The Harm Associated with Weight Bias, Weight Stigma, and Weight Focused Interventions Alison St. Germain MS, RD, LD Iowa Academy of Nutrition and Dietetics Representative Assistant Clinical Professor at Iowa State University Legalizing Eating with Diabetes. An Intuitive Approach I have no conflict(s) with commercial interest companies to disclose.
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Legalizing Eating with Diabetes. An Intuitive Approach Eating...–Indiv w/diabetes have increased difficulty losing weight •Starvation occurs even in a larger body –Body will
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The Harm Associated with Weight Bias, Weight Stigma, and Weight Focused Interventions
Alison St. Germain MS, RD, LDIowa Academy of Nutrition and Dietetics Representative
Assistant Clinical Professor at Iowa State University
Legalizing Eating with Diabetes.
An Intuitive Approach
I have no conflict(s) with commercial interest companies to disclose.
Why am I here today?
• RD 24 years • Iowa State University Food Science & Human Nutrition Clinical Professor• Iowa Academy Representative • St. Germain Consulting: Redefining Health—Nutrition for ALL Bodies• Advanced areas of expertise
– Certified Intuitive Eating® Counselor– Certified Craving Change™ Facilitator (Cognitive Behavior Therapy)– Health at Every Size® (HAES®) & Health For Every Body Facilitator – Eating Disorders—awareness, prevention and treatment– Non-diet Weight Neutral Registered Dietitian – Body Respect & Size Acceptance
• Finding my passion
Objectives
• Deconstruct weight stigma and learn how it hinders clinician-patient communication; learn how it increases the likelihood of poor health outcomes.
• Explore non-diet weight neutral approaches to well-being as an alternative to weight centered interventions with specific application to diabetes.
• Learn from examples shown and handouts provided for practitioners to use with patients.
Jot it Down
Weight Stigma
• Definition
– Weight bias or weight discrimination
– Shame, judgement, inequalities and stereotypes placed on individuals based on weight and body size.
Adapted from BEDA National Weight Stigma Awareness Week materials
• Remember someone WITHOUT diabetes has high rate of weight re-gain, now add in factors of hyperinsulinemia, meds, insulin promoting weight gain in individuals with Type 2.
“Food for Thought”…
What would happen if we thought of weight gain as a sign or symptom and NOT the problem, etiology or the goal?
How would our intervention change?
What do we know about symptom based treatment?
What would happen if we gave same recommendations to a person of size as a thin or middle of the road person?
How to incorporate non diet weight neutral approaches into your practice
Poodle Science Video
Health At Every Size HAES® Framework
Acceptance of:
• Natural diversity in body shape and size
• Ineffectiveness and dangers of dieting for weight loss
• Health centered/weight neutral paradigm
• Importance of relaxed eating in response to internal body cues
– Intuitive and mindful eating
• Critical contribution of social, emotional, spiritual and physical factors to health and happiness
Resources
Principles of Intuitive EatingEvelyn Tribole & Elyse Resch
• Reject the Diet Mentality
• Honor Your Hunger
• Make Peace With Food
• Challenge the Food Police
• Feel Your Fullness
• Discover the Satisfaction Factor
• Coping with Emotions without using food
• Respect Your Body
• Exercise—Feel the Difference
• Honor Your Health with Gentle Nutrition
Paradigm Change
Diet Mentality
Intense Desire to be Dieting/Food Restrictionsthin/lose weight Cravings/Reduced self control
OvereatingBingingWeight Gain Disordered Eating
Low Self Esteem Eating Disorder
Anderson et al, 2015Denny et al 2013
Created by Alison St. Germain, MS, RD, LDAdapted from concepts of Intuitive Eating Tribole 2012
Intuitive Eating
Desire to feel Intuitive EatingGood/Healthy All Foods w/Balance
Body Respect
Healthy RelationshipFood/Mind/BodyWeight Changes
Gast et al 2014Tribole et al 2012Madden et al 2012Hawks et al 2005
Diets Don’t Work
• Traditional weight loss counseling ineffective long-term
• Sustainable framework
– Honor genetic diversity
– Non-diet weight neutral approach
– Bring focus on eating and moving/exercising
• To feel healthy strong, empowered vs to burn energy
• Remember all aspects of health not just physical
– Highly individual
Reject the Diet Mentality
Health & Weight
• Fitness surpasses fatness (Barry et al 2013)
• BMI is an awful indicator of health & not evidenced based
• Behaviors that have more impact on health than weight
– Food Choice
– Physical Activity
– Drinking or Smoking
– Social Determinants of Health
Reject the Diet Mentality
Health & Weight continued…
• Social Determinants of health– Socioeconomic status
– Race
– Education level
– Access to health care
– Stigma
– Social support
– Public safety
– Literacy
Activity From: The Non-Diet Approach Guidebook for Dietitians (Fiona Willner 2013) page 62
• Debunking Diets
• Pinpointing Diet Dreams
• Key point for clients after doing the activity
– The diet promises more than it delivers
– Diets don’t work and lead to binging and obsessing about food and weight.
