Finding Fat-Friendly Health Care

DU + AmpleI am often painfully reminded of the fat phobia perpetuated by the medical community on a regular basis. Not just from my clients and others who have countless stories of being denied adequate health care because of their weight, but also from my own personal experience.

I was 15 years old when I went to the doctor for my annual check-up, stepped on the scale, and was told that I was getting “too heavy” and would have to eat differently. Since at age 15 I was still largely reliant on my mother for meals and my school cafeteria for lunch, I could not imagine what “eat differently” looked like, especially as it pertained to my weight. Luckily, my Mom must have delivered a private screed to this doctor (the one that later dismissed her expanding belly as “weight gain” instead of the ovarian cancer it actually was) because he never mentioned it after that and my strategy to never get on the scale again worked until my early 20s, when I turned to dieting to manage a major life crisis. Notably, after that comment from my doctor, my eating became increasingly disordered as I internalized the shame of that visit.

I was reminded of all this the other day when I went to a “sleep class” to diagnose possible sleep apnea (a long shot, but my doctor thought it was worth a try for some recent stuff going on). The person leading the class explained how to use the equipment we would take home to monitor our sleep that night. She also said, “If you are diagnosed with sleep apnea and you weigh too much, you will have to lose weight, because that is probably why you have it.” She went on to say that thin people had it for other reasons, and that once we lost weight, they could look to see if we also had it for those other reasons. As though our weight was an impermeable barrier that would obscure any other problems we could potentially have.

It took all the willpower in the world for me not to stand up on a table and have my Norma Rae fat-solidarity moment, and luckily we found that no matter what we weighed, if we had sleep apnea, we would get the APAP machine anyway. Because, you know, “you need to be able to sleep so you can lose weight.” Whereas I thought we needed good sleep for health and to feel well, silly me!!

Anyway, all this to say that we need medical care and medical providers that aren’t fat phobic, that don’t prescribe interventions that are temporary at best, and who provide us with the medical care that people in smaller, more conforming bodies get. But where can we find these providers?

That’s where Ample comes in. Aaron and I recently did a podcast with Alissa Sobo, one of the founders of Ample, a rating site for people in marginalized bodies (think fat, trans, people of color, disabled people). The creators of Ample know that when someone fears stigmatization from the doctor, they don’t go, and that can lead to worse health in the long run. But we need to know who can provide stigma-free health care – and that’s where Ample comes in.

I hope you’ll give this great Dietitians Unplugged episode a listen to find out more about Ample and how you can help build this amazing resource. THIS is how we exercise the power of voice that we do have — and we CAN create a better future.

Ample

Listen now:

Episode 50 – Finding Fat Friendly Providers on Ample with Alissa Sobo

Show notes:

Is it Ample? Aaron and Glenys talk to Alissa Sobo, the creator of Ample, the first app that rates businesses specifically on their accessibility and inclusiveness towards marginalized bodies (fat, trans, people of color and more). In this episode, Alissa talks about her origin story of being fat-shamed at the doctor when she was pregnant and why she decided she needed to create a review site for people in marginalized bodies whose needs are just not being met. She also explains how this amazing resources works and how we can all help build on it. This is something all our listeners can help contribute to and we can’t wait to introduce you to Ample! BONUS CONTENT: stay tuned to the very end to listen to our first fun bonus content!

ample logo

Need help with non-diet diabetes care?

HAES Care for Diabetes starting soon – get on the mailing list to be notified first when registration opens!

image

 

Say No to Diets This Year

ice cream not dietsI wish I didn’t still have to say it, but the reality is that the diet industry still exists, people still feel bad about their bodies, weight loss is still the go-to medical intervention for people in fat bodies, and harm is still being done.

So I will say it loud and clear again for the new year: WEIGHT LOSS DIETS DON’T WORK.

Or to be perfectly accurate, they may work for a while, but all the available evidence points to the fact that over the long run, they DON’T work — the weight people lose is regained within three to five years. The science could not be clearer on this.

Looking at it another way — the Center for Disease Control and Prevention’s National Center for Health Statistics reports that nearly half of American adults are trying to lose weight at any given time, yet the statistics for “overweight” and “obesity” remain static at about 1 in 3 adults for each category. I’ve been hearing these numbers for years…so if our massive dieting efforts aren’t changing them, then that tells us something.

