How to promote health without being healthist

Have you ever felt suffocated by the pressure to be healthy? To eat “clean food,” run 5ks, go vegan, lose weight, tone up, eat paleo, buy agave nectar, do Crossfit, meditate, track your steps, count calories, eat organic, go paraben-free, switch to coconut oil, try acupuncture, use a Himalayan Salt Lamp, or quit sugar?

Do you ever feel like a bad person for failing to meet this standard of health so clearly articulated on sites like Pinterest?

health on pinterestWhen it’s your job to promote health, it’s also your responsibility to be aware of the barrage of health messaging out there and of the way it can make people feel: confused, overwhelmed, frustrated, insufficient, lazy, incapable, flawed, ugly, less-than, defeated, worthless, or even hopeless.

I’m going to throw out a radical thought experiment. What if I chose to be unhealthy? What if I simply opted out our contemporary culture of wellness? What if I decided that I didn’t care about longevity or preventing disease? What if I wasn’t interested in athletic pursuits? What if I was happy with my life without any of that stuff?

Would that make me a “bad” person? Would that make me less deserving of civil rights and legal protections? Healthcare? Federal or state assistance? Education? Would it make me less deserving of respect? Kindness? Compassion?

What if rejecting the active pursuit of health and wellness was a valid choice? 

Believe it or not, I do think it’s a valid choice. This may be surprising coming from a public health professional. But I think it is especially an important perspective for health professionals to have. My job is to promote health and wellness as well as to prevent and alleviate illness, violence, and suffering in the community I serve. Convincing people to care about their health and wellness is part of my job, but it’s something that has to be done carefully and thoughtfully so that I do not fall into the trap of perpetuating an oppressive culture of “healthism.”

What is Healthism?

The term “healthism” can be traced back to a 1980 article by political economist Robert Crawford, “Healthism and the medicalization of everyday life”:

Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being. –  Inlt J Health Serv

Implicit in healthism is morality, a driving force behind public health since the Civil War. The sanitation movement of the 1860s and 70s was largely led by the social (and moral) reformers of the Women’s Christian Temperance Union, who fought unsanitary living conditions and prostitution in the same breath.

Sylvester Graham (of Graham Crackers) and later Dr. John Harvey Kellogg (of Kellogg’s Cornflakes) were practicing healthists in the 1880s. They believed in a connection between immorality and disease, and prescribed bland foods and abstinence (from masturbation especially) as part of a healthy lifestyle that would produce a “higher. purer, and nobler type.”

Petr Skrabanek, whose 1994 book The Death of Humane Medicine and the Rise of Coercive Healthism explored this issue, wrote that healthism begins when all human activities are judged according to their health impact, and deemed either “healthy” or “unhealthy”, “responsible” or “irresponsible”, “acceptable” and “not acceptable” based on this measure. Skrabanek goes further to claim that “healthism either leads to, or is a symptom of, incipient totalitarianism … Healthism justifies racism, segregation, and eugenic control; for the healthist, what is ‘healthy’ is moral, patriotic, and pure; while what is ‘unhealthy’ is foreign, polluted, and impure.”

In his review of Skrabanek’s book, Bryan Appleyard wrote:

Skrabanek has two arguments against healthism. First he insists that this kind of pressure and coercion amounts to a fascistic imposition on the lives and freedom of individuals.

And, secondly, he points out that most of the healthist assumptions are either not proven, wrong or highly biased. For example, he says that screening – a central doctrine of healthism – has been found to have no health benefits, but that this finding has been suppressed. And he regards the caring of the healthists as a hypocritical cover for crude authoritarianism.

‘As healthism is driven by power,’ he writes, ‘rather than by concern for the welfare of fellow men, it is devoid of any moral principles.’

, calls healthism “the new Puritanism“:

Healthism is an avenue for subliminal narcissism. There is something seductively deterministic and morally appealing about eating like a cheese-fearing vegan rabbit and looking better, living longer and getting 50 % of the insurance premium back thanks to Affordable Care Act’s Zen-sounding Wellness provisions.

In short, healthism is the new puritanism. The old puritans worked for God’s glory with a famed work ethic which, according to Max Weber, might have been the chiefly responsible for the success of capitalism.

The righteous, mirthless, po-faced, lycra-clad new puritans are forever punching numbers in to risk calculators and obsessing over arbitrary thresholds of LDL-cholesterol whilst watching the Dr. Oz show with the fastidiousness with which the old puritans internalized Leviticus, lest they miss another opportunity for a miniscule relative risk reduction.

Fall Ferguson, Assistant Professor of Health Education at John F. Kennedy University and current President of the Association for Size Diversity in Health says:

Healthism includes the idea that anyone who isn’t healthy just isn’t trying hard enough or has some moral failing or sin to account for … More subtly, healthism represents the widespread ethic of individual responsibility for health in our culture. In the debate over U.S. health care reform, we obsess over the health of individuals, whether it’s reshaping individual behavior to our liking or finding ways to pay for the expensive treatment protocols that we see as being needed because of people’s personal “failure” to care for their own health.

At best, “healthism” refers to a cultural preoccupation with health. At worst, it describes an ethical paradigm in which certain health behaviors are considered moral imperatives and a person’s value and character is judged based on their adherence to those behaviors. A person might also be denied services, benefits, and rights based on their adherence to those behaviors. This is highly problematic.

People engaged in the work of health education/promotion, public health, medicine, nutrition and fitness, etc., must be aware of the pitfalls of healthism, and try to avoid them whenever possible.

Why is healthism bad for INDIVIDUAL HEALTH?

Obsession is not healthy, even if it’s an obsession with health. Encouraging or condoning this kind of preoccupation or obsession in others can be seriously detrimental to their mental, emotional, and physical health. It’s what leads to disordered eating and exercise behaviors, as well as what some are calling “orthorexia nervosa” – a rigid fixation on food quality and purity. It teaches people to ignore their body’s signals – to “push through the pain” – resulting in injury. It robs people of time and resources that they otherwise could put towards fostering social connections, creative hobbies, community service, and other worthwhile pursuits that foster well-being and happiness.

