“Tell me, what is it you plan to do with your one wild and precious life?”
—Mary Oliver, “The Summer Day”
Last June, a Senate subcommittee led by Missouri Senator Claire McCaskill held a hearing on the often deceptive advertising of weight-loss products and gimmicks. Its star witness was the not so great but still powerful Dr. Mehmet Oz, a Harvard-trained cardiothoracic surgeon with a huge TV following who got his start on The Oprah Winfrey Show. McCaskill took Oz to task for his claims about a number of diet supplements, which he touted on air and in print as “miracle cures” that would “bust your body fat for good”—unproven and untested supplements like green coffee bean extract, raspberry ketone, and garcinia cambogia.
“I get that you do a lot of good on your show,” said McCaskill. “I understand that you give a lot of great information about health in a way that’s easily understandable. You’re very talented, you’re obviously very bright, and you’ve been trained in science-based medicine. I don’t get why you need to say this stuff when you know it’s not true. The scientific community is almost monolithic against you in terms of the efficacy of the three products you called ‘miracles.’”
Oz’s response was telling. “My job, I feel, on the show is to be a cheerleader for the audience,” he said to the committee. “And when they don’t think they have hope, when they don’t think they can make it happen, I want to look, and I do look everywhere, including in alternative healing traditions, for any evidence that might be supportive to them.”1
What Oz was really saying was that people’s longing for weight loss is so desperately important to them, so relatable, so understandable, that it’s OK to sell them questionable supplements because it gives them hope. He was saying that being overweight or obese is such a terrible fate that it’s OK to put lives at risk just so people don’t fall into a sinkhole of despair and give up on ever being thin. It’s OK to encourage people in the folly of thin-at-any-cost because, hey, there’s a one-in-a-million chance they might pop some green coffee bean extract and “burn fat fast,” as Oz said.
It’s a perfectly absurd conclusion that grows directly from the perfectly absurd situation we find ourselves in when it comes to weight. As a doctor (and reputedly a good one, at least at some point), Oz has to be aware of the long list of weight-loss drugs and supplements known to cause serious side effects or death: fen-phen, sibutramine, rimonabant, ephedra, kava kava, and a slew of others. He’s got to know that there is no magic pill, no fat-burning compound that (a) works and (b) does more good than harm. His real crime, then, is ignoring reality and continuing to act as though being thin is so crucial that it’s worth trying anything to achieve it.
In researching and writing this book, I’ve had many, many moments of extreme cognitive dissonance, jolts of realizing what a ridiculous and pointless and dangerous cycle we’re caught up in. I had one of them not long ago, reading an editorial in a medical journal that bemoaned the rise of severe obesity among young people and called for new and “serious treatments,” including more diet drugs and more bariatric surgeries for children and teenagers.2 Nothing new there; I’ve read such opinions before. The sentence that made me want to bang my head on the desk was this one: “The good news is that healthy lifestyle changes, when implemented during childhood, appear to be relatively effective in reducing adiposity.”3
I had to read this several times before its absolute ludicrousness sank in. These physicians are advocating for “healthy lifestyle changes” (which isn’t defined, so could mean almost anything) just to make kids lose weight. But isn’t the whole point here making kids healthier? We’ve become uber focused on weight as a proxy for health, what doctors call an endpoint or surrogate, a kind of marker for other conditions. Wouldn’t it be more useful to focus instead on the actual goal of better health for kids, teens, and adults? Why are we still talking about weight as if it was the only thing that mattered? (And how do we keep ignoring the fact that only 5 percent of people at most maintain weight loss over time, that we actually don’t know how to make people lose weight over the long term?)
We’d do better for ourselves and our children if, instead of pushing diets and surgeries and medications, we looked at real-world strategies for eating more fruits and vegetables, getting enough sleep, dancing and playing sports, and other joyful physical activities. And especially if we supported those things for everyone, no matter what they weighed.
This is the big disconnect at the heart of our conversations about weight and health. Michelle Obama’s Let’s Move! campaign, for instance, includes some smart, constructive recommendations: starting school and community gardens, calling out food marketing to kids, getting rid of food deserts, bringing back recess. These excellent and much needed ideas could go a long way toward making all Americans healthier.
