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So many diet doctors are frauds. I am not, haven’t been, and never will be a diet doctor — but I was a fraud, too. As I wrote in our first post, I honestly thought that I was giving useful medical “advice” about weight loss by espousing the usual platitudes of eating less and moving more. But what good does it do to tell someone that calories-in/calories-out is a simple equation? What good does it to do tell someone that they should exercise? How do those words help someone to become motivated to change and to develop strategies to help sustain the success? Here's the answer: they don’t.
It never occurred to me that not only was I not encouraging my patients in a helpful way, but I was also just adding to the discouragement they felt in their struggles with weight. It took my own experience with becoming overweight and then finding my own path to losing weight to have a better appreciation of my patients’ challenges and then to be able to help them in a meaningful way. Let me tell you how it happened.
I didn’t really have a weight problem until I was 40, after the birth of my second baby. But that doesn’t mean that I didn’t have food issues before that. I had always had a “sweet tooth,” and I ate large portions, but I could get away with that when I was young. My mother was a fabulous baker, and Friday was her baking day. I’d come home from school every Friday, and there would be two pies on the counter: one for the family and one just for me. My pie was smaller — but not by a whole lot. I ate the whole thing right then and there. And I remained slim.
I never enjoyed exercise either. Years ago, when I was a teenager, girls didn’t have to participate in gym if they had their periods. Somehow, my gym teachers never seemed to notice (or perhaps just pretended not to notice, since I was so pathetic at sports) that I seemed to have my period just about every week. Later, when I was in my 20’s and 30’s, I was grateful that I was slim and didn’t “need” to be physically active.
Somehow, I got away with these habits. Until I didn’t. Eventually, my age and my changing metabolism caught up with me. I had no idea what to do. Don’t get me wrong — I knew full well what I “should” eat. I was a doctor, after all — an expert! I would try one diet or another, and each one did work for a while. Until it didn’t. There was always something that would derail my efforts. I was frustrated and furious with myself for not having more “willpower.”
One day, in 2013, after years of this pattern, I found myself on a stepladder in my kitchen, trying to reach into the back of the cabinet over the refrigerator. I was foraging for some old Halloween candy or any other chocolate I could lay my hands on. I knew that it was going to be uncomfortable coming down off the ladder because my knees hurt. I knew that my knees hurt in part because I had gained weight — a lot of weight — and now weighed exactly what I had weighed when I was nine months’ pregnant. Just baby fat, right? Except that the baby was now 23 years old. I also knew that in four months from this time, I was going on a trip to Switzerland with my two daughters, and I had been hoping to go hiking with them.
It was at this moment that something clicked for me: it was the realization that being disgusted with myself was not going to motivate me to change in a sustainable way, but that wanting to take good care of myself might be just the thing. I decided to shift my thinking. I would think about being more active with my daughters and with my future (please, God) grandchildren. I would think about being able to live an independent and vigorous life as an old lady. I would make more space in my brain by not playing the continuous loop in my head about what I wanted to eat but shouldn’t eat or shouldn’t have eaten and now felt ashamed and undisciplined and hopeless — that undermining voice of the "Evil Twin.” It dawned on me — finally — that I would never lose weight by hating myself or feeling ashamed of myself. Never. Then I climbed down, uncomfortably, from the stepladder and wrote down some lists:
List 1: what are the reasons that I want to lose weight?
List 2: how do I go about this in a self-compassionate way?
Once I reframed wanting to lose weight into a new paradigm of wanting to take care of myself, the day-to-day strategies fell into place. I gave myself constant, gushy positive feedback. I got rid of all the chocolate in the house. I started every meal with vegetables. I planned ahead for what I was going to eat at the next snack and at the next meal. I created short-term goals that were achievable and sustainable. It had to be a positive experience! Goal-setting was a strategy that Jay and I have talked about before, and I will share these strategies with you in greater detail in future posts.