It tells us that trying to permanently lose weight is about as futile as trying to permanently change your height. But the weight loss industry continues to take people’s money and then blame them when their product doesn’t work.

So for the new year, my friend and Dietitians Unplugged podcast co-host, Aaron, and I decided to talk about why dieting doesn’t work. This is a great place to start for anyone new to our podcast, and hopefully our long-time die-hard listeners will appreciate the reminder of why they, too, are trying a different path to health.

Episode 49 – Why Your Weight Loss Diet is a Bad Idea

Listen on iTunes

Show notes:

12 Reasons to Ditch the Diet Mentality on Huffington Post

This is a great blog post by our last guest, Dr. Linda Baggett: 10 Reasons to Ditch Dieting in 2019

Aaron’s Men’s Body Trust Group starts January

Glenys’ and Rebecca Scritfield’s HAES for Diabetes Group starts in March – get on the list for updates straight to your inbox

Mindfulness for Diabetes Self-Care with Megrette Fletcher

DU + MegretteAs many of you know, this past year I delved into the realm of Health at Every Size care for diabetes.

Many people contact me looking for help with normalizing their eating, and I’ve noticed that folks struggling with blood sugar abnormalities often feel that a non-diet way of eating does not include them. They’ve been told by doctors or other health care professionals that they must focus on restriction and weight loss to improve their labs and health.

This could not be further from the truth. I have seen it with my clients who struggle from both disordered eating and diabetes or pre-diabetes. I have seen that helping them normalize eating patterns without a focus on restriction (in fact I emphasize including all the foods a person loves including sweets) or weight has improved their blood sugars, not to mention their quality of life.

That’s why I I was so excited to so a podcast earlier this year with Megrette Fletcher, MEd, RD, CDE. Megrette is a certified diabetes educator who provides non-weight-focused education for people with diabetes and pre-diabetes, and teaches other professionals how to provide this care as well. Founder of the Center for Mindful Eating, Megrette advocates for pleasurable, mindful eating and shame reduction to help manage blood sugars instead of restriction and weight loss. She is so generous with her knowledge, and truly someone I consider a mentor.

In this episode, she gives us a handy metaphor for understanding how our insulin works (the Insulin Knife!) and how we can best help our own bodies utilize its insulin. For those who have been scared by or felt shame for a diagnosis or family history of diabetes, we think you’ll find this episode extremely helpful in helping you get your self-compassionate self-care on.

Listen now:

Episode 41 – Mindfulness for Diabetes Self-Care with Megrette Fletcher

Also available in iTunes and Stitcher.

Show notes:

Diabetes Counseling and Education Activities (for Professionals)

Eat What you Love, Love What You Eat with Diabetes 2017 Edition – most recent edition

 

Did you miss getting non-diet help with diabetes this year?

So many people reached out to us late this year to tell us they were sad to have missed enrolling in the group I run with Rebecca Scritchfield,RDN, HAES Care for Diabetes, and wanted to know when we were running our next cohorts. Good news! We are taking names for our waiting list on our HAES Care for Diabetes page, so just click the link or the image below and make sure to sign up so you’ll be the first to get notified when our next groups are available (likely early 2019). We help people concerned with blood sugars to stop focusing on restriction and weight, and to start making positive changes that feel good and are sustainable. We have had great feedback and will keep making this group better for you in future iterations.

image

Why Body Image Work is Crucial

woman sunsetA few months ago I went to a Body Image Workshop hosted by Marci Evans, RD and Fiona Sutherland, RD. But…what’s a dietitian’s work got to do with body image healing??

When we are in school getting our nutrition degrees, we learn all about food safety, how to counsel a nutritious diet, a metric ton of chemistry, and medical nutrition therapy to treat various conditions and diseases. We spent some time learning nutrition counseling techniques too.

But rarely are we prepared for what is often at the root of so many eating problems: a fractured relationship with our body image.

In school, they never gave us the language to understand this, for ourselves or other people, and they certainly never gave us the idea that we might also help the healing.

But in fact, we need to be able to help our clients heal not just their relationship to food and eating, but also their bodies.

