my opinion, health is a multifaceted amorphous concept that is not always attainable. It is also something that changes during our lifespan for a multitude of reasons. Even if we engage in all of the “health-promoting behaviors” we have been told to do, there is no guarantee that we will be healthy. In addition, there is no moral requirement for us to engage in these behaviors. As the wise Ragen Chastain so eloquently states: “Health is not an obligation, a barometer of worthiness, completely within our control, or guaranteed.”

The wellness industry loves to prey on our fears of illness and death. It purports to give us the answers to living longer, healthier lives. All we need to do is buy their program, supplement, or detox, and we can unlock the secret to immortality. It’s a brilliant marketing scheme that swindles millions upon millions of people every year. What if we decided to care more about our mental health and wellbeing? What if we made healthcare accessible to everyone? What if we eradicated weight stigma from the medical field? What if we decided that health doesn’t look the same on every body and that this is okay? My guess is the wellness industry would lose billions of dollars. Worrying about and obsessing over our “health” is most definitely not good for us. I wonder when our society will figure this out.

An Open Letter to Daycares, Preschools, Nursery Schools, and Elementary Schools

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We so appreciate the care you take of our little ones. In fact, I am sure that most parents would agree being able to send our kiddos to daycare, preschool, and/or elementary school is a huge factor in maintaining our sanity. The way that you help our children learn, grow, and adapt is amazing, and we are grateful for you. Having said all this, we need to talk about the policing of our kids’ food in school.

Lately, I have begun hearing more and more from parents whose kids are being sent back home with notes about their packed lunch. One parent received a phone call from a daycare saying that they were not going to give her daughter the 10 M&Ms that she had packed in her daughter’s lunchbox because they were “unhealthy.” Keep in mind, this mom had the forethought to pack in her daughter’s lunch The Feeding Doctor’s lunch box card stating that she did not want the staff to interfere with her daughter’s eating of lunch and that her daughter is allowed to eat any or all (or none) of the foods packed in the lunch in any order she wants. The staff overruled these directions and said that candy is “frowned upon” in their program.

Listen, I get it. In our fatphobic, diet culture world, we’ve been taught that sugar is the enemy. That if we give it to our kids, they will turn into sweets-addicted, hyperactive lunatics who will be out of control, that their bodies will balloon up like Violet Beauregarde in Willy Wonka’s Chocolate Factory, and that their teeth will fall out due to cavities. As a registered dietitian who has a Master of Science in Nutrition and Health Promotion with over a decade of experience in the dietetic field, I’m here to tell you that all of this is false.

Kids are naturally born intuitive eaters. Newborn babies cry when they are hungry and drink breastmilk (or formula) provided by their caregivers until they are satiated. They are perfectly in tune with their bodies’ cues and eat in response to them.  As babies grow and they start eating solids, they continue to eat intuitively. If you’ve ever tried to get a baby to eat anything they don’t want to eat (I’m looking at you, strained peas.), you know they just won’t have it. As kids reach toddlerhood, often their eating habits become erratic. Some days, it seems like my daughter barely eats anything, but on other days, she appears to eat more than a grown adult. Despite this seeming chaos, our kids’ bodies know what they are doing. While meals might seem hit-or-miss during one day, it’s best to look at our kids’ eating over a period of days as things will usually average out.   

Kids usually remain intuitive eaters until the adults in their lives start interfering with their food. Whether it be pressuring kids to take “one more bite” at dinner even if they are no longer hungry, limiting their access to sweets and other highly palatable foods because they are “unhealthy”, or expressing concern about their eating “too much,” parents and other adults can really throw a monkey wrench into their kids’ relationship with food.  Many parents worry about their kids gravitating towards foods that are high in fat, sugar, and/or salt because they themselves have a complicated relationship with those foods. In reality, if we relax around these foods and include them regularly with more “nutrient-dense” foods, we can neutralize them and take the “shine” off of them as well. In my work with kids and families, it’s the kids who are the most restricted around highly palatable foods that end up bingeing on them when they get the chance, sneak eating them in their room, or being hyperfixated on them at their friends’ houses. If we teach our kids that food has no moral value (i.e., eating vegetables doesn’t make you a “good” person and cookies aren’t the devil’s food), they will be able to make choices about what and how much to eat based on their internal hunger and fullness cues.

