Curate Your Feed with Diverse Body Positive Accounts on Instagram

Photo, Resilient Fat Goddess Instagram

by Sarah Thompson, Resilient Fat Goddess and Lauren Muhlheim, Eating Disorder Therapy LA

“Body positivity can’t be just about thin, straight, cisgendered, white women who became comfortable with an additional ten pounds on their frame.” —Stacey Rosenfeld, Ph.D., Shape magazine (July, 2018).

Eating disorders are about so much more than body image, but the current diet culture, idealization of the thin ideal, and “war on obesity” make it much harder for people with eating disorders to recover. We are barraged on a daily basis by media images of people who represent only a small portion of the population.

As Dr. Muhlheim discussed in a previous post about fat photography, the mainstream media images we see are not diverse, and the images we do see of larger bodies are often portrayed in a particularly negative and stigmatizing way, adding fuel to the fire.

Thus, an important exercise for people of all sizes in recovery is to curate their social media feed by removing accounts that perpetuate the thin ideal and expand the range of body sizes and types to which one is exposed. Adding diversity to your social media feed isn’t only important for people in recovery, it can be just as important for partners as Sarah Thompson wrote about here. It would even be useful for parents and family members of those recovering.

The term used to describe the absence of representation in media was coined by George Gerbner in 1972. This phenomenon is “symbolic annihilation.” Gerbner was a Hungarian Jewish immigrant and communications professor who researched the influence of television trends on viewers’ perceptions of the world. According to Coleman and Yochim, Gerbner explained that “representation in the fictional world signifies social existence; absence means symbolic annihilation.” Representations, or lack thereof, lead to assumptions about how the world works and who holds power.

Gerbner did not assign symbolic annihilation to any particular group, so it has since been applied to many different identities. We can apply the concept to non-dominant systemic identities, such as larger bodied people, people of color, trans and gender-expansive people, disabled people, etc. If we don’t see bodies like our own represented, we may come to believe “my body doesn’t matter”. Often, this can turn into “I don’t matter”. This means that for people whose bodies are marginalized in any way, it is essential to see images of people that look like them.

We have developed a roundup of Instagram accounts to help you on the journey. While it is not comprehensive, it is a starting point. What follows are some Instagram accounts that show body-positive images that celebrate diverse bodies in ways that mainstream media does not.

At the time of this posting, these accounts are free of body shaming, fat shaming, food shaming, and disordered eating. Some are people in recovery from eating disorders. If we missed one of your favorite accounts that consistently publishes photos of bodies at the margins, please email us and let us know!

Larger-bodied women

@madeonagenerousplan

@iamdaniadriana

@themilitantbaker

@fatgirlflow

@fatwomenofcolor

@cosmiccollette

@bampowlife

@danielle_bex

@fatlippodcast

@shesallfatpod

Larger-bodied men

@bigboysarecute

@johnasavoia

@abearnamedtroy

@chubstr

@bear_skn

@zachmiko

@300poundsandrunning

People of color

@iamivyfelicia

@onebeautifulyes

@thefriendineverwanted

@nalgonapositivitypride

@sonyareneetaylor

@virgietovar

@genizeribeiro

@ihartericka

@diannebondyyoga

@mynameisjessamyn

@biggalyoga

@sassy_latte

@adydelvalle_

@melissadtoler

Gender diverse people

@transfolxfightingeds

@comfyfattravels

@chairbreaker

@thirdwheeled

@alokvmenon

@nonnormativebodyclub

@shooglet

@resilientfatgoddess

@thefatsextherapist

@watchshayslay

Older people

@efftheiragingstandards

@idaho_amy

@lamplight.space

@gidget3304

@glitterglama

@fruitbat5150

@26kleisen

@finally_bopo

People with disabilities

@the_feeding_of_the_fox

@dietitiananna

@theonearmedwonder

@rollettes_la

@disabilityisdiversity

@the_hapless_roller

@spookyfatbabe

@disabled_fashion

@princesscakep0p

@everybodyisworthy

Multiple Identities

@thebodyisnotanapology

@decolonizingfitness

@subversesirens

@fatkiddanceparty

@adipositivity

@underneath_we_are_women

@lkt_consulting

@flourorchalk

Other body positive accounts to follow

@sweetamaranth

@iamannachapman

@nolatrees

@bopolena

@bopo_watercolour

@shoogsart

@shelby.bergen

@neoqlassicalart

@lovefromdanica

@bopo.boy

Source

Coleman and Yochim. The Symbolic Annihilation of Race: A Review of the “Blackness” Literature. Perspectives. Spring 2008. http://www.rcgd.isr.umich.edu/prba/perspectives/spring%202008/Means%20Coleman-Yochim.pdf

Fat Positive Photography

Fat Positive Photography
Representation Matters

I’ve recently returned from the Association for Size Diversity and Health (ASDAH) Conference and I’m reflecting on all I’ve learned. I’ve wanted to share and further explore Substantia Jones’ keynote, “Fat Visibility Through Photography: the Who, the How, and the Hell Yeah.”