Healthism also creates and encourages stigma, particularly fat stigma. By promoting this idea that “fat = always unhealthy” (which is just not true), fat people are singled out as failing to uphold their “personal responsibility” to maintain their health. As a result, they are labeled as “lazy,” “ignorant,” “lacking willpower,” “gluttonous,” “greedy,” etc.

Whoever came up with the idea of making dieting about health is simply brilliant. Now, society can be prejudiced, but it is ok because it’s about health. Now, you are not shallow if you focus all your attention on dieting, you are righteous. And, whoa be to you who do not diet – for thou art sinning! – Lonie McMichael in Talking Fat

If fat people are automatically “sinners” by virtue of being fat, then it becomes socially acceptable to insult them or shame them. In some cases it can even be seen as a moral imperative to insult and shame them, especially if one believes that will cause them to lose weight. But being fat does not necessarily mean someone is unhealthy. And not only is insulting and shaming people a generally shitty thing to do, it DOES. NOT. HELP. PROMOTE. WEIGHT. LOSS. In fact, it can result in weight gain. So, not only is it cruel, it’s detrimental.

laci green quoteWhy is healthism bad for PUBLIC HEALTH?

Another major problem with healthism is that it tends to focus the attention and resources of public health work on fostering individual behavior change, when we know that social determinants of health influence our health more than individual behaviors do. Public health professionals and health educators pay a lot of lip service to the socio-ecological model intended to address these social determinants.

S-E-ModelYet, due to the influence of healthism, health professionals tend to concentrate most of their efforts at the individual level. Fall Ferguson writes:

In my own field of health education/health promotion, there is a disturbing disconnect between the evidence about the social determinants of health and the profession’s focus on changing individual health behaviors. Even “ecological” approaches to health education, which are inspired by systems perspectives that highlight the interconnected web of health causes, tend to focus on the end result of changing individual behavior rather than collective solutions to health issues. A 2012 article in Health Education and Behavior reviewed 20 years of reported ecological health education interventions; the article acknowledged the field’s shortcomings in this arena, and noted that in addition to certain structural barriers, we may need to move past our own training: “health educators may not have the training or resources to successfully plan and implement institutional-, community-, or policy-level programs.”

Maybe it’s more than just our training that holds us back. Maybe we need to acknowledge our basic healthism instilled by our cultural milieu as well as our professional training. And maybe we need to unpack the privilege that has allowed us to focus so much attention on the role of individual behavior in health.

Why is healthism bad for SOCIETY?

Today we often speak about eating and exercise in terms of morality, often to the point of absurdity. Amy Schumer did a great job of calling out the way we self-flagellate for eating dessert in her sketch, “I’m so bad!”

But this is one symptom of a much bigger problem. Healthism is a social justice issue. To focus on wellness requires resources, namely money, access, and time. This is a matter of privilege. Who has access to organic foods in their neighborhood and who does not? Who can afford childcare in order to exercise and who cannot? Who has healthcare benefits and who does not? Who can devote time to their meditation practice and who cannot? Fall Ferguson writes:

It seems to me that healthism is reflective of deep privilege; it is (in my opinion) a classic “first-world” problem. Healthism can only thrive in a culture where the dominant groups do not have to worry about such things as famine, infectious disease, war, poverty, and hatred as factors that affect their health. It’s privilege that allows us to make health a “project” that we can judge others for not taking up.

Those with lower socioeconomic status do not always have the luxury to focus on their wellness, especially if they are struggling with the basics of Maslow’s Hierarchy of Needs, like safety, housing, and hunger. We cannot talk health behaviors as “necessary” or “essential” or “mandatory,” (as in, “eating GMO-free is basically mandatory”) when they are often beyond the reach of lots of people. We must not judge people for failing to prioritize wellness based on our assumptions about their lives and our paternalistic ideas about what is best for them.

We also must remain vigilant and push back against legislation and policies that discriminate against people based on their health. As Ragen Chastain, educator, activist, and fitness enthusiast, frequently reminds us: “the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent.

The good news? There are things we can do to help avoid the pitfalls of healthism.

Here are some tips for health professionals:

  • Do not focus your work solely on individual behavior change. Make sure that you’re spending equal, if not more, time and resources on addressing social determinants through policy and environmental approaches. If your wellness program is focused solely on individual behavior change and there is no additional support for addressing social determinants in place, you need to rethink your program.
  • When sharing health promotion knowledge/tips/techniques/advice, always start with a disclaimer. For example, “Nobody has any obligation to participate in exercise, however for those who would like to participate – or just learn about the benefits of physical activity- I’m going to share the following info and tips.” Remind people that their heath habits have no bearing on their worth, their moral “goodness,” or their human and civil rights.
  • Be reasonable with your goals and expectations. Not everyone has to have the body of an athlete. Not everyone has to eat like a “health nut.” When you share guidelines, make them reasonable for the average person. Remember that for some people, the absence of illness and suffering is healthy enough, and that’s their choice and it’s valid.
  • Do not impose your beliefs about health and morality on your patient/client/student by automatically assuming they want to lose weight or devote time and other resources to fitness, nutrition, wellness, or weight loss. Use motivational interviewing techniques to find out what their motivations are for seeking help and work from there. Find out what they believe and respect their goals and value system.
  • Understand that shame and guilt are NEVER good motivators. Under any circumstance. Not only do they NOT WORK, they have a negative impact on a person’s mental and emotional well-being and can actually discourage them from participating in healthy behaviors.
  • Help every person cultivate a positive body image. It will not “promote obesity,” I promise.

Have you encountered healthism in your life or work? Have any other tips for how to avoid these pitfalls? Please share your thought and experiences in the comments!

WTF is “lifestyle change” supposed to mean anyway?

lifestyle changeIf you’re like me, you’ve heard the term “lifestyle change” thrown around quite a bit. For example, it was used plenty of times in the comments on my recent post, My Breakup with Exercise. People are always saying things like, “It’s not about dieting, it’s about making a lifestyle change.” But oftentimes one person’s “lifestyle change” is another person’s diet, and vice versa. So WTF does “lifestyle change” actually mean?

