Lisa Rutledge, RD, on Mindful Eating and Health at Every Size: Ignite self-kindness and fight back against fat-shaming

When we last chatted with Lisa Rutledge, Registered Dietitian and Founder and CEO of Custom Nutrition, our interview highlighted the importance of understanding personal eating needs, food trends and the work that goes into undoing self-doubt and an unhealthy relationship with food.

I reached out to Lisa again after reading, and interacting with, a Facebook post on my newsfeed where I found myself having to explain why fat-shaming is wrong (I know, I’m surprised that I had to have this conversation, too). So many of us have experiences with shaming, of any type, and the aftermath leaves us feeling self-hate and self-aggression. It takes years, if not lifetimes, to get over the harm that comes as a result of shaming (which is a form of harassment and bullying), and with personal experience with being fat-shamed, it continues to be crucial for me to talk about how we can work to become a more body positive society. I spent a long time hating food, and hating myself, which I recently wrote about in the Huffington Post.

Post-Facebook feud, I wanted to know what a dietitian had to say about fat-shaming and the judgments we so quickly pass on people based on their food choices, weight, shape and size. And, I wanted to share that information with our readers. This conversation has to keep going.

You can read our full interview with Lisa, below, where she also shares numerous resources about the subjectivity of health and wellness.

  1. When we last chatted, our interview focused on healthy eating, with the importance of individualized meal plans. How has your counselling and approach changed or adapted since December 2015?

This is going to sound corny, but I feel that my practice is always changing! I have continued to better understand how to integrate mindful eating, weight neutrality and body acceptance into my nutrition counselling to help my clients feel happier and healthier. Since these “philosophies” are often co-opted by people and companies to sell weight loss products/books/food/etc, it is easy to get sucked into the world of weight control (versus actual health improvement).

I see the words “meal plan” in your question and I cringe! Since mindful/intuitive eating has everything to do with turning “inwards” to ask our bodies and minds what they need in terms of types of foods, and quantity of foods, using an external thing like a meal plan to tell us what, when and how much to eat moves us away from following our intuition (what is partly made up of our body’s appetite regulatory system). There are certain circumstances where a flexible meal plan may be temporarily useful for a client and that usually involves recovery from an eating disorder or disordered eating (when intuition about eating may need to be re-discovered). However, the comforts of a meal plan and someone else taking the responsibility to decide what to eat turns into a form of restriction once any disordered eating has been resolved. Moving into a practice of mindful eating allows for formal meal plans to morph into flexible eating that is in line with hunger, tastes, convenience and budget.  

  1. You recently returned from a conference on body image and self-esteem held by National Eating Disorder Information Centre (NEDIC), where talks discussed a Health at Every Size (HAES®). What does this philosophy include?

The basic HAES® philosophy includes the beliefs that:

  • There is naturally existing diversity in body shapes and sizes. In other words, we are not all meant be a BMI between 20-25. Diversity in our sizes has and always be present. Kind of like how there are all sorts of types of dogs – bog, medium, tall, short, fuzzy, etc. This also means that size does not reflect one’s health. We have to look at the actual health factors like cholesterol, stress levels, sleep quality, blood pressure, etc., to determine one’s health status.
  • The ineffectiveness and dangers of dieting for weight loss. About 95 per cent of all diets lead back to weight regain and of those people who regain the weight, 60 per cent of them will regain MORE. There are serious mental health consequences to dieting, not to mention physical consequences.
  • The importance of relaxed eating in response to internal body cues. As I mentioned above, hearing and heeding hunger cues, fullness cues as well as enjoying food to help it be satiating is important.
  • The critical contribution of social, emotional, spiritual and physical factors and their interdependence with health and happiness. It has been found that there are many factors that determine our health and the things we can mostly control – how we eat, sleep, move – only count for about 20 per cent of our health, according to the Centres for Disease Control and Prevention (CDC). So, blaming others for their own unhealthiness is not only unfair but wrong.
  • HAES® is NOT stating that everyone is healthy at all sizes – it is that health is determined by factors other than size/weight. Also, that health includes both mental and physical health.  
  1. How can a HAES® philosophy not only improve your patients’ lives, but the lives of people around them?