The trouble is, the campaign has been framed exclusively around weight loss. Obama famously promised to “solve the challenge of childhood obesity within a generation,” and that’s the fundamental goal of her campaign. The Let’s Move! website is full of statistics about childhood obesity, and its components are all offered in the context of making kids thinner. The implication is that if they’re thinner, they’ll be healthier, which we know isn’t necessarily true. Kids and families who do make changes but don’t lose weight will likely feel like they’ve failed, because the only yardstick available is weight loss. Obama’s campaign uses weight as a proxy for health, and so falls into the same diet-and-exercise traps as every other weight-loss program, no matter how well disguised or well intentioned. And that’s a missed opportunity, not just for the First Lady but for all of us.4
So the question is, given everything we’ve come to know about how and why we struggle and obsess and despair over weight, how do we move forward? How do we begin to broaden the conversation, bring in other kinds of information, and inspire the kind of social change around weight that will promote health and well-being rather than destroy it?
One early pioneer in this effort is a former engineer named Bill Fabrey, who was furious at the kinds of prejudice his wife, a fat woman, confronted every day. In 1969, Fabrey helped found the National Association to Aid Fat Americans (NAAFA), now known as the National Association to Advance Fat Acceptance, with a focus on ending size discrimination.
Another pioneer is dietitian and social worker Ellyn Satter, who for years gave her clients the standard nutritional advice of the day: watch what you eat, control your portions, count calories. At some point it began to dawn on her that her advice and guidance wasn’t making the people she treated thinner, healthier, or happier. On the contrary: demonizing whole categories of food, trying to undereat, and relentlessly worrying and feeling guilty about what and how much to eat pushed people into a pattern of restricting/overeating, and taught them not to trust their own appetites.
Satter began developing a different approach. She’d observed, for example, that babies instinctively knew how to eat. A baby who’s had enough will turn his head and press his lips together. He knows when he’s done, and he’ll stop eating, unless parents or caregivers consistently overrule him, forcing him to eat more than he wants or withholding food when he’s hungry. Then he learns not to trust his own feelings around food, and begins to look outside himself to know when to eat, what to eat, and how much.
That’s exactly what had happened to many of her clients, Satter realized. Those dysfunctional patterns had been set up early and were still shaping the ways her clients handled the primal act of feeding themselves. The best way to help them, she decided, was to support them as they repaired their relationships with food, eating, and their own bodies.
She called this new model competent eating, and outlined its four basic components: having a positive attitude around eating and food; being tuned in to internal cues of hunger and fullness; being able to eat a variety of foods; and trusting yourself to manage food well. Every one of these elements stood in sharp contrast to the advice she’d been doling out for years.
Satter’s competent eating is all about providing yourself with food rather than depriving yourself. It doesn’t classify foods as “good” or “bad” but focuses instead on the idea of feeding yourself a range of delicious foods—some of which will be more nutritious than others—in a structured, organized series of meals and snacks throughout the day. It gives people permission to honor their appetites, being aware of when they’re hungry, what they’re hungry for, and when they’re satisfied.
More than that, it supports the idea that there’s joy in eating. Remember the mother who brought her baby to Satter, embarrassed and worried because the girl loved eating so much she would moan with pleasure? While most of us would probably avoid moaning audibly at the table (at least when we’re eating with other people), Satter believes we not only can give ourselves permission to enjoy food but that we should. That it’s a necessary part of learning to take care of yourself with food. Because if you’re not enjoying what you eat, you’re consuming it out of duty or responsibility or to deprive yourself of pleasure. And that’s a very different process than eating to sustain and nourish yourself.
Competent eating makes sense on a lot of levels. Research has shown that competent eaters have lower blood pressure, blood sugar, triglycerides, and overall cholesterol, (and, yes, BMI) than those who are constantly dieting and weight cycling.5 And there are psychological benefits, too. People who become competent eaters can let go of a lot of food-related angst. I know this from personal experience, because Satter was the therapist who asked me the fateful question years ago and who taught me the principles of competent eating.
Like many women who’ve dieted on and off for years, I was scared to stop counting Weight Watchers points or calories or fat grams or whatever I was counting at any given moment, afraid that if I stopped restraining myself, my hunger would be insatiable. I had to learn to trust my own appetite, and man, was that scary. I mean, if there were no rules, what would stop me from just eating and eating and eating until I weighed five hundred pounds? How would I know when to stop eating the foods I loved if there was no one to tell me to stop?