Jones is a photographer, a “Fat Acceptance Photo-Activist,” and the proprietor of the Adipositivity Project.  She started Adipositivity in 2007 to “promote the acceptance of benign human size variation and encourage discussion of body politics” by publishing images of women, men, and couples in larger bodies. Substantia is passionate about the fact that fat people don’t see a balanced representation of themselves in the media—as she says, “Humans need visibility. Positive and neutral visibility is being denied to fat people.”

So many of the media images we see of larger-bodied people portray them in negative and stereotyped ways: unkempt, unhappy, eating fast food, and often headless—as if they are ashamed to show their faces. At the same time, the range of body types provided by media images does not really represent most bodies. The media typically culls the thinnest or fittest sliver of the population, and then proceeds to photoshop the images of these bodies.  According to the Body Project, “Only 5% of women have the body type (tall, genetically thin, broad-shouldered, narrow-hipped, long-legged and usually small-breasted) seen in almost all advertising. (When the models have large breasts, they’ve almost always had breast implants.)”

In September 2009, Glamour included a photo of Lizzie Miller, a model who is a size 12-14. The photo showed Lizzie nude and looking joyful while displaying a roll of belly fat. The response was overwhelming—American women were thrilled to see a woman who looked more like them and was happy to boot.

While this was groundbreaking, the average American woman is a size 16. So where are the images of the upper half of the weight spectrum? It should be noted that it is not only larger bodies that are marginalized; other bodies are often not portrayed in mainstream media. These include bodies that are darker-skinned, disabled, aging, and gender diverse.

It is important that people in larger bodies see images of people that look like them. It is also important for all people to broaden their aperture on what people should look like. This includes viewing images of fat people who are happy, sexy, desired, and beautiful and engaging in all the activities that make up a fulfilled life.

Those working in the field of body acceptance confirm the therapeutic value of seeing attractive images of larger-bodied people. Unfortunately, these images can still be hard to find. One must look outside of the mainstream media. With that in mind, I thought it would be useful to provide resources for beautiful, artful photos of people living in larger bodies.

During her keynote, Substantia shared photos from several of her favorite fat-positive photographers, including those that inspired her. Below I list some of the photographers she shared and where to find their photos and information about them.

  • The photography of Patricia Schwarz can be found in Women of Substance – Portrait and Nude Studies of Large Women, published in Japan in 1996 by The Kiyosato Museum of Photographic Arts. Little has been published about her aside from this article, which states that Schwarz, who belonged to the fat liberation community in the 1980s, specialized in full-color photography of fat women. The book features women posing in domestic, natural and urban settings in various stages of clothing and nudity.
  • Laura Aguilar is known for her photographs of people from various marginalized communities (including fat, lesbian, and Latina). She is particularly known for portraying her own nude body as a sculptural element in desert landscapes.
  • Leonard Nimoy (yes, that one) published The Full Body Project, a collection of black-and-white nude photos of members of a burlesque troupe called the Fat-Bottom Revue. According to Nimoy, the purpose of the book was to challenge the harmful beauty ideals promoted by Hollywood.
  • Catherine Oakson was described in an obituary as a creator of “artistic self-portraits—some playful, some sensuous—and messages of body positivity.” Unfortunately, since her death, her photographs are extremely hard to find. Her website, “Cat’s House of Fun,” is only available via web archives (web.archive.org). Search for the website, http://catay.com and look at screen grabs prior to 2017
  • Shoog McDaniel, an artist and photographer living in Florida, was also present at the ASDAH conference, and their art was used in the conference program. Shoog was featured in this article in Teen Vogue which described them as “the photographer pushing the boundaries of queer, fat-positive photography.” Shoog states “the work that I do is about telling the stories of people who are marginalized and not usually put on the forefront, and whose lives are beautiful and important.”

Although Substantia’s presentation did not touch upon it, it’s worth mentioning Representation Matters, the world’s first website providing high-resolution, royalty-free, stock images of diverse bodies for commercial use. (The image in this post is from Representation Matters.) They specifically include larger bodies portrayed in a positive light. These photos are available for purchase.