HAES® can help ease people’s concerns about their weight, while improving their health and the quality of their lives.

Since science has shown us body size is dependant on so many different factors (biology and physiology, mental health, history of dieting, our economic status, where we live, where we work, our social circle, our living circumstances, etc.). Blaming and shaming people for not being a size society deems appropriate/sexy/healthy (which, by the way, changes every decade) leads to stress and discrimination which in turn leads to poor health. Dr. Linda Bacon puts it nicely in her book Body Respect: “Current ideas about weight [focus on treating and preventing fatness] leads to cycles of weight loss and regain, food and body preoccupation, self-hate, eating disorders, weight stigma, discrimination and thus poor health.”

Our lives and the lives of people around us can improve by adopting a HAES® approach to life and health because it helps us focus on the important factors that improve health AND reduces propagation of unscientific and wrong health advice (that does nothing to actually improve health).  

I think the Binge Eating Disorder Association, BEDA, puts it well: “It is commonly believed that weight stigma is an issue only for girls and women, and only for those in bodies larger than our culture deems acceptable. In fact, weight stigma has a profound impact on us all. For those in more socially ‘acceptable’ bodies, there is often a fear of weight gain, and of losing ‘thin privilege.’ Increasingly, boys and men are being pressured to focus on weight and shape as well. Having ‘six pack abs and muscle definition, in addition to being tall and trim, is a highly reinforced cultural goal.”

  1. Our society is so quick to judge a person’s health and wellness just by looking at them. One glance at someone’s size, and we assume we know whether they’re healthy, including their exercise and eating patterns. What can we do to train ourselves to understand that the word “health” doesn’t come with just one, government-approved definition?

Firstly, weight is NOT a sign or factor of health so I even have an issue with saying that it is not the “only” one. It is an easy one to judge given that it is easy to see and compare. Our cholesterol, blood pressure, stress levels are not written on our forehead so cannot be guessed by looking at us.

It is important to know that weight stigma is defined as, “bullying, teasing, negative body language, harsh comments, discrimination or prejudice based on a person’s body size or weight.” Weight stigma depends upon three basic assumptions: thin is always preferable, thin is always possible, and thin people are better people.

Multiple studies have shown that across disciplines, health care providers think of larger-bodied clients as non-compliant, lazy, awkward, weak-willed, dishonest, lacking in self-control, sloppy, unsuccessful, and unintelligent. And this is just addressing how the medical/health community of professionals think – imagine what the greater population believes!

You could take this quick, online test to evaluate your level of weight stigma: http://weightstigma.info/

The biggest question to ask yourself is, “Do I make assumptions based only on weight regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors?” I suggest keeping track one day of the number of times you speak about your weight, others’ weights, weight loss as the means to health or beauty, think about someone’s size, describe someone based on their size and/or make judgements based on what you see. Just tracking the number of times we think or speak these things can be a powerful way to bring to light just how often we do these things.

The interesting factor is that everyone, regardless of size, can hold weight bias beliefs. In fact, many of my clients who live in larger bodies judge themselves for having larger bodies, which does nothing to help improve their self-care, self-esteem, respect for their bodies and food and exercise habits. They are often less healthy because of this body hate.

  1. As someone who has personally been on an uphill battle with how I perceive my body and the food that I eat, I’m easily offended when I see others making negative comments about a person’s shape or size. How can people like me help to reduce body-shaming and work to create a more welcoming society for people of all weights and waistlines? 

