2021 Fall Roundtable: Unpacking Diet Culture & Body Image

The third HER Health Collective Roundtable of 2021 focused on exploring diet culture and body image issues.⁠ Our quarterly roundtables bring the HER Expert Panelists together to share their knowledge and discuss important health topics that affect mothers. It’s our hope that shedding light on this important topic and having open discussions like this, will help reduce the number of women who are silently struggling.

With HER Expert Panelists

HER Expert Panelists participating in this discussion  include:

  • Katherine Andrew – MPH, RD, LDN – Registered Dietitian Nutritionist – Areas of Specialty: gut health, food sensitivities, hormones, family food dynamics & intuitive eating
  • Dr. Erkada DeRouen – MD – Family Medicine – Lifestyle medicine board certified physician – Associate Medical Director Telemedicine, focus: health equity and diversity and inclusion in the telemedicine and start up space.
  • Dr. Lisa Folden – DPT – Healthy Phit Physical Therapy & Wellness – Mom Life Coaching
  • Kerry Jones – RD – Pediatric and Maternal Nutrition – Milestones Nutrition
  • Dr. Susan Lovelle – MD, MACM – Holistic Wellness – Founder, CEO Premiere Wellness
  • Anna Lutz – MPH, RD, LDN, CEDRD-S – Lutz Alexander and Associates Nutrition Therapy – Non-diet Nutritional Counseling (HAES & Intuitive Eating)

Summary:

  • History of diet culture
  • Definition of diet culture
  • Evolution of the “perfect body”
  • Weight bias, social status and power
  • Co-opting of HAES terms
  • Financial influence of diet culture
  • Inflammation and weight, BMI and weight, outdated and questionable research
  • Dealing with statements that promote diet culture and spread fat phobic beliefs
  • The rise of orthorexia nervosa
  • How each expert personally practices body appreciation

The reality is, if we're living in a way that is healthy for us, we're making good decisions about the activities we participate in, the nutritious foods we're feeding ourselves, our bodies will settle into a healthy region. It just may not be the ideal look of health for people because we see fat as being so unhealthy.

- Dr. Lisa Folden

Transcript:

Cindi 

HER Health Collective is built on a value structure that consists of health, empowerment, and respect for all moms. We strive to help moms transform their self care. All too often moms put the needs of others ahead of themselves. We work to support moms and their self care through having a supportive community. And by connecting moms to vetted reliable women’s health experts. Our roundtables provide the opportunity for us to bring our panel of experts together to discuss important issues that are relevant to mother’s health. The Fall roundtable is on the topic of diet culture and body image, we will be unpacking these topics and all the ways moms are affected by them, which is a lot. So with that, we would love to introduce our panel. If you could just jump on and say what your specialty is and what your certification is. So, Anna, if we could go ahead with Anna Lutz, have you pop on and say hi.

 

Anna Lutz 

Hi, everyone. I’m so thrilled to be here. I’m Anna Lutz. I’m a registered dietitian. And I’m based in Raleigh, North Carolina. And I specialize in eating disorders and family feeding.  All the work I do is from a weight inclusive approach and aligned with the Health at Every Size principles. So I’m thrilled and I’m very excited about this discussion.

 

Cindi 

Wonderful. Anna, thank you so much. I’m going to head over to Kerry Jones. Hi, Kerry.

 

Kerry Jones 

Hello. Thank you for having me. As you said my name is Kerry. I’m a registered dietitian in Cary, so I found my place. I do pediatric and maternal nutrition within my practice.

 

Cindi 

Wonderful. Thanks so much. Dr. DeRouen, would you be able to pop on and say hi.

 

Dr. Erkeda DeRouen 

Sure. Hi, everyone. My name is Erkeda DeRouen. I’m a family medicine doctor with other board certifications in diversity medicine and lifestyle medicine and I’m in the DC area.

 

Cindi 

Lovely. Thanks so much. Hi, Dr. Lovelle, can you pop on and say hello to everybody?

 

Dr. Susan Lovelle 

Sure. Hi, I’m Dr. Susan Lovelle, of Premiere Wellness. And I am a former plastic surgeon, now a holistic health provider, working primarily with women professionals who want to increase their energy, weight and hormones. So excited to be on this today.

 

Cindi 

Perfect. Thanks so much. Dr. Folden. Hi, there.

 

Dr. Lisa Folden 

Hi, ladies. I’m Dr. Lisa folden. I’m a licensed physical therapist and a behavior change specialist which is essentially a health coach. I specialize in working with busy moms and I am also aligned with Health at Every Size principles and I approach all of my clients from an anti diet and weight loss perspective. Very excited to be here and I’m in Charlotte, North Carolina.

 

Cindi 

We’re so glad to have you here. Hi, Katherine. Katherine Andrew, if you could pop on and just say hi.

 

Katherine Andrew 

I’m Katherine Andrew. I am a registered dietician based out of Raleigh, North Carolina as well. I use a functional approach to help men and women dig into issues that are challenging them and keeping them from really enjoying food and living life to its fullest. I specialize probably in hormone and digestion issues mostly.

 

Cindi 

Thank you so much. As we progress into the questions, the questions are not directed at anyone in particular, so feel free to hop on whenever you have a thought. We want to hear from everyone and hear how these different topics are influenced within your industry. So why don’t we go ahead and pass it over to Crissy and we can start with our first question.

 

Crissy 

Awesome. Thank you so much, everybody for being here. I know this is going to be a very enlightening conversation. We’d like to start with the historical element of this, so we’d love to dive into a discussion about the history of diet culture. How has it come to be such a toxic element of our society? Has it always been this way? Or was there a time when this idea of diet culture was first exposed and really kind of took root in our society?  I think if we look back in time, what people look at has changed. So you know, in some ages, you were wonderful if you were larger, especially in say, in Africa, and others like you mentioned in the Victorian ages, because that meant wealth, that meant that you were secure and stable. And then we flip flop back and forth, there were times when you know, having a tan, like now having a tan is a great thing, because it means you’ve got the means to have excess time to be out in the sun. Whereas years ago, it wasn’t.  If you had a tan that meant that you were you know, that you were working. So it really depends on the people and the time and the agencies and something that I want to mention that it’s not just weight, it’s not just a body image. It’s also for women, I would say it’s also for men, because we look at the president, you know. Look at the height of presidents, the shortest president that we had was way back in the you know, the 1700s. So it’s  all a matter of how we look at things over time.