In addition to being natural-born intuitive eaters, young kids have very binary thinking. That is, when we present them with the idea that there are “good” foods and “bad” foods, they take this information quite literally and are unable to see the gray. So many children feel guilt or shame for enjoying “bad” foods because they feel like they are bad for eating them. This is setting our kids up to have a very charged emotional experience around these foods which can continue on into adulthood for many of them.  If we teach kids that all foods fit and that the most important thing is getting a good variety of all sorts of foods, we can help foster their relationship with food and their bodies.

Another thing to consider is the concept of helping our kids become “competent eaters.” Coined by child feeding therapist and dietitian Ellyn Satter, competent eaters are those who eat in accordance with their hunger and fullness cues while taking into consideration their bodies’ needs and preferences. Parents’ (and caregivers’) role in this process is to be in charge of certain aspects of meals and snacks. Satter’s Division of Responsibility further clarifies that parents are in charge of what food is being served, when and where this food is offered. Meanwhile, kids are responsible for whether they choose to eat the food provided and how much they want to eat of said food. Ideally, parents offer their kids a variety of foods, including both highly palatable foods and foods that are more nutrient dense, and then let their kids eat in accordance with their bodies. This model posits that interfering with kids’ eating by cajoling them to eat more vegetables, discouraging them from eating other foods, or even praising them for eating more nutrient-dense foods will lead to power struggles at the dinner table.

So what can we adults do to help our kids develop a healthy relationship with food and their bodies? Here are some strategies:

  1. Avoid categorizing some foods as “junk” or “bad” and others as “good” or “healthy.” Food is just food and does not have moral value. Food is only “bad” if you are allergic to it or it is rotten or spoiled.
  2. Parents need to provide a wide variety of foods to their kids, including regular access to highly palatable foods in order to take these foods off the pedestal and make them morally equivalent to more nutrient-dense foods.
  3. Caregivers at school should refrain from pressuring kids to eat certain parts of their lunch before letting them eat other parts (e.g., “You need to finish your sandwich before you can have your cookies.”) If a child wants to eat their cookies first, please let them.
  4. Caregivers at school should also avoid confiscating food from kids’ lunchboxes unless those foods are an allergy or choking risk. If the parents packed the lunch, please respect that they know how to feed their kids.  
  5. Finally, school caregivers, please be mindful about sharing your own food anxiety with kids. Kids should not be hearing about your latest diet or how you don’t allow yourself to eat X, Y, or Z. Children are like sponges and absorb all of this information.

Again, thank you for everything you do for our little ones. We are so grateful to have you in our kids’ lives. Let’s help our children develop a healthy relationship with food and their bodies by setting a good example and not letting diet culture into the classroom.  

Reentry

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It’s hard to believe that we have been living in this pandemic for over a year. In some ways, it feels like the year flew by, but in other ways, it feels like 10 years have passed. Jonah and I have been lucky that we have been able to continue seeing patients remotely during this time. And we are fortunate that no one in our immediate family has gotten COVID. We’ve spent the past year plus ordering our groceries online to avoid going to the store, drastically cutting back on getting together with friends, and playing little to no tennis (only outdoors). Our daughter, who is nearly three years old, has not had that much disruption in her life, unlike school-age kiddos. While we had planned to put her into a nursery school in March of last year, we decided to hold off until we felt it was safe. Our tentative plans are to send her to preschool in the fall. Aside from having to wear masks outside, she has been blissfully ignorant of the pandemic.

Jonah and I were also lucky in the fact that we were able to get our COVID vaccinations back in February because we are healthcare providers. This has been a huge relief, although it hasn’t changed our behavior that much. We still get most of our groceries delivered, aren’t eating indoors at any restaurants, and are limiting our socializing to outdoors. But we know that as the summer approaches, things will likely start to loosen up. More and more people will become vaccinated, outdoor activities will be more prevalent, and we will have more opportunities to socialize with friends and family.

While part of me is excited to start getting back to “normal,” I also have some anxiety about it. Like many people, I know that my body has changed over the past year. My pants are fitting a bit snugger, and my body just feels different. I’ve had to buy some new clothes to accommodate the changes, which has felt hard. And sometimes I feel my internalized fatphobia bubble to the surface. I worry what people will think of me when they see my larger body. I worry that others will judge me for weight gain over the past year. I worry that I won’t be good at playing tennis anymore. I worry that this body won’t be able to do the things it was able to do previously. I worry that I won’t be able to fit into different spaces.