Unfortunately, diet culture and thin privilege are alive and well, and those in larger bodies remain marginalized and excluded from most mainstream media. I hope you’ll check out these resources and come to appreciate the vast diversity of the human body. I purchased some photography books to share at my office. Together we need to work to challenge the notion that there is a best way to have a body and learn to celebrate the beauty of all bodies.

On a closely related topic, I’m thrilled to see that Meredith Noble has a great list of body positive artists to follow.

Source

Baker, Cindy. 2013. “Aesthetic Priorities and Sociopolitical Concerns: The Fat Female Body in the Photography of Patricia Schwarz and Jennette Williams A Review of Patricia Schwarz: Women of Substance, by Patricia Schwarz, and The Bathers: Photography by Jennette Williams, by Jennette Williams.” Fat Studies 2 (1): 99–102. https://doi.org/10.1080/21604851.2012.709447.

On Buying Bigger Clothes: The Tale of Nana and Her New Shoes

buying bigger clothesbuying bigger clothesRecently, I went to visit my grandmother, who is almost 103 years old.  She was complaining of leg pain. She asked me to help her put on her shoes.  I tried really hard.  But in her sweltering apartment (she can’t stand any temperature below 80), I was sweating and the shoes were not going on.  I had visions of Cinderella’s stepsister needing to cut off her heels to get her feet into her shoes.

Nana has edema—swelling in the lower part of her legs—because she has been sitting in a wheelchair a lot lately.  She is quite fashionable and still loves to get dressed up every day.  But no shoes were fitting.

I had to nearly drag her, but I convinced her to go shoe shopping with me. When we went to the shoe warehouse, we pushed her in her wheelchair but brought along her walker as well.  Nana has always worn a size 7, but we could not fit her into any shoes smaller than an 8.5 or 9!  We tried on one pair of gold shoes —Size 9.  Finally, we were finding some shoes that fit.

Nana loved them.  And she found them comfortable. The woman who had insisted on wheelchairing everywhere, refusing to walk, suddenly started walking with her walker and refused to stop!  She was not taking off those shoes and she was not going to ride in the wheelchair again.  Suddenly, Nana was transformed.  Not only was she comfortable, but she felt stylish.

Why am I telling this story? Often when I am working with patients of any size who have eating disorders, they may have gained weight from a previous lower weight that the eating disorder was an attempt to maintain.  People often experience a sense of failure and surprise when their clothing size goes up a level, just like Nana did. This is no surprise:  our culture overvalues thinness.  But continuing to wear too small clothing is uncomfortable physically and mentally.

People often have a lot of reasons for not shopping for larger clothing —they worry they will be unable to handle the anxiety and sense of failure, and they also don’t want to spend the money on a larger size.  I had to help Nana face this.  She didn’t totally understand why her shoes didn’t fit, she felt disappointed, and she definitely didn’t want to spend any money. But boy, after she got those shoes on, she felt so much better!

My patients tell me the same thing —once they have clothes that fit well and are stylish, they feel more able to face the world, and getting dressed each morning is no longer an occasion for self-deprecation.

Bodies age and change in ways that we can’t control.  We need to accept that.  My advice is always to buy a few things that fit you well and help you to feel great and put the other clothes out of sight for now.

And when I spoke to Nana last week, she let me know how much she was loving her gold shoes and walking more again!

To the Family Member Who Worries I Am Not Helping Your Loved One’s “Weight Problem”

To the family member who worries I am not helping your loved ones "weight problem"
image by Representation Matters

Dear Family Member,

I understand your fears. I get it. You want the best for your loved one. You want him or her to have the best and healthiest and fullest life possible. I do too.

You believe that helping your loved one to lose weight will help achieve these goals. Here, I disagree—I will explain below.

You believe that weight loss will lead to better health. You have heard the scary information about the dangers of obesity and know there is an all-out war on obesity. Or you have seen or heard your loved one ridiculed or judged negatively by peers because they didn’t conform to a certain size.

 

However, did you know that:

I have been working in the field of eating disorders since my training at a bulimia research lab in 1991. When I first learned to treat binge-eating disorder, a course of cognitive behavioral therapy (CBT) for binge eating was expected to be followed by a course of behavioral weight loss. However, since that time we have learned that behavioral weight loss doesn’t work. And while CBT for binge-eating disorder can be successful, it rarely leads to significant weight loss, even among those considered to be in an “overweight” weight category. However, CBT does lead to cessation of binge eating and prevention of further weight gain, which are lofty goals in their own right.