Isn’t it amazing how a life experience or even a dip into the HAES® world can lead to seeing how weight based our society is? It is a joke in the HAES® community to say, “You’ve been HAES’d,” because once you go HAES, you can’t go back to the traditional ways of thinking about food and our bodies. It can certainly lead to strong reactions to outdated messages on social media and lots of frustration.

Standing up for yourself and your food/exercise/lifestyle choices is a good place to start. Having a set of things to say to shut down other people’s comments is helpful. For example, if you are in a conversation that revolves weight loss you could say:

  • “Sorry, I make it a rule not to talk politics, religion or weight/diets at work!”
  • “If my eating/weight ever becomes your business, I’ll let you know.”
  • “I keep the weight and diet talk for conversations with my dietitian.”

Jennifer Rollin, MSW, LCSW-C has some great advice for ways to respond. A few examples are outlined below:

  • “I’d rather talk about anything other than your diet! Did you watch the new Beyoncé video?”
  • “How about that new Game of Thrones episode?”
  • “I hear that you’re really into your new diet, but talking about it keeps me from enjoying this meal and my time with you.”
  • “I’m trying not to focus on weight; there are so many more interesting things about people.”
  • “Health and happiness is not size specific.”
  • “I’m trying to focus on listening to my body’s needs, so could we refrain from the diet talk please?”
  • “Life is too short to worry so much about food, so I choose to focus on other things.”

If you feel you’ve encountered weight stigma by a health professional or at work, the Rudd Centre suggests: “Depending on the situation that you experienced, you may also consider approaching the provider to express that your feelings were hurt by his/her comments or actions. If you do this, you may want to first write down the events that occurred and your feelings or concerns, so that you can clearly express yourself when having this conversation. It may also be helpful to ask the provider for suggestions of what steps can be taken to prevent a similar situation from happening again in the future.”

As for sticking up for other people, it can be tricky to do that when the other person is in the room. Perhaps speaking with them afterwards to ask them how you could have helped in that moment (did they need support in the moment? Were they handling the comments in their own way?).

If these are general statements about size or the person is not present, you could site some of the research I mentioned above (or check out all these resources via the Association for Size Diversity and Health: https://www.sizediversityandhealth.org/content.asp?id=34 and https://www.sizediversityandhealth.org/images/uploaded/HAES%20FACT%20SHEET%20SM%20rev%206%206%2010.pdf.

It may be “normal” these days to judge food or weight, BUT doing so is certainly rude and disrespectful. Sometimes not engaging in the conversation (or saying nothing at all) can be quite telling. We can’t change everyone’s opinion, but we can certainly plant the seed to different thinking.

  1. In your experiences as a Registered Dietitian and the Founder and CEO of Custom Nutrition, you must hear and witness experiences of body and fat-shaming. How does bullying of this nature impact the person on the receiving end?

The impact has no end to how it can affect someone. If it has been occurring for a long time (for example, since they were a kid) it makes repairing their relationship with food and their body that much harder (not impossible, but the journey can take longer).

Not only does healing take longer, but they are more likely to have suffered more consequences of trying to change their size. So, as I mentioned above, cycles of weight loss and regain (which leads to poorer mental and physical health), food and body preoccupation, self-hate, eating disorders, weight stigma, discrimination and thus poor health.

Since mental and physical health are affected, they often need a larger team of health professionals to help them heal (HAES® and eating disorder dietitian, psychologist, specialist doctors, etc).

  1. On average, when does a person begin to experience bullying because of their weight and size? 

To be honest, I have no idea what the stats are. However, with the media’s habit of over reporting and hyping up child obesity, it has no doubt increased bullying in young children (by other children, teachers, parents, and other adults).

One study states that: Overweight and obese children are more likely to be bullied than their normal-weight peers. For example: In a survey of 11 to 16-year-olds, 10 per cent of normal-weight children reported being bullied, compared to 15 per cent of overweight and 23 per cent of obese children. Obese girls were 2.7 times more likely than normal weight girls to be verbally bullied on a regular basis and 3.4 times more likely to be excluded from group activities (Janssen, I., Craig, W. M., Boyce, W. F. & Pickett, W. (2004).