Growing up, I first heard my parents use the term to describe a family friend and the healthy changes she made many years ago. Even then I was confused because her story began with everyone’s favorite diet company, Weight Watchers. Even though she no longer follows the program, she continues to practice some of their tips and tricks to maintain her weight, like tracking what she eats, looking for foods high in fiber, etc. A relative told me about a coworker who “doesn’t diet” but just has “plus days” and “minus days”; if she had a “plus day,” she’d compensate by having a “minus day.” To me, this all still sounds like dieting because it involves monitoring your food intake, following food “rules” or restrictions, and placing value judgements on foods or eating habits as being “good” or “bad.” Of course, you might not agree, and that’s okay.

Although the intention is usually good, telling someone to make a “lifestyle change” is problematic because everyone’s understanding of what that means is different. For example, it could mean switching to sugar-free versions of your favorite foods, or it could mean never eating artificial sweeteners ever again. Those of us who struggle with weight and body image often understand the term to apply to eating and exercise behaviors, but for others it could refer to quitting smoking or taking up a meditation practice or switching to paraben-free bath products.

The beauty of the term, though, is that it can mean whatever you want it to mean — whatever makes sense to you.

At it’s most basic level, a “lifestyle change” means making changes to support one’s personal wellness. Did you know that there are actually seven different dimensions of wellness?

  • Physical wellness can include fitness, diet and nutrition, sexual behavior, substance use or abuse, medical care, and sleep.
  • Intellectual wellness can include the pursuit of knowledge, awareness of current events, and the expression or experience of creativity.
  • Emotional wellness can include stress management and relaxation, as well as self-awareness, self-acceptance, and mental health.
  • Social wellness can include interpersonal relationships, social justice, and community service.
  • Spiritual wellness can include your value or belief system (including but not limited to religion), and finding personal meaning, hope, and optimism.
  • Environmental wellness can include the protection and conservation of natural resources, as well as the health and safety of animals, humans, and our own bodies.
  • Occupational wellness can include job satisfaction, work/life balance, and financial security.

It’s helpful to consider of all of these dimensions because it reminds us that neither our worth nor our happiness nor our “wellness” is defined by our appearance, our fitness, or our diet. Part of figuring out what making a “lifestyle change” means to you is figuring out what dimensions of wellness you want to pay more attention to–recognizing that each are equally valid and important in your personal pursuit of health and happiness.

Last year I taught a course on leadership and we used a ranking activity to help students think deeper about their own values. (Mad props to Steve R. for the activity!) I modified it and I think this version could be helpful in terms of figuring out what “lifestyle change” you might be interested in. Below are 50 different things that could be part of making a healthy “lifestyle” change, in no particular order.

 Weight management

 Fitness/ Strength

 Smoking

 Religious belief & practice

 Community Service

 Finances/debt management

  Job satisfaction

 Inner Harmony

 Environmental conservation

 Social Justice activism

 Hope/Optimism

 Stress management

 Animal rights

Being active

  Nutrition

 Vegetarian diet/ vegan diet

 Mindfullness/ meditation

  Sleep

 Creativity/ Creative expression

 Sexual pleasure/sex life

 Family relationships

 Social life/ friendships

 Avoiding processed foods

 Career Advancement

 Romantic relationships

 Pursuit of knowledge

 Alcohol use/abuse

 Medical care

 Sexuality/ gender identity and expression

 Self-care/ Self-compassion

 Awareness of current events

 Political involvement

 Mental health

 Avoiding artificial sweeteners

 Body image

 Reducing intake of chemicals in bath/beauty/cleaning products, etc.

 Intuitive eating/mindful eating practice

 

 Self-acceptance

Avoiding artificial growth hormones in meat/dairy

 Drug use/abuse

 Community engagement

 

Experiencing new things/places

Eating less sugar/high fructose corn syrup

 JOY!

FUN!

 Eating whole grains

 Work/life balance

 Hobbies/skill development

 Gratitude

 Eating local/food sustainability

 

 Intimacy

Okay, here’s the hard part. Here’s the link to download and print it out: Defining your Wellness Values Chart

  1. Cross off the 10 that either a) you’re already satisfied with, or b) that are least important to you right now. (Remember that this doesn’t mean these things are unimportant, just that they are less important to you, right now, than the remaining 40.)
  2. Now cross off 10 more (30 remaining). Give yourself a time limit.
  3. Now cross off 7 (23 remaining). Take a quick break and then come back to it.
  4. Now cross off another 7 (16 remaining).
  5. Cross off 6 more (10 remaining). This is getting tough, huh?
  6. Cross off 5 more (5 remaining).
  7. Circle the most important wellness element to you at this point in time.

I just did this activity and it was really freaking hard, but I narrowed my top 5 wellness elements to: building fitness/strength, improving family relationships, self-acceptance, intuitive eating, and reducing my intake of chemicals, These are the areas I want to focus on to improve my overall “wellness.” So, for me, a “lifestyle change” means working out, accepting myself the way I am, finding more ways to make meaningful and positive connections with my family, listening to what my body wants, and staying away from processed foods and chemicalized bath and beauty products.

The thing about changing your lifestyle is that it has to be something you actually WANT to do. Wanting to lose weight because you struggle with body image is not the same thing as wanting to change the way you eat. For example, the person in that scenario might experience more success and actually feel better by choosing to focus on positive body image and building self-esteem.

Only you know what a “healthy lifestyle” means for you. And if you’re not sure yet, perhaps this activity will help.

Let me know how it goes! I am hoping to try this with my students next year, and your feedback will be super useful.

 

 

My Breakup with Exercise

In November, I met the amazing Ragen Chastain at a conference. She was the keynote speaker and blew the minds of college health professionals about Health at Every Size. During one of her talks she explained that many people are currently experiencing a “bad breakup with exercise.” That phrase was a gift to me – I finally have the  words to describe my fraught and complex relationship with exercise.

I was never an overly active kid. I loved to read, play with plastic dinosaurs, and find salamanders in the woods. I hated gym class. I did not like sports. Nor did I like hiking or cross-country skiing, my parents’ favorite activities. Once I hit puberty my body became soft and pudgy and my dislike of physical activity was no longer just a personality trait – it became a flaw. It became an indicator of my laziness and bad attitude, or at least, that’s how my parents seemed to interpret my spirited protests. I quickly understood that I was being forced to go hiking because I was fat. My mom encouraged me to go to the gym with her. I felt out of place there and embarrassed. My presence in this dark, smelly, scary adult space was punishment for being a fat and lazy kid.