Three months later, I had lost 15 pounds and gotten myself into better shape — and then I hiked the Alps with my daughters! After six months, I had lost a total of 30 pounds, which I have not regained (except for a brief “Trump Ten” relapse, but I reversed that, too). Since that time, in working with my patients, I have come to believe even more strongly in the importance of kindness and compassion toward oneself as key to losing weight in a sustainable way.
More than I have helped my patients, though, my patients have helped me to deepen my understanding of the connection between food and shame. This came as a result of starting a group for students at the University of Pennsylvania, where I work, to address issues around healthy eating and weight loss. I talked a little about this in our introductory post,. The big issue wasn’t weight, and it wasn’t food. It was shame.
I no longer discuss with my patients what they “should” weigh. I talk about eating and moving in a physically and emotionally healthy way. I talk about strategies to reinforce positivity and to negate shame. Here are a just few examples:
- Every time you notice that you’re thinking negatively about yourself, reframe the thought into something positive. You ate a second piece of cake after dinner and now you're a failure? Uh-uh. You ate a second piece of cake, that’s all. You don’t like how that feels, and so for now, you’ll make your kitchen a no-cake zone and have cake on special occasions when you’re at a restaurant.
- Every single time you make a healthy decision — fruit instead of cookies, going to the gym instead of to the mall — thank yourself and congratulate yourself.
- Don’t eat anything unless you’ve decided ahead of time — even if it’s five seconds — that you want to eat it.
These are the kind of strategies continue to work for me and for my patients. That’s the reason this blog exists, as well as why Jay and I are writing our book. There’s no place any more for shame.
Can Body Positivity and Weight Consciousness Co-Exist?
It is terrible to tell people to try to be thinner; it is also terrible to tell them that wanting to lose weight is hopeless and wrong.
So begins the insightful article by Taffy Brodesser-Akner in a recent New York Times article. An important and contentious debate in our society has centered on “fat-acceptance” verses thinness as a goal. Today, in addition to discussing this article, we’ll also include excerpts from the books of two articulate and eloquent writers on the subject: Roxane Gay’s Hunger and Lindy West’s Shrill. We hope that you’ll be willing to weigh in, so to speak, on the subject and share your thoughts with us.
We Judge Others, and We Judge Ourselves
Those of us who struggle with weight are not immune to being part of the problem of fat-shaming. Roxane Gay writes:
I know, having grown up in a culture that is generally toxic to women and constantly trying to discipline women’s bodies, that it is important to resist unreasonable standards for how my body or any body should look.
What I know and what I feel are two very different things (1).
It may be that you are ashamed of yourself for being overweight. It may be that you judge others for being overweight, and it may be that you're ashamed of feeling that way. You may want those people who judge you to feel ashamed. None of this is working. Shame never works.
Jay – Since my weight loss, people are more interested in what I have to say because of my appearance, and I no longer feel invisible. I feel ambivalent about this change, however. Of course, I appreciate being acknowledged; but I don’t appreciate, for example, that people from high school who never gave me the time of day now want to be my friend. These are people who measured my worth by my weight, and that feels really bad to me.
Now that I’m thin, being out in public feels very, very different, too. If someone bumps into me and says, “Excuse me,” it no longer feels like they’re saying, “Get out of the way.” On the other hand, I get harassed now that I’m “hot.” I get catcalled. Men walk up to me and ask me to smile. No, I do not appreciate this unwelcome attention and obnoxious behavior. I feel uncomfortable and violated. I’ll smile when I want to; I will not smile when some jerk wants me to wear a Happy Face for him.
Appreciating Your Body in a Fat-Shaming World
Obese people are perceived by the media, by doctors, by perfect strangers, and by potential employers and life partners as undisciplined and even lazy (2,3,4). This weight bias has terrible ramifications with regard to academic achievement, financial success, and emotional well-being throughout life.
...I live in a world where the open hatred of fat people is vigorously tolerated and encouraged. I am a product of my environment (1).