 

Dr. Erkeda DeRouen 

This is Dr. DeRouen speaking. I can definitely agree with that, because even if you look at women over the years, if you look back in Egyptian times, more women were thinner, and they had a certain aesthetic. And then as you go over to other times in history, like in Greece or in England, in the 1800s, women were more valued by being a little plumper, because it showed your wealth and that you could afford food. And then even more recently in our history is just looking at celebrities in celebrity culture over time. Whereas in the 50s, with Marilyn Monroe, and everybody like that they wanted a little more shapely bodies were designated and kind of desired. And now we’re seeing changes over the years where it’s going towards thinner and things like that. And even now, more recently, you’re seeing people who are having a little bit of different body desires that may not be as natural, where they’re getting the injections and the different surgeries to take some weight off of their waist and put it to their bottom. So it’s definitely been an evolution.

 

Dr. Lisa Folden 

Yeah, I agree. It’s definitely been an evolution. I think, with regard to the toxic part of diet culture, I think we saw it starting in the early 1900s for most Americans, when it just became even more popularized, to look a certain way to indicate or look a certain way, usually by way of being thin to indicate your health status or your superior status. And I think it got really overdone in the 80s, when we started in the 80s and 90s, when we started the war on obesity, and, you know, diets became like, all the rage, and everybody is you know, thin and in a unitard working out. And it turned into I think the core root of it may have started with the idea that we should be healthier, and take better care of ourselves. But I think it was very, very quickly taken over by this, this focus on the aesthetic, this focus on what you look like. Less of a focus on your actual health and well being, but more on how you look and how you fit in. And for women in particular, you know, sadly, as a marginalized group in many ways, we have often and always been valued by the way that we look. And our value has come from that. So this idea of dieting and maintaining a certain size or weight or hip ratio, or whatever it is, for that particular time in history has always been a little bit more important than actually managing our health and our real wellness. So I would say for us where it became a toxic feature is probably, you know, I’d say maybe 1970s and 80s but it’s been around and there’s some there’s a lot of history to this. This is kind of a You could go into this for a long time, and I will not. But I know Fearing the Black Body is a great book to kind of take you through some of the historical evolution of thinness and dieting and body shaming and all of that so

 

Kerry Jones 

Just to jump into what Dr. Folden was saying that it definitely affects women more. And I just wanted to emphasize that I feel like it starts at such a young age and in ways that we maybe don’t even think about how it’s affecting children, like things like Barbie dolls, showing that ideal size or Disney princesses. It wasn’t until recently that we started having Disney Princesses that reflected other people and different body sizes. So it definitely is so ingrained in our society, and definitely has that kind of toxic nature and effect on our children and us from a young age as we grow up.

 

Cindi 

Thank you, Kerry. And thank you everyone that contributed to that. I don’t mean to put you on the spot, Anna. But I just know that we’ve talked about this quite a bit, if you could just give a quick summary on the definition of diet culture. That way, now that we’ve been discussing the history of it, it might be a little bit more clear to our listeners.

 

Anna Lutz 

Great. Well, I really, usually reference Christy Harrison’s definition of diet culture, I think she’s written a really thorough definition. And also, in response to the last question, her  book, Anti Diet has really researched the history of what we’re discussing. And I’m so glad Dr. Folden mentioned, Fearing the Black Body also, both of those resources, I think are so pertinent to our discussion. But really looking at Christie Harrison’s definition as she talks about that it’s a set of beliefs, I don’t have it here in front of me, so I’m not going to read it, but it’s a set of beliefs that really elevates, eating a certain way and looking a certain way, is morally better. And there’s the health piece to it. So there’s the connection with health if you eat a certain way and look a certain way, but also you’re morally superior to other people. And so it’s not just about being on a diet, but that our whole culture is, you know, have these subtle and very, not subtle messages. And I think that that kind of virtue piece of it is a really important piece to kind of start to notice and understand.

 

Cindi 

Thank you so much for adding that definition in there. The pressure women experienced to achieve a certain body. I’m going to put air quotes around this “ideal” that can be seen throughout history. We’ve discussed the history of diet culture. Now let’s discuss the female body. We did touch on that just a little bit about how during certain timeframes, women’s bodies might be more voluptuous and they might be more slender. Beauty standards are not consistent. They are specific to periods in history, and are also culturally defined. An example of this is Victorian England, and the use of corsets and crinolines (I don’t even know if I said that right. But everyone knows what I mean). In many cultures, beauty standards of women advertised social status and power, which some of you had already discussed a little bit. It’s beneficial for women to understand how we got here, to a place where women are subjected to higher standards of appearance and objectification than men, to a place where people believe that beauty and fitness is a route to success. Will you all share some historical knowledge on a quote unquote, perfect body and how it was stressed for women, even though all bodies are different. And if there’s if you can try to make some parallels to today.

 

Dr. Lisa Folden 

I think that some of it is what we mentioned earlier, it’s this idea of superiority or having to be looked at as someone with some notoriety or someone of importance looking a certain way fitting the part. And women, which is even weird to even say it when I’m talking about it in a historical context because of all the amazing things women have done in history. But women were very much undervalued for their contributions and more so you know, it’s the idea of like a trophy wife, it was about what you look like, how you complimented your partner. You know, it wasn’t expected in certain parts of our history that you could, you know, create a career and create a life for yourself it was you needed to attain some status by getting a man. And in order to do that, you need to look a certain way. So there was so much stress put on your physical appearance. And again, whether that was a time or a culture where thinness was valued or more curviness, and more of a voluptuous body was valued wherever you were in history. And in the culture, it was important even to this very day, to look the part to fit the bill to to be a woman with great beauty. And it was something we owed to society really, like I owe you my beauty, I owe you my thinness, it is a part of my value and worth as a woman. So yeah, tons of parallels to today. Like, literally, it’s the exact same thing, we have shifted in maybe the size or the shape. But it is the same thing. Women are still looked at objectified, you know, listen we’re still protesting these things, like we’re still dealing with it every day. It’s like in sports, you know, can’t cover up. In school, you must cover up, it’s this, this whole thing about policing women’s bodies, how they look and what they do. And I hope that we will eventually be through this fight. But it’s, it’s ongoing, it’s been going on for literally hundreds of years. So yeah, I think there’s too many parallels to today, you know, for today, in my opinion.