I was not so different from my students now, who are so invested in disordered eating that they have no idea what “normal eating” means. Many of us don’t. Here’s Satter’s definition, which I find immensely helpful:
Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it—not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.6
© 2014 Ellyn Satter. Reprinted with permission.
I had to essentially learn how to feed myself again. For one thing, I had to figure what I actually liked and didn’t like. I was so used to automatically avoiding or bingeing on “bad” foods like cheese and chocolate and pasta, I had no idea whether I actually wanted to eat them. For another, I didn’t know how to tell when I was hungry and when I was full. That sounds ridiculous, I know, and before I began the process I would have said of course I know what I like to eat and what I don’t, and of course I know when I’m full. But I didn’t. The truth was, I was more ignorant than even the newest newborn. I had to completely reboot my relationship with food and figure out how to eat all over again.
Stacey, fifty-three, is a therapist who treats eating disorders and body image problems in Wisconsin.
My mom was always dieting, and my maternal grandmother was a die-hard dieter as well. All the women on that side of the family were dieters. My sister and I took after our mom, who was short and pear-shaped. I have never been severely obese, but I had a belly as a little kid and have always had bigger thighs and hips.
I started dieting in early adolescence, and I also struggled with some binge eating, because of the long dieting. Even when I would lose weight, I would still be preoccupied with my thighs. I was convinced they were the cause of every bad thing that ever happened to me.
After college I worked for an eating-disorder therapist doing research and working on the unit at the hospital. All of us who worked for him used to go to these breakfasts, and one day my colleagues looked at me and said, “What are you using margarine for?” They introduced me to the works of Geneen Roth, who wrote Breaking Free from Emotional Eating. I started working on intuitive eating, literally doing what she wrote in the book, eating foods I used to overeat because they weren’t allowed in the house or we weren’t supposed to be eating them. One day it was cookies, one day it was peanut butter. It didn’t take long, about a week maybe, before I was like, Oh, OK, I get it now.
When you really listen, your body tells you what it needs. So it’s all about paying attention, and it’s amazing. For instance, I was eating some potato chips yesterday and suddenly I was like, I’m done with these. It’s still a wonder to me that I can stop eating potato chips. It was the most mind-blowing thing! But I’m still not perfect at intuitive eating. Old habits die hard.
The last time my mother commented on my weight was about seven years ago. She said, “You know, honey, it wouldn’t hurt to lose a few pounds.” And I ripped her a new one. I was like, “I couldn’t ever do that again, and I wouldn’t even know how to do that again.” No one walks away from conversations like that feeling good, even women who are on the “good” end, who have dieted and lost weight. They still have that fragile feeling. It’s such a negative way women relate to each other. Trying to fit in to this culture on that level is really very painful.
The process of reconnecting with an internal sense of appetite is a huge part of moving the needle on weight and health. “Many people have been taught the diet behaviors and thought distortions, and are unaware now of the hard-wired appetite and satiety cues they were almost certainly born with,” says Deb Burgard, a psychologist in Los Altos, California, who treats people across the weight and eating spectrum.7 “They are innocently and with increasing desperation trying to use cognitive means to regulate their eating 24/7, and cognitive means are lousy tools for this project.” In other words, we turn to diet books and programs and manuals, looking for structures and plans to tell us what to eat, how much to eat, and when to eat it. But like Dorothy in the land of Oz, the answers we long for don’t exist in the outside world but are already within us; we just don’t know it yet.
Satter’s concept of competent eating is similar to intuitive eating, a term coined in the mid-1990s8 by Evelyn Tribole, a dietitian in Newport Beach, California, and Elyse Resch, a dietitian and therapist in Beverly Hills. As the name suggests, intuitive eating encourages people to honor their appetites, reject dieting, respect their bodies, and pursue healthy behaviors regardless of weight. To eat intuitively, in tune with their own senses and feelings, rather than according to an external plan.
Intuitive eating is, in turn, linked to a larger movement called Health at Every Size, or HAES (pronounced hays), which grew organically from many of the ideas forged in the 1980s and 1990s. Nutrition professor and researcher Linda Bacon literally wrote the book on HAES, publishing Health at Every Size: The Surprising Truth About Your Weight in 2008.
