Last Friday, I featured part one of my interview with Linda Bacon, Ph.D, author of Health At Every Size: The Surprising Truth About Your Weight, and nutrition professor and researcher in the Biology Department at City College of San Francisco. She debunked many of the misconceptions we have about weight loss and the obesity epidemic.
Today, in part two, Linda talks more about the meaning of Health At Every Size, the problem with weight-loss programs, how to truly honor and listen to your body…and more!
(Oh, and I know that Mondays are usually the day I feature a body image tip or two, but stay tuned for that tomorrow.)
4. Q: Why do you think we don’t hear about the research (e.g., that diets don’t work and we can’t really control our weight) in the media or from our own primary care physicians, who’re the experts who typically advocate weight loss in the first place?
A: We all grow up in the same world. We’re all exposed at birth to cultural assumptions, and we see the world through the lens that we’ve been taught. We reach a point that these assumptions become the basis. I think about this a lot. For instance, I have a really hard time believing that the world is round. So why don’t we fall off the world? You need a flat surface, and I’m sure when it was first suggested that the world is round it seemed so counter-intuitive. Who are those creative thinkers that are able to let go of their assumptions and look at the evidence in a new way?
We’ve believed in the calorie balance equation for so long, we know that energy just doesn’t disappear. Calories stay on the body unless we burn them off. It’s clear scientifically, but it’s hard to believe that we have no control over this, especially since we all have personal experiences of being able to beat the calorie equation. You temporarily see your weight changing and it seems to get confirmed. It’s very hard to believe that there’s something going on behind the scenes that isn’t congruent.
We see that heavier people are much more likely to have type 2 diabetes, and since culturally we’ve been told for so long that fat causes diabetes, it seems like a no- brainer that the weight must be causing that. If you let go of the assumption that weight causes bad health, there’s a whole other way to look at the same measurements. Look at diabetes; is there anything else that they have in common? In fact, you’d find people who have type 2 diabetes tend to get less exercise, and we know that a sedentary lifestyle sets up disease conditions that make you susceptible. If we can let go of the weight issue, there’s a lot of underlying things that can end up causing both the type 2 diabetes and weight gain. It’s a different way of interpreting the facts that’s not about weight but other issues.
I think unfortunately that scientists and physicians are just as rooted as anyone else with the common assumptions around weight. We’re at a different point where this thinking causes a lot of damage. With Health At Every Size, we’re saying that it gets in the way of progress. What we’ve believed in hasn’t worked. We’ve caused people difficulty and pain. If we look at what’s really important for health it’s honoring your body and restoring a state of wellness.
I think the big issue is that our healthcare industry is as mired in the old assumptions as anyone else is. We have to help people see their assumptions are quite damaging. It takes courage for people to have that paradigm shift and for those of us that do challenge the paradigm, we get a lot of resistance. But I do think it’s all shifting, that the old paradigm isn’t working for us. We’re tired. We’re tired of feeling guilty about food and dieting. We’re at a point of real openness and people seem ready to hear a different message.
That’s why I wrote the book Health At Every Size, to help people to see all the faulty assumptions and the research that shows that fat people are actually living longer. The problem has been in our assumption and the way we interpret the data. While it’s true that heavier people are more prone to certain diseases, we can see the underlying issues. We can see that genetics and behaviors are much more important and as is the science behind set point.
Once people can understand all of the science and challenge all their assumptions, the second part is learning how to work within their internal system. It’s important to reconnect with your hunger and fullness; to savor chocolate and learn how to read chocolate, such as the messages it gives your body when you’ve had enough. There’s a large movement that’s trying to transform the paradigm. For instance, the Association for Size Diversity and Health (ASDAH) is committed to health at every size values and provides a place for health professionals to get support for the kind of work they do to support their clients. It’s having a dramatic effect on changing the profession.
5. Q: Many will say that being over 300 pounds isn’t healthy. What would you say to critics of HAES who say we should be focusing on weight loss, since being heavier has health implications, especially when we’re talking about morbid obesity?
A: No doubt some people are above a weight that is healthy for them. But we don’t have a clue how to help people lose weight and maintain it. Prescriptions to lose weight set people up for feelings of failure and deprivation and a lot of other difficulties, including teaching them not to trust their bodies. What’s the harm in supporting people in developing good health behaviors? If their body is meant to be healthier at a lower weight, with healthier habits, they may lose weight as a side effect – and that weight loss is maintained because it’s what their body wants. Health at Every Size is just as important for everyone, regardless of where they are on the weight spectrum.
6. Q: In your book, you write that we’re the best experts on how to take care of ourselves. But many people may automatically say that if they listen to their bodies and eat when and what they want, they’ll inevitably overeat and gain weight. Or if they do only things that they enjoy, then they’ll never exercise. What are your thoughts on how we can become experts on ourselves?