I didn’t touch exercise again until my junior year of college. My university required everyone to take a certain number of gym credits and I signed up for a step aerobics class I had heard good things about. I loved it. The instructor was an athletic female coach who was all about strength and fitness, not about appearance. She wore a giant t-shirt and long, baggy gym shorts. I started coming to the gym a few times a week and doing the elliptical machine, crunches and pushups. I signed up for Pilates and a strength-building classes even though I had already fulfilled my Phys Ed requirements. It felt good. It was a happy time for me. I finally was developing some positive experiences with exercise.

In 2009, I moved to Boston to begin my first full-time job.I got myself a gym membership. I started doing Weight Watchers with a coworker, and religiously tracked every morsel I ate. I signed up for personal training. I went to the gym at least 5 times a week. My sessions at the gym now lasted about 2 hours. I would start with 15 minutes of cardio on the elliptical to warm up. Then I would do 30-45 minutes of strength training. Then I would do 45 mins-1 hour of cardio – rotating between the elliptical, stairmaster, and bike. Then I would stretch for 20 minutes. For a month or two, I added another 15 minutes of ab work each night before I went to bed. I turned down offers to go to dinner or evening events in order to go to the gym. I knew that I needed at least a 3-hour block of time to do my regular workout, shower, and change; there was simply not enough time to do anything else on a weeknight. I had no hobbies to speak of, besides working out. I did this for about a year.

Everyone thought I looked great. I lost 25 lbs and fit into size 8 pants for the first time since high school. For a brief period, you could actually see my ab muscles when I flexed. I could wear really short shorts. I ate mostly processed frozen dinners, raw vegetables, and Greek yogurt (no time to cook). I got compliments from friends, coworkers, and my family. Guys asked me for my number. My parents no longer chided me for my behavior; now they were asking me for tips. They soon signed up with personal trainers themselves.

I was down to 145 lbs, but I was convinced that I needed to get to 125. I believed that was considered “normal weight” or “healthy weight” for a woman of my height. I was excited and happy about the changes I felt and saw in the mirror, but I in no way considered myself “done.” I was in the best shape of my life, but I still thought I was fat. And according to my BMI, I was technically still “overweight.”

This too can be yours! Just eat hardly anything and exercise 2 hours a day for the rest of your life!

This too can be yours! Just eat hardly anything and exercise 2 hours a day for the rest of your life!

Then I started grad school. I was working full-time and taking a full course load at night. Suddenly, there was no time to go to the gym. I had night classes and homework. I still tried to go as often as I could, but if I wasn’t able to complete my full 2-hour workout, it felt like failure. A waste. Moderation was simply not in my vocabulary. My new body was slipping away.

Soon I become so mentally exhausted that I had no room left for tracking Weight Watchers points. I had no time to go grocery shopping. I started living off of cafe sandwiches, takeout, and Red Bull. My beloved trainer experienced some health problems and had to retire. The trainer assigned to replace him was a douchebro jock who kept talking about getting me a “hot bikini body” and I hated him. Eventually, I stopped going to the gym altogether. And, naturally, I started to gain weight. Like so many people, I ended up gaining more than I had lost.

Three years later, I am the heaviest I’ve been in my life. My parents have expressed their concern, and I have pushed back on their well-intentioned but incredibly painful statements with every ounce of spirit in my body; I will not feel like a worthless fat girl again. And no, exercise is not so simple as “Just do it.”

For most of 2013 I was sedentary. I had multiple false starts as I tried to “get back into the gym.”  Each time I returned, there was a new manager at the personal training company who would spot me on the elliptical and approach me, saying “Congratulations on taking the first step towards a better you!” or some bullshit like that.

I wanted to punch them every time. I am already a better me. I have hobbies now. I have friends. I have a life.

Then the manager would encourage me to try personal training because “beginners always need someone to show them how to do things properly.”

“FUCK YOU, I am NOT a beginner,” I would think.

“If you only knew me when…” And then my anger would dissolve into shame. I was embarrassed at failing so spectacularly.

But looking back on it now, I wonder how could I have done anything else but fail. My Biggest Loser-esque workout regime was extreme and unsustainable. Dieting was unsustainable. My abs were unsustainable. And no matter how thin or muscular I got, I always thought I was fat. I always needed to lose more. I was never not unhappy with my body. Losing weight did not improve my body image whatsoever.

In 2013 I vowed to stop dieting forever and began the long process of making peace with my body. Though I was making progress on the eating and body image fronts, I was still having a really hard time with exercise. Friends would say, “Couldn’t you just go to the gym for like 20 minutes? Couldn’t you just take the stairs? That’s better than nothing!” The thought of going to the gym for 20 minutes or taking the stairs was foreign and confusing. How could you do anything worthwhile in 20 minutes? I would never get my abs back by going to the gym for 20 minutes. I would never lose 40 lbs by taking the stairs. It became obvious that thinking of physical activity in moderate and sustainable terms was going to be extremely challenging for me.

I spent a lot of time thinking of ways to get active that would be fun and sustainable. I didn’t come up with any radical new ideas. There was yoga and hiking, which I have learned to like now that it isn’t mandatory and I can choose to do it on my own terms. But I haven’t found a yoga studio I like yet and hiking is difficult to do on a regular basis when you live in a northeastern city. I kept coming back to the gym – the first place I ever really enjoyed exercise.

But I was, as Ragen deftly stated, going through a bad breakup with the gym. The gym had ghosts of my thinner self in every mirror. The gym was full of people who would assume I had never worked out before. And I still never had enough time to do the kind of workouts I felt were necessary. “Do it right or don’t do it at all” would echo in the back of my head.