In many ways, HAES is the social justice movement Philadelphia cardiologist Joseph Majdan wished for. It emphasizes process—the experience of living a joyful and healthy life at any weight—rather than outcome, that is, a particular number on the scale. One of its tenets is that people naturally come in many shapes and sizes rather than in one narrowly defined, culturally approved package. Another is that no matter what people’s body type or size, they can incorporate behaviors into their lives that foster health, eating well, and exercising with pleasure rather than focusing on weight or weight loss.
Critics like Tam Fry, who made the famous “black forest gateaux” crack about Katherine Flegal’s 2013 study, deride HAES as a license to sit on the couch and eat bon-bons all day. They say it promotes obesity and unhealthy “lifestyles.” Advocates say nothing could be further from the truth. HAES, they explain, is actually more focused on health because it’s not chasing the red herring of weight loss. “The traditional dieting, weight-loss paradigm blinds us from being able to look at health directly, because we’re so stuck on the fact that the only way to mediate it is through weight,” explains Bacon. In fact, the US Department of Agriculture, one of the most conservative government agencies in existence, endorsed HAES after a two-year study found it superior to more traditional approaches on pretty much every score.9
Bacon and others describe HAES as “weight-neutral.” If people pursue health without focusing on weight, they may (a) gain weight, (b) lose weight, or (c) stay the same as their bodies find a set point that’s comfortable and sustainable. “For some people, weight is a symbol of something going wrong in their bodies. For some, it’s just about natural diversity,” explains Bacon. “So it’s important that we separate behaviors from weight, because we also know fat is not always a sign of disease or bad behavior. Studies show there are many metabolically healthy fat people living long, healthy lives. There may be a smaller percentage of them than in the normal-weight category, but it shows you can be fat and healthy and fit.”
Robin Flamm, forty-nine, from Portland, Oregon, found her way to HAES two years ago after a lifetime of dieting. “If anybody asked me ‘What do you want most in your life?’ I’d say ‘To be thin.’ Besides having a family,” she says. She’d done practically every diet plan in existence—Weight Watchers over and over, the Paleo Diet, Overeaters Anonymous, even Medifast. Every weight-loss plan she tried worked—for a while. She’d lose thirty pounds and gain back thirty-five, lose thirty-five and regain forty. Mentally she was just as single-minded, just as committed, the tenth time as she was the first. But physically the pounds came off more slowly each time. It was as if her body was fighting to hang on to every ounce.
Flamm convinced herself she’d been lazy; she just had to work harder, walk faster, eat less, keep at it. And she tried, she really did, in between full-time parenting and doing advocacy work for a national nonprofit. When stomach pains and rising liver enzymes sent her to a gastrointestinal specialist, he told her to lose twenty pounds and come back in a month. On her way out of the office he called, condescendingly, “Just keep your mouth shut!”
At first she took his comment as a wake-up call, an inspiration to try harder, find a new program or approach. But the more she thought about it, the more she realized she didn’t need a wake-up call; she’d been “awake” since middle school, and what had it gotten her? More doctors who attributed every health problem that popped up to her weight, who didn’t believe her when she described what she was eating and how much she was exercising. More pressure to eat less and work out more. “I thought, wait, how many times did I set my mind to losing weight?” she says now. “I’ve always wanted to be thin. I’ve been obsessed with it my whole life.”
Instead of going back to the doctor she wrote him a letter, explaining how she felt about the way he’d spoken to her. That was satisfying, but it left her in a familiar dilemma. She still blamed herself, really, for the fact that after all this longing and effort and anguish she wasn’t thin. She knew she’d internalized the message she got from doctors, nurses, magazines, movies, friends: being fat is a question of personal responsibility. But she couldn’t seem to shake it off.
By the time she worked up the courage to see a therapist at Being Nourished, a center in Portland run by two therapists who practice HAES, she was desperate for a change. Even so, the thought of putting away her scale and getting rid of her calorie-counting app terrified her. She stuck with it, though, using the same determination that had seen her through so many diets and exercise regimens. And slowly, she started to relax. She saw her therapist weekly and started taking yoga classes because she liked the way they made her feel.