I know that I am not alone in this anxiety around resurfacing post pandemic. Many of my patients have experienced changes in their bodies over the past year. We have all gotten used to seeing our friends, family, and co-workers via computer, with our views limited to the shoulders and up. It’s been a while since we have been fully visible to people other than family. In some ways, it has been nice not to worry about how our body might look to others. I know that I have seriously gotten used to wearing leggings and sweatpants to work every day, and it will be difficult to go back to office attire once we start seeing patients in person again! Telehealth has also made it easier for me to really focus on my patients, rather than being distracted by my own body.

One thing that I also have had to remind myself about is stress and its effects on weight. Our bodies are unbelievably smart, and when they are under stress (whether being chased by a sabretooth tiger or, you know, dealing with the uncertainty and fear of a pandemic), certain chemical processes are put in motion. One of these chemical processes is an increase in the stress hormone cortisol. When we are stressed, our adrenal glands release adrenaline and cortisol. Cortisol kicks off a release of glucose (our bodies’ primary source of energy) into the bloodstream in order to provide us more energy as part of the “fight or flight” response to dangerous situations. Increased levels of cortisol also cause an uptick in insulin levels, which results in our blood sugar dropping. As a result of this drop, we tend to find ourselves gravitating towards more energy-dense foods (i.e., foods high in carbohydrates and fat). This process also slows down our metabolism and increases our propensity to store fat in preparation for the next threat. All of these mechanisms have been in place in the human body since the beginning of time as a way of helping us survive. So it should be no surprise that many people have experienced weight gain over the past year as a result of living through an unprecedented pandemic. It’s our bodies’ way of trying to survive.

When I find myself perseverating on my body changing, I try to remind myself to breathe. Bodies change. That is what they do. Our bodies will change throughout our lifespan. It doesn’t need to signify something negative. My body has gotten me through this past year – it has survived a freakin’ pandemic! That, in and of itself, is an amazing feat. My body changed for myriad reasons, many of which I don’t know. Maybe it was ordering more takeout, playing less tennis, not leaving the house as much, feeling more stressed and anxious, or maybe it is just plain old middle age. In the end, it doesn’t matter. There doesn’t need to be a reason for my body changing, and there really isn’t anything I can (or should) do about it. I will continue to take care of myself and my body the best ways I know how, to give myself some compassion around reentering the world and remember that this amazing body has gotten me this far. I hope that your reentries go well too.

Exercise Checklist

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Exercise. The word alone carries a lot of meaning for many of my patients. For some of them, exercise is something that feels compulsive, that if they did not do it every day, they would feel panic. For other patients, exercise brings up old memories from childhood, such as when their parents forced them to exercise. One patient told me that when she was just eight years old, her father made her go for a run every weekday for 30 minutes to “help” her lose weight and be “healthy.” Not surprisingly, this patient has an utter hatred for running now. The word “exercise” itself can be triggering for some people as it feels intrinsically linked to diet culture. As we all know (insert sarcasm), exercise is “good for you” and therefore the more the better. “No pain, no gain” is another message that diet culture tells us about exercise. In other words, if it doesn’t hurt, you aren’t doing it right.

In my work with patients who struggle with compulsive dieting, disordered eating, and eating disorders, the question of exercise often will come up after much progress has been made with eating. A great number of my patients feel afraid to start exercising again for fear that they will get sucked back into diet culture. These patients worry that they will not be able to view exercise as something enjoyable and not required. They have concerns that their old thoughts about weight loss will start popping up again as they have associated exercise with changing their body. Some feel just completely overwhelmed at the idea of moving their body in a way that feels good because they had been so used to suffering through boring, pain-inducing workouts. And still other patients are at a loss as to what physical activity they actually enjoy.

One tool that many of my patients have found helpful is a “checklist.” It is a list of questions to consider before engaging in physical activity. The goal of this list is to help the patient check in with their body and decide whether or not they want to be physically active, and if so, what kind of activity would they like to engage in. Here is a basic checklist:

  • Am I injured or sick? If the answer is yes, then it is likely that you should be resting and not pushing yourself to be active.
  • Have I eaten enough in order to do this physical activity? Am I hungry right now? If you have not been consistently feeding yourself, exercising would be contraindicated as doing so could put a lot of stress on the body. If you are hungry, then you should eat.
  • Am I well-rested? If not, you might be too tired to be physically active right now. Perhaps your body needs a nap.
  • What am I looking to get out of this physical activity? Different forms of exercise can help our body improve endurance, strength, or flexibility. And sometimes physical activity can boost one’s mood via stress relief.
  • Do I feel like I have to do this physical activity in order to deserve food today? If you feel the answer is yes, try to reframe this thought. You deserve to eat no matter how much or how little you exercise. You do not have to “burn it to earn it.”
  • Am I using this activity as a way to try to lose weight or change how my body looks? Again, if the answer is yes, then some body image work could be indicated. Instead of asking yourself “how will this activity change my body?” try asking yourself “how will this activity make my body feel?”
  • What kind of activity would I like to engage in right now? Do I want something high intensity like spinning, something low impact like walking, or something very relaxing like yoga nidra?
  • If I don’t feel like moving my body right now, what else can I do? Maybe taking a nap or talking to a friend would feel best right now.

