Wait…Why are we talking about my weight?

Raise your hand if you look forward to going to the doctor…

People, Weight Bias, Weight Stigma

Me neither.

Not long ago, I had a check-up that I had been dreading more than usual. I contemplated canceling several times. As I was considering whether or not I would go to the appointment, I thought about all that would be done at the check-up. One of the first things that came to mind was getting my weight checked. Lately, I’ve encouraged several of my clients to decline weighing at the doctor’s office if not medically necessary for their care as few of my clients look at the number on the scale as “interesting data.” I felt convicted to practice what I had been preaching to my clients, so I pondered what it would be like if I said “no” to the scale that day. When I started thinking about speaking up and not getting weighed, I -much to my surprise- started to feel nervous…my heart was beating fast!

I’ve had clients share that it’s easier to just get weighed to avoid getting questions or receiving funny looks from the nurse who is in charge of getting vital signs. If this sounds like you, you are not alone. I, too, was wrestling with the idea of refusing to be weighed! Many people fear making their doctor mad, seeming ungrateful for their help, or acting like they know more than their doctor. I’ve also had clients share that they were treated differently after refusing to be weighed at a doctor’s appointment, but it wasn’t until this particular day that I began to understand why my clients struggle so much with the scale in the doctor’s office.

I chickened out.

It truly felt easier to just step on the scale that day. The nurse took note of my weight. I saw my doctor, expressed my concerns, and attempted to get my questions answered. During my appointment, the doctor was not particularly forthcoming with lots of helpful information, but I was – for some reason- completely shocked at what she was forthcoming about. Right before walking out of the room, she decided to tell me, “And just so you know, you’ve gained [x] pounds over the last year.”

I stared at her blankly, basically in shock, wondering why she felt the need to tell me this information. I certainly hadn’t asked about my weight. Before I could formulate a response (or close my mouth after my jaw had dropped), she continued, “You’re still fine. It’s just something I tell everyone just so they know.” I think I managed to utter an puny “OK?” before she left the room.

Immediately, I was so disappointed in myself. I began thinking of all the things I should’ve said in that moment. Even more, I began thinking about my clients and the weight bias and weight stigma they have experienced. My weight remains in a range that is deemed “healthy” or “normal” by the medical community’s [sometimes arbitrary] standards, so IWait...Why are we talking about my weight? Weight Stigma & Bias by Healthcare Providers cringed thinking about how this conversation may have gone for a person who was considered “overweight” or “obese.” I thought to myself, “No wonder people decide to delay or avoid medical care!

I also thought about those who have struggled to gain the weight they need to be healthy. Hearing this comment could’ve been a major trigger for them. What if a patient gains muscle, making them stronger and healthier? What if the patient was recovering from an eating disorder? What about all of the other factors that can lead to weight gain?

Apparently, I’m not the only one who felt terrible about this one-sided conversation. It’s estimated that 20-30% of people will be strongly impacted by weight stigma from professionals but will not speak up for themselves, even when they know the truth about weight and health and want to be treated accordingly. The percentage is probably higher for those who receive unsolicited comments about their weight.

When it comes to weighing and weight, what can healthcare providers say and do to respect their patients?

What will I do differently next time (and what could you do in a similar situation)?

  • Plan and rehearse some responses beforehand to prevent being caught off-guard and subsequently left speechless when comments about weight are made or when asked to step on the scale.
  • Ask my provider, “How is my weight connected to the medical problem I have?”
  • Do my best to remain calm and engaged throughout the conversation. Ask as many questions as are needed to fully understand my provider’s perspective and assess whether or not it lines up with the research.
  • Consider sharing research with the provider.

Unsolicited comments about weight are not appropriate. Period. Fortunately, I’m at a point in my life where I feel confident and content with my health, shape, and size. It certainly hasn’t always been that way for me, and I’d venture to say it isn’t that way for most people in this world. As I look back on this experience, I’m grateful for the opportunity to share my perspective and hopefully prevent similar doctor’s office incidents. I’ve learned a lot from this recent check-up and couldn’t let it go before sharing it with you.

I’d love for you to send me your feedback and share your experiences. Have you ever been the recipient of an inappropriate comment about your weight? If so, how did you respond?


If you enjoyed this post, you may also like:

Practicing Weight Neutrality in a Weight-Biased Healthcare System

PracticingWeightNeutrality

In recent years, our society has become more open and understanding regarding peoples’ differences, but it seems weight is one area in which our culture has miserably failed to become more accepting. When it comes to size and weight, people continue to be judged against unrealistic and arbitrary ideals. Where is weight neutrality in this picture?

Too often, larger people are criticized, shamed, and misunderstood because of their weight. Furthermore, the perception of many healthcare providers remains that “if people would just lose weight, they could be healthy.”

Where’s the weight neutrality?

How ridiculous it is to think we can begin our lives with entirely different sets of genetics and end up looking the same or staying healthy at unnatural weights for our bodies!