According to Neumark-Sztainer, D. R., (2007), body-based teasing can have a serious impact on girls’ attitudes and behaviours. Girls who reported teasing by family members were 1.5 times more likely to engage in binge-eating and extreme weight control behaviours five years later.

Another study has haunting results: Adolescent girls who diet are at 324 per cent greater risk for obesity than those who do not diet (Stice et al., 1999).

The problem with weight bias is that even people who are living in “acceptable” body sizes are affected, since they worry about what may happen if they are hit with the “obesity epidemic.” Thirty-seven per cent of girls in grade nine and 40 per ent in grade 10 perceived themselves as too fat. Even among students of normal-weight (based on BMI), 19 per cent believed that they were too fat and 12 per cent of students reported attempting to lose weight (Boyce et. Al. 2008),

  1. I experienced bullying because of my size the second I started school – so just weeks before my fourth birthday – until my second year of high school. I’ve had to work really hard at undoing and untangling the wires in my head that tell me I’m unhealthily and fat. It sometimes feels like I wasn’t programmed correctly, and jumping over these hurdles is not even a little bit easy. What steps do you complete when working with your clients who may have had similar experiences?

I am sorry to hear that you’ve had to live through these super tough experiences.

Helping clients improve self-image and esteem is a newer area in which dietitians work. Since self-talk and body acceptance plays such a huge role in food choices, it is an area we can’t avoid.

I will usually start by asking the client how they perceive their past experiences with weight shaming/bullying affecting their life and view of themselves (if they have indicated that it’s been an issue). Bringing to light the science behind our weight and body size can help reduce the perpetuation of the myths linking body size to eating habits and health.

Some people are unaware how often they criticize or judge their body, so I usually suggest an exercise where they track their negative thoughts about themselves. Seeing the actual number of times we are mean to ourselves is quite powerful. However, taking this exercise to another level can be achieved by noticing these thoughts as they happen and letting it pass by without reacting to it. You could also counter these thoughts (which are usually exaggerated or downright wrong) with a positive thought or alternative way of wording the criticism.

Sometimes we have a negative thought about our body that has been triggered by an outside stress. Figuring out what that stressor could be can help to put things into perspective. Sometime we cope with stress or things we can’t control by turning them into a problem we can control (or think we can control) such as our weight.

A more popular exercise these days is to make a “gratitude list” about your body or other aspects of your life. Some may call this a “top-10” list of things you like about yourself (things that aren’t related to how much you weigh or what you look like). Reminding ourselves of all the good we contain can be necessary in this negative-obsessed world.

Decontaminating your social feeds can help tremendously with removing the influence of others on your self-esteem. Fill your Facebook and Instagram feeds with activists of the body positive, weight neutral, HAES ® and mindful eating philosophies. There are SO MANY to choose from these days and they are not hard to find.

  1. Recently, I had a heated Facebook discussion about why fat-shaming is unacceptable. There is a common misconception and assumption that fat-shaming enables a person who is overweight to continue to fall into unhealthy patterns. I’ve also heard comments like, “Telling them they’re fat prepares them for rejection, and it’s a form of tough-love.” What would you say to someone if they made a comment like this to you? 

Oh boy. I think my reaction may depend on the day!

If I am feeling calm and collected, I may remind them that people in abundant bodies are well aware of their size. They’ve been living with bias for perhaps a long, long time. They don’t need a reminder that society is treating them differently.

Tough love has never worked well to encourage people to change their lifestyle (and that is assuming they aren’t already living a healthy lifestyle). In fact, lots of research shows that we must accept things as they are, without judgement or shame, to truly be able to change something or improve something. Shame keeps people from changing, it does NOT encourage them to self-improve.