I took my time. I thought about things. I let myself get comfortable with tenets of Heath at Every Size. I practiced self-compassion. I forgave myself for “failing” and gaining weight. But most importantly, I worked on letting go of the idea that I could someday be 125 lbs or “get my abs back” or achieve the extreme physical transformation I did back in 2010. This has been, and continues to be, the hardest part. There is a very real sense of loss involved in abandoning the idealized, aspirational vision of yourself that’s been in your head since you were a teenager.

Then I agreed, for the first time in my life, to participate in a fundraiser stair climbing challenge. I knew this would force me to get back to the gym, and it did. The stair climb event is two days away, so last week I forced myself to return to the gym for the first time in many months.

Walking in the door was really hard. I could barely finish my first 20-minute cardio workout on the cross trainer. Five days later, I can do 30 minutes without too much difficulty. I think it’s amazing that my body can adjust back so quickly after so long. I am grateful for its strength and responsiveness. I suppress the faint urges to pull my scale out of storage.

This time, I’m trying to commit to realistic goals. 25 minutes. 30 minutes. Mostly cardio, with some Yoga Meltdown or free weights every now and then when I want to work on building strength. No more than 45 minutes per workout, 3-4 days a week.

Workouts that will help keep me active and give me the health benefits I’m looking for, but won’t consume me. Workouts I can squeeze into my busy life without having to sacrifice other hobbies or time with friends. Workouts that have absolutely nothing to do with losing weight or achieving a “hot bikini body.” Those are the kind of workouts I am aiming for now.

I’ll have to wait and see how it goes, but I’ve got a good feeling about this “moderation” thing. Maybe it could work for you too.

Size 14 and that’s okay.

Your Fat is Not Your Fault 2: Blocking Out the Noise

Sunday night I returned from a long camping weekend off the grid to find a whole slew of angry comments on my most recent post, Your Fat is Not Your Fault. Apparently people get really mad when you deign to suggest that it’s okay to be fat on the internet.

Most of the comments were mean and/or stupid in that predictable way people like to be mean to fat people. Those were, and will continue to be, deleted. There were also some typical interweb lols like “I lost 100 lbs eating Paleo. Have you considered that everyone should just eat Paleo?”

There were, however, some comments written by actual thinking, feeling, people critical of  my assertion that dieting almost always fails, and that obesity as a social problem that must first and foremost be addressed on a systematic, societal level. While I won’t address all of those arguments right now, I feel that they are secondary to (and distracting from) my overall point. My point–that it’s okay and important to forgive yourself for being fat–unfortunately got lost in the politics of fatness.

I’m not here to debate whether or not obesity is unhealthy (at least not today). I am here to argue that guilt, shame, and self-hatred are unhealthy. If it makes me a  radical to suggest that guilt, shame, and self-hatred are significant problems then so be it. Body image disturbance (the term for all types of body image issues including dissatisfaction and distortion) is associated with eating disorders and low self-esteem. Self-hatred and low self-esteem keep people from reaching their full potential; they keep people from participating fully in their own lives and becoming productive, contributing members of society.

Think obesity is a drain on the healthcare system? Well, body image disturbance is a drain on every system.

Last year I wrote a post called Positive Body Image Won’t Make You Fat: The Case for Body Positive Health Promotion. Read it.

Having a positive body image won’t make you fat. Letting go of the guilt and blame will not keep you fat. In fact, it will help you begin to heal and one day embrace self-compassion and fun as motivators for healthy eating and fulfilling physical activity.  And once you’ve embraced self-compassion and let yourself have fun-while-fat,  you can start to make those positive lifestyle changes that will allow you live your life to the fullest, whether or not it results in weight loss. If you’re looking for help with this, there are some amazing books on the subject like Kate Harding’s Lessons from the Fat-O-Sphere and Linda  Bacon’s Health At Every Size, as well as coaches like Isabel Foxen Duke and Sarah Jenks.

But forgiving yourself for your fat is especially hard when everyone wants you to fix it, apologize for it, or suffer for it. It’s especially hard when when everyone acts as if it’s as easy as “putting down the cheeseburger,” when in reality it’s a gargantuan, exhausting, and wholly demoralizing task that requires strict self-regulation of every thing you eat or do for the rest of your entire life. It’s not helpful to listen to the noise, ever, even if you do want to lose weight.

Unfortunately, fat shaming trolls can be found just about everywhere, including the medical and public health establishment. I’ve recently learned that they are especially virulent among the uber-libertarians (“fat people are destroying our economy because they’re lazy and looking for handouts just like homeless people are lazy and looking for handouts”)  and men’s rights communities (“feminists are destroying my game by telling fatties it’s okay to stay fat”). Add ’em to the bingo card, boys.

In order to “become healthy” — whether that means getting fit, raising your self-esteem, having more fun in your life, etc. — you need to practice self-compassion. Treat yourself the way you would treat someone you love. That means looking backwards and thinking about when you “became fat.”

  • Were you a child? Not your fault.
  • Were you a teenager? The teenage world is one of desperate insecurity; you coped the best you could.
  • Were you in college? You were stressed and not sleeping and maybe partying a lot and still feeling invincible – it’s okay. As my fellow college health professionals often say, it’s “developmentally appropriate” behavior.
  • Were you pregnant or did you just have a baby? Were you coping with depression or another mental illness or maybe a disability? Were you working long hours with no time for yourself? Were you dealing with an eating disorder?

You are not to blame for all the circumstances of your life. Give yourself the compassion and respect you deserve. You would not blame your best friend. Don’t blame yourself.

If anyone out there wants to make you feel bad about your body or feel bad about yourself because of your body correctly identify them for what they are: a troll. If they act concerned for your health, they are a concern troll.

Only you know what’s best for you. Only you can determine what it means for you to live a healthy, happy lifestyle.

Block out the noise. Delete the comments. Do you.

And if anyone has any questions about my comment policy, this is basically sums it up:

Your fat is not your fault

Your fat is not your fault.

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You are not lacking willpower.

You are not lacking willpower because you can’t stick to your diet. You are fine; it’s dieting that doesn’t work. No really. Diet and exercise DO NOT CURE BEING FAT. They may help you lose weight for a few months to a year to six years… but, according to a massive analysis of every long-term weight loss study, no one — statistically speaking NOT A ONE PERSON — has kept off a significant amount of weight (i.e. more than 15-20 lbs) permanently. There is a lot of emerging evidence that when a person goes on a diet, their chemistry changes so that they’re bodies will continue to fight against weight loss long after the dieting has stopped. As David Wong from Cracked put it, “It’s like being an addict where the withdrawal symptoms last for decades.”

