Be Nourished

The Size of Your Doctor?

By Hilary Kinavey, MS, LPC

Did you see this little article in the New York Times magazine on 3/18/12?

"How Fat Is Your Doctor" By Hope Reeves

"In addition to the hassles and indignities they face on a daily basis, it turns out that overweight people also may not make very good doctors — at least when it comes to treating overweight patients. Researchers at Johns Hopkins University surveyed 500 primary-care physicians and found that doctors who battled the bulge themselves (those with a body-mass index of 25 or above) were less likely to recognize fatness or offer their patients diet tips. Basically,says the researcher Sara Bleich, “your doctor is unlikely to diagnose obesity or have weight-loss discussions with you if they weigh more than you.” Thin doctors, typically, seem to be just freaking perfect."

This weight-biased data suggests that the discussions regarding weight in doctors offices across this country are actually helpful at producing change.  It also suggests that the discussions between doctors in larger bodies and their patients are not happening and those patients are somehow missing out on some important information.

Hmmmm? 

It has been my experience that many of my “overweight” clients are actually having second thoughts or actively avoiding medical care to steer clear of the recognition of fatness that is referred to in this article. Some work diligently to find medical practitioners who are willing to entertain discussions with patients of all sizes that involve sustainable and weight-neutral self-care.  Most don’t know where to turn, but certainly would like to avoid the sometimes shaming and often unproductive recommendations regarding weight loss. 

In fact, the research on weight bias through the Yale Rudd Center is showing that the most reported incidence of weight bias that people experience is coming from healthcare practitioners and family members.  Weight bias research shows the more bias someone experiences, the more times they will try to cope with that bias through overeating, dieting and other shame inducing methods that do not support sustainable health behaviors. (Puhl and Brownell, 2006/2007)

We also know, from research on Intuitive Eating, that women who can approach their bodies with some acceptance are more likely to eat healthy (Tylka, 2006).  Making assumptions about a person based on their weight, even in a clinical setting, has not necessarily encouraged sustainable health behavior change, and has often done the opposite, producing more shame and potential alienation. 

This article, in it’s own tongue in cheek way, suggests that finding a medical professional who mirrors your experience may be the way to go to avoid stigma. I also believe that sharing your needs and expectations with your medical professionals is one of the most important ways you can participate in your own care.

Linda Bacon, in Health at Every Size offers a letter that patients can offer to their health care providers that discusses a sensitive care approach for people of all sizes.

If you have or know of a provider that you have received compassionate or weight-neutral care from, we’d love to know. We are compiling a referral list! Email amaya@benourished.org with the name and contact information.

I'm Not Good (Smart, Funny, Thin) Enough

By Cayla Panitz, MA

Brené Brown says that, “Knowledge is important, but only if we’re being kind and gentle with ourselves as we work to discover who we are.” For many of us, our inner critic gets in the w

ay of this process. You know the inner critic: That part of you that says you do not get a choice to be treated kindly by yourself. The part that tells you that YOU are not smart enough. Funny enough. Thin enough. It tells you that who you are right this minute is not good enough. And never will be. That somehow you are not worthy. The inner critic is best buddies with shame.  These two powerful forces tag team and make us think they are right. They remind us how much we have relied on them, how much we need them.

When we follow the path of the inner critic, we lose access to our True Self. Who we are becomes not enough. Sometimes we believe the inner critic so much that we forget that IT is NOT all of who we are.  The inner critic then robs us of vitality and connection, of being alive. Often, the inner critic blames us for negative emotions-it tells us we feel this way because we are not good enough. This perfectionist attitude removes us from what it is like to be human. It blocks our ability for self-compassion. When we think we are “not enough” we become disengaged from being connected, authentic, and vulnerable with others and with ourselves.

The good news is that we don’t have to be under the spell of the inner critic. There are different strategies to combat the inner critic and become more connected to our core selves. Self-awareness can lead to greater self-compassion, connection and a kinder, gentler, more accepting You. When we release our self-loathing and hatred and the idea that we will never measure up, we realize that, like everyone else, we are not perfect. That worthiness has no prerequisites. And we begin to become our true authentic selves now. Right this minute. As is.