I firmly believe that bodies are meant to come in a variety of shapes and sizes. We are not all meant to be Size 0 or 2 or 4.

Take shoe size: while the average woman today has an 8 shoe size, most do not—some will have size 5 and others will have size 10. Shoe size has a normal distribution within the population.

Just as with shoe size, so it is with body weight. Every body appears to have a set point, a weight at which it functions optimally. This set point is not destined to be at the 50th percentile for every person—some will be heavier and some will lighter. Repeated attempts at dieting seem to increase a body’s setpoint, which is the opposite of what most dieters are trying to achieve.

I no longer support attempts at deliberate weight loss because I have come to believe it is not only fruitless but in fact harmful. Every day in my practice I witness the destruction left by the war on obesity and failed diet attempts. I see the carnage of past dieting, weight regain, shame and self-loathing in the form of disordered eating and intractable eating disorders. Against this backdrop, I believe that above all else, my duty to your family member is to not harm them.

There is no magic solution. Failing to fit the thin mold can be a burden. I wish I could wave a magic wand and have your loved one’s body transform into one that would not be stigmatized, would be celebrated, and would fit into all spaces. But I can’t change your loved one’s genetic body destiny, just as I can’t change any person’s ethnic background or skin color to conform to the privileged group. And I believe the solution is not to change your loved one’s body to conform—the solution is to fight to end weight stigma and the oppression of larger bodies.

Here’s what I can do:

  • I can help your loved one recover from an eating disorder, using evidence-based treatments backed by scientific research.
  • I can help your loved one work on accepting and appreciating their body and all its capabilities.
  • I can help your loved one unfetter themselves from self-imposed rules and restrictions and live a fuller life.
  • I can help your loved unburden themselves from shame and self-loathing.
  • I can help your loved one to advocate for themselves if he or she needs accommodations from a world that was not built to accommodate his or her body.
  • I can help your loved one learn to stand up to weight stigma and bullying.
  • I can help your loved one request and receive respectful health care.
  • I can help your loved one improve their relationship with food so that eating and social situations are enjoyable.
  • I can help your loved one achieve peace.

If you want these things for your loved one, please let me do what I was hired to do—guide your loved one to healthiest, best, and fullest life possible. Please examine the basis of your own hope that your loved one will conform to the thin standard. While I know this comes from a good place, it’s not pointing to the right destination. There are happier places to land. There is much work to be done. We all have weight stigma.

To learn more, I suggest reading the following articles:

Interested in Weight Loss? I CAN’T Help You. Here’s Why

Are We Setting Recovery Weights Too Low?

Is Weight Suppression Driving Your Binge Eating?

How Health at Every Size Can Help With Eating Disorder Recovery

On Living 100 years in Diet Culture

Living 100 years in Diet Culture

I recently went to visit my 102-year-old grandmother. In 1921, at the age of six, Nana emigrated from Russia to Kansas City.

She entertains her living facility with her piano playing and loves to talk all day. She continues to leave sassy messages on my phone. She sends thoughtful gifts to her great grandkids. With such a full life, the following stands out to me.Living 100 years in Diet Culture

 

Always concerned about her shape and weight, at 102 this is still a concern as evidenced by her bathroom in assisted living. Although Nana walks with a walker and now requires some assistance with getting dressed, she still steps on her bathroom scale every day. (How exactly she does this without falling, I don’t know!)

She declared to me, “I weigh x. If I could lose 10 pounds, I’d look younger.”

Two years ago, when she turned 100, I actually did a brief interview with her about dieting. After all, how many 100-year-olds are there who can offer a perspective on dieting in the 1930s and into their centenarian years?

Following is an excerpt from my interview with Nana:

How old were you when you first became concerned about your weight and shape?

At 9 years old people wanted me to start appearing on stage playing the piano. My teacher wanted to speak with my parents and told them he thought I was overweight and should lose some weight. He wanted to groom me for concert piano playing. I remembered how he spoke about my being a little heavy. It didn’t set in right with me. It didn’t bother me. I wasn’t obese, but I was heavy.

When was the first time that you dieted?

On January 2, 1935 (at age 19), I started a strict diet (for me) while at the University of Missouri in Columbia. In 3.5 months I lost 45 pounds. I worked very hard at that. Not only did I have a diet plan, but I also read a great deal. Just before that I also bought a powder that I put in tomato juice and it helped reduce hunger. When I came back to college after Christmas I was told by a friend who was a medical student to stop taking it. He said it was harmful. And then I continued on with the diet plans and that was in 1935. That’s when I really lost the weight. I became ever more popular and I noticed that the weight loss was really helpful.