You are not lazy.

You are not lazy because you choose to focus your time and energy on things other than losing weight. To quote David Wong again, “The people who successfully [lose weight and keep it off] are the ones who become psychologically obsessive about it, like that weird guy who built an Eiffel Tower out of toothpicks.” So congratulations, you aren’t spending every waking moment of your life focusing on your waistline. You are doing amazing things, whatever they are. Seriously! Whatever you are doing with your precious time and brainspace (reading, writing, working, creating, studying, caretaking, being nice–contributing to society in any small way) is worthwhile and meaningful and more important than spending it obsessing about your weight.

If you want to be more active, then cool. Go for it. Hopefully you’ll find some activities that will bring you pleasure and joy. But don’t think that being more active is going to make you lose weight. It’s not. (See above). So don’t force yourself into a lifestyle that doesn’t work for you–you’ll only end up making you feel worse.

tumblr_mab2gzHeHb1qm339ko1_500You are not unhealthy.

You are not unhealthy just because you happen to be fat, I mean. Isn’t that great? Your weight and your health are two different things. You can be healthy at any size.  Health is determined by your behaviors, luck, and genetics (more luck). Your behaviors are up to you. And they are NO ONE’S BUSINESS but yours. For whatever reason, being “healthy” has been equated to being moral or being “good” in our society. Let me blow your mind for just a second by throwing this nugget out there: You have a right to be unhealthy. For any reason. It’s YOUR body and you can treat it however you wish. But if you choose to be healthy, eat nutritious food and try to sleep for 8-10 hours a night. Find some active things to do that you enjoy and quit smoking. But don’t conflate your health with your weight. Losing weight probably wont improve your health, and improving your health often times doesn’t result in weight loss. This is okay.

You are not stupid.

You are not stupid for trying that juice cleanse or hoping that trying Weight Watchers or eating paleo or forcing yourself to go to the gym every day would “fix” your fat. Our society believes that diet and exercise cures fat. This is what our doctors tell us. This is what the medical and public health arms of our government advise. They are wrong. They have failed us.

Instead of focusing on fixing the real, structural, environmental problems that cause people to become overweight, like poverty or food deserts or lack of sleep or being overworked/overstressed, food advertising, agricultural subsidies, high fructose corn syrup and processed flour…. public health officials have spent millions of dollars and time and energy telling you to diet and exercise. Why? Because it’s easier. It’s much, much easier (politically) to tell individuals to diet and exercise than it would be to fight the lobbyists or make any real headway in regulating the food industry or addressing poverty or our tradition of overwork in America. As Gary Taubes wrote in The Daily Beast, “…the reason the anti-obesity efforts championed by the IOM, the CDC, and the NIH haven’t worked and won’t work is not because we’re not listening, and not because we just can’t say no, but because these efforts are not addressing the fundamental cause of the problem. Like trying to prevent lung cancer by getting smokers to eat less and run more, it won’t work because the intervention is wrong.”

You are not weak.

You are not weak. In fact, your strength is incredible. You are living in a world that does not make it easy for you. You are living in a world that tells you you have to look a certain way in order to be loved, and at the same tells us food is love. You are told to resist eating foods that are scientifically engineered to be literally irresistible — as in, they trick our senses in order to make us physically unable to resist eating them. You have struggled with stigma and shame and guilt and survived. You are alive and you are living.

So let me say this one more time: Your fat is not your fault.

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Give yourself permission to forgive yourself.

Go out and live your amazing life.

Addressing the sleep deficit, NOT one person at a time

The more I learn about health and wellness, the more convinced I am that sleep is magic.

Not only does getting the recommended 7-9 hours help you feel awake and refreshed in the morning, it also helps regulate your metabolism and improves your memory, focus, judgment, problem solving, and athletic performance.

New and terrifying research links not-enough-sleep (the 5-6 hours most Americans currently get) with weight gain, increased risk of cold/flu, diabetes, cancer, and ADHD-like symptoms. Additionally, not getting enough sleep results in poorer cognitive abilities (lack of focus, concentration, ability to remember what you’ve learned), poor judgment, and impaired driving on par with drunk driving. It’s also correlated with depression, anxiety, and other mental illness.

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When I saw this New York Times post basically summing it all up (and providing links if you want to check out the research) I was ecstatic and all “That’s what I’ve been saying!” Then I read the comments.

“You assume it’s a choice, that people actively choose to get less sleep and, if they want to, can choose to get more. That may well be true of upper class people who can hire others to do their work for them – housework, tutoring, etc. As for me, a middle class shlub, well, I would LOVE to get more sleep. But I am a single mom. I have to get up at 5:30 am for my job. And I have to work or I will land in the street with my kids. ANd I have to stay up at least until 10:30 pm most nights to get this or that child hither and thither, help with homework, and son on. I cannot hire anyone to do any chore– lawnmowing, housecare, homework, driving, shopping, bill paying, college planning for kids, etc etc etc etc. Basically, I work from the moment I get up until the moment I sleep. I have no time to exercise either.”

And it hit me. The sleep deficit is a lot like the obesity epidemic; it is a systemic problem that cannot be solved by encouraging individuals to make healthier choices.

I work with college students who probably could get more sleep if they spent a couple fewer hours playing videogames.

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Shit college students say.

Of course, some of my students work more than the recommended 10 hours per week and can’t choose to sleep more. But in general, I feel okay about trying to encourage them to prioritize sleep over partying or more time on Reddit because they can usually make changes without too much trouble. For the general adult population, however, this really isn’t the case.

The comments on the New York Times post read like a laundry list of reasons why Americans are not sleeping. Parents are kept up by new babies. Physicians-in-training are working 28-hour shifts. People who travel constantly for work (flight crews, journalists, musicians, etc.) are forced to keep irregular schedules in different time zones. Single parents are working full time jobs in addition to the “second shift” just to make ends meet.

