HER Expert Panel
Summer Roundtable

Crissy Fishbane:

Alright we are excited to go ahead and dive in. We have roughly 3 questions. We’re
going to spend approximately 15 minutes on each of those conversations and we’re just going to let our
panelists dive in and just have that conversation going. So our first question:

In what ways do weight changes across the lifespan, body image and diet culture impact mothers today? What do you see being the long term effects of these trends if we don’t see a shift in societal norms?

Anna Lutz:

I’ll jump in. You know, the thing that comes to my mind first is just the pressure on women
to return to pre-pregnancy weight immediately after the baby is born. And that somehow our society
decided that that’s how things are supposed to happen.

Instead if we could be sending messages to women that they need to nurture their body, take care of
their body, have a strong body so that they can take care of this wonderful baby that is here.

That might mean that their body is different, and it probably does mean their body is different. That’s
not a bad thing.

It’s actually something that as a society I hope we can move toward celebrating rather than this pressure that plays out with many detrimental mental health outcomes if the only focus is that a woman is supposed to get back to their pre-pregnancy body.

Jessica Altemara:

I agree with that focus being something that is prevalent across the board. One of the places like social media has the ability, especially right now when people are physically isolating, that social media has the ability to provide a community where it might not otherwise be available. At the same time social media is a place where you see that pressure where people only put their best face forward. You see people posting about how their exercise routine that they return to when they’re two weeks postpartum.

Like my almost 13 year old I took a picture the other day he looked at it and he said “oh that’s insta-
worthy mom” and it made me think about how many freshly postpartum people are just trying to be
insta-worthy.

I read a study that was talking about how people feel, because of social media and reality tv, people
have this weird idea that there’s always somebody watching them and that they are in this constant
performance mindset. And I think that that’s a huge distractor for a lot of people in making the
connections that you are talking about that are healthier.

Katherine Andrews:

I’m gonna second everyone, and just agree that it’s not even just postpartum but also as we age. We’ve seen that additional weight is actually health protective in older age.

I find that I’m seeing more disordered eating among the 40-50 year old women I see than any other age population right now. In terms of the question of what happens long term, it leads to restrictive eating and over exercising which then leads to hormone problems and menopause being far worse than what it would have been had they just accepted and embraced some of that minor weight change.

So it feels like there’s so much negative gut problems, right, that come from this fear of weight that
drives so much of what we do as a culture.

Dr. Lindsay Mumma:

I really don’t think that you’re going to get any sort of contention in this question. I think we can all pretty much agree that the idea that having weight on your body is a problem is ridiculous and that the pressure that women place on themselves because people are placing this external pressure on them is just so huge and it impacts so many different things.

It impacts their relationship that they have with food. It impacts the relationship that they have with themselves and then with their family and with everyone that they come into contact with.

Talking about the far end of the spectrum, my mother in law is a wonderful, beautiful, incredible woman and she is 67 and she still talks about how she had a large incision when she birthed my husband. And so her abdomen has never looked the same. And it breaks my heart to hear her talk about how she wants to be smaller in her stomach. She has such a disordered eating relationship with food and it’s so sad because my niece sees that.

My sister-in-law and I have talked about how we want to model the behavior that we want to see in our
children because it’s been going on for quite a long time and we don’t want that to pass on to the next
generation because this is what they’re seeing.

I mean babies are so aware of what’s going on. Gabriella knows what Elizabeth is doing right now and
she senses it and she can sense if Elizabeth is like “ugh I’m eating the thing and it’s bad”, you know, and
just being able to appreciate that the postpartum time period is for, like Anna said, nourishing and to
allow healing to happen.

One of the things I tell all of the women that I work with is that, from the moment that you either conceive or decide to adopt, your brain will change and everything in you will change. Everything from the cellular level to the metaphysical level changes when you become a mother. And so to go back to your pre-baby body is just a nonsensical thing.

I joke that I don’t talk to a lot of butterflies but I’m pretty sure none of them are trying to be caterpillars.
Because once you go through a transformation, everything’s changed and you become this more
incredible version of yourself. Why would you want to go back? But you’re being told that being back
there in those same jeans is really going to change your life. Leggings are pants. We don’t need that.

Jessica:

Did you finally, did you bring up something that actually could be debated? If leggings are
pants? (laughing)

Lindsay:

The leggings thing? I mean we can debate it if we want. (laughing).

Jessica:

I think you might have found something that we can debate. I’m not actually disagreeing with you, I totally agree.

Lindsay:

I’m totally agreeing with you. Leggings are pants.

