When I first met Wendy, she tearfully explained that since she was four years old, she's been told she's "too fat!"' Her story is that while her mom was in the hospital giving birth to her younger sibling, she stayed with her grandmother and "blew up like a balloon." She was put on Weight Watchers as a pre-teen while at the same time food was 1ove.
She was told repeatedly lo finish everything on her plate. Over the next 40 years Wendy never questioned her own body hatred, until one day she heard me interviewed on a podcast talking about diet culture, and she decided that maybe there was a different way to feel about her body.
As I listened to Wendy's story, I expressed empathy around her desperation to lose weight and for how hard she's tried lo "follow the rules.” As we went over the details of her diet-binge history, I gently added information about the high failure rate of diets. I explained the physiology behind weight regain that typically increases set point over time. helping her to understand why her own struggle to keep off the pounds wasn’t her fault.
Most importantly, I offered hope about how she could make peace, with food and learn to accept, appreciate and respect her body. Wendy left our first session exclaiming, “No one has ever spoken to me before with such compassion about this topic. I feel a weight lifted.” We both look a deep breath, and I felt her relief.
As Wendy collected attuned eating experiences - honoring hunger and fullness signals - her bingeing decreased significantly.
The loss of her dieting mindset meant she could enjoy her eating experiences without emotional and physical discomfort. However, I often find that making peace with food is the less challenging part of the journey. Letting go of body shame is fraught with challenges from the internalized weight stigma our clients carry and the very real weight stigma that exists in the world.
But Wendy surprised me. During one of our sessions I felt a smile cross my face when Wendy referred to her "weight issues" as a kid and then quickly corrected herself; she reframed it as her family's issues about weight. The following week she brought in a picture of herself as a child and pronounced that looking back she remembers feeling "just fine" in her body. She had also perused family photos and realized that she resembled her ancestors built with sturdy bodies.
When Wendy attended her first plus size yoga class, she again felt tearful as she experienced an environment of body acceptance. With a supportive husband, a sibling who had also recently came across Intuitive Eating, and the discovery of anti-diet, Health at Every Size resources, Wendy continues working at rejecting cultural messages about body size. Even as she mourns the loss of time. money and energy wasted in pursuit of weight loss. Wendy has also lost much of the shame while gaining acceptance, compassion and connection.
I wish all of my clients could heal their body shame at this pace. I use many strategies to help people feel comfortable in – and take care of – their bodies: cultivating self-compassion and focusing on behaviors that support their physical and emotional well-being regardless of whether weight is lost.
Seeking out communities and social media that reject fat shaming and weight stigma also help my clients move toward body acceptance. But most express that even when they feel better in their bodies at home or in my office, they have to walk back out into a fat phobic and fat shaming world.
This is the aspect of my clinical practice that leaves me feeling broken hearted at times because the impact of weight stigma is so pervasive in session after session.
Victoria came to see me about her ongoing depression, binge eating and unsuccessful attempts at dieting. Her mother was also depressed, and Victoria explored how she turned to food growing up because there was no safe place to get the soothing she needed in times of distress.
In our early sessions, I helped Victoria work toward ending her deprivation driven eating, and as she gave herself permission to eat all types of foods without judgement, her bingeing decreased.
But Victoria felt triggered about her body size at work when her colleagues frequently commented that they couldn’t eat those items because they were dieting. They went on to discuss what’s “good” and “bad” as well as their latest weight loss attempts.
Victoria found a place to eat by herself so she wouldn’t have to hear their comments, but her strategy also meant a loss of connection with co-workers. While these kinds of conversations are normative in our culture, does it surprise you to learn Victoria works in an eating disorders treatment program and her colleagues are eating disorder specialists?
Unfortunately, Victoria’s encounter with fat phobia among mental health professionals is not unusual. Early on in my work with clients I witnessed the devastating impacts of weight stigma on my clients who struggled with eating and weight concerns: the client who felt the relief of accepting her current size, but felt the loss of connection with her family as conversations continued to focus on the latest diets, and they chided her for “giving up.”
The client experienced the actual loss of income because of policies at his workplace that gave employees a discount on insurance if they maintained a lower BMI. I realized that no matter what kind of healing took place in treatment, I also had a responsibility to work toward changing diet culture.
My view of my role as a therapist has moved beyond my counseling practice to include ally and advocate. I’ve found that I have the most reach through my writing and through the trainings I give across the country.
During trainings, clinicians participate in an experiential exercise to assess attitudes and implicit weight bias. Their typical responses include, “I would never make fat shaming comments, but I think them,” or "I don’t judge other people, but I feel upset about my own body size.” Another common reaction is “Wow! I didn’t realize I had these biases about weight.”
I encourage mental health professionals to stay compassionate toward themselves as they reflect on their attitudes toward “thin” and “fat.” After all, we’ve all marinated in diet culture. At the same time, I believe that each of us has an obligation to address our biases so that we no longer contribute, even inadvertently, to the fat shaming our clients may feel as the result of our own attitudes.
I gave my first workshop on attitudes on body size at the Renfrew conference in 2003 where, along with Ellen Frankel and Sally Strosahl, we explored how body size of both the therapist and client impacts interactions. We ended the workshop by asking the participants: What did you think of each of us, of our size, and each other’s size, as you walked in the room today? Did your impressions of us change during the workshop? If so, how and why?
As I speak around the country, I’ve slightly changed that question. I talk about thin privilege – the unearned advantages that came from having a thinner body in culture. Then, as a thinner presenter, I ask the following: Would you have heard the information I’ve presented today any differently if I were a higher weight presenter? I’m met with looks of surprise and heads nodding “yes.”
As the saying goes, if you’re not part of the solution, you’re part of the problem.
What does it mean for us as a profession to a weight inclusive model where we focus on behaviors that support health and well being rather than using weight as a proxy for diagnosis and successful recovery? What does it look like to become an ally to higher weight clients, including those with marginalized identities, and to advocate for their respectful treatment and care? What kind of loss would these changes lead to for you?
I ask these questions with the hope that they will foster more conversations about our profession and the role we can play in combatting weight stigma so that all of us – all shapes, sizes, colors, gender identities – can exist peacefully in our bodies in this diverse world.
Editor's Note: This article appeared in Perspectives, A Journal of the Renfrew Center Foundation
, Winter 2020 and is shared with permission.
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