Carly Onopa MS, RDN

Gabrielle Katz LCSW, CEDS-S

Lindsay Everhart LCSW, LICSW

Counter-Cultural Eating Disorder Recovery: Implementing Health at Every Size®

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Agenda

• Our Current Culture – Diet Culture

• How This Contributes to Eating Disorders

• Why We Teach Current Culture vs Counter Culture

• The Counter Culture – Health at Every Size®

• Hear How it Sounds

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Our Current Culture

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Diet Culture

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Diet Culture• Thin ideal

• Food Rules

• Eat this Not That Language

• Weight = Health

• No Pain, No Gain

Photo: Vidmir Raic, Pixabay 2014

Photo: Muhammad Sadeeq, Pixabay 2020

Photo: Pixy, 2017 5

How This Contributes to

Eating Disorders

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Eating Disorders

Eating Disorders are the result of the following influence:

• Genetic/Biological

• Psychological

• Environmental/Social

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Diet Culture’s Impact on Youth and Development of EDs

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(Crenshaw, & Liu, 2020).

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Viti Levu, Fiji Study

BEFORE TV:

• Prosperity was traditionally associated with food and Fijians “appreciate large, robust bodies”

• “You’ve gained weight” was a traditional compliment

• 1995, without television, girls in Fiji appeared to be free of the eating disorders common in the West

• 3% induced vomiting to control their weight

• 13% scored highly on a test of eating disorder risk

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Viti Levu, Fiji Study

AFTER TV: 1995 satellites brought television signals to the region

• Fiji has one television station, which broadcasts programs from the UK, US, and New Zealand such as Seinfield, ER, Melrose Place, and Xena: Warrior Princess

• 1998 (38 months after the station went on air)

• 74% felt they were “too big or fat"

• ~15% reported at least once had induced vomiting to lose weight

• Young girls in Fiji “got the idea they could resculpt their lives” and began to “think of themselves as poor and fat.”

• 2007

• 45% of girls reported they had purged in the last month

• The same girls sometimes used appetite stimulants

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Viti Levu, Fiji Study

“Epidemiological studies have shown that eating disorders are more prevalent in industrialized countries, suggesting that cultural factors play a role.”

The New York Times, Erica Goode

"The teenagers see TV as a model for how one gets by in the modern world. They believe the shows depict reality.”

Dr. Anne Becker

“Many groups say the world-wide increase in eating disorders is down to the prevalence of images equating a slim figure with beauty.”

British Broadcasting Corporation, James Westhead

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Why We Teach Current Culture vs Counter Culture

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Weight Stigma is Trauma

Weight stigma is trauma. Therefore, trauma-informed care and a safe health care environment are of utmost importance.

ꟷ Anonymous

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Teaching Self Acceptance -Has Body Acceptance In It“There was a time when you were five years old,and you woke up full of awesome.

You knew you were awesome.

You loved yourself.

You thought you were beautiful,even with missing teeth and messy hair and mismatched socks inside your grubby sneakers.

You loved your body, and the things it could do.

You thought you were strong.

You knew you were smart.

Do you still have it?The awesome.

Did someone take it from you?Did you let them?Did you hand it over, because someone told you weren’t beautiful enough, thin enough, smart enough, good enough?Why would you listen to them?Did you consider they might be full of it?

Wouldn’t that be nuts, to tell my little girl below that in another five or ten years she might hate herself because she doesn’t look like a starving and Photoshopped fashion model?Or even more bizarre, that she should be sexy over smart, beautiful over bold?Are you kidding me?

Look at her. She is full of awesome.

You were, once. Maybe you still are. Maybe you are in the process of getting it back.

All I know is that if you aren’t waking up feeling like this about yourself, you are really missing out.”

~Melissa from PigtailPals.com

*edited: removed curse words14

Whole Person Health

Photo: Interactive Wheel Wellness College of Health Studies Marquette;

CC BY-NC-ND 4.0, No alterations made 15

Diet Culture Isn’t Working!

• 95% of dieters regain their lost weight within 1-5 years• Food restriction/diets can lead to…

• increased food preoccupation• binge eating• weight cycling • muscle loss • loss of innate hunger/fullness cues• feelings of guilt, shame, and anxiety when diet fails

• Yo-yo dieting is linked to heart disease, insulin resistance, higher blood pressure, inflammation

• Recent research suggests that losing weight does not actually improve health markers-- such as blood pressure, fasting glucose, or triglyceride levels for most people.

• Trying to manipulate weight is fundamentally incompatible with eating disorder recovery as it reinforces disordered behaviors

• An anti-diet framework is essential in both promoting eating disorder recovery and in the prevention of eating disorders

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The Counter Culture – Health at Every Size®

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Weight Inclusivity

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Health Enhancement

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Respectful Care

• Providers are called to:

• Acknowledge their biases

• Work to end weight discrimination, stigma, and bias

• Understand and acknowledge health inequities and how socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma

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Eating for Well Being

“Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure rather than externally regulated eating plan focused on weight control”

- Health at Every Size ® Approach as presented on Association for Size Diversity and Health website

Intuitive eating principles align with

eating for well being

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Eating for Well Being: Intuitive Eating Principles

1. Reject the Diet Mentality

2. Honor Your Hunger

3. Make Peace with Food

4. Challenge the Food Police

5. Feel Your Fullness

6. Discover the Satisfaction Factor

7. Cope with Your Emotions without Using Food

8. Respect Your Body

9. Exercise –Feel the Difference

10. Honor Your Health

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Life-Enhancing Movement

“Support physical activities that allow people of all sizes, abilities, and interest to engage in enjoyable movement, to the degree that they choose.”