Jessica:

I’m just saying you might have found something that we could debate. (smiling)

Dr. Elizabeth Sierkowski:

I’ll jump in here. I think one of the things that I like to touch on is each of us can talk about this from being a woman, from some of us being a mother. But honestly from so many perspectives – being a sister, being a friend, being a daughter. We’ve all interacted with ourselves and with other women and we see the challenge that this brings up and now as a mother, and I’ll talk about it from the medical perspective, it starts right now with her.

We’re a bit obsessed with numbers as they say. I mean, we’re already, I’m tracking, I’m plotting her
growth on a chart. Ultimately the point of those growth charts is not to scrutinize her body habits, right, it’s to make sure that she’s generally tracking the way that she’s supposed to. But that’s not how they’re used.

Even myself, I find that “oh she was born in the 88th percentile but now she’s the 83rd percentile, am I
making enough breastmilk? Is my milk rich enough? Am I losing weight too fast? Am I losing weight fast enough? Do I feel guilty about one or the other?”

We can scrutinize to the ends of the earth and, ultimately, when people come into my office, I don’t
weigh them unless there’s a reason to weigh them, but that’s not conventional care. Conventional care
is get them in, get their vital signs, because weight is somehow whether you’re alive or not. And then
put them in a room and put that on a chart and we’re supposed to judge you by these numbers on this
piece of paper. It’s just so ingrained in everything that we do. No wonder people are obsessed about it.

You know if you’re getting it from the Instagram point and you’re getting it from your friend and you’re
getting it from your mom and you’re getting it from your doctor and it starts when you’re little about
whether you’re big enough or small enough. It’s all disordered. None of that is normal.

The dialogue that I’m using with my patients and friends and my mom which, to speak to Lindsay’s
point, when she eats cheese puffs and feels guilty I’m like “either don’t eat the cheese puffs or stop
feeling guilty about it.” Just eat them and be happy about it and enjoy every one of those little cheese
puffs. It’s just her favorite food.

Instead the dialogue is: Are you happy? Are you functional? Can you move? Does your breast feed or
not? What is really the point of your body? Because it’s not the number on the piece of paper.

I pull a lot of this from one of my favorite books of all time which is “Women Who Run With The Wolves” and if anybody hasn’t read it, or its been awhile, it’s a really good time for a reread.

Crissy Fishbane:

You are all posing these amazing points. What do we do to shift this? How do we make this the new norm?

Dr. Lindsay Mumma:

For me, personally, I take it on myself to just always be honest and to deal in facts.

The facts are I don’t really care what my relationship with gravity is. I will talk to my patients and the women in classes and my friends and have honest and open conversations.

I also choose to share more than a highlight reel on my Instagram and I don’t think that that’s the biggest change in the world to make. But you can expect that you’re going to get honesty.

Today I found out that a friend of mine overdosed and it’s obviously still hard. I worked out and in the
middle of my workout I just started crying. I was making a video of working out. But I posted that video because I wanted people to see me work through challenges.

I get so many messages because I always have minimal clothes on because I just really like the sun and I like to get as much vitamin D as I can. I get so many messages from women who are like “the fact that you’re wearing a bathing suit right now makes me want to put a bathing suit on and I wasn’t going to.”

I don’t take it, like, some people get offended by that “well because your body’s not perfect, I feel ok in
my imperfect body.”

My body is imperfect and I love it that way. And so just showing my own self and then within my circle
of friends and my community, what it looks like to love myself at any size, in any shape, in any situation and through any hard challenge. I just want to let people see how I do it. Because I have tools and I like to use them.

So I think that what we do is, us professionals who are dealing with women who are frequently having issues surrounding this, we don’t put it on the back burner. We ask them questions about how it’s going. How do you feel in your body?

Like Elizabeth was saying, asking the questions that matter instead of “well how much weight have you
lost since you had your baby.”

Being mindful of the things that we say to new moms like, “oh you don’t even look like you had a kid.” I worked for that kid, I better look like I had one. There’s a lot of things in here that have changed. I would like for you to notice those. Look how big my boobs are. I don’t want to look like I don’t have a kid. And just being honest is how, that’s the approach that I take to specifically answer your question in a very long and emotional way.

Katherine Andrew:

Real quick – I think as practitioners, we can continue to emphasize and do our own research, if you will, around other tools of measurement.

People want ways, I mean especially even in quarantine, schedules help and tools of measurement help. To Lindsay’s point, how do we pose those questions, the better questions, so that it doesn’t come back to traditional medicine’s evaluation of what Dr. Sierkowski said in terms of numbers and weight being the baseline for everything.