A: I understand that fear. We’ve been told for so long that we can’t trust ourselves, that many people are disconnected with their signals. If you’ve believed that ice cream is bad and never allowed yourself to eat it, despite loving it, then when you finally give your permission to eat, it may feel a little scary. But once you realize that you are allowed to eat it when you want, an amazing thing happens: you can stop eating the ice cream because you know it will stay in the freezer and be available next time you want it. It’s the idea that you can’t have it that prompts you to eat massive amounts.
If you overeat, you feel uncomfortable, so that’s a signal that you are not eating in tandem with what your body wants. The Health at Every Size approach encourages people to eat so that it feels good, to be attentive to what’s going on. Your body lets you know if you’ve eaten too much and you can use that learning experience to help you make a different choice next time. HAES isn’t about eating with abandon: it’s about eating attentively, so that you can enjoy food and feel good.
There are some similar points to be made around exercise. Try some stuff – everyone can find something that makes them feel good – and it’s this good feeling that motivates them to do it again. Ever have that exhilarating feeling after you’ve run somewhere? Or that sense of accomplishment from planting in your garden? Did you feel more connected with your friend when you went for a walk together?
Also, it may be valuable to just try to be more active and see what happens over time. If you take the stairs regularly for about three weeks, for example, your body may start producing more serotonin, which contributes to a feeling of well-being. Once you start to notice that it helps you feel better it becomes more appealing. I assure you – if you’re not regularly active and then you start to just do a little bit regularly – you will see some shifts in your energy level and how you feel throughout the day.
7. Q: Anything else you’d like to add?
A: The biggest take-home message that I’d like to leave people with is that you’re OK just the way you are. Your body is an amazing thing, even if you’ve got a disease. Consider the incredible ways it does support you. We can all find ways to connect with the magic of being human. The more we can celebrate and honor our bodies, the better we can take care of them. Everything starts with self-love and appreciation for who you are. When you start there, it allows you to make changes in your entire life. You want to eat so you feel good. It inspires you to make better choices and have better people around you who honor you for who you are, instead of people who will dump on you. The starting point is always about self-appreciation and it has dramatic effects. I’d really like to encourage everyone to focus on the beauty of who you are and honoring that and that’ll help you to expand.
Also, I’d like to acknowledge that there is a huge community of people committed to Health at Every Size. You can learn more about that community and get connected by visiting the HAES Community Resources at www. HAESCommunity.Org. My book, Health at Every Size: The Surprising Truth About Your Weight also has a lot of information and gives support for adopting HAES. Check out its website: www.HAESbook.com for a lot of free resources and additional information.
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Thank you so much, Linda, for opening our eyes to the realities of weight loss, damaging assumptions and self-care. I highly recommend Linda’s well-researched, insightful and inspiring book.
I know that it may be tough to take the focus away from weight loss and dieting. These concepts have been ingrained in us since childhood. Our society views being thin, restricting one’s food intake and exercising excessively as all virtuous things. And with the anti-obesity hoopla at an all time high, it’s even tougher to identify what being healthy really means.
That’s why I’m so excited about HAES. Like Linda said, focus on honoring your body and listening to it. Being healthy doesn’t mean losing weight at all costs. It means just that – adopting healthy habits that nurture your body by eating nutritious foods, staying active and becoming attuned to your body’s internal cues.
I also want to highlight a recent response from the National Association to Advance Fat Acceptance (NAAFA) that challenges the First Lady’s campaign for anti-obesity prevention. Check it out and let me know what you think. Here’s an excerpt:
• When important figures such as parents, teachers and peers in children’s social environment endorse a preference for thinness and place an importance on weight control, this can contribute to body dissatisfaction, dieting, low self-esteem and weight bias among children and adolescents (Davison & Birch,2001; Davison & Birch, 2004; Dohnt & Tiggemann, 2006; Smolak, Levine, & Schermer, 1999).
• The stigmatization of large children has increased by 40% over the last 30 years (Latner & Stunkard, 2003).
• Many drugs presently being prescribed to children cause weight gain. There was a 40 fold increase in bi-polar diagnoses in children between 1994 and 2003. 90.6% of youth received a psychotropic medication during bipolar disorder visits. For many, mood stabilizers, antipsychotics, and antidepressants were also prescribed. (Arch Gen Psychiatr,. 2007)
• Prescribing dieting is, in effect, prescribing weight cycling, and many people will be fatter in the long run (Mann, 2007).
• Weight-control practices among young people reliably predict greater weight gain, regardless of baseline weight, than that of adolescents who do not engage in such practices (Neumark-Sztainer et al., 2006).
• Based on results from a population-based, longitudinal study with 2,500 teens, Neumark-Sztainer and colleagues at the University of Minnesota (2006) concluded that to prevent obesity and eating disorders, the focus needs to be on health much more than weight. The more weight per se is talked about, the more likely teens are to adopt dangerous dieting behaviors.