- Health at Every Size ® Approach as presented on Association for Size Diversity and Health website

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Hear How it Sounds

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Hear how Health at Every Size ® sounds from a client….

• “I can trust my body to do what it needs to do”

• “I like to go for hikes because I enjoying being in nature.”

• “My body is settling in a different place and that is okay.”

• “I’m eating foods that taste good and that I like.”

• “I can eat all kinds of foods.”

• “I move my body because it feels good and brings me joy.”

• “My weight does not determine my health.”

• “I may not always love how my body looks and I can still treat my body with respect.”

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Hear how Health at

Every Size ® sounds from

a support person….

• “I know it’s hard to trust someone with your food and body thoughts, but your treatment team knows how to help you.”

• “Your body will find it’s happy place and wherever it decides to settle is a good place. You can trust your body to take care of you.”

• “Food can’t hurt you. There are no good or bad foods. Your body knows what to do with the food we are having. So please come have your snack.“

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Hear how Health at Every Size ® sounds from a clinician….

• If the clinician lives in a smaller body: "As we start to work together I want to acknowledge I live in a smaller body. There are going to be things that you experience in your life that I haven’t even considered or thought about because of my privilege. I am willing and open to listen to what you have experienced and not judge them.”

• “I don’t know if you will lose weight. Regardless, that is not our goal. Our goal is to help you with cessation of behaviors. We are going to work on your relationship with food, and accepting yourself right now, including the body you have right now.”

• “Your body knows what to do and how to protect you. As long as your treating your body right it will get to the set point it is supposed to be at.”

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Resources

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References• https://news.harvard.edu/gazette/story/2009/03/fijian-girls-succumb-to-western-

dysmorphia/

• https://www.nytimes.com/1999/05/20/world/study-finds-tv-alters-fiji-girls-view-of-body.html

• http://news.bbc.co.uk/2/hi/health/347637.stm

• Bacon, L. (2008). Health at Every Size: The Surprising Truth about your Weight. Benbella Books.

• http://traumadissociation.com/complexptsd

• Linda Bacon, Health at Every Size: The Surprising Truth about Your Weight, 2nd ed. (Dallas: BenBella Books, 2010).

• Bacon, L., & Aphramor, L. (2014). Body respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. BenBella Books.

• https://asdah.org/

• Barraclough, E. L., Hay-Smith, E. J. C., Boucher, S. E., Tylka, T. L., & Horwath, C. C. (2019). Learning to eat intuitively: A qualitative exploration of the experience of mid-age women. Health Psychology Open, 6(1), 2055102918824064

• https://sizediversityandhealth.org/health-at-every-size-haes-approach/

• Crenshaw, K., Meschke, A., & Liu, L. (2020). Her body can. Houston, TX: East 26th Publishing.

• Dohnt, H. K., & Tiggemann, M. (2004). Development of perceived body size and dieting awareness in young girls. Perceptual and Motor Skills, 99(3), 790-792.

• Dohnt, H. K., & Tiggemann, M. (2006). Body image concerns in young girls: The role of peers and media prior to adolescence. Journal of youth and adolescence, 35(2), 135-145.

• López-Guimerà, G., Levine, M. P., Sánchez-Carracedo, D., & Fauquet, J. (2010). Influence of mass media on body image and eating disordered attitudes and behaviors in females: A review of effects and processes. Media Psychology, 13(4), 387-416.

• Lowes, J., & Tiggemann, M. (2003). Body dissatisfaction, dieting awareness and the impact of parental influence in young children. British journal of health psychology, 8(2), 135-147.

• Pai, S., & Schryver, K. (2015, January 21). Children, Teens, Media, and Body Image: Common Sense Media. Retrieved January 27, 2021, from https://www.commonsensemedia.org/research/children-teens-media-and-body-image

• Northup, T., & Liebler, C. M. (2010). The good, the bad, and the beautiful: Beauty ideals on the Disney and Nickelodeon channels. Journal of Children and Media, 4(3), 265-282.

• Tomiyama, A. J., Ahlstrom, B., & Mann, T. (2013). Long‐term effects of dieting: Is weight loss related to health?. Social and Personality Psychology Compass, 7(12), 861-877.

• Uchôa, F. N. M., Uchôa, N. M., Daniele, T. M. D. C., Lustosa, R. P., Garrido, N. D., Deana, N. F., ... & Alves, N. (2019). Influence of the mass media and body dissatisfaction on the risk in adolescents of developing eating disorders. International journal of environmental research and public health, 16(9), 1508.

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Carly Onopa MS, RDN

Gabrielle Katz LCSW, CEDS-S

Lindsay Everhart LCSW, LICSW

Thank You!!

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