Do you still worry about your weight?

I’m still concerned about my weight. I watch it very carefully. I get on the scale every single morning because I want to get in the clothes I have. I used to measure myself with a tape measure every day. 

Why do you think it is important to be thin?

I think it’s important. I love my clothes and if I don’t hold my weight to the clothing that I’ve bought, I’d feel very sad so I watch my weight carefully and I am able to get into clothing that I’ve had for years. There are some skirts that I can’t fasten at the waist, but I don’t wear skirts anymore. But weight has always been a very important concern. I don’t think you have to be thin but you have to look good in your clothing and for me, I don’t want to have to buy new clothes.

Nana’s Legacy

It is sad to me that after all these years,  the fear of returning to a bigger size still looms over her. When she eventually passes I doubt many will remember Nana for her shape.

Instead, I expect they will remember her for how friendly and caring she is, how she finds the positive in everything, her desire to make everyone around her happy, the sharp dresser she is, and what a great pianist she is (she makes you FEEL the music).

I know I will always hold dear in my heart her tremendous love for so many people, her years of serving the community as a social worker and volunteer for numerous charitable organizations, her delicious pound cake, her witty jokes (mostly from Readers Digest!), her long stories, her piano playing, and for how she knows (and is loved by) everyone in Kansas City.

 

Winter 2017 LACPA Eating Disorders SIG Events

Glenys Oyston, RDN1.  Date: Thursday, January 26 at 7:30 pm

Speaker: Glenys Oyston, RDN

Title: The Dangers of Dieting

Description: Dieting for weight loss is a cultural norm – everyone does it, has tried it, or has been told to do it at one time or another. But is dieting for weight loss truly beneficial, or is it causing more harm than good? Registered Dietitian Glenys Oyston, discusses how intentional weight loss efforts are actually harmful to the physical, social and psychological well-being of people who engage in them, and what to do about it.

Bio: Glenys Oyston is a registered dietitian, size acceptance activist, eating coach, and blogger who runs Dare To Not Diet, a coaching business for long-timer dieters and weight cyclers who want to break free of food restriction and body dissatisfaction. She coaches people online or by phone through one-on-one and group coaching programs. She is based on Los Angeles, CA. You can find her at www.daretonotdiet.com.

Glenys Oyston, RDN

Dare To Not Diet

Dietitians Unplugged Podcast

@glenysoRD on twitter

Facebook

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

abby22. February 10 at 11 am – LACPA Office (in conjunction with Sport and Performance Psychology SIG)

The LACPA Sport & Performance and Eating Disorders SIGs are pleased to announce our jointly held meeting for February, 2017:

Date: Friday, February 10, 2017

Time: 11:00 AM – 12:30 PM

Location: the LACPA Office, Encino

6345 Balboa Blvd. Building 2, Suite 126

Topic: When an Athlete Gets an Eating Disorder

Speaker: Abby McCrea, LMFT

More about our topic and speaker:

Clinical eating disorders cause significant problems for more than 40% of athletes. Subsequently, the subtleties between “good athlete” and “eating disorder” mindsets can become particularly tricky to discern after the onset of an eating disorder. Knowing the risks, possible causes, and how to support athletes with eating problems is essential for developing and sustaining athletic wellbeing. 

This talk is designed to help you:

  1. Explain how and why athletes get eating problems
  2. Recognize the subtle differences between a “good athlete” and an “eating  disorder” mindset
  3. Create ways to support athletes with eating problems

Abby McCrea is a Licensed Marriage and Family Therapist who has a private practice in Sierra Madre, CA. She graduated from Fuller Theological Seminary with a Master’s of Science degree and a clinical focus on the integration between psychology and spirituality. 

With over 13 years of experience in a variety of mental health settings including inner city gang rehab community programs, college counseling centers, and eating disorder residential centers, she brings a depth of understanding, experience, respect, and compassion to her work. In her private practice she specializes and works to empower teens, adults, and families that recovery from an eating disorder is possible.  Additionally, she is passionate about developing research and treatment for athletes with eating problems, and helps clients, families, and coaches in her practice to navigate and manage the delicate balance between life, sport, and recovery.

 Abby speaks nationally on the topics of eating disorders and athletes, eating disorder education, deconstructing social ideals of body image, spirituality and the rituals of eating problems, and identity development among teenagers in life transitions.