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But it isn’t just our jobs, families, and full schedules that are keeping us up. The world has changed. Energy drinks and caffeinated latte drinks are sold on every corner and and marketed either as health supplements or entertainment. We are constantly connected, if not tethered to, our phones, tablets, and the internet — whether it’s for work, entertainment, or connection. A recent study found that the light from backlit screens can disrupt sleep by suppressing melatonin, a hormone that helps regulate our circadian systems. But this is even bigger than a gadget issue.

Our circadian rhythm, which is how our body knows when to sleep and when to wake, is informed by both light and temperature. Darkness and cooler temperatures let our bodies know it’s nighttime, and therefore bedtime. So what happens to our circadian rhythm when we live in consistently temperature-controlled environments? And about that darkness thing? Yeah. We don’t really have that anymore. Just check out these NASA images of the world at night.

Captured in 1994

Captured in 1994

Light pollution projected growth

Light pollution projected growth in 2025

So basically our artificial environment is  really screwing with our circadian systems, and we wonder why no one can sleep? Some scientists are even concerned that light pollution is killing off wildlife.

Animals need sleep too.

Animals need sleep too.

It’s no wonder that the New York Times post, which encouraged readers to get more sleep and discuss the issue with their doctors, made some people angry. For so many of us, sleep is simply outside our realm of control. Before I’ve made the argument that our obesity problem should not be addressed through individual behavior change because it is a systemic problem that can really only be solved through systemic changes to our environments and our policies. When we try to treat obesity as if it were simply an individual problem, it manifests as shaming people for things beyond their control. When we consider that sleep and weight are inextricably linked, it’s not surprising that the same thing happens when we tell people they need more sleep.

And, just like weight shaming can cause people to develop eating disorders or depression/self-esteem issues that lead to further weight gain, warning people about the health risks of sleep deficit can actually make the problem worse:

“As a law school graduate studying for the New York Bar and planning an impending move to NYC–without yet a job, praying to find one in public interest law–I lie awake every night, worrying.  But at least now I know all of the harmful things that are happening to me.”

“Constantly counting the number of hours of sleep I got each night hasn’t been good for my mental health either. It’s like counting calories. It made me obsessed. So I stopped.”

“One thing that would help me sleep is not being constantly told how awful it is not to get it.”

The Health Belief Model of behavior change tells us that if you scare people about a health issue without providing a clear solution for how they can prevent or treat it, they are not going to respond well. Telling folks the dangers of not getting enough sleep without providing realistic solutions will cause them to feel like it’s hopeless and shut down. This issue cannot be solved by telling people to try to get more sleep.

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So how can we address the sleep deficit at the systematic level? In college health we have an advantage because we have a fair amount of control over the environment our students inhabit. We have the ability to provide a campus that encourages and supports healthy behavior. We can close down our libraries, gyms, labs, and campus centers at 10 pm. We can ban 8 am classes to let our students sleep in later. We can mandate quiet hours in our residence halls. We can ban Red Bull and 5 Hour Energy from promoting their goods on campus. It’s a little more complicated in the real world.

tumblr_inline_mmq91iJGyJ1qz4rgpWhat could some of those systemic changes look like? Is it even possible to regulate light pollution in urban areas? How would we accomplish that? We could tax the crap out of energy drinks like we tax cigarettes. We could create similar disincentives for 24-hour service availability. For example, in Spain, most businesses are closed during siesta in the afternoon. People simply have to run errands another time, and they make it work. We could also place stricter regulations around the “full time” (read: eligible for benefits) work week, reducing it from the standard 4o-45 hours to something closer to 35. (Again, a lot of Europeans do it this way.)

But beyond regulation, true systemic change requires a culture shift. We need to foster a culture that doesn’t reward employees for putting in extra hours, or make anyone feel like they need to put in extra hours to keep their job. In industries where it’s possible, like in most office jobs, we need to institutionalize flex time and let workers telecommute in order to snooze that extra hour it would take to commute. We need to change the norm from one where we lie in bed with our phones checking email to one where that kind of behavior is uncommon. We could stop creating reasons for people to stay up late, like scheduling evening events earlier and no longer airing popular TV shows after 10 pm.

But this kind of societal change takes decades and requires tireless efforts from public health folks and other advocates. Perhaps the first step of that work is recognizing that the sleep deficit is bigger than you and your insomnia, her and her new baby, or him and his ridiculous work schedule. For those who can make the choice to sleep more, doing so will definitely improve their health. But the focus of public health messaging and health journalism should not be to scare or shame people who, for whatever reason, can’t get enough sleep.

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TL;DR sleep zombie friends?

What I’m really trying to say is that the only way to really address the issue is to treat society’s sleep deficit as the gigantic, systemic, clusterfuck of a problem that it truly is.

Goodnight.

Goodnight.

Healthy Choice™ and healthy changes

I’ve recently taken note of a new ad campaign by Healthy Choice stating, “Don’t diet. Live healthy.” Turns out the campaign isn’t actually that new since the New York Times covered it in September, 2012, but since I didn’t have television until recently, it’s new for me.

I liked this ad as a wellness educator and body image researcher, and as a former dieter and purchaser of SmartOnes Weight-Watchers-friendly frozen dinners, it made me laugh.

Yes, you heard right. I am a former dieter. At the end of 2012, after yet another frustrating year of failed attempts at dieting and weight loss, I made a serious decision. I decided to stop dieting, forever. I cancelled my Weight Watchers Online subscription for what will be the last and final time. It all started last year when I started researching body image and “fat talk” for my dissertation-equivalent Health Communication project. Conducting that research often and unintentionally became “mesearch,” forcing me to examine my own feelings and behaviors with the intensity of a laser beam. It was painful and I did not like what I found.

I learned that I was one of the 90% of students with body image concerns. I learned that body image disturbance, an umbrella term for body image dissatisfaction and distortion (believing you are bigger than you really are), is associated with depression and low self-esteem. I learned that I was one of the majority of women who engaged in “fat talk” — a term coined in 1994 to describe the specific way girls and women talk to each other about the size and shape of their bodies or diet and exercise regimens, typically in a negative or self-disparaging manner. “I’m so fat.” “You’re not fat! If you’re fat, what does that make me?”