The checklist looks different for each patient, but at its core, it is about checking in with your body and trying to listen to what it is telling you. The more that we can practice checking in with our body around its needs – including but not limited to food, physical activity, sleep, and stress relief – we will be able to develop and foster body trust.

“Food Addiction”

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As we make our way into the fall season, it is inevitable that the topic of sweets at Halloween starts coming up with our patients. Many of our patients have a love/hate relationship with Halloween, starting when they were kids. Most remember being restricted around candy by their parents and have vivid memories of having limited access to their haul or sometimes no access at all. One recalls when her parents actually paid her $50 in exchange for her giving up all of the candy she had gathered. Another remembers sneaking her candy bag into her bedroom and eating chocolate in her closet so her mom wouldn’t see. Most of these individuals grew up feeling like they were addicted to sugar or food in general and that they could not be trusted to be around these foods.

Diet culture would have us believe that sugar/food addiction is a real phenomenon and that it is the reason for our “obesity epidemic.” Countless diet gurus and programs are dedicated to helping their clients “break the sugar habit” and cure themselves of their addiction to food. The food addiction model claims that certain foods light up the pleasure centers of the brain, which means that these foods elicit a pleasure response similar to that of drugs and alcohol. Other things that light up the pleasure centers of our brain: hugging a loved one, laughing at a funny joke, breastfeeding and/or holding your baby, listening to music you enjoy, and falling in love.

The only reason the food addiction model has been posited is because of fatphobia. Are we concerned with laughing addiction or hugging addiction? No. It’s only because people who feel that they are addicted to food are likely engaging in a lot of physical and/or mental restriction to try and control their weight. If being or becoming fat was not vilified like it is in our diet culture, people would not be restricting themselves and thereby would not feel out of control with these foods. Restriction begets bingeing.

Most studies that have been done on food addiction have been performed on mice. Interestingly, most of these studies found that the mice that were restricted from the highly palatable rewards foods and were presented these rewards at intermittent intervals were much more likely to overeat at these times. Similarly, other studies have shown that when humans are deprived of certain highly palatable foods (foods high in sugar, salt and fat), they have a heightened brain response to those foods when they see them. This means that those “forbidden” foods become much more appealing and attractive to the restrained eater than the non-restrained eater. None of the food addiction research currently controls for deprivation, meaning that they don’t measure if the subjects are currently dieting or have dieted in the past before conducting their studies.

The abstinence model of substance addiction is considered the gold standard right now. But unlike drugs and alcohol, one cannot simply abstain from food. There is a biological reason why food lights up the reward pathways in our brain – survival instinct! This causes us to seek out food when our bodies need it, which is necessary in order for our species to survive. On the other hand, we could live our lives without consuming any recreational drugs or alcohol and survive just fine.

All of this is to say that many people feel like they are addicted to food. What I would argue is that the behavior of eating might feel like an addictive or compulsive one, but that food in and of itself is not an addictive substance. So what should we do about kids and candy? My advice is to make candy (and other highly palatable foods) available on a regular basis in your home – add them to meals (i.e., have them be part of the actual meal), let them be the afternoon snack here and there. And don’t refer to these foods as “treats” or “junk” as this immediately makes them that much more appealing and also much more likely that your kids will sneak and overeat these foods when they are available. By including these foods regularly, they will lose their “shine,” and when holidays like Halloween or Christmas or Easter roll around, the magnetic pull to these foods will be markedly diminished.

Coming Out

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I am officially coming out as fat today. I’ve been thinking about doing this for a while now. This concept might seem laughable to some of you. How can someone come out as something that everyone can plainly see? Take one look at me and my size and there is no question that I am fat, but up until fairly recently, I had eschewed the title of “fat,” something that I never wanted to claim to be.