Please RSVP and/or direct any questions to Sari Shepphird at drshepp@msn.com

LACPA SIG Meetings are a LACPA member benefit and are open to all LACPA Members. For more information about LACPA Membership, SIG’s and other events, visit the LACPA events calendar: www.lapsych.org

Parking Information:

The LACPA office address is THE ENCINO OFFICE PARK, 6345 Balboa Blvd, Building 2, Suite 126, Encino, CA 91316 – second building from Balboa Blvd., conveniently located near ample free daytime/weekday street parking on Balboa Blvd, south of Victory Blvd.  Both sides of Balboa have all day free parking.  There is also plenty of free parking at the Sepulveda Basin Sports Complex on the west side of Balboa, south of Victory, 6201 Balboa Blvd. (2nd driveway past the Busway). 2-3 minute walk to the office door.  Wherever you park, please check the signs. 

Parking at The Encino Office Park lot between the hours of 9 a.m. – 6:30 p.m. is restricted to building tenants only.  Do not park in the lot at the building. 

 

Book Recommendation: “Dietland” by Sarai Walker

Marti Noxon and Joy Nash at Dietland Luncheon in Los Angeles

Dietland

This summer (2016) I read the novel Dietland by Sarai Walker. It’s rare to find a novel that is both relevant and sensitive to the concerns of my patients, rarer still one that features a main character in a large body whose happiness is not predicated upon successfully losing weight. I found the book so empowering, I’ve been recommending it to patients.

The book tells the story of Plum Kettle, a young 300-pound woman who lives in New York and works as a ghost-writer answering angsty emails to the editor of a teen magazine. She has been on multiple diets and is planning to have weight loss surgery. While living in the crowded city, she tries hard to not be noticed. Rather than living in the present, she focuses on planning for her future life as a thin person. She orders clothing online that will fit her future thin body.

Walker vividly portrays the stigma and unjust treatment faced by people who inhabit larger bodies. Like many of my larger patients with histories of repeated dieting, Plum suffers from depression and oppression related to being in a larger body. Living in a larger body in a world consumed by diet culture means not physically conforming in certain situations (think restaurant booths, waiting room chairs, and airplanes) and leads to shame and fear of being persecuted in social situations due to one’s size. Not surprisingly, people in larger bodies often have histories of dieting to try to make their bodies conform to the thin cultural ideal. However, because dieting doesn’t work and weight suppression ultimately drives eating disorders and weight regain, people in larger bodies often experience weight regain binge eating, and anxiety and depression.

Out of fear of being teased about her weight, Plum avoids parties, clubs, bars, beaches, amusement parks, and airplanes and, painfully, spends most of her time alone, answering emails either from the café or at home in her apartment.

Through a series of unconventional events, over the course of the book, Plum gains the strength to resist the unrealistic cultural archetype. She turns her anger outward, confronts weight stigma, and stands up to the pressure of society. Ultimately Plum finds her voice and becomes empowered. She learns to accept a body that does not fit the thin ideal, stops putting her life on hold, and starts living her life as she is:

It felt good to be free. With unexpected power in my legs, I kept going, racing ahead with the wind and the sun on my face, taking a leap into the wide world, which now seemed too small to contain me.

While the treatment I offer to patients is more traditional than Plum’s journey in the novel, I hope my patients will undergo the same transformations. In my work with all patients of every size, I employ CBT for eating disorders, but I supplement this evidence-based treatment with a weight-neutral approach and education about the impact of diet culture and weight stigma. I help clients to cultivate a more accepting and compassionate relationship to their bodies and to turn their anger outward, holding up a new lens through which to see the world. I seek to empower them to advocate for their needs while challenging diet culture. This transformation is profound and exciting to witness.

My favorite passage in the book is a line of questions I want to ask my clients:

“I want you to consider something, hon. What if it’s not possible for you to ever become thin? What if there is no one day? What if this is your real life right now? What if you’re already living it?”

The book is both fun and inspiring.

Addendum: June 2018: And, it is being turned into a television show which premieres on AMC on Monday, June 4th and stars Joy Nash as Plum Kettle. Appropriately, the tagline is “Join the Revolution!” I hope you’ll join me and tune in. I was fortunate to attend an event with Marti Noxon, the producer to discuss some of the important issues that will be highlighted by the show, including weight stigma.

 

Lauren Muhlheim and Marti Noxon at Dietland Luncheon 

A most misguided device

Slide1

To the long list of desperate and dangerous weight loss products, we can now add the AspireAssist, sadly approved by the US Food and Drug Administration (FDA) this week. The device is marketed as a “minimally invasive” and “reversible” weight loss “solution” for “people with obesity.” Essentially, an aspiration tube is inserted into the patient’s stomach so that the patient can, after eating, empty the contents of their stomach into the toilet by pressing a button on the device. To critics such as me, this device sounds a lot like a bulimia machine.