Non-diet dietitians are already like fish swimming upstream in a river of 61-billion dollars-worth of diets, and the current becomes even stronger when practicing weight neutrality, especially when serving as the only weight neutral provider on an interdisciplinary team.

For several months, I worked with a woman (we’ll call her Beth) whose goal was to manage her diabetes, blood pressure, and cholesterol. She wanted to be healthy and to live longer, and she initially assumed the way to do so was through dieting. Our first sessions were spent reviewing and discussing research about diets versus intuitive eating, and Beth emphatically vowed, “I’m definitely not going back to dieting EVER!!!” stating she loved the newfound freedom she had with eating.

Eating intuitively, moving mindfully

In the meantime, through learning to eat intuitively and incorporate movement mindfully, Beth managed to cut her triglycerides in half and bring her cholesterol down to a normal range. She gained incredible insight into her relationship with food and recognized how satisfied she felt when she ate healthy AND tasty foods.

Giving up the scale

But there was one major challenge she continued to face: giving up the scale. After much discussion, Beth recognized how the scale was blinding her to the progress she was making toward health. She reluctantly agreed to put the scale in the attic for a while and contact me if she felt the urge to weigh herself.

Changing the view of progress

Beth acknowledged her need to change her view of progress. She began to accept the possibility (which was becoming a reality) of being healthy in a larger body and to recognize that her size did not change her worth and value in life.

She moved away from… She moved toward…
·  Focusing on a number on the scale that she could not directly control ·  Focusing on behaviors that lead to health
·  Focusing on weight first and foremost ·  Concentrating on actions she could control
·  Asking: “How many pounds did I lose?” ·  Noticing her increased trust in herself with food
·  Questioning: “How do I look?” ·  Questioning: “How do I feel?”
·  Priding herself on having good willpower or self-control ·  Priding herself on recognizing inner body cues

(Adapted from Intuitive EatingEvelyn Tribole & Elyse Resch, 2003/2012)

At her next check-up with her primary care physician, the first topic addressed related to weight loss. The physician praised Beth, exclaiming, ”You’ve lost 9 pounds!” Immediately, her mind wandered back to the number she originally had in mind that might make her “healthy” again.

Already feeling ashamed and discouraged, Beth hesitantly told her doctor, “I’ve been feeling exhausted lately.” Her physician responded by stating, “You’re still carrying around lots of extra weight. Imagine carrying around your 10-year-old son all day. You’d feel exhausted, wouldn’t you? That extra weight is keeping you tired!”

Validate the patient’s concerns

In one conversation, Beth’s physician not only fueled her recent fantasy of weight loss as a magic bullet to solve her health problems, she also failed to validate her patient’s concerns. Rather than taking inventory of the lifestyle, psychological, or medical conditions that could be causing her fatigue and offering a plan of care to reach the root of the problem, she gave the simplistic answer: “Lose weight.”

Make evidence-based recommendations

According to the research, 97 percent of diets fail, and most people regain their lost weight in 1-5 years (Puhl, 2008). Combine dieting and weight cycling, and you have a recipe for a physical and emotional health disaster.

Leslie Schilling, MA, RDN, CSSD, LDN puts it this way: “If you were prescribed a drug with such a high failure rate, would you fill the prescription?”

People trust their providers to administer quality, evidence-based care; however, when they receive different messages from different providers, how do they know whom to trust?

It’s time all health professionals learn that the number on the scale does not define a person’s health, worth, or value. Our patients are human beings, not human bodies, and they deserve evidence-based guidance, rather than judgment, shame, or “easy answers.”

Equip people to advocate for themselves

Perhaps as you read about Beth’s experience, you felt anger, sadness, and frustration bubbling up. It is my hope that the feelings you experience throughout Weight Stigma Awareness Week will be used as fuel to begin to educate other providers and equip those with whom you come in contact to advocate for themselves.

Ignoring weight bias does not increase awareness or lead to change, but here are some practices that can:

  • Derail “fat talk” or weight-biased conversations and deflect them using research to support your case.
  • Engage in body activism and encourage body acceptance.
  • Focus on functionality versus appearance in your practice.
  • Listen to your patients and seek to validate their concerns.

And remember to start with yourself. Examine yourself, looking for weight bias in your own life. Though the previous case study only addressed weight bias from a physician, I think we’ve all been taught or heard ideas that perpetuate weight stigma in our training. I know I have.

Practice weight neutrality

As providers, let’s stop believing that differences in weight and size define a patient’s health or worthiness of quality care. Let’s practice weight neutrality. Continue to remove weight stigma and bias in the provider community by changing the view of progress, validating the patient’s concerns, making evidence-based recommendations, and equipping professionals with knowledge and people to advocate for themselves.


It was an honor to contribute this post to Binge Eating Disorder Association’s Weight Stigma Awareness Week 2015. See the original blog post here.