How can you stop feeling shame when it seems like the rest of the world wants you to be ashamed? It takes mental toughness to counter that attitude from others. It takes kindness to counter that attitude from yourself. We have both struggled with internalizing the cultural norms that dictate how women “should” look.
Janice — Medical school was a very happy time of my life. I felt like I was doing something worthwhile, and I was proud to be there. I loved school, and I loved my classmates. So why did I miss my 20-year reunion? It was because I weighed 40 pounds more than I had in med school, and I was embarrassed. . As I write these words, I think to myself, “What is wrong with this person?” I regret that I am not strong enough to be more than a mere product of my culture, but there you have it.
We suggest that it is both useful and empowering to shift the paradigm and to reframe the meaning of having a large body. This is what Roxane Gay has to say about the subject:
I hate how I feel in my body. I hate how people see my body. I hate how people stare at my body, treat my body, comment on my body. I hate equating my self-worth with the state of my body and how difficult it is to overcome this equation. I hate how hard it is to accept my human frailties. I hate that I am letting down so many women when I cannot embrace my body at any size.
But I also like myself, my personality, my weirdness, my sense of humor, my wild and deep romantic streak, how I love, how I write, my kindness and my mean streak. It is only now, in my forties, that I am able to admit that I like myself, even though I am nagged by this suspicion that I shouldn’t. For so long, I have given in to my self-loathing. I refused to allow myself the simple pleasure of accepting who I am and how I live and love and think and see the world. But then, I got older and I cared less about what other people think.
I don’t want to change who I am. I want to change how I look… Fierce vanity smolders in the cave of my chest. I want to look good. I want to feel good. I want to be beautiful in this body I am in (1).
Inside every overweight woman is a woman she knows she can be.
Apparently, there was quite a bit of backlash, justifiably so, against this statement. What is this nonsense about there being a thin woman inside every fat one? If you think that you’re not a good enough person now and that you will be worthy of love and respect only after you lose weight, please rethink your strategy. Self-loathing is guaranteed to lead to more shame and more weight.
Here’s more reframing, this time from Lindy West:
I hate being fat. I hate the way people look at me, or don’t. I hate being a joke; I hate the disorienting limbo between too visible and invisible; I hate the way that complete strangers waste my life out of supposed concern for my death. I hate knowing that if I did die of a condition that correlates with weight, a certain subset of people would feel their prejudices validated, and some would outright celebrate.
I also love being fat. The breadth of my shoulders makes me feel safe. I am unassailable. I intimidate…I can absorb blows — literal and metaphorical — meant for other women, smaller women, breakable women, women who need me.
Maybe you are thin. You hiked that trail and you are fit and beautiful and wanted and I am so proud of you, I am so in awe of your wiry brightness, and I’m miles behind you, my breathing ragged. But you didn’t carry this up the mountain. You only carried yourself. How hard would you breathe if you had to carry me? You couldn’t. But I can (5).
What then, can we finally say about this tension between accepting one’s body and striving to attain a lower, healthy weight? Perhaps it’s simply this: being obese may be unhealthy, but it’s not a moral failing, and we all share in the responsibility to detach shame from body size.
Janice — Here’s what I tell my patients: I don’t care what you weigh. I do care that you eat healthy food and that you incorporate movement into your life. I care that you don’t hate yourself. I care that you get enough sleep. I care that you spend time with people you love. I care that you go to the dentist twice a year and practice safe sex. The rest is up to you.
(1) Gay Roxane. Hunger. New York: Harper Collins, 2017.
(2) Lindeman, M et al. The effects of messages about the causes of obesity on disciplinary action decisions for overweight employees. J Psychol 2017; 151(4):345-358.
(3) Phelan SM et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16:319-26.
(4) Puhl RM, Heuer CA. The Stigma of Obesity: A Review and Update. Obesity 2009;17(5):941-64.
(5) West, Lindy. Shrill. New York: Hachette, 2016.
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