 

Anna Lutz 

Something I think about is that the ideal body seems to be the thing in history that’s harder to achieve. So when there wasn’t enough food, you know, being fat, being in a large body was the sign of wealth and fertility and this wonderful thing that, you know, people could achieve. And now that we have, at least here in the United States, an abundance of food available, of course, there is significant food insecurity in our country so I don’t want to diminish that. But there’s, you know, cheaper food available, it is harder, quote, unquote, to achieve this kind of ideal body of being quite thin. And so I think that is something that’s kind of interesting is that wealth and success is kind of the symbol of a harder to achieve body.

 

Dr. Susan Lovelle 

I just wanted to kind of put also in that, when we’re talking about historical changes on the women’s body, you know, one of those the the most important things and impactful was how the Chinese for over a thousand years would bind women’s feet, and initially started to be because, you know, if you had your feet bound, you could not work that therefore that meant that you were wealthy, but it eventually turned into something where even those who were in the lower classes, bound their feet that made them more that since they couldn’t go anywhere, they would just sit there and do piece work. And so on both ends, there was something that was enforced upon women to get them to fit a specific profile.




Cindi 

And a lot of these profiles that they were striving to achieve were put in place by people of power. And do you feel there’s been any improvements in weight bias with regard to power, success and social status nowadays?

 

Dr. Lisa Folden 

I would say the only improvement and this is probably one of the few benefits of social media and a few benefits. One of the benefits of social media is we have more access. Now we can see other people in other bodies, you know, that we wouldn’t consider mainstream thin, beautiful, whatever. We can see them doing things that we may not have had access to previously. So I feel like that’s been an improvement. You know, I can go to someone’s Instagram page, who is in a larger body, you know, expressing their body positivity or showing the amazing things they can do with their body and treating themselves in a way that the world doesn’t usually treat them. And so that has been eye opening and extremely inspiring. Outside of that, I don’t know how many improvements there have actually been in weight bias. We maintain our weight bias as a society and as a country and the way that you know we do is by watching television, by reading magazines, or going on social media, the mainstream is always thin, the thin ideal still exists. If you are in the Hollywood world and you’re in a larger body, you are not cast as the main attraction. You are the sidekick, the fat friend. So I kick it and it’s been our whole lives going up. I mean, just recently, they started to make mannequins and stores in larger shapes or sizes. So, we’ve been seeing this forever, I’ll be 40 this year, my entire life, like you mentioned the Barbies. My entire life, it’s been that size Barbie, that size mannequin, it’s not changed very much, we just have more people that are vocal and speaking up against it, which you know, I’m so grateful for, but it’s definitely very much still there.

 

Dr. Erkeda DeRouen 

I agree with you that social media is definitely helping show that there are other people that other people can identify with. For example, there is a controversial singer, I’ll say her name, Lizzo. That is very focused on body positivity in a lot of people. And there have been controversial statements about her and everything like that. But it’s showing people that there are different sizes, and you can be happy, and you can be healthy. And also where people are going on Pinterest and other different things to find examples of people who look like them out there in the media, because it was harder back in the day when everything was in print. And you were looking in certain magazines, and you didn’t see yourself or even on the runway where they just had New York Fashion Week. But most of the runway sizes don’t go up but to a certain extent. And even plus size starts at a size like 12, which is crazy, because that’s the average size of most American women. So I just think that, like you said, we are moving forward.  There weren’t Barbies of different sizes, even different ethnicities and things like that. And now in the past few years, they have come out with a plus size Barbie, and they are showing children other representations out there.

 

Kerry Jones 

And I just wanted to add that I definitely think that it’s gotten better, I definitely think  we’re making progress. So there’s definitely still so much work we have to do. I know that a lot of research has been coming out about the weight bias that’s kind of ingrained within society, of individuals that are considered obese receive lower starting salaries, they’re ranked as less qualified, they work longer hours. They’re deemed unsuitable for employment, less likely to be interviewed. And really, that’s just the workplace. Clearly, there’s issues within health care of having less access, lower time with their doctors in health care, people are getting less education. And, of course, that leads to the poor treatment outcomes, which just kind of brings it all around. So there’s definitely a lot more work that we have to do. And hopefully, in the future we’ll get there staying optimistic, but still a lot of work we have to do.

 

Crissy 

Thank you very much, Kerry for that. We mentioned briefly how diet culture is becoming more well known. It’s becoming more popularized. Many Health at Every Size practitioners – I’ve seen this mentioned multiple times in social media posts and things like that – they mentioned this idea of the terms being co-opted. Health at Every Size terms being co-opted by the fitness and wellness industries. Can you give some examples of what is meant by that? What is meant by this idea that it’s being co-opted?

 

Anna Lutz 

It’s great that these terms and these movements are becoming more mainstream. I think that we don’t want that to change. But I think as it becomes more popularized, people want to make money off of it, right. and so then people will use these popular terms and it can be another kind of diet. So they’re using terms like lifestyle change and you know, if you just even think about Weight Watchers calling themselves ww instead of Weight Watchers and saying it’s a behavior change, not a diet. And so they’re using these buzz phrases as we have more and more research that diets don’t work, that diets cause people harm, that people that are selling the idea that thinness is better. You are using these new terms when it’s just the same thing that it’s always been, and so that’s the negative part of this information getting out there. And so I think we all just have to be, you know, smart consumers when we’re looking at social media and, and other kinds of ways that we consume media.