I’m not talking about doing the work of a therapist. I’m talking about being able to listen and validate and understand WHY someone could hate their bodies so much that they lose their ability to eat in any peaceful, nourishing way. And helping them to find ways to reconnect with their bodies with self-compassion.

We CAN and SHOULD talk about this with our clients, and in the below episode of Dietitians Unplugged, Aaron and I talk more about how we as dietitians can start doing this work.

Episode 40 – Body Image Work is Crucial

Will I ever love my body again?

lindleyashline_2018-07-07_041
Photo courtesy of RepresentationMatters.me

“I used to love my thinner body, even though I hated dieting. Will I ever love my body again?”

This is an occasionally-heard refrain heard from some of the brave souls who have chosen to give up the pursuit of weight control through dieting and have instead opted for the unknown of what their bodies will do in response to a more peaceful relationship with food.

To review, there are three possible outcomes of giving up dieting:

  1. You may lose weight.
  2. You may gain weight.
  3. Your weight may stay the same.

For anyone experiencing any of these outcomes (even weight loss), the work of body acceptance is necessary to help clear the path to a more peaceful relationship with eating. This is the work of body image healing.

I love the goal of body neutrality as a result of the body image healing work that we do. Body neutrality, to me, means you don’t have to feel in love with your body or how it looks, but you don’t loathe it either. You’re able to see your body as an instrument, not an ornament, and get on with your life and all the things you want to experience in it.

But sometimes we wonder if we will ever get to a place of loving how our bodies look. For some, body neutrality doesn’t feel like enough, and they remember a time when they were maintaining a lower body weight, getting societal accolades, and enjoying the way their bodies looked to the world.

Rarely do we seem to question why we need to love how our bodies look. Would we have this same desire to love our appearance if there weren’t such strong cultural messages about beauty standards? Would this need exist if we were stranded alone on a deserted island like Tom Hanks in the movie Castaway? I strongly believe the answer is no.

That’s why we need to talk about self-objectification, which is experiencing one’s body not from the inside, but from the outside, looking in. It arises from an unfair system in which women are judged more for how they look and not for what they do (one of the many unpleasant side effects of patriarchy).

We are presented with a relentless barrage of media images of women and messages around what constitutes the “right” look (and from the mere absence of other types of images, we can easily infer what constitutes the “wrong” look). It’s so easy to constantly compare ourselves to these images and develop that outside-in-gaze that becomes more dominant than the experience of being in our bodies.

I think it’s lovely to be able to look in the mirror and say, “Yep, good outfit” or “Awesome style I’ve got going today.” That’s a world away from, “I love how my body is mirroring unrealistic cultural beauty standards by being as small as it can today!” The first two statements are about objects on your body; the latter statement is about your body as an object.

For me, opting for body neutrality and appreciation of its usefulness was a far saner goal than needing to love how I looked on a physical level, because I no longer wanted to be a mere object to be admired.

I don’t actually think we need to love how our bodies look to live a richer life. We do need to understand why that desire exists, though.

Here are two great blog posts about self-objectification from one of my favorite anti-diet, pro-body sites, Beauty Redefined:
Selfies and Self-Objectification
Running from Self-Objectification

I hope you go straight down the rabbit hole of this site because they have so many wise things to say on the subject of self-objectification!

Need help managing your diabetes, pre-diabetes, or insulin resistance?

HAES Care for Diabetes is back! Two tracks are available, starting on September 11 and September 13. Rebecca Scritchfield, HAES dietitian and author of the book Body Kindness, and I will be providing sound and compassionate non-diet, non-restrictive, non-weight-focused advice and support for managing your blood sugars. Click on the image below for all the details about this 4 week virtual counseling group and how to register!

image

Thank you to Lindley Ashline at RepresentationMatters.me for her free stock photo images!

Summer Podcast Round Up 2: From Our Loud Inner Critics to Sugar Addiction

Dietitians Unplugged Episode 37 – Aaron and Glenys Tackle Their Inner Critics

Cover2We all have an inner critic. I don’t know anyone who doesn’t. It’s the voice that’s try to keep us safe by avoiding unnecessary risk.

So, yes, sometimes that little voice can be really helpful in keeping us safe…but sometimes it can hold us back by sending damaging and unhelpful thoughts.