But when her clothes started to feel a little tighter, she panicked. Her first impulse was to bolt back to the familiarity of Weight Watchers. Instead, she asked herself if she was eating mindfully, if she was exercising in a way that gave her pleasure, if she, maybe, needed to buy new clothes. “It’s really hard to let go of results,” she says. “It’s like free falling. And even though there’s no safety net ever, really, this time it’s knowing there’s no safety net.”
When Robin Flamm talked about giving up the safety net, what she really meant was giving up the fantasy of being thin. Letting go of the idea that someday, something would happen, and she would lose the weight forever, that she’d suddenly become a 5 percenter, one of the rare few who could lose weight and keep it off. But it’s intensely, incredibly hard to buck the mainstream on an issue that holds so much power over our lives. At the end of the day, we all have to come to terms with these issues in our own way and for ourselves.
How I Started to Learn to Love My Body
Dawn, forty-five, is a therapist in Columbus, Ohio.
My mom, who’s five eight, weighed 148 pounds the day she gave birth to my brother. My dad, on the other hand, is built like Lou Grant. Guess who I take after? I quickly internalized the message that something was wrong with my body—wrong with me—although I thought I’d hit the teen years and get long and leggy like my mother.
My mom was strict about what food we could eat and what we couldn’t. Part of this was about money and part of it was about staying thin. When my sister would reach for seconds my mom would say, “Why don’t you just slap that directly on your ass?” But it was my dad who was constantly on a diet (the Mayo Clinic Diet was xeroxed and posted on our fridge).
As a young adult, I remember sitting behind a woman at a conference. I liked her style—kind of funky, messy, short hair and no makeup—and I liked the smart questions she asked during the presentation. We got to talking and she seemed very attractive to me, very charismatic. After we became friends I realized that she felt she was too fat. The only thing I’d noticed when we met was that she was attractive, not that she didn’t fit a particular mold of attractive.
That’s when I realized that perhaps people saw me and not what I perceived as lacking about my appearance. Or if they did notice how I was fat and stocky and built like a linebacker (so said one of my high school boyfriends), maybe it didn’t matter because they also saw me, and I felt I was pretty likeable or at least interesting. I thought, “What if I just lived as if I knew this was true?” and I started working toward that. That was nineteen years ago, and I haven’t totally nailed it, but today I am more like my attractive, charismatic friend (with far less negative body talk) than the insecure bundle of nerves I was when I met her.
This growth and love and acceptance thing—it’s an ongoing negotiation, and I imagine that’s true for all of us.
One person who clearly doesn’t understand is Amanda Sainsbury-Salis, a researcher at the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders in Sydney, Australia. Last year, Sainsbury-Salis published a commentary calling for an “urgent rethink” of HAES, arguing that it’s impossible to be both fat and healthy and that for anyone who’s overweight or obese, things will inevitably go badly wrong, healthwise. She characterized HAES as the idea that “people can have health at every size,” which is inaccurate, since HAES is about the pursuit of health and the idea that people can incorporate healthy behaviors into their lives no matter how much they weigh.
Sainsbury-Salis opened her commentary with a reference to how her grandmother used to warn her not to make an ugly face because it might freeze that way, adding, “I say ‘Don’t eat an ugly diet or let yourself stay fat, because if the wind changes you may become stuck with permanent obesity.’” The dubious literary quality of this analogy makes it hard to take it seriously (if the wind changes?), and so do its underlying assumptions. She conflates eating “an ugly diet”—presumably Cheetos, McDonald’s, and ice cream at every meal—with permanent obesity, though thin people are just as likely to eat junk food and processed food as fat people. She also suggests that “staying fat” is a mistake and implies that HAES encourages such risky behavior. How exactly does Sainsbury-Salis propose that people avoid “staying fat”? Diets, exercise, and medications don’t work for most people; surgery is dangerous, expensive, irreversible, and doesn’t work for at least half the people who undergo it. As we’ve already seen, people who keep doggedly chasing weight loss usually wind up weight cycling, which may be even worse for health than “staying fat.” Oh, and they usually wind up fatter than when they started.