 

Dr. Lisa Folden 

I agree. And I think diet culture is driven by money. I mean, that’s, that’s what it’s about. It is about profiting off people’s insecurities. That’s what it boils down to. If I can get you to believe that, you’re just, you know, you’re still not there. You still got a little bit more to go. Lose a few more pounds, you can do it, you can look like this person. You can live your very best life. If I can get people to believe that I can, I can have their money forever, and I can have them as a customer or client forever. And so as our society starts to shift, and people’s eyes are opened up to the Health at Every Size movement, and to this idea that, you know, diets really are not sustainable, nor are they healthy, nor are they beneficial, tons of research out there to show that people who engage in intentional weight loss, less than 5% of them are able to maintain that for beyond one or two years. And I don’t even think they have the research for five years and beyond. Because nobody, nobody does. So now that that’s becoming more, it’s not mainstream, but it’s becoming more popular. Yes, diet culture has to figure out how to recoup their clients and not steer people away and expand their audiences. So yes, they are absolutely taking terms, you know, the very popular book Intuitive Eating by Evelyn Tribole, and Elise Reish. Amazing book, and that’s being attached to fasting, intuitive fasting. Let me teach you how to intuitively not eat. For me the dumbest thing I’ve ever heard, but it will get people’s attention. And it will get them interested like, Oh, you know, because so many of us hold on to this hope that like, there is a perfect diet out there somewhere I can find something that can get me where I need to be. And it’s because it’s been ingrained in us forever. So yeah, diet culture, because it’s about money, and consumers and having you know, more profit, they will take the terms that are meant really totally against dieting, and incorporate them into their diet and rebrand. It’s marketing, its strategy, and it’s about money.

 

Dr. Susan Lovelle 

I totally agree with that, that it really is, is definitely all about money. And I also wanted to point out a couple of things. One of them is that studies recently have been showing that being slightly overweight is actually more protective to your health going forward. Okay, slightly overweight, and across the board, no ifs, ands, or buts. But I also want to point out that one of the things on the other side is that we’re saying that being overweight or being obese, that you can be metabolically healthy, and then everything is okay. And I will say that, yes, you absolutely can be overweight, obese and be metabolically okay. You can be very thin and be metabolically not healthy at all. So what we want to do is number one, get our lab work, get our things of that sort in the right optimal level, whatever weight we are. That’s one thing. The next thing that I do want to point out is that even if we’re not looking at metabolics, we also want to look at what’s happening to us physiologically. And then, I’m just gonna say that the truth is that with extra weight, you are putting more stress on joints. And that’s just a fact of life. I mean, just imagine taking the 50 pound weight and carrying that around all day long, there is stress, so there is a balance. And that’s what we have to learn that there is a balance between what is right for our bodies, and that’s individual for every single person, what’s right for our bodies metabolically now looking at what we look like, but metabolically and physiologically, those are the two things that have to jive. And then we’re at that optimal health for ourselves. And that’s different for everyone.

 

Dr. Lisa Folden 

I agree with that, just to an extent. And in my line of work as a physical therapist, there’s a lot of talk about extra weight on joints, and you know how that’s good or bad or indifferent. And what I will say is, you can have a very negative impact on your joints if there is a lot of weight gained in a short window of time. It’s sort of a shock to the system. So if you gain a lot of weight in a very narrow window, your joints may feel that. But in general, overall, this typical weight gain that I think most most of us experience over the course of our lives, that has not really shown to make any significant effect to your joints, and even even if it does, or if you’re having joint pain, and you happen to be in a larger body, the problems that we’re running into is people in those positions are just being told to lose weight. And the reality is, that is not achievable for most people, for the vast majority of us. And so in health care when we’re dealing with these disparities, and like I said, I see it in my line of work a lot, I’ve been a physical therapist for 14 years, people are being discriminated against because they’re in larger bodies. And the assumption is, oh, you’re fat, you just have too much weight and load on your joints, you just need to lose weight. That’s not true. It’s not the case for most of us. Again, if these are people that have always been in larger bodies, their joints are not under any significantly severe stress that it’s not been their entire lives. It has more to do with addressing everything else, what’s the flexibility, like, you know, what’s your strength, like? What’s your endurance like? We can improve health behaviors, we can attack your issues from different ways, it doesn’t always have to go back to weight. And I would say far more of an issue than weight, because we’d like to just kind of lump it together, I would say that some of the negative health factors that we’re concerned about have more to do with the body fat percentage versus the weight, you know. We know people are in larger bodies, and they have more muscle tone, and they just weigh more, that’s a different situation than someone who just has more fatty tissue or more visceral fat. But even in those situations, again, people, our bodies are supposed to be different. And I say this on my social media, and sometimes I get a lot of flack for it, the reality is some of us will be fat is just and it’s okay. Some of us will be fat. And it’s totally fine. That doesn’t make us unhealthy. It doesn’t necessarily make us healthy. That’s your individual journey. But it does not, it’s not an early death sentence. It’s not something that should necessarily be looked at as negative. And it’s not something that we have to feel this desire to fix. We’re obsessed with fixing ourselves, you know, anything out of place, anything wrong, let me fix it, and weight, in my opinion, it’s just not something that always needs to be fixed. I think you can improve your health, you can change your health behaviors. For some people, it’ll result in a slightly lower weight. For some people, it might result in a higher weight and for others, it’ll be no difference in your weight. But you can pursue health without any regard to your body weight or size. And that’s just my preference on how to pursue it. Because when you focus on weight, and your weight doesn’t change, you are less likely to stick with those positive health behaviors.

 

Dr. Susan Lovelle 

Absolutely, right. Absolutely. Right. Health first and weight and appearance second, it’s got to be that way. It’s just knowing that it’s different for everyone. So I agree.

 

Crissy 

Thank you, everybody so much. That was a very, very interesting conversation to listen to. Do you see any other consequences emerging as awareness of diet culture increases and with the popularization of movements like Health at Every Size?