I would describe myself with euphemisms: chubby, chunky, curvy, plus size. I would try to shrink myself in public, taking up as little space as possible lest someone feel like my body imposed on them. I would keep my gaze down as I passed strangers on the street, a way of showing my own shame and embarrassment for my body. I would dress in loose, baggy clothes so no one would be forced to see my belly rolls. If I went to the beach, I would be sure to wear a cover-up the entire time unless I decided to be brave and go for a swim. Then I would sprint into the water so that bystanders would not need to be assailed by the vision of a fat woman in a bathing suit.

All of this was an attempt not to take up space in the world, to show that I, as a fat person, was aware of my horrible shortcomings and was not okay with being in this body. The world that we live in confirmed these feelings often. Microaggressions would come in the form of friends discussing another friend’s weight gain or loss, family members commenting on what I was or was not eating, and doctors suggesting changing my diet without asking me what my diet looked like in the first place.

Like any “good fatty,” from a young age I would engage in different weight loss attempts to try to shrink myself and be “healthy.” My first earnest weight loss attempt was in my senior year of high school. I had made up my mind that I would finally lose the weight that had plagued me throughout my childhood and adolescence and be thin by the time I started college in the fall. Then I could start my new adult life in a socially acceptable body and everything would be perfect. I dutifully dieted, restricting all the foods that I loved, instead living on fat-free cottage cheese, vegetables, and sadness.

My body began to shrink and everyone noticed. I got compliments, invitations to parties, acceptance. My doctor was so impressed that he told me to “keep going” and “get skinny.” Meanwhile, I had lost my period, become completely obsessed with eating as little as possible, and was a grumpy, exhausted mess. At my worst, I was exercising twice a day to try to break the plateau. I was downing sugar-free candies to prevent myself from snacking between meals. (P.S. Fun fact about those candies: They are wicked laxatives!) I would loathe going out to eat with my friends and family, as I would be faced with all the foods I no longer allowed myself to have. Food and weight were all that I could think about.

When I went off to college in the fall, the wheels fell off the proverbial wagon, and I gained back all the weight I had lost and then some. The weight loss/gain cycle continued throughout college and into my 20s as I tried diet after diet, thinking that this time it will stick. But inevitably, the weight would creep back up, and I would feel humiliated and ashamed.

Little did I know then that my experience was not unique. In an analysis of 31 long-term diet studies, researchers concluded that while individuals can expect to initially lose 5% to 10% of their weight regardless of which diet or “lifestyle change” they choose, the weight inevitably comes back, with at least one-third to two-thirds of people regaining even more weight than they had lost in the first place. Another study that looked at the effectiveness of traditional dietary and exercise interventions for weight loss determined that while there is not much long-term follow-up data in the effectiveness of these interventions, “the data that do exist suggest almost complete relapse after 3-5 years.” And those 3-5% of dieters who do manage to keep the weight off for more than 5 years spend all of their time and energy trying to stay that way, often by using disordered eating and exercise behaviors.

I remember reading an article in the New York Times about nine years ago that focused on the National Weight Control Registry (WCR), a research study that follows individuals who have lost at least 30 pounds and have kept it off for at least a year. The article featured a husband and wife who had lost over one hundred pounds each and had been on the WCR for five years. In order to maintain their weight, the couple engaged in a rigid regimen of diet and exercise. Both of them not only exercised for a minimum of two hours per day, they also weighed and measured every morsel of food they ate, logging it into a food diary. They severely limited not only their calories, but the types of calories they were eating (e.g., low carb, no desserts). The wife herself said, “It’s pretty easy to get angry with the amount of work and dedication it takes to keep this weight off,” but the alternative (i.e., gaining the weight back) was not an acceptable outcome for her.

Part of the reason I made the decision to become a registered dietitian was the hope that I could finally crack the code of weight loss. I figured, well, if I learn about all the aspects of nutrition, I will be able to lose weight, keep it off, and help others to do so, too. Before entering the nutrition program, I had dieted down to a lower weight and thus was obsessively thinking about food and my body. Interestingly, by the time I had completed my dietetic program, internship, and Master of Science in nutrition, I had again gained back all of the weight I had lost. Of course, I was quite unhappy with this development but still believed that I could figure out my weight dilemma eventually.

My first dietetic job was at an eating disorder center where I was a registered dietitian working with residential patients. It was around this time that things started to shift slightly for me. I saw how the patients were treated differently based on their body size. For instance, those patients in larger bodies, regardless if they had been admitted for restriction or not, were put on “weight maintenance” meal plans to prevent them from becoming “too fat,” while those patients in smaller bodies were encouraged to eat more to restore their weights to a “healthy weight.”