Reading commentaries like this makes me feel like I’m right back inside that M. C. Escher drawing. Sainsbury-Salis describes herself as a neuroscientist who studies diet, appetite, and body weight; surely she’s seen all the research. Yet she and other scientists talk about these issues as if they live on another planet where different rules apply. For instance, she acknowledges the well-supported fact that overweight and obese people can make “substantial health gains” without changing their weight at all, which is one of the foundations of HAES. But in the very next paragraph, she insists it’s still not healthy to have a BMI outside certain parameters, and concludes “even for obese people who are metabolically healthy, it is only a question of time before a variety of issues raise their heads.” As an example, she offers the correlation between higher BMI and greater risk of developing knee arthritis, which she attributes to “the mechanical effects of excess weight and the resultant gait abnormalities, combined with systemic inflammation.”10
I laughed out loud when I read this, mostly because Sainsbury-Salis’ “urgent rethink” turns out to consist of the same arguments that have been made for the last fifty years. They’re no more accurate or relevant now than they were before. And she offers no new evidence or strategies for making people thinner in the long term and in the real world. As psychologist Deb Burgard puts it, “People who have maintained a weight loss, who eat flexibly, who are truly at peace with food—they’re like unicorns.”
Which is why Linda Bacon and others see HAES as not just a health movement but a social justice movement, one that speaks to psychological well-being as much as physical health. “We can’t tell people you’re wrong, you’re bad, we want to make you different,” says Bacon. “That’s what the whole model of obesity treatment is based on—something being wrong.”
Bacon told me about a sixteen-year-old girl who interviewed her for a school project and broke down crying on the phone. The girl’s school was holding an anti-obesity campaign, and she was being bullied at lunch for her food choices, even when she ate exactly what the thinner kids were eating. That kind of tunnel vision about food and weight, said Bacon, not only gives the thin kids permission to think there’s something wrong with the fat kids, maybe even to bully them; it also absolves them from worrying about their own health. As long as they’re thin, they think, they’re healthy. Only now we know that’s not true.
YEARS AFTER THAT day in the therapist’s office, I still think I should weigh less than I do, though I no longer care about being thin enough to fit into the appropriate BMI category (especially since I’ve gotten shorter in the last few years, which means I’d have to hit an even lower weight to have a “normal” BMI). I’ve been there and done that and it’s not a happy or sustainable place for me. I still think I might look better if I weighed, say, fifteen pounds less than I do; though I no longer see being thin as the only way to be beautiful, it’s hard for me to see my own fleshy body as attractive. I’m working on it. I choose instead to focus on what I do rather than what I weigh.
I rarely waste time and energy and creativity flailing and angsting over my body the way I did in my teens and twenties and thirties. I don’t wallow in shame or despair. I don’t obsess about food or my body. I don’t want to spend my life caught in that cycle of self-loathing. I can’t, I won’t live that way anymore. How many mornings was I late for work because I couldn’t find an outfit that magically changed the way I felt about my body? How many evenings did I stand in the middle of a grocery-store aisle, paralyzed with fear and indecision? It’s not just the time I regret; it’s the loss of who I might have been if I wasn’t so consumed. It’s who I might have loved, how I might have lived, what I might have accomplished. I might have been a force to be reckoned with. Instead, I spent way too much time weeping on my bedroom floor, surrounded by crumpled shirts and pants turned inside out.
Back then, self-care for me meant “making an effort,” as my grandmother might have said, starving myself, jogging despite my bad knees, trying my best to fit my body, literally and metaphorically, into the image it was “supposed” to resemble. Now taking care of myself means what I do rather than what I look like. And over time I’ve figured out what I need to do to feel healthy and creative and, yes, joyful physically and emotionally. What I need to do will no doubt look different than what you need to do, but I’ll tell you anyway in case it’s useful:
• Some kind of physical exercise every day; a brisk stroll around the neighborhood works, but I also love cycling and hiking
• Making and eating foods I like, and letting myself enjoy them
• Being able to stop eating when I’m full
• Getting enough sleep
• Spending time with friends and family
• Taking medication for my depression and anxiety disorder; I resisted this for years, in part because the meds make me gain weight, but finally decided I wanted to live a wholly functional life, and this is what I need to do that
And, finally (and this has been the hardest of all)
• Letting go of self-loathing
Notice I’m not saying “love myself.” While that concept and that phrasing might work for others, it’s always seemed irrelevant to me personally. I find it more helpful to think “inhabit myself,” meaning stay in my body, know that it’s my body, and appreciate what it does. And, yes, actively deflect those self-loathing thoughts when they intrude, as they do.