 

Katherine Andrew 

I guess the one thing I can think of negatively here, I mean, there’s a lot but it goes back to what Dr. Folden was saying, or maybe it was Dr. Lovelle about the money making industry, right? That this has now become something that is going to be another path for someone to create a program, or a supplement, or a book,  or you name it. Which is not always a bad thing, right? Information is great and education is wonderful. But I think all of these things, the filter that we have to come back through is this helping me connect to my body more or is it actually helping me disconnect to my body, right? But so many of these quote/unquote “good tools” that we’ve been given over the years whether it’s a tracker of some sort or a way to monitor something right like again all bring us back to how can this help someone else make more money? How can they make me rely on a system, or another person, or program, or tool more and myself less, and in the process trusting myself less and becoming more and more disconnected from what my body is telling me. So even down to the conversation about you know, weight and health and joint and all these things, right? It still comes back to a lot of times what are we watching? What are we listening to, what are we being driven by that’s actually pulling us away from how we’re connecting with ourselves. So I think that would be the one thing I would say about the danger of the Health at Every Size is just like any other Hot Topic, right? It has the potential to to actually remove us from what is really going to help us heal and become healthier rather than connect us.

 

Anna Lutz 

Something else I think about as a kind of a negative consequence to Health at Every Size, intuitive eating and non diet becoming more popularized is that we lose sight of how it started and what is true. There’s lots of myths around what Health at Every Size is and what it’s not, what intuitive eating is and what it’s not. And I think the more these terms become popularized, then people don’t really understand what it is. And they’re these very false myths of, you know, people thinking that it’s about doing whatever you want, and, you know, not listening to your body or, you know, you know, I think it’s really important to acknowledge that the Health at Every Size movement started as a social justice movement. As it’s becoming more popularized, and because of social media, and, you know, becoming more mainstream, I think that piece is being lost. And so I think that’s, you know, a negative consequence that, you know, again, there’s, it’s two sides to every coin.

 

Cindi 

I’d like to expand a little bit more on the contradictory scientific evidence. We’ve discussed it just a little bit, when we were talking about joints. One of the components of diet culture that the health and fitness industry tends to stress is that health and weight loss are related. And we would love to clarify this for our audience. Why does it seem that weight loss improves health? For example, somebody that loses weight, will say that their blood pressure decreased, their cholesterol was lower, they lowered their risk of diabetes. And we would like to have you all share a little bit more about the scientific evidence or trusted resources that point out that weight loss isn’t the cure for everything.

 

Dr. Erkeda DeRouen 

I love the conversation that we’re having about body positivity and all of those things. But obesity does affect livelihood. And people who have higher BMI’s can have different parts of their body be affected, it can affect their blood pressure. You can just think about the ABCs of the causes of BMI like people have higher levels of arthritis, more back pain, higher blood pressure, if you’re thinking about the seas, you’re thinking of an increased risk of cancers and cholesterol, for diabetes, you there are so many different things that people with higher BMI and obesity have. And I think that it’s important for us to stress body positivity and kind of figuring out ways to not do fad diets and beat yourself up if that’s how your body is, but also figuring out ways to change your lifestyles. And as a result of that, then, more than likely some of the weight will come off and try to just focus on Being Well. So there have been numerous studies just on the effects of obesity. The New England Journal of Medicine came out with a study in 2017, I believe, where they talked about the health effects of overweight and obesity in 195 countries. And it showed that increased BMI accounted for 4 million deaths globally. And that was due to different things. So it could be due to just the increased inflammation from the body from different cells or fatty liver and all of those different things that obesity can have. So I think the focus should be more on lifestyle changes and figuring out ways because like you guys mentioned with the industry, they always are throwing out a fad diet like try this try that are trying to get to this perfect, ideal quickly. But there isn’t a magic pill, there isn’t something that will just make you snap and do it. And that’s a lot of times why people fail their diets and they go and move on to the next and the next. So some resources that I would recommend that people look into. Definitely nutritionfacts.org. They have a lot of evidence based medicine talking about different diets and how different nutrition components can affect you in different parts of your body and different things. There are two books written by the father of lifestyle, medicine, How Not to Die, which looks through the different parts of your body. So your brain, your heart, and all of those different things. And it talks about how to eat and to live, and exercise and meditate. And all of those kinds of things that come along with decreasing the stress and impact on the body, getting more sleep, and all of those things that you don’t think can impact weight. And then there’s another one called, How Not to Diet, which is the follow up on that. And it looks at the studies of each of the major diets, and a lot of them do work, I’m not gonna lie. And I know a lot of people who are here may be like, Okay, I’m going to do the keto diet, and it works. But then what happens when you stop it. So looking into what works, why it works, and what may be better for you, and what may be better for you, may be different for me. So trying to figure out what is best for your body. And like you guys said how to listen to it.

 

Dr. Lisa Folden 

I do want to jump in really quickly. Because we’re using some terms that are like to HAES people, make you want to feel like you’re being stabbed and one of them is BMI. OMG. BMI makes me want to vomit, I’m so sorry. Um, it is so hard to hear BMI because I understand the history of it, created by a mathematician has zero, when I say zero, like negative numbers, nothing to do with our actual health at all. Literally a ratio of your height and weight. It does not apply to us. And there’s if you read the book Health at Every Size by Dr. Linda Bacon, they talk about the history of BMI and how these boards met to figure out you know, what was healthy, what was not. And based on the research, it made more sense for healthy BMI to be considered something higher, and instead it was lowered. So there’s a lot to play in that. When we talk about research studies, I understand that, you know, the lay people are not going to just be looking to research for fun. That is not my idea of fun on a Saturday night. But what’s really important to digest about some of the research that we see is what I like to say is following the money.  Who’s funding this research? Who stands to benefit from this research? If it’s a corporation that specializes in weight loss drugs or weight loss material rather than components, that might not be the research you want to look at. So when we use terms like BMI, we’ll use terms like even obesity at that’s not even because again, it was based on this idea of the BMI, which is in my opinion, complete trash, it should be thrown out of health care, because it does not adequately represent the health of any person. And then we dig into the good research, because there’s good research out there. And we do see associative relationships between people’s body size and their health conditions. That is an absolute fact. The problem is we sometimes misinterpret this research to assume that because fat people may have a higher rate of this or that or that, is that it’s a causal thing. And it’s not always causal. There is an association. That may be health behaviors. It may have a whole lot to do with what we’ve touched on briefly earlier, is the discrimination that fat people face in the medical field. So if you’re not getting adequate health care, because you’re being discriminated against you feel like trash every time you go see your doctor, you might start to develop a cancer that’s never caught. Also, you can be misdiagnosed because the first thing that you’re being confronted with in the healthcare system for a lot of people in fat bodies or large bodies is that the cause of your issue is the weight. You just need to lose some weight. And then people are being misdiagnosed or not diagnosed from real life threatening diseases. And if we could shift the focus from your body weight causing a problem, to let’s look at some new health behaviors that we can try to make you healthier with no regard to the size of their bodies. Because the reality is if we’re living in a way that is healthy for us, we’re making good decisions about the activities we participate in, the nutritious foods we’re feeding ourselves, our bodies will settle into a healthy region. It just may not be the ideal, like look of health for people because we see fat as being so unhealthy. So that I could say more, but I don’t want to dominate this conversation. So I’m gonna be quiet, but it’s really hard for me to hear BMI and obesity because I’m just like, Oh, I wish those terms would just die.