The AspireAssist has been through limited research; potential negative consequences remain unknown. It represents yet another example of how larger people are stigmatized and then preyed upon by manufacturers (abetted by the US government) who reinforce the belief that their bodies are inadequate and sell them various misguided products to help them attain the thin ideal. These dangerous products range from medications (remember phen/fen?) to surgeries, and now a device to empty one’s stomach.

Dagan Vandemark, Program and Policy Coordinator of Trans Folx Fighting Eating Disorders, stated, “This is a medicalized, surgicalized imposition of bulimia on higher-weight bodies, telling folks that having an eating disorder is better than being fat.” Bariatric surgery is often touted as the solution to obesity. And yet, I have seen clients post-bariatric surgery who were no better off.

A number of compensatory behaviors, including vomiting, exercising, and laxative use, can qualify one for a diagnosis of bulimia nervosa according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The only difference between these behaviors and the Aspire Assist is that the latter is medically prescribed.

Psychologist Deb Burgard has eloquently made the case that the behaviors society prescribes to help large patients lose weight are those same behaviors we diagnose as an eating disorder in lower weight patients. The Aspire Assist goes one step further by mechanizing bulimia nervosa. This device has a potential for the same kinds of weight loss abuse as do laxatives and diabetes medications.

The FDA press release lists among the potential side effects of the AspireAssist “occasional indigestion, nausea, vomiting, constipation, and diarrhea.” The endoscopic surgical procedure to insert the tube includes potential problems ranging from a sore throat, bleeding, pneumonia, unintended puncture of the stomach, and death. Risks related to the stomach opening include infection and bleeding.

As someone who has treated patients with bulimia nervosa and binge eating disorder for many years, this concerns me greatly. Helping clients to stop purging when it involves a behavior as unpleasant as vomiting is difficult enough. The leverage clinicians use to help people stop purging involves the individual’s own shame and disgust as well as negative health consequences. It is appalling that we now have a device that makes it easier (and permissible) for people to remove food from their stomachs.

Additionally, to help clients break a bulimia cycle, clinicians help clients employ strategies to stop restricting and purging. Bingeing is often the hardest behavior to change. Clients who continue to purge give themselves permission to engage in bigger binges. The thinking is, “Since I am going to purge anyway, I’m going to go ahead and eat more and then get rid of it.” An important intervention is for clients to remove purging as an option; this makes binges easier to modify. Outfitting clients with a no-fuss purge device will only encourage more binge eating.

Eating disorders occur commonly enough; there is a shortage of adequately trained professionals to treat the current number of patients with eating disorders. Let’s not make the problem worse by inducing eating disorders in even more patients.

We need to stop preying on and oppressing people in larger bodies and leading them to believe they are a problem to be fixed. We need to stop subjecting them to insane procedures in an effort to conform to an unnecessary standard. No treatment for obesity has been shown to work long term. We need as a society to accept that people come in all shapes and sizes.

When is it ok to comment on another person’s body?

When is it ok to comment on another person’s body? Spoiler alert: Never!

By Elisha Carcieri, Ph.D.

As a relatively new mom of an 11-month-old, I’m on the tail end of almost two years of a complete metamorphosis. In nine months my body grew to accommodate another human, delivered that human into the world, and has since been slowly returning to its original, albeit changed, form.

Something bizarre happens when you’re pregnant. For some reason, people take this as an opportunity to comment on physical appearance, especially size and weight, perhaps more so than they do with non-pregnant women. Most don’t mean any harm, and most of the time no harm is done. But even so, I ask…why do it? And I beg…please stop! For the most part, commenting on another person’s body size is, at the very least, unproductive and unhelpful, and at worst a triggering assault on the already high-jacked consciousness of an eating disorder sufferer.

Oftentimes pregnant women will receive comments such as, “looks like you’re ready to pop!” or, “any day now, huh?” But what if that’s not the case? Saying this to a woman who has many months of pregnancy ahead of her has the potential to bring up all sorts of emotions and uncertainties. I recall a stranger stopping me on the street to give me her business card for prenatal water aerobics. She asked me how far along I was and promptly added that I was “showing early for being only 6 months along” and could therefore especially benefit from her services.