Basically, we were prescribing behaviors to one group of patients (restriction for those in larger bodies) that were considered disordered in the other group of patients. This double standard did not sit well with me, but I adhered to the guidelines at the center. At the same time, I was still fixated on shrinking my own body, terribly self-conscious of being a fat dietitian in a field known for a very specific type of person: white, female, thin. I thought to myself, “How will any of these patients take me seriously when they see my body?” I dieted once again during this period of time, and with my own wedding day approaching, I got even more obsessed about the number on the scale.

It wasn’t until after the wedding (and subsequent weight regain) that I finally had enough. This wasn’t working for me anymore, and it wasn’t for lack of trying. I had hit diet rock bottom and knew there had to be a better way. So when I learned of Health at Every Size® (HAES) and Intuitive Eating (IE) at a talk given by a colleague, I was so ready to hear the message that there was a way to live a happier and healthier life, a life where food is not the focus and where I could be free of the chains of dieting.

I delved into all of the HAES, body positive, and intuitive eating material I could find online and in various books. I attended workshops and lectures and even spent three weeks at a HAES/IE retreat. I started listening to podcasts, connecting with other HAES and IE practitioners, and before I knew it, my mindset had shifted significantly. HAES and IE spoke to me like no other paradigms or approaches, and once I learned that they are also both backed by scientific research, I was a convert.

During this time, of course I gained some weight after years of losing and gaining (in addition to having a baby), with my body finally landing in the “obese” range, at least for now. It is difficult to be in a larger body for many reasons. Doctor appointments have become more fraught as I brace myself for the weight lecture. Luckily I was able to find a weight-neutral doctor who knows not to talk to me about weight loss, but if I ever need to see a specialist, I know that inevitably my weight will come into the discussion.

Being in a larger body makes it harder to shop for clothes, fit in some spaces, and feel “normal” amongst my mostly slim friends and family. I never had to think before, “Will I fit in this seat?” But now these are things I need to consider. Being a “small-mid fat,” I want to acknowledge that I have much more privilege than those who identify as “large-fat,” “super-fat,” or “infinifat.” The hatred, mistreatment, and oftentimes abuse these individuals deal with on a daily basis make me simultaneously so angry and so sad.

Our diet-obsessed, fatphobic culture makes sure to remind me and other fat people that we are lazy, gross, sloppy gluttons who could be thin if we just tried hard enough and put down the bonbons. The overwhelming majority of people believe that weight is controllable and that if fat people just ate less and exercised more, they could be thin. Most people also believe that the health conditions that are often associated with larger body sizes (such as heart disease and diabetes) are directly caused by weight, even though there are thin people who develop these conditions, too.

While obviously what we eat and how much we move can affect our health, they are a very small part of the picture of overall health and wellness. Access to healthcare, socioeconomic status, oppression, and weight stigma have even greater impacts on our health than just diet and exercise. And just because someone does all of the “right” and “healthy” things does not guarantee that they will never become ill. Society would have us believe that the pursuit of health is a moral imperative and totally within our reach if we just try hard enough. But in the wise words of fat activist Ragen Chastain, “health is not an obligation, a barometer of worthiness, completely within our control, or guaranteed.”

Otherwise open-minded, liberal people who believe in equality and respect for those of different races, ethnicities, sexual orientations, religions, abilities, and gender identities do not consider body size diversity as something that also needs to be respected and protected. This world is not built for larger people, and existing in it can be torturous at times.

In addition to all of this, I still have a great deal of internalized fatphobia that I am constantly trying to counteract with body acceptance. I have had to come to terms that I will never likely be in a smaller body and that this is not the end of the world. At the same time, nearly everyone in my life lives and breathes the same diet culture air we live in, so it’s rare that I am not faced with some fatphobia, diet talk, or weight stigma. It’s like I’m swimming against the current of diet culture nearly 24-7, and sometimes I just want to give up and go with the flow or jump out of the water entirely. But knowing what I know about the lies of diet culture and how miserable my life was when I pursued thinness, I can’t go back.

So I am coming out as fat today to reclaim this word that has been used to taunt me and millions of other people but should honestly be just a neutral descriptor. I am a fat, fair-skinned, red-headed registered dietitian, wife, daughter, sister, friend, and mother. I am all of these things. And I am no longer going to stay in the body shame closet.

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.