 

Dr. Susan Lovelle

Both of my kids do sports. Well, they’re retired now, out of college. They were always, all their lives considered overweight, or even on that border of being obese because they had a higher BMI. And they were in the best shape and all it was, was muscle. So we know that muscle, not pound for pound, because pound for pound, they weigh the same, but volume wise muscle is much denser than fat, and therefore you’re going to be you’re going to weigh more for the same height and you’ll be in life can be higher. So I agree with you, Dr. Folden, we need to throw out BMI. However, I will also say that, you know that one of the things we have seen, and I’m going to take this away from traditional medicine, and go more into the lifestyle slash functional medicine arena where we’re looking at more optimal levels of everything. And we see that more fat leads to more inflammation. And inflammation is at the basis of so many other things, heart disease, diabetes, or arthritis. So that is more I think, where the issue is. Not so much in the weight per se of itself, but in the amount of inflammation that a body has. And if you can lower that inflammation, you lower your risk for all of those secondary conditions.

 

Anna Lutz 

I appreciate everyone’s comments. And I really wanted to add and highlight what Dr. Foden said about causation versus correlation. A few things that come to mind. One is there’s lots of correlation in healthcare, or in health. One I always like to bring up is bald men are more likely to have heart disease, but we don’t try to grow hair on men to decrease their risk of heart disease. Similarly, taller women, the taller you are, you’re at an increased risk for ovarian cancer. But we don’t tell women they need to be shorter. And so the same thing, there’s this correlation. But because of our biases, we say well, then you need to lower your weight.  The really big health studies like the Haynes and the Framingham health studies that show this correlation between weight and different health conditions, blood pressure, high glucose, etc. If you control for weight cycling, those correlations actually go away. And I feel like this is a really important part because the people that are weight cycling, and weight cycling is when you lose weight and gain weight and lose weight and gain weight. The people that are weight cycling are in larger bodies and are being told to diet and so that to a Dr. Lovelle’s point causes inflammation. When the correlation goes away, when we control for weight cycling, that actual correlation goes away, we need to be looking at how can we reduce weight cycling? How can we provide better healthcare for people in all bodies so they can take care of the body they have at this moment. And so there’s so much research that we need to dig into. One other quick thing I’ll say is the American Medical Association many years ago had a whole committee to decide if I’m going to use this term, because they use it, obesity should be a medical condition. And that’s not a term I usually use. And their committee looked at all the research and recommended to the American Medical Association that it should not be a medical condition. And the AMA went against their own committee’s recommendation based on research, which I think just shows the levels of biases that our healthcare system is operating under.

 

Dr. Lisa Folden 

And one other really quick thing, some of the diseases and conditions that we attribute to being caused by weight gain or fat, you know, body composition, oftentimes those conditions actually increase your fat and or weight gain. So sometimes there is a causal relationship, but it’s in the reverse. And the reason that’s important to say is because people in larger bodies are blamed for being fat and for having diseases. We blame them because you’re not doing something right, you’re not taking good care of yourself, you know, you need to just diet and work harder and you’ll be healthier. And in reality, a good portion, a large portion of our health and a large part or a large percentage of our weight and body size is not in our control like that, not like we think it is. We think we can diet, do the next thing and fix it and we’re good. But as we mentioned earlier for most people, the weight comes back and our metabolism is lowered and then we cycle and we go through this whole thing for our whole lives. So the reality is getting people to focus on just living in a healthy way, whatever their bodies look like and not focusing on that, because again, sometimes the disease itself is what’s causing the weight gain.

 

Dr. Susan Lovelle 

Sometimes even the treatment for the disease. So with diabetes, you know, insulin actually causes more fat gain, you know, and we don’t even think about that.

 

Crissy 

Thank you, everybody so much for that conversation, we’re going to kind of jump topics just a little bit. I’m sure somebody here in this group, if not most of us had said to them at some point, you don’t even look like you had a baby, or something along those lines. Statements like that are a classic example of someone trying to compliment another person, when in fact, it’s spreading diet culture, and fat phobic ideas and biases. What are some other examples of fat phobic and diet culture soaked statements?

 

Dr. Lisa Folden 

How much time do we have? No, I’m joking.

 

Anna Lutz 

Oh, you look so good. I feel like any comment about someone’s weight is rooted in diet culture, right? Have you lost weight?  Or commenting on someone else… Look, that other person has gained weight! Gosh, I feel like this should be easy, but it’s a little bit harder coming to mind.

 

Dr. Lisa Folden 

She’s really let herself go.

 

Anna Lutz 

That’s a good one.

 

Dr. Lisa Folden 

Yeah, that happens a lot for moms.

 

Crissy 

So really, just any comment about a person’s weight? It’s not our place. Now, if any of our listeners happened to make a statement like this innocently. Not, you know, aware of it. How does one begin to revamp the own biases that we might hold? And how you know, a slip of the tongue, we might say something like that to a friend or in just general passing?

 

Dr. Susan Lovelle 

I think the first thing is you have to be aware. You know, I think a lot of us don’t even think about what’s coming out of our mouths. So the very first step is being aware of what you’re saying, and what it can mean to others.