In this Dietitians Unplugged podcast episode, Aaron and I talked about our own inner critics, how they manifest, and how we deal with them. This is a truly unplugged (and sometimes unhinged!) discussion that  we’re sure you’ll enjoy and hopefully will give you a few more tools for your self-care toolbox.

Episode 37 – Aaron and Glenys Tackle Their Inner Critics

Dietitians Unplugged Episode 38 – ED Treatment for Marginalized People with Gloria Lucas

DU + GloriaIn this fabulous episode, Aaron and I were thrilled to welcome to the podcast Gloria Lucas, founder of Nalgona Positivity Pride (NPP). I got to see Gloria speak a few years ago at the 2016 BEDA conference on the role of colonialism in historical trauma and we’ve been excited to have her on ever since then.

Gloria shared her story of how and why she came to found NPP, which helps to provide eating disorder resources to marginalized people.  She also talked about how eating disorder communities must learn to do better to include people of color into the discussion and make treatment more available and inclusive of marginalized people.

Episode 38 – ED Treatment for Marginalized People with Gloria Lucas

Links:

Nalgona Positivity Pride

Nalgona Positivity Pride Etsy Store

 

Dietitians Unplugged Episode 39 – Is Sugar Addiction a Real Thing? with Tiffany Haug

DU + TiffanyEver wonder if you’re addicted to sugar? Or some other kind of food? Aaron and I talked to Tiffany Haug, MS, RD, EDOC, who broke down the science of addiction for us, and explains why your diet history makes all the difference in how you approach highly palatable foods. Tiffany also talked about the problem with how food addiction is studied and the problems with the Yale Food Addiction Scale.

Episode 39 – Is Sugar Addiction a Real Thing? with Tiffany Haug

 

 

Summer Podcast Round Up 1: From Self-Care to Body Love

Dietitians Unplugged Podcast Episode 34: Healthism vs. Self-Care with Lucy Aphramor

DU + Lucy

I’ve been a little remiss in the last few months about updating this blog with our latest Dietitians Unplugged podcast episodes. I have been crazy busy this past year – in reality, too busy, because I was trying to do way too much.

It took it’s toll. I had to find ways to triage everything in my life. That meant I had to pick between writing, which I really enjoy, and doing the podcast, which I really love too. It even meant I had to let go of things like updating this blog with the podcast, which pricked at me frequently but also was just something I didn’t have room for.

I termed this self-care. No one can do everything all the time. Some things have to go by the wayside. Until something gave way in my schedule (which it finally did) I decided to only do the very most important things in my life — that was spending time with my partner, going to my job, caring for my clients, podcasting and resting.

The topic of self-care makes a great introduction to this podcast we did back in February about the necessity of self-care, and how “healthlism” — the belief that health is our sole responsibility, and even obligation, and is not affected by our economic status, race, environment, sex, etc. — isn’t really making us healthy in any meaningful way.

UK-based radical dietitian Lucy Aphramor guided us through this topic with her usual eloquence (no surprise that she’s also a poet).  As a radical dietitian, she focuses on the deep roots of what causes judgement, war and shame.

Episdoe 34 – Healthism vs. Self-Care with Lucy Aphramor


Dietitians Unplugged Episode 35 – Metaphors & Storytelling in healing Eating Disorders with Dr. Anita Johnston

DU + Dr. Anita JEating in the Light of the Moon by Dr. Anita Johnson, eating disorder psychologist and storyteller, is one of the seminal works on eating disorders and one of the books that people tell me first helped them in their recovery from EDs and diet culture. We were so thrilled to have Dr. Johnson on our show and talk about how story-telling can be integral to our healing.

In addition to authoring this amazing book, Dr. Johnson is co-creator of the Light of the Moon Cafe, a series of online interactive courses and women’s support circles, and Soul Hunger workshops. She is currently the Clinical Director of Ai Pono Hawaii eating disorder programs with out-patient programs on Oahu and the Big Island of Hawaii, and an ocean-front residential program on Maui.

She also gifted our listeners with this handy guide to help discover the meaning behind your food cravings or phobias.

Dietitians Unplugged Episode 35 – Metaphors & Storytelling in healing Eating Disorders with Dr. Anita Johnston


Dietitians Unplugged Episode Episode 36 – You are More than Your Body with Summer Innanen

DU + summerOne of my absolute favorite people in the body positive, anti-diet world is Summer Innanen. She has a genuine, no BS way about her that I just can’t resist. And it’s not just because we’re both Canadian, I swear!