Honor Your Hunger
• Keep body fed to prevent ravenous hunger
– excessive hunger →ravenous eating
– bingeing is a result of restriction
• Not lack of willpower
• Body is working correctly to prevent starvation
• The more true hunger is denied…
– the more intense food cravings & obsessions
• Denying true hunger →bingeing & deafness to internal cues
Clues You May Have Had Enough Food
• Food doesn’t taste as good as first bite
• Stomach sensation of fullness
• Starting to numb feelings and eating unconsciously
Activity From: The Non-Diet Approach Guidebook for Dietitians (Fiona Willner 2013) page 45, 48
• Hunger and Fullness
• Investigate how your body responds to hunger and fullness
• Investigate when it is hungry, full
• Goal
– Gain information not judgement
– Revive lost innate cues of hunger and satiety
Respect Your Body
• Fear of Acceptance of Current Body Size
– Giving up, getting bigger
– Complacency
Respect Your Body
Respect/accepting your body doesn’t mean disregard it
– It means taking care of your health
– Feeding well + physical activity = respect
– Treat it with dignity and meet its basic needs
–Don’t have to like every part to accept/respect it
– You don’t have to eat perfectly to feed it well
Respect Your Body
Hard to reject the diet mentality if:
–Unrealistic about body shape
–Overly Critical about body
–Hard to escape the body torture when the whole country is playing.
– STOP body negativity talk
Winnie the Pooh on Body Image
Winnie the Pooh wore crop tops with no pants, ate his favorite food AND loved himself too!
Honor Your Health With Gentle Nutrition
• Closing the loop between “eating what you want” and honoring your body with nutrition and health.
• Deciding on what to eat goes beyond what your taste buds crave
– Interoceptive awareness
Interoceptive Awareness
• Represents how a particular food choice feels in your body
• This internal awareness causes a shift in how you decide what to eat
• Goes beyond what your taste buds may crave
– Tongue is not the only part of the body that is honored
– This does not mean that the tongue should be ignored
– Takes practice to be able to figure out what tastes good yet honors your health and body functioning
Summary of Gentle Nutrition Principle
Primarily making food choices based on:
• Health to support diabetes diagnosis – Carb counting? Consistent carb? Moderate fat? High fiber?
• Interoceptive Awareness ie Body functioning– Link high blood glucose to how body feels and possible food choice– Link low blood glucose to how body feels – Checking blood sugar when feeling hungry/full can provide valuable information
• If low—likely physical hunger
• Taste
Playtime vs “Nutritious Food”
• Play food definition
– Food that you crave whose main nutritional value is an energy source (aka Calories).
– Lacks in vitamins, minerals, protein, fiber
• ie Devils Food Cake for breakfast
• Teach how to incorporate into their life without harm
– VERY individual
– Discussion of “give and take”
Playtime vs “Nutritious Food”
• Play time and rest are needed in our lives for balance
– Same is true for eating
• What would happen if all you ate was rigidly health food?
Tips with Gentle Nutrition Principle
• Checking in before/during/after eating to develop interoceptive awareness
• Viewing foods as Emotionally Equivalent
– Devils Food Cake for Breakfast example ☺
• Was this choice based on interoceptive awareness?
Changing the Language
Push LanguageYou must
You should
It is important because
Here is what you need to do
Pull Language You might
Why might you consider..
In what way is this important to you
How might you possibly go about making these changes
Bacon L. Health at Every Size: The Surprising Truth about Your Weight; TX: BenBella Books; 2010.
Barry V, Baruth M, Beets M, Durstine J, Jihong L, Blair S. Fitness vs Fatness on All-Cause Mortality: A Meta-analysis. 2014 https://doi.org/10.1016/j.pcad.2013.09.002
Clifford Dawn, Curtis Laura. Motivational Interviewing in Nutrition and Fitness; NY: The Guilford Press 2016.
Garcia-Mayor RV, Garcia-Soidan FJ. Eating Disorders in Type 2 Diabetic People: Brief Review. Diabetes & Metabolic Syndrome. Clinical Research & Reviews; 2017; 11(3), 221-224. doi: 10.1016/j.dsx. 2016.08.004
Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist; 2007 62, 220-233.
O’Hara L, Taylor J. What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift; Sage April-June 2018 1-28.
Pearl RL, Puhl RM; Weight Bias Internalization and Health: a Systematic Review. Obesity Reviews 2018.
Ellyn Satter Institute http://ellynsatterinstitute.org
Scritchfield R. Body Kindness; NY: Workman Publishing; 2016.
Sobczak C. Embody; CA: Gurz Books; 2014.
Tribole E, Resch E. Intuitive Eating; NY: St. Martin’s Griffin; 2012.
Tribole E, Resch E. The Intuitive Eating Workbook. 10 Principles for Nourishing a Healthy Relationship with Food; CA: New Harbinger Productions, Inc; 2017.
Willer F. The Non-Diet Approach Guidebook for Dietitians; NC: Lulu Publishing; 2013.
Don’t forget about all the links in the presentation and your handouts!!