 

Dr. Lisa Folden 

I think it’s a lot of unlearning. And sort of, you know, just no longer doing the status quo. I think a short quick rule is don’t comment on anybody’s body. Like, that’s just it. Unless they invite you or ask an opinion about something, don’t comment on anyone’s body. Pregnant, just had a baby, all of it, just don’t comment.

 

Kerry Jones 

Self reflecting, like, why did I make this statement? Am I trying to influence their weight? Why do I think they need to lose weight, just kind of having that internal dialogue, to just kind of, hopefully, reveal your own biases and hopefully work through this.

 

Cindi 

How about when someone makes a comment about their own body to you? How would one, not a professional, just anyone, respond to that?

 

Dr. Lisa Folden 

I think what we see a lot is like, you know, you have a friend and she’s like, Oh, I’m feeling so fat or whatever, I gained so much weight. And then our response is like, oh, you’re not fat, you’re beautiful. So that’s another diet culture statement. Because fat and beauty can coexist. It doesn’t have to be one or the other. I think what you can do is try to support them. You know, here’s, we all do this, like I would, I would argue that everyone on here has done this at one point or another. Nobody is perfect. We are human beings. So giving yourself some grace and giving them some grace. So it’s not about chastising them, but maybe just saying, Oh, you know, I don’t, that’s not true. I don’t think that’s true. Or, you know, or you can if it’s more comfortable for you, you can not respond to it. Because if you don’t play into it and have a conversation about it, maybe they’re less likely to say those negative things. But if my friends say something like, Oh, I look so fat, or Oh, I’m not this or I’m like oh, well, I don’t agree. I don’t think that’s true, you know, but you know it ultimately people have to make these reconciliations within themselves.

 

Katherine Andrew 

I think one other thing along those lines is just helping people think about their words, right? So like feeling fat, and then looking, you know, beautiful like what what does that mean to you and what like, what Tell me what feels off and what feels like it hurts and what feels wrong right now and why do you Why do you not feel good? Like describe that in words that actually you can feel in touch and see and instead of our cultural words, right, so I think pushing back a little bit gently on people with grace, as you said, on, you know, like just getting people to use their words a little differently rather than the lazy version, which is what you know, we tend to use because we see it on TV or elsewhere on social media.

 

Anna Lutz 

I love that Katherine because that’s, my go to. If my children say something that catches me off guard, or I don’t know how to respond, just to ask a question back. Like, tell me why you’d say that, I’m surprised you would say that, tell me more. Because they may be trying to communicate something different to you, then what’s kind of our society is kind of saying what they should say, which is a comment on their body.

 

Cindi 

Thank you. That’s all fantastic. I’m going to take it into the direction of mental health now. We would love to discuss the concept of snapback culture, and the role it plays specifically on a mother’s mental health. How is this societal pressure on women to get their body back to a certain size, to look a certain way after giving birth, to be a certain shape impacting the overall health of new moms?

 

Kerry Jones 

I feel like new moms are already dealing with so much. They’re learning how to feed and care for their newborn, and they’re recovering from childbirth, they’re experiencing hormonal fluctuations. And then that’s on top of considerable challenges like lack of sleep, pain, breastfeeding stress. So there’s so many things that’s already going on. So to add that unrealistic expectation of snapback culture can definitely cause moms to neglect their own rest and recovery and increase their risk for developing a variety of mental health challenges, whether it’s postpartum depression or other things like delaying their postpartum recovery or breastfeeding difficulties. So it really just, it has such an impact, we definitely need to support moms, especially the new moms.

 

Crissy 

Thank you so much, Kerry, we have seen a huge increase within the last two decades in the number of people who are affected by orthorexia nervosa. Coming from the fitness industry, my view of this might be a little more skewed, because I feel like everyone I know has this to some degree. And I’m speaking of that within the fitness and wellness industry. Would you please define orthorexia and explain why it is not yet in the Diagnostic and Statistical Manual of Mental Disorders, the DSM five, and why it’s classified as other specified feeding or eating disorder. And why is this particular disorder on the rise?

 

Dr. Susan Lovelle 

The entomological word route behind that is ortho, which means straight and then straight eating. So it’s people who feel that there is a specific way of eating, and only that way works. So we can see that in all different ways. We’ve got people who eat paleo, and you know, if you eat a grain, you’re gonna die. And same thing with, you know, vegetarians and vegans and not in it for the health part. But for it for the belief that what they are doing is the absolute best and only way to eat. So that’s where it starts. And then it can, it builds out into, you know, feeling that if you eat anything outside of that, that there’s something wrong with you. And that brings all of that emotional torture, torment, really. And so it just kind of goes out from there. The idea that this is the only way to eat, and anything outside of that, anyone or even if I’m doing that, and there’s something wrong. So that’s where it begins.

 

Dr. Lisa Folden 

And I think too, it’s the obsession with those behaviors. So it’s the obsession with my healthy way of eating, the obsession with my specific exercise or, or way of moving. And it’s, you know, I think I think anybody can fall into this because it’s a slippery slope, right? When we get on these, our fitness trackers, and we’re like, oh, I didn’t burn enough calories today. I gotta go back out or I’ve seen people stop in the middle of work to, like, run in place to get their points up, you know, get their steps up. It’s sort of this obsession, we know anything, even a good thing, too much of a good thing can be bad. So when you’re obsessing over something, and you’re putting this idea of like, my physical health, even if we’re talking about real health, but we’re putting our physical health, above everything else, our mental, emotional, spiritual well being, then it’s not really healthy, because we’re not giving attention to the other parts of us, you know. We are far more than a body like each of us. So there’s more to address in our health and just what we’re eating and how we’re moving and what we look like.

 

Anna Lutz 

Totally agree. And I think the reason we’re seeing it more and more is because of, you know, fad diets, over the years have become more and more extreme, they’re just being kind of layered on top of each other. And, and becoming popularized in, you know, going to even go into the grocery store, you’ll see you’ll see about fad diets. And so I think it’s these fad diets, and if you look at it right now, are kind of everywhere, go into a restaurant, they’ll have the Paleo menu, or this menu or that menu. And so I think it’s becoming more accepted like that is how you’re supposed to eat, you’re supposed to be always on some kind of restrictive fad diet. And then people really can fall into it and orthorexia has all the same, can have all the same health consequences as any of the other eating disorders. I think it’s a fairly new proposed diagnosis. It was first written about by someone who wasn’t even proposing it to be in the DSM, five or four at the time, probably. And so I think it takes years and years and years for it to actually get into the DSM five, I don’t know if it will. But certainly from a medical and mental health standpoint, it has just as serious consequences as other eating disorders.