As Brene Brown puts it, “Shame is much more likely to be the source of destructive, hurtful behavior than the solution or cure. Shame corrodes the very part of us that believes we are capable of change.”

If I was quick on my feet, I’d quote Marilyn Wann (author of Fat!So?): “The only thing anyone can diagnose by looking at a fat person is their own level of prejudice toward fat people.”

  1. Comments about food, weight and size can be triggers for so many of us, and sometimes, these remarks can be hard to hide from! What advice do you have for people discussing fat-shaming and any form of bullying, really, in public and on social media? 

Some people’s opinions about food, weight and size will never change. Stop wasting your energy on trolls or people who are obviously invested in weight loss culture (especially those who are making money like selling a book, supplement or program). Focus your efforts on the important people in your life. Sometimes we have to take a break from being a loud advocate for these counter-cultural things in order to protect our sanity.

Surround yourself by like-minded people on social media with whom you can discuss ways they are dealing with advocating and their mental health.

If you feel courageous enough to speak out in a public setting to stand up for yourself or others, say what is on your mind. What you eat is most definitely not anyone else’s business. As I mentioned earlier, have a few witty comebacks in your back pocket for times like those. For example, I have an amazing colleague who felt shamed for her body size after having two kids, multiple health issues and just finished cancer treatment. She is an RD and felt like others were judging her for not having an “expected” RD’s body. I sarcastically told her that she should say, “Well, that’s what beating cancer can do!” I was only half joking! If someone has the nerve to make a comment about your body or food, why not bite back? They certainly didn’t spare your feelings, why should you extend that courtesy?

  1. Unfortunately, for many who live with misconceptions of body image, there is so much guilt that we carry when we indulge in a treat, like pizza on Saturday night or cake after Sunday lunch. Your approach involves encouraging a balanced diet – including leaving room for sweets and salty snacks. How do you work with your clients to help them overcome those feelings of guilt, and those feelings of self-doubt?

For most people, including (or giving yourself permission to eat) all foods is very therapeutic. So, for some, calling it a form of “therapy” to improve their health is helpful. Scientifically, it helps tremendously to reduce binge eating, emotional eating, fear of foods, preoccupation with foods and the feeling of being “addicted” to certain foods.

Also, eating all foods is a normal way of living. Meaning, it is not normal for a human to worry or overthink what they are eating. Our brain was made for making more important choices. Normal eating is flexible and it varies in response to your hunger, your schedule, your proximity to food and your feelings.

I would take the idea of, “make room for sweets and treats” further by saying that they are foods like any other. When we start to make a distinction between “good and bad” foods, or “healthy and treats,” we can easily slide down the slope of judging foods, which perpetuates our guilt and self-doubt. So removing these labels is one step to reducing guilt. Some clients find it useful to assign good reasons for eating these foods (for example, ice cream contains calcium, pizza is a balanced meal, etc.). However, keep in mind that a food doesn’t need to contain a virtuous nutrient in order for it be consumed.

Tearing apart the reasons why you feel guilty for eating certain foods is something I work on with my clients. Is it due to something you were taught at home? Based on a myth or a past diet rule you followed? Suggested by someone who is selling something? Will eating a bit of that one food really change your weight or affect your health?

Understanding that guilt gets in the way of changing habits AND why that guilt is unnecessary (or based on myths) is useful for my clients. Rarely do my clients have the chance in the real world to hear someone say that guilt is bad. It is often glorified!

A huge thank you to Lisa for speaking with A Quarter Young on this important issue, for sharing facts about the diet industry we often overlook and for supporting all definitions of kindness, health and wellness.

Lisa also recommends the following resources to learn more about HAES® and the importance of body positivity and body inclusivity:

Podcasts:

Books:

Blogs/Websites:

Do you have a question for Lisa or want to learn more? Visit her website at lisarutlledge.ca, where she will broadcast her first podcast episode. You can also follow along via her Facebook and Instagram.

 

 

 

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