It’s a tough process for anyone who’s spent a long time constructing an identity around a particular vision of herself, even if it’s a negative view. Or maybe because it’s so negative. I think of that quote by spiritual writer Marianne Williamson: “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us.” Given the culture we live in, the pressures that come at us from so many directions to feel anxious, insecure, less than, especially when it comes to our bodies, no wonder we sometimes cling to our own feelings of inadequacy.
It gets easier, though. It really does. One of the most useful teaching tools I’ve found on this issue is Harvard’s Project Implicit test on weight bias (implicit.harvard.edu), which measures how closely a person’s underlying feelings about weight align with the culture’s norms. I’m sure if I’d taken the test fifteen years ago, I would have gotten the same results my students do when I have them take it: a strong preference for thinness. (They’re always upset by their results, which leads to some fruitful classroom conversations.) When I take the test now, it shows a moderate preference for fatness. Given how overwhelmingly our culture prefers thinness, I consider that major progress.
I regret feeling the way I did about myself for so many years, though regret isn’t exactly the right word. Regret implies sorrow, and sure, I feel sorry about it. But mostly I feel mad—at the culture I grew up in, at myself for being susceptible to it, at the fact that it’s 2014 and we’re still dealing with this and it’s so much worse than it was when I was a girl. I’m furious that so many children and women and men are suffering for no good reason.
Learning to trust myself, my body, my appetite, and my feelings has been one of the most empowering experiences of my life. Yet even as I write this, I can imagine what the Walter Willetts and Daniel Callahans and Tam Frys of the world would say—something along the lines of “Most Americans already feel too empowered around food/appetite/body image.” As one writer suggested in an online opinion piece for Philadelphia magazine, “The stigma once rightly associated with obesity is disappearing as quickly as fat is accumulating. How do we get to the bottom of this problem? For starters, shame. Because no matter what else is attempted, if shame is not the cornerstone of the solution, the situation will never improve.”11 Anyone who thinks we don’t do enough shaming of fat people should dip into the comments section for that story.
This attitude comes from and perpetuates the kind of assumptions we know aren’t true. And it’s precisely the type of rhetoric that got us into this dysfunctional relationship with food in the first place, that’s left us eating chaotically, not competently. Articles and attitudes like this have helped make us fatter and less healthy in every way.
SO IT SEEMS to me we’re at a crossroads. This is a moment, as people say, meaning an opportunity to stop and take stock and make choices. The conversation that’s been taking place in the background and on the fringes and out of the mainstream—about competent eating and intuitive eating and HAES and health rather than weight—is slowly, tentatively becoming a little more visible, thanks mostly to social media. Much of what I’ve covered in this book is still considered by many to be crackpot or self-serving or just plain wrong—fat people rationalizing why they can sit on that couch and eat those bon-bons all day. And the messages we get from the mainstream—the beauty industry, medical professionals, advertising, and media of all types—are so dominant, so loud, and so scary that it’s hard to even consider questioning them. Clearly we are, as individuals and as a society, still under their spell. We’ve been drinking that Kool-Aid for a long time, and we’re understandably nervous about putting down the glass.
Marsha, sixty-five, is a dietitian who runs a “non-diet” center in Vermont.
I developed body image issues very young. I’m tall, five eight, and the rest of my family was very thin, so I was always singled out for my weight. In my teens I started dieting and developed an eating disorder. It took me about ten years to overcome that.
In my midfifties I started getting really ill, with ailments ranging from severe fatigue to joint and muscle problems. Eventually I was diagnosed with fibromyalgia. I discovered I was gluten sensitive and had a lot of chronic inflammation going on in my body. I was hungry a lot, having cravings, and that was affecting my weight, too. I was probably twenty-five pounds heavier than my normal weight.
By really focusing on dealing with the chronic inflammation and gluten sensitivity, my weight normalized for my body, and there haven’t been any ups or downs since then. My focus was to feel better, to get rid of the aches and pains. It wasn’t intentional weight loss.