If you enjoyed this post, you may also like these posts:

The Letter I Wish Someone Had Written To Me

Better Body Image in Just 4 Hours

The Letter I Wish Someone Had Written to Me

The Letter I Wish Someone Had Written To Me

Dear precious girl,

I know you are in  season of life when loving or even just being content and accepting of your body seems impossible. I remember standing in similar shoes years ago throughout high school and college. I recall feeling as though I could never achieve the thin ideal our society promotes and calls “the perfect woman” (unless, of course, I worked a lot harder AND had my own team of chefs, trainers, and stylists). As a result, I paid a very high price for several years trying to achieve this unrealistic and arbitrary standard of perfection. I missed out on fun memories and deeper friendships. I missed the peace and freedom with my body, food, and movement that comes from seeking a healthy ideal.

Stress and worry about my body, my exercise, and my diet took up so much of my time, energy, and mental space that could have been used making fun, spontaneous memories with those I loved most. Instead of trusting that I was “fearfully and wonderfully made,” my self-worth became tied to numbers and how I looked compared to others. I write this letter because I don’t want you to look back on this ONE life, this ONE body you’ve been given with sadness or disappointment about missed opportunities or isolation from family and friends.

Looking back in life to a younger me, I would tell her what I’m telling you today: To compare is to despair! We were created to be unique. How boring would life be if we were all the same? Sadly, we are taught to pursue the “thin ideal” which convinces us that even though we are all so different, we should all strive to fit the same “perfect” mold. How ridiculous! I wonder what might happen if we set our goals based on health and functionality rather than appearance.

Imagine how freeing and safe it might feel to embrace our imperfections and live an authentic life without worry about our height, weight, shape, age, etc. What if we challenged people who said the “F” word (aka “fat talk”) to stop judging themselves or others based on external appearance? By modeling this in our own lives, we have the potential to create a domino effect and encourage body acceptance in generations to come. Instead of competing with ourselves or other women, we could be breaking down barriers, reducing shame, saving money, staying healthy, and most importantly, turning our eyes toward the inner qualities that make us beautiful.

I see so many incredible qualities in you as a daughter, friend, sister, and child of God that far surpass the importance of any external quality. Though this letter talks about my own experiences and struggles and I have no way of completely understanding exactly where you are with your body image concerns, I believe our trials can be used to help others facing similar struggles or insecurities. You have been on my heart and mind, and my hope is that you will reject this thin ideal and focus on living your life for something that will outlast it. Our bodies will age and change over the years as they should, but your Creator, your family, and your true friends will cherish you based on your inward qualities and your heart. I see that inner beauty, and I support and affirm these qualities in you.

Love,

Blair


If you enjoyed this post, you may also like this post:

Better Body Image in Just 4 Hours!

Better Body Image in Just 4 Hours!

IMG_6132

Can you relate to this comic? Have you ever experienced one of those “body image seizures?” I often wonder if there is a person out there who doesn’t struggle with body image to an extent. I know I can’t say that I’ve always been 100% appreciative of my body…

What would you say if I told you the only thing standing between you and a better body image was 4 hours? You’d probably say something like, “This sounds too good to be true!” That’s understandable. Our society is full of “too good to be true” messages about a lot of things, but there is a workshop called The Body Project that truly delivers on the following promise: By the end of the workshop, participants can expect to significantly change the way they feel about their bodies and how they will treat their bodies in the future. You can imagine my skepticism at achieving this goal for myself as I embarked on the facilitator training as a body-positive professional, but my life was positively impacted both personally and professionally! I’ll be sharing more about this in later posts, but first…

What is The Body Project?

The Body Project is a dissonance-based body-acceptance program designed to help high school girls up to young women (typically up to age 40) resist cultural pressures to conform to the thin-ideal standard of female beauty and reduce their pursuit of unhealthy thinness. Group size is limited to 9-16 individuals so that everyone has the opportunity to interact and actively participate.

I knew I had to become a facilitator of this workshop back in November of 2014 when I learned these 3 things:

  1. The Body Project has already been delivered to over 200,000 females across the world and has never failed to be effective.
  2. The Body Project is supported by more research than any other body image program (15 years worth of research support this workshop…it has never failed to show effect sizes!).
  3. The Body Project has been found to reduce onset of eating disorders. If you think about it, this workshop could save lives!

I am thrilled to finally bring this workshop to Memphis, Tennessee along with my colleagues at Schilling Nutrition Therapy.

The Body Project challenged me to continue not only thinking about the high cost of pursuing the “thin ideal” our society promotes but to also actively reject the idea that we have to meet such an unrealistic standard in order to be considered acceptable. The workshop significantly increased my confidence in speaking out against “fat talk” (or diet, weight-related talk) that I encounter on almost a daily basis. Wouldn’t you love to feel empowered to speak out when someone says, “You are so thin, how do you do it?” or “I’m way too fat to be eating this.”? These comments are NOT okay. 

Maybe you’re like the character in the cartoon above. When you look at yourself in the mirror, you (consciously or unconsciously) look to find something wrong with yourself. Take the first step toward a better body image TODAY, and begin looking for the positive on both the outside AND inside next time you glance at yourself in the mirror. Then, contact me to sign up for the next Body Project workshop in Memphis, Tennessee! Your time is precious, but 4 hours to a better body image is priceless and worth the time.