Join us on April 7th for our Body Trust Network to further explore the functions of the inner critic, what it means to get in touch with your true authentic self, and how self-awareness can lead to greater self-compassion and connection.  

“A moment of self-compassion can change your entire day. A string of such moments can change the course of your life.” –Christopher Germer

Finding Your Voice

By Hilary Kinavey, MA, LPC

The process of becoming an intuitive eater can act as a powerful metaphor for understanding the places in us that scare us the most. When we learn to say “yes” or “no” to foods in response to a connection to what we know in our bodies, that same knowing begins to be available in other areas of our lives. These areas may have been long ignored, or under-explored simply due to the amount of time and space your worry and obsessive thoughts about food took up in your life. It’s a time when we begin to really see ourselves as whole for the first time in a long time.

When we are struggling to set boundaries in our lives and relationships, we are challenged to have boundaries with food. It just seems to work like that. When we begin to understand our body's requests and begin to have permission to enjoy food and stop eating food, then all of a sudden, we begin to seek and require boundaries in other parts of our lives.

The challenge here may be that eating and food have always stepped in when assertiveness and boundaries were actually what was needed. Many of us never really learned how to state our limits to the people around us, and food (or spending, drinking, etc, etc) supported us by creating a reliable, albeit temporary buffer between us and our discomfort in our relationships.

Learning to ask for what you need and feeling entitled to do so can be very intimidating because it may not be something you have had to do before. Many have stated that “it feels easier” not to, although it is clear that not having an authentic voice for many years has been far from easy. When our voices are diminished we lose connection to our innate joy, talents, wisdom and sense of place in ourselves.

In “The Dance of Connection” author Harriet Lerner suggests that the challenge “in conversations is not just to be our self, but to be the self we want to be. That’s why we don’t discover who we are by sitting alone on a mountaintop and meditating, or by being introspective and going deeper, as valuable as these disciplines might be. The royal road for discovering and reinventing the self is through our relationships with other people and the conversations we engage in.”

Not engaging authentically with the world from behind the mask of disordered eating is a powerful and creative coping method that was developed when needed the most. Stepping out from behind the mask of poor body image and dysmorphic ideas about your self is the way to heal all the way through. Brene Brown, a researcher who studies the impacts of shame, uses the following mantra to stay true to her authentic voice. “Don’t shrink. Don’t puff up. Just stand your sacred ground.” We are all entitled to take up space and use our voices to secure that space. It takes practice to really know this is true.

Love Your Body Day

By Dana Sturtevant, MA, RD

Today is Love Your Body day - a day when women of all sizes, colors, ages and abilities come together to celebrate self-acceptance and to promote positive body image. Every day should be love your body day because what sustainable self care practices come from body hatred?

Most of our clients come to us after years of using body hatred as the primary motivation for ‘eating better’ and ‘exercising more.’ I put these phrases in quotes because these behaviors are often far from healthy or sustainable. People restrict entire groups of food or eat such a small amount of food in a given day that it sets them up for overeating or bingeing. And the types of activities people engage in are often not pleasurable and are solely viewed as a way to ‘make up for’ eating or for getting rid of a handful of insert body part.

So how can we improve our health and hate our bodies at the same time? Is it really possible? I don’t think so.

When you love something, you take care of it. If you hated your dog, would you take it out for walks? Would you care if it got fed? Would you play with it? Give it the attention it so desires? Buy it cute collars, new toys and fun treats? Of course not! So how is it possible to do these exact same things for a body you don’t like? How has body hatred as a source of motivation worked for you so far?

Here are some tips to help you feel better about the body you have today.

• Spend less time body checking – weighing, mirror gazing, feeling your body for fat and/or bones, and comparing your body to others.
• Notice what your body lets you do. When we are so focused on what we look like, we forget that our body does AMAZING things for us every day.
• Dress your body in beautiful, comfortable clothing today. Stop waiting (or weighting) for your body to change to wear clothing that you like and that fits you well.
• Exercise for the joy of feeling your body move and function effectively, not to purge fat from your body or compensate for calories eaten.
• Pay attention to what your body tells you it needs and desires – joyful movement, food that tastes great and makes you feel good, sensual pleasures, and relaxation.