Summer is a professionally trained coach specializing in body image, self-worth, and confidence. She helps women all over the world through her private and group coaching to break out of the diet culture cage and cultivate their inner, rampant untameability so they can wear, say and do what they want. She is the best-selling author of Body Image Remix, creator of the You, On Fire online program, and host of Fearless Rebelle Radio, a podcast dedicated to anti-dieting, body positivity, and feminism.

Listen now:

Episode 36 – You are More than Your Body with Summer Innanen

 

HAES Care for Diabetes is starting again soon!

Rebecca Scritchfield and I are running our virtual groups again focusing on non-diet, non-weight-focused care for diabetes and other related metabolic conditions. Two tracks available starting September 11 and 13. Group size is limited so sign up soon!

Go to HAES Care for Diabetes to find out if this is for you!

 

Dieting is NOT Self-care

DIETING ISNOTSELF-CAREOne thing that gets my angry inner goat going like nothing else is the constant insistence out there in the world that dieting to lose weight is the equivalent of “eating healthy” or “becoming healthy.”

As a former dieter, and someone who treats long-term chronic dieters and weight-cyclers in my private practice, I can tell you that while this might start out as the intention, it almost never ends that way.

And while some people who do make positive changes in their eating habits may experience some weight loss, there is little evidence that eating “healthier” will absolutely lead to significant long-term weight loss for the majority of people, or turn large people into small people. This is why people tend to resort to diets that involve calorie deprivation to achieve weight loss.

I want to point out, however, that while a nutritionally-dense diet may not lead to weight loss, it can certainly help to improve your health (but is not the whole picture of “health”) and is worth pursuing if that is what you want to do.

But let’s be honest: most diets are not about getting healthier. They are about losing weight, which we are told will automatically make us healthier. Unfortunately, this is not always true.

When I “successfully” dieted for 16 years, at my thinnest and most restrictive point, I ate few fruits and vegetables (“waste of calories”), ignored my hunger for so long I wanted to cry at times, then secretly binged when I couldn’t take it anymore, and ate a mostly monotonous diet of “safe” foods. During this time, I developed crippling back pain from over-exercising and osteoarthritis in my feet, likely hastened by the complete lack of calcium in my diet for so long (though also likely genetically determined). I fought a psychological war with the scale daily that usually resulted in defeat for me, no matter what the number said.

This was not pursuit of health in any way. These are the things I needed to do to maintain weight loss, because simply eating healthfully didn’t.

I was thin, but I was not healthy either physically (witness my body breaking down, and feeling weak, tired, and hungry most of the time) or psychologically (thinking about 24 hours a day about food in a very disordered way, feeling constantly dissatisfied with my body despite its thinness).

I am not an isolated case; many of my clients arrive in my practice with some version of the same story. Their diets may have started as an attempt to eat “healthy” (albeit focused completely on weight as the main measure of health) but they ended up in a never-ending cycle of restriction and binge-eating, feelings of shame around their bodies and failure to follow a diet, and often higher weights than they started at. They are also very confused about how to eat in a way that actually supports health and well-being without feeling deprived (which is why they have come to me).

Let me tell you this: it isn’t that hard to have a balanced, nutritionally adequate diet when you feel relaxed around food. Behavior change can be challenging, but it is much less so when you see body shame for what it is and leave fatphobia behind. That is why dieting isn’t really about health – because diets involve intense shame around your current body and a desire to make it something it isn’t.

When changes feel really hard or unsustainable (and sometimes make you want to cry), consider that you might actually be on a diet. If your diet changes are supposed to produce a tangible change in the appearance of your body, then you are on a diet.

And if you’re worried about health, know that a non-diet approach actually will support making positive changes for health.

In the meantime: This article is a great example of how diseases like diabetes are more likely related to nutritionally inadequate diets than higher weights. It makes so much sense when we look at how long-term yo-yo dieting may be linked to development of diabetes as well as weight gain. Again, “successful” deprivation does not equal health!

Looking for help with Diabetes?

Check out our group series, HAES Care for Diabetes. We will be running this intermittently throughout the year. Stay tuned for new dates soon!

Need help with your relationship to eating?