As a society, we’re generally obsessed with weight loss, wellness, thinness, and, with regard to pregnant women, “bouncing back.” I think there is an assumption that if you’re saying someone is small or thin, then its fine. But my caution against body comments rings true for comments about thinness or smallness just as much as it does for fatness, largeness, bigness, etc. It can be difficult to understand how comments about smallness might affect someone. We all want to be thin, right? But for a woman carrying a baby, being told you’re looking small can be scary and can bring up unwarranted uncertainties and fears. I can recall being told at the end of my pregnancy that I looked small. “What a tiny baby bump,” “you don’t even look like you’re about to have that baby.” (Mind you, this was the same body that elicited the above “big for 6 months” comment.) These comments came after my doctor told me that I was, in fact, measuring small during that particular week of pregnancy. It took some work to cope with and wrangle the anxious thoughts running through my head. I went on to deliver a 9lb baby…further illustrating the fruitlessness of sharing our flawed perceptions of another person’s size or shape.

The truth is that you just don’t know what another human is dealing with at any given moment. You’re also not likely to be telling them anything they don’t know already. So what’s the point?

Experiencing these comments on my body during and after pregnancy has had me thinking about how difficult it would be to tolerate for someone with an eating disorder, and how difficult comments on body shape and size must be for those with eating disorders even in the absence of pregnancy. I do want to clarify here that no eating disorder is caused by comments made by another person or even necessarily by the negative body image that can result from being on the receiving end of body-focused comments. We don’t know what causes eating disorders. Eating disorders are likely the result of a myriad of genetic/biological, social, and psychological factors. However, we do know that for many men and women suffering from an eating disorder, there is often a core overvaluation of weight and shape in the person’s overall self-concept that places them at risk for engaging in efforts to control their weight or shape. This dieting or extreme restricting food intake can result in binge eating and subsequent control behaviors such as vomiting/laxative use/over-exercise/further restriction of food intake, resulting in a vicious cycle.

For a person in the throes of an eating disorder, a positive or approving comment on weight loss can serve as fuel to the already burning fire that is the eating disorder mindset. Also, what is the message we are sending when we comment on another person’s appearance with approval only when there is an observed weight loss? Isn’t the underlying message that that person is not worthy of approval when their weight is higher? Why would you want to send that message to a loved one? Alternatively, for someone in any stage of recovery from an eating disorder, comments on weight gain can be difficult to manage. I’ll also say that even for those of us who are neither suffering from an eating disorder or in recovery, fielding, and processing these comments simply sucks.

So, the next time you feel compelled to comment on another person’s body shape or size, no matter the circumstances, just don’t! Ask them about themselves, share something about yourself, tell them how great it is to see them, or comment on the weather if there is nothing better to talk about. There is little to gain and much to lose from body-focused comments, no pun intended.

Los Angeles Eating Disorder Events for Professionals January 2016

We are so lucky to have two amazing dynamic internationally recognized speakers regarding eating disorders in January via the Los Angeles County Psychological Association (LACPA).  One is a FREE SIG event (members only) and the other is a CE event with a charge (open to all professionals).

1)  Eating Disorder SIG meeting featuring international speaker and fat acceptance activist, Ragen Chastain

Wednesday, January 20 at 7:15 pm 

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description:  You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

2)  A CE event (tell your colleagues who are nonmembers; we provide CEUs for psychologists, nurses, drug counsellors, MFTs, LCSWs, and LPCC)

“Unraveling the Enigma of Male Eating Disorders” with Stuart Murray, Ph.D. on Saturday, January 30, 2016 

10:00 a.m. – 1:00 p.m. CE Credits 3.0 

Held at the NEW LACPA Office

6345 Balboa Blvd. Building 2, Suite 126

Encino, CA 91316

Click here to register online:

http://www.lapsych.org/events/event_details.asp?id=726923

This three hour workshop will provide a historical, theoretical, and clinical overview of eating disorder in males. Dr Murray will provide a historical overview of the development of our diagnostic framework, highlighting how this may be inaccurate in indexing male eating disorder concerns. Dr Murray will also provide an overview of the most recent empirical evidence pertaining to the transdiagnostic array of EDs in males. Finally, this workshop will include an in-depth discussion of the clinical quandaries faced in working with EDs in males.

Stuart Murray, Ph.D., is an Assistant Professor at UCSF, where he leads an international research group dedicated to advancing our understanding of male eating disorders. He also serves as the Director of the National Association for Males with Eating Disorders, and as the Co-Chair for the Academy of Eating Disorders Special Interest Group on Males & EDs. To date, Dr. Murray has published more than 70 scientific journal articles and book chapters, and has conducted workshops and seminars internationally on the topic of male eating disorders.