If you wait for the day that you like your body, chances are it will never come. That magic number or size seems to change as often as the weather.

Love Your Body Day

Love Your Body Day Blog Carnival

Can I love my body and still want to lose weight?

End Fat Talk

Orthorexia: The Road to Health is Paved with Good Intentions

By Hilary Kinavey, MA, LPC

"Many of the most unbalanced people I have ever met are those who have devoted themselves to healthy eating."
- Dr. Steven Bratman

We all know someone like this -- someone who obsessively eats so healthfully that you find yourself unable to relax in her presence at the dinner table. Perhaps you know several people like this, but in a few examples, you actually worry about whether or not someone is getting enough to eat to be healthy.

Maybe you've also noticed that she seems to medicate herself with food, believing that a chronic illness or pain is managed by their diet and, not only that, that this friend of yours talks about it quite a bit.

When you've found yourself worrying about this person, you likely reassure yourself by the fact that this person is knowledgeable about nutrition and, if anyone is eating well, it's this person, so you may dismiss your concerns.

Well, you might need to rethink that belief, according to Dr. Steven Bratman, who has coined the term "orthorexia nervosa" recently to refer to what he deems "a pathological fixation on eating proper food."

According to Bratman, orthorexia begins as a desire to overcome chronic illness or to improve general health but, because it depends on an iron will to change habits ingrained in childhood and reinforced by a fast-food-driven culture, some people find themselves obsessing about their dietary choices, ironically, to the detriment of their own health.

Like obsessive-compulsive disorder or, its close relation, anorexia nervosa, orthorexia quickly becomes a vicious cyle. When the orthorexic individual doesn't meet his own high standards of dietary perfection by indulging in ice cream or fettucine alfredo in a "moment of weakness," he will often respond by putting himself on even stricter diets and/or an exhausting exercise regimen, perpetuating the downward spiral.

According to Bratman:

"Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic's day."

One study on food preoccupation showed that people with no disorder spend 15-20 percent of their day thinking about food, while dieters, 20-65 percent; people with bulimia, 70-90%; and those who struggle with anorexia, 90-110 percent (Healthy Weight Journal, 1998).

Bratman warns on his website that the motivation behind the disorder "is a health food theory, such as rawfoodism, macrobiotics, veganism (and) that, in most cases, the underlying diet is reasonably healthy (if unreasonably specific). It's in the obsessive approach to diet taken by an orthorexic that the disorder lies." He describes how for the orthorexic eating healthy food is not unlike a religion and "begins to carry pseudospiritual connotations." This dogmatic approach can extend to the processes of planning and purchasing meals, dominating their lives, making their self-esteem dependent on their incredibly high dietary standards, and infusing them with a sense of superiority over others with what they deem unhealthy eating habits. One may question if someone can truly pursue "health" at the expense of their emotional wellness.

Like people with anorexia and bulimia, orthorexics give food a sense of disproportionate priority, and the yard stick by which they measure "healthy" eating habits varies depending on the individual. Bratman says there was a time when he wouldn't eat a vegetable if it had spent more than 15 minutes outside the garden, insisted on chewing each mouthful of food 50 times, would only eat alone and always left his stomach partially empty at the end of a meal. He also habitually lectured his friends and family about the perils of processed foods and the dangers of pesticides and fertilizers.

While their eating habits in and of themselves may not jeopardize their well being, people with orthorexia suffer from their tendency to alienate themselves socially and the stress they inflict on themselves from pursuing impossible eating and, in some cases, exercise regimens. Like other eating-disordered people, moreover, those with orthorexia do, in severe cases, run the risk of depriving themselves of the calories and nutrients required in a given day, endangering the health and their lives.

Even food politics leader Michael Pollan, in his well-regarded book In Defense of Food: An Eater's Manifesto, mentions orthorexia, describing America in general as "becoming a nation of orthorexics." While acknowledging that orthorexia is not yet formally recognized by the DSM IV, Pollan notes that "academic investigation is under way."

More information about this intriguing disorder is available at www.orthorexia.com , and Bratman has written a book on the subject, Health Food Junkies: Orthorexia Nervosa - the Health Food Eating Disorder