I have an online course that only takes minutes a day to get all the best tools in my non-diet toolbox to help you get more relaxed around food. Check out Dare to Eat.

HAES Care for Diabetes

imageSomething I’ve been thinking a lot about lately is diabetes.

I’m getting older and I have a family risk, and taking care of myself in the best possible way (where “best” sometimes means “good enough”) is something I’m always working on.

And of course, I don’t diet anymore and never will again. So the standard “lose weight to lower your risk” advice just isn’t going to fly with me (sorry, Doc!). I eat as healthfully as I can (knowing I get to determine what that means for me) and move joyfully, but those things don’t make me thinner, just like they don’t make most people thinner which is why people end up going on whackadoodle diets. But I do know that they can help to make me healthier, and hopefully decrease my risk for diabetes.

My Grandmother was diagnosed later in life and ended up living quite a long time despite some seriously flawed self-care over the years, in part due to becoming my Grandfather’s full-time caregiver after a stroke. She had been a life-long dieter who ended up at a much higher weight by the time she was in her 60s. She really did eat like a bird from what I could see, which doesn’t actually surprise me given what I know about how dieting affects metabolism. (Fun fact: this would drive my Mother crazy when she would cook a massive Christmas dinner once a year and Gram would then pick deliberately at it and leave most of it on her plate. Ah, families) All this backstory to say, she had diabetes and she still managed to have a life. I think it’s important to remember that a diagnosis of diabetes does not mean the end of one’s life.

At one of my day jobs, I have done a lot of diabetes education. Not once did I recommend weight loss. Why? Because we know that route, even if it did help with blood sugar control, is temporary at best and usually results in massive disinhibition with food later on which is definitely not good for blood sugar control.

Yet there persists this idea that while Health at Every Size (HAES) and intuitive eating are fine for the perfectly healthy person, it’s simply not doable for those with medical conditions.

I disagree, and so does much of the science. People who have a good relationship to food have been shown to be healthier physically, socially and psychologically. Once a good relationship to food and eating has been established, from there it’s easy to work to improve diet quality (if that’s what’s needed) or add in joyful movement and compassionate self-care.

Back when I ran my Facebook group, time and again, people would post about how they were struggling to manage their diabetes diagnosis or risk (or other metabolic-type condition) without it feeling like they were going on a diet.

I’ll admit, there is an art to this. Nobody knows this better than a HAES RD.

That’s why my friend and mentor Rebecca Scritchfield, author of the non-diet self-care book Body Kindness, and I came up with something we think is much needed in the HAES world. We’ve developed a new VIRTUAL support and education group called HAES Care for Diabetes Concerns.

This 4-week group (done via video conference) is open to anyone with a diabetes diagnosis or risk, or any other metabolic-type condition (hypertension, high cholesterol) and members will get direct support from the two of us.

Group size is intentionally small so that people get the attention they need. We have a few spots left in both tracks (Mondays 9 am and Thursdays 5:30 pm Pacific Time) so we hope you’ll join us.

Check out all the details here: HAES Care for Diabetes Concerns.

Don’t struggle alone! Help is just a click away.

Podcast: Dressing the Plus Size Dude at Chubstr

DU + BruceWhen I first began my body acceptance journey back in 2010, I started out looking at fat fashion blogs. One of those blogs I found was Chubstr.com. Since then, founder Bruce Sturgell has turned Chubstr into a comprehensive lifestyle site and invaluable resource for large men. Because fat guys should have great clothing too!

In this episode of Dietitians Uplugged, we chat with Bruce about why he founded Chubstr, two things everyone should do when they’re starting to figure out their own style, and some of the best places to find big men’s clothing right now.

Listen now:

Libysn
iTunes
Stitcher

Do you struggle with PCOS and your weight…but don’t want to diet ever again?

If you’ve been given the standard advice when it comes to Poly Cystic Ovarian Syndrome — which has traditionally been to lose weight — but never want to diet again and aren’t sure the best way to eat for your health and fertility, I have exciting news for you. My friend, registered dietitian Julie Duffy Dillon, has created a course that is 100% diet-free to help those suffering with PCOS, called Your Step-By-Step Guide to PCOS and Food Peace. Registration is open until January 31, so check it out now!
Your-step-by-step-guide-300x300