When I work with women now, we start out with gentle guidelines. So many of them are lost when it comes to being able to know how their body feels in response to eating different types of foods in different ways. We move people away from the “burn those calories because you ate that piece of cake” mind-set around physical activity. The other big thing is stress management, helping women and men recognize that body dissatisfaction is a huge source of stress in our lives. We help them figure out what they can do on a regular basis that’s going to really help them feel well and stay feeling well.
Weight loss rarely takes people where they want to go. If they focus on health and how they feel, they find themselves in a much better place in the long run.
But we need to realize that staying with the status quo is no longer just a default position but a choice, and it’s not the only one on the menu. We can also, for example, take a step away from the kind of either–or thinking that permeates our belief system around weight and health. We can make a mental paradigm shift away from the black-and-white perspective we’ve grown up with and take, instead, a broader view. A this-and-that perspective.
If each of us is willing to just consider the possibility that what we think we know about weight and health isn’t as simplistic and clear-cut as we believe, we’d have the beginning of a truly constructive conversation. If we could become aware of how the rhetoric around weight and obesity has shaped the way we think, and challenge ourselves to imagine other truths and perspectives, we can potentially help create real and lasting change for ourselves and our children.
So what does that mean exactly? In the ideal world (you know, the one we don’t live in), we wouldn’t starve ourselves or spend four hours a day at the gym or crouch over a toilet or refuse to swim because we didn’t want to wear a bathing suit. We wouldn’t avoid mirrors. We wouldn’t torture ourselves. Instead, we would each explore our own definition of health, based on our individual physical, psychological, and emotional needs. We’d acknowledge that health and weight are complicated issues, that they’re not the same for everyone, and we’d be free to make our own choices about how to live and take care of ourselves. We’d be kind to ourselves and to one another.
On a more practical level, we would at least be open to hearing points of view beyond the mainstream. We’d be willing to think critically about weight and health; right now, our culture makes it nearly impossible to do that. We have to make the effort. It might not change what we do or how we behave, but I think regardless of outcome it’s an important and even crucial step.
There are also some specific strategies that can help us grapple with the issues day to day. As I researched this book, especially the section on beauty standards, I kept thinking about the phenomenon of social comparison, our innate tendency to compare ourselves against others, first described by social psychologist Leon Festinger in the 1950s. According to Festinger, the more similar we are to others (or the more similar we think we are, which isn’t always the same thing), the more likely we are to judge ourselves against them.12
We can compare ourselves to others in two basic ways. Upward comparison, where we judge ourselves against those we see as better than us, tends to make us feel more depressed, enraged, and worthless. Downward comparison, where we judge ourselves against those we see as worse off, makes us feel better about ourselves.13 (This notion is closely related to, but not exactly the same as, the delightful concept of schadenfreude, or taking pleasure in others’ misfortunes.)
When we look at pictures of impossibly thin models in magazines or online or in advertisements, we’re basically engaging in upward comparison, judging ourselves against those we see as superior. Researchers at the University of South Florida-Tampa, who published a 2000 study on body image and social comparison, think it’s important to broaden the field, so to speak.14 For instance, they suggest, spend time in a public place people-watching. Unless you’re standing on a Hollywood movie lot, you’re bound to see a range of people who run the gamut of attractiveness and body type. Look at all kinds of shapes and sizes, not just the one kind we see most often in media and marketing. Think of it as resetting your inner beauty detector.
Interestingly, exercise can also help, though not in the way you might expect. In one 2012 study, women and men who were randomized to a group that exercised six times over two weeks felt better about their bodies afterward, even though their weight and fitness levels stayed the same. (A control group who read rather than exercised felt worse about their bodies at the end of the two weeks, though this may have had something to do with the fact that they read at the gym, where everyone else was exercising.)15
One survey of college freshwomen turned up a range of coping mechanisms for what researchers called “bad body image days.” These included exercise, talking to friends and family, spending time alone, getting out and doing something, and self-acceptance.16 Different strategies seem to help different people, so a little experimenting might be in order.
That’s the challenge I want to leave you with: to think beyond the messages we’re getting a thousand times a day. To question the conventional wisdom. You may wind up making the same exact choices in your life as you do now, but at the very least you’ll be making those choices more consciously. Or you may wind up with an entirely different point of view, one that could help set you free from the painful and punishing rules we’ve been living by for so long.