 

Cindi 

It’s also hard for individuals with the regular public to know what to do. So they look to professionals or people that call themselves doctors or know what they’re saying. And they say to don’t eat grain, or don’t drink dairy, and they just don’t know what to do. And it’s overwhelming. And so you just start adopting all of these different practices, and it slides downhill pretty quickly. So thank you all for sharing that. The vast majority of people have a desire to look good, and have their appearance appreciated by others. And it’s very hard to let that attachment to Appearance go when we’re surrounded by it all the time. How do you personally practice body appreciation? And how do you occur, encourage it with your own clients, or patients?

 

Dr. Lisa Folden 

I coach moms, specifically busy moms, and we spend a lot of time talking about this. It’s obviously very normal to want to look good and to get compliments. And in my personal experience with diet, weight cycling, dieting, yo yo dieting is that I did. I went really hard for six months and lost a bunch of weight, was looking great. Everybody was telling me how awesome I looked. Then I got really tired and went back to sort of a normal workout schedule instead of seven days a week, I just did like four. And then I gained the weight back and then I wasn’t getting those compliments. And I had to deal with the mental trauma of like, you know, feeling like oh, people don’t really see me as like, you know, as I guess attractive when I don’t when I’m not thinner, my thinnest self. And so there’s a lot that plays into that. But I think for a lot of my clients, the first step is just recognizing that external validation, while it can feel good, is not necessary for you to value and appreciate yourself. And so we don’t even go as far as body positivity early on, we start with just neutrality. Let’s appreciate our bodies because it’s brought us through something. It’s carried life into the world or it’s gotten me through a pandemic or it gets me up and down the stairs every day. So we start there with the utility. What is your body doing for you that you’re grateful for? As a physical therapist, I work with people who have you know amputations or who cannot walk or who you know. So recognizing the full spectrum of the potential of your life on this planet, you could be in a different position with less abilities or less, whatever. So just starting there with being appreciation for what you can do and what you do have.

 

Dr. Susan Lovelle 

I would say the biggest thing that I work with with my clients is understanding what their own body’s trying to tell them. And that’s where we start. And if you have that under your belt, and it’s the best thing, and I have to say, it’s not even where I trained in how I started, I was a dancer, a ballet dancer for 14 years. So you know what that culture is all about. Then I went into plastic surgery, so you know what that culture is all about. And it really wasn’t until I had my own health issues and had to figure out what not just looking better was, but actually being healthier really meant that I really understood what that meant for me. And that’s what I try to bring to the clients that I work with.

 

Dr. Erkeda DeRouen 

I agree with everything that was said before, and I kind of think it goes back to what someone said earlier about, what is the emotion that you want? Like from all of this experience? Why do you want to feel or look a certain way? And just dealing and kind of reflecting within? Like, what makes you feel good? And and what can you appreciate about your body that it’s able to do because some people don’t have those capabilities, and surrounding yourself with positive people that can also discuss those things like a good girlfriend group or family members that you can talk to and just share how thankful you are for certain things that you can do. And it doesn’t matter what you look like. And then in terms of the patient’s also sharing that with them trying to figure out why do you want to lose this weight? What will it help you do? When do you want to be able to climb a flight of stairs? Okay, let’s work on that. Do you want to not get winded when you walk to the mailbox? That’s great. Do you want to improve your heart health? Any of the other medical conditions that may get better with weight loss? But like what do you want to gain from that? And how will it help you continue to live your best life.

 

Anna Lutz 

I might be repeating a bit but really with my clients and myself, we really focus on that gratitude that Dr. Folden mentioned. You know, what makes what makes your body unique? What does your body do rather than what it looks like? What are the unique things that your body can do? And, and even like kind of faking it till you make it you know, really trying everyday to say something positive about yourself, doesn’t even have to be about your appearance. But just something positive, say it out loud, say it in front of your children, you know, that can really kind of start to shift that belief system. We know that gratitude can really rewire our brain. And so if we can practice it each day, there’s no telling how that will shift our own body image.

 

Katherine Andrew 

I’m just going to Amen that one because I agree with the gratitude piece and just how to fake it till you make it. I tell that to clients a lot. Believing that you’re a whole that we’re not going to really find someone different, but we’re going to refine who you are and uncover who you are, it is like such a different process than fighting against myself. So really trying to help clients work with their bodies rather than against their bodies and understand what that looks like, as Anna said, really comes from a place of finding gratitude, even if it’s like the tiniest little thing every day, like what you know, one little thing that we can focus on and move forward from. And then just reminding people that it’s a process, right that it’s not, it took 40 years to get me here, in this way of thinking and like it’s going to maybe take that long to reverse it right. And so every time I can turn away from those thoughts and towards something that’s more uplifting is a win and just continuing to find those wins.

 

Anna Lutz 

And it’s not their fault, right? We are all swimming in it. We’re all swimming in diet culture all the time. So it’s no one’s fault to be thinking that way.

 

Kerry Jones 

And I second everything that everyone’s said, I’m just I’m personally focused on things that make my body feel good mentally and physically. And just like Anna was saying, kind of have those phrases that just kind of give you that momentum to go forward. If you’re having a bad day or you’re just not feeling good in your body. And that’s the exact thing that I tell my clients to do.



Crissy 

Thank you everybody so much. We really, really appreciate you being here. And this was an incredible conversation, beginning to end. It was very, very interesting and we can’t wait to share it with our listeners.

HER Health Collective roundtables provide an opportunity for us to bring our panel of experts together to discuss important issues that are relevant to mothers in our community. Our expert panelists are carefully vetted. They submit an application or are nominated by someone in the community. The experts then go through an interview and selection process.

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