Am I pooping daily? Do I have a sex drive? What are the better things that, as a female, I could be
evaluating for my own health? Because right now a lot of people don’t know that. All we know is blood
pressure and weight and when you ask people about “what is health” they come up with this very dry
list of numbers that you have to get from a physician. So what does it look like for me: Am I sleeping? Do I wake up rested? That would describe my healthy versus someone else’s.

Jessica Altemara:

I think that motivation is one key factor.

How do we help people feel motivated to change the way they approach things? That’s hard. Especially
for someone in the process of a transition, just becoming a parent or adding a family member, that
when you’ve just had a baby self-care is hard. Talking about what that looks like can mean a lot of
different things.

Finding something that motivates us to change the way that we think and approach this is important. Years ago a friend of mine was talking about how her whole life her mother was always saying disparaging things about her body. “Oh my butt is so big” and they would go clothing shopping and she would make remarks, and that she really wanted to be more thoughtful. She had just had a daughter and she wanted to think about what she was modeling because she realized that her own internal dialogue about her body was mirroring, was an echo of her mother.

She said that she was going to try to do it but she just felt dishonest. I said just fake it fake it till you
make it” and try to think about what you’re modeling.

A lot of times people think, “ I want to model good nutrition. I want to model a healthy weight.” But also
we have to model how we feel about all of that. What is actually healthy?

I love the question, what are our bodies for?

They’re not really for looking great in a bathing suit or a dress. One thing we can use to motivate
ourselves and to help motivate other moms is to consider what you’re practicing and what you’re
portraying to your children.

Say good things about your body. Notice what’s good, what’s healthy.

Talk about “ I want to eat this food because I feel better when I eat this food.” And not “I want to eat
this food so I can be beach worthy.”

I think for me, I’m not good at remembering self-care. But I’m really good at thinking about what I’m
doing to pass on healthy things to my kids. If we frame the concept of changing our language and
changing our approach as something we’re doing for our kids, we’ll benefit but I do think that it could
motivate people. It’s a good motivator that might work more potently than self-care.

Eva Miller:

I think we’re talking about self-compassion and self-acceptance too.

I’m curious what you all think, as I’m talking to you, and I’m looking at your faces, I’m also looking at my
face and my body. That’s a real shift in the time of this pandemic when we’re doing zoom calls. As I’m
seeing my clients I also have myself looking at me. I’m looking at myself too.

I’m curious what you all are noticing about that. I’m sure for new moms, but also for anybody. I know some clients in treatment for eating disorders are really uncomfortable with looking at their image. We’re finding ways to work around that, whether it’s covering their image with a sticky note or
an affirmation.

I know even personally I feel like my relationship with my sense of self has shifted in the last couple of months because I’m seeing myself. I’m thinking “oh that’s what I look like when I’m talking to you? Oh that’s hilarious.”

Some of it is just compassion and humor. Self-acceptance can go such a long way. Well that’s overall during this pandemic, but in general.

Dr. Lindsay Mumma:

I’m actually really glad that you brought that up Eva, because that was not
something that I thought about at all when we moved all our classes to be online.

Then my sweet wonderful mother-in-law is not participating in the church group that she loves because
she says that she hates to see herself on camera. I was like, “for all that is holy. Okay, let’s get you a
great headshot and you can just put your picture up. Then you can still connect with the people that you
love. You can have your fancy little face up there if you want to.” But I had not thought of that at all.

I think it’s a really good point for where we are right now. A lot of people are looking for some amount
of connection but aren’t really feeling that accepting of themselves as they are. The place that they are
right now they don’t necessarily want to see.

Then there is, on the other side of it, if you’re teaching a class or working with people and they don’t have their camera up, it is much harder to feel a sense of connection.

I mean even when in person and they have a mask on and you can’t see their reaction. I happen to have
very expressive eyebrows so most people know what I’m doing at any point in time with whatever amount of face you can see, but not everybody does and it’s hard to read.

I think that there are some aspects of how we’re connecting right now that are actually going to be
impacting us for a long time. That’s a good point Eva.

Jessica Altemara:

After the last roundtable discussion, I sent out an article to everybody that was about why virtual consultations are exhausting.

Usually when I work with a client I feel energized afterwards, but I have found that after a virtual
consultation I’m starving, I’m exhausted, my nervous system just feels raw.

It was so interesting and the article was very informative. One of the reasons why was that you’re watching yourself. It’s not just an engagement in some kind of therapeutic practice, it is a performance.

Instead of just being a conversation that we’re having with each other, it feels like a performance.

What happens to us energetically, psychologically, physiologically when we’re performing is very
different from what happens to us when we’re engaging socially.