After leaning that fat talk is associated with greater body image disturbance and thin-ideal internalization (the idea that skinny=pretty) and coming to understand the way it normalizes and reinforces body image concerns at the societal level, I started paying attention. It was staggering to realize how many of my conversations with other women were about dieting, exercise routines, the clothes we “could” or “couldn’t” wear, how much weight we wanted to lose, the reasons why we hadn’t been able to “commit” to our weight loss plans. I never realized how often I apologized for eating (“I’m sorry but I’m getting a big burrito tonight”) or made excuses for eating (“I ate like nothing all day today so I’m going to get fries”).

I started to learn more about dieting. I began to realize that all dieting is bad. Yes, ALL dieting is bad. Even if you really need to lose weight for medical reasons like heart disease or diabetes, dieting only helps in the short term. Dieting offers nothing that might help you stick to your diet. Dieting doesn’t help once you’ve reached your goal weight. Cleanses and fasts are even more stupid than diets. They’re like douching–completely unnecessary when you’re healthy, and potentially harmful when you’re not.

I have come to believe that dieting is unhealthy. Slowly but surely, I came round to the philosophy behind Health At Every Size. Believe me, it took a while.

I am overweight but not horribly so. I have been this way for most of my life. I have wanted to lose weight ever since I was 10 years old. That’s a long time to want something. So, making the decision to stop dieting and pursue health rather than weight loss is nothing short of worldview-shattering. A complete about face. A completely new paradigm positioned 180 degrees from my former belief system.

This kind of conversion doesn’t happen easily or quickly. I’ve sat and mulled and struggled with these feelings and developing beliefs for a year or two now. Even today I’m still often shocked by how radical they sound to my own ears. Deciding to stop dieting has been one of the most terrifying things I’ve ever done, and I’ve just barely gotten started.

I created a plan for myself. Instead of dieting, I would:

  1. Get active for the right reasons. Find and embrace the pleasure in physical activity. Exercise because it feels good or to meet goals other than weight loss (do 30 push ups, hike that mountain, etc.).
  2. Learn to cook and eat take-out and prepared food less often
  3. Practice mindful eating, listen to my hunger signals, etc
  4. Practice good sleep hygiene (lack of sleep affects the hormones that regulate your appetite and feelings of satisfaction after eating, not to mention the myriad other physical and mental effects)
  5. Cut out “fat talk” entirely; if others around me are doing it I will not participate or change the subject

Truthfully, I started on number five about a year before I made the rest of my plan to stop dieting. Cutting out fat talk turned out be easier than I thought. At first it felt awkward and I didn’t know how how to act or react when friends and coworkers launched into the usual self-put downs and mutual reassurance tango. It turns out that simply not participating or changing the subject works pretty darn well. In a couple of instances, I talked with some close friends about it and my decision to stop. They were receptive and overtime less and less fat talk creeped into our conversations. Overall, I think I am happier for it. Now when I hear fat talk I’m struck by how annoying and insipid it is, and grateful that it’s no longer a part of my social repertoire  It’s been harder, of course, to silence the fat talk that goes on inside my own head, but hey. One step at a time.

This January, I  started the rest of the plan. The first week of diet-free living felt amazing. It was FREEDOM. I felt great to eat something “normal” (non-diet food) and even better to allow myself to NOT feel guilty afterwards. The elation didn’t last long, though, as my insecurities and doubts bounced back with a vengeance. They’re still with me today, louder than ever:

I doubt that I will be able to make any real measurable changes in my weight or my health without dieting. I doubt I will be able to stick to my 5 point plan. I doubt I will be able to be happy if I stay at my current weight, even if I’m super healthy and fit.

I doubt everything regularly, but I’m so committed to building sustainable, healthy habits that will last for the rest of my life that I can’t give up.

It turns out that quitting dieting is the easiest part of making this lifestyle change. A harder part is actually developing and maintaining my new, healthier, lifestyle and the hardest part of all is silencing the doubts and insecurities that make me want to give up or give in to the seeming futility of it all.

I appreciate the message behind Healthy Choice’s latest ad campaign: “Don’t diet. Live Healthy.” I believe it to be a healing message for both individuals and our sick culture. Of course, if it were easy to “live healthy” in America today we wouldn’t have turned to dieting in the first place. And as great as Healthy Choice products are (that is, marginally better than SmartOnes and other diet food), frozen dinners are not the answer.

“All Adventurous Women Do”

HBO's GirlsOn the third episode of HBO’s new series, Girls, the protagonist Hannah (played by creator Lena Dunham) is diagnosed with human papilloma virus (HPV). Distraught, she tells her best friend, who replies with the most revolutionary phrase ever uttered on television regarding STI stigma: “All adventurous women do.”

STI stigma is not difficult to understand. Since STIs are sexually transmitted, they’re easy to interpret as punishment for promiscuity. People with STIs are often characterized as slutty, dirty, trashy, or stupid and reckless. And when someone is diagnosed with HPV–no matter how confident she is in her choices, no matter how careful she is–she’s faced with the crushing weight of this stigma. She must try her darndest not to internalize it–not to believe that she is being punished for her sexuality, not to believe that she brought this upon herself, or that this viral infection is indicative of poor moral character. This is extremely difficult because no one has prepared her for this, and she will almost certainly go through it alone.

Since HPV and STIs are treated as a shameful secret, we don’t ever talk about what the process of diagnosis and its aftermath is like, and as a result, we never hear what it was like for someone else. We each have to figure out how to cope on our own, in silence, without the comfort or guidance of those who have been there and can understand. There are no celebrity spokespeople for HPV. No star athlete role models. And so very few narratives in television, film, or literature.

It’s rare to see STIs on television. Rather, it’s rare to see STIs on television outside of medical and crime dramas where STIs are used as a “who done it” plot device to reveal some unexpected twist regarding infidelity or some otherwise inappropriate sexual behavior. It’s rare to see a character simply living with an STI–getting diagnosed, experiencing treatment, navigating relationships, and dealing with shame and stigma in every day life. It’s rare, but it shouldn’t be.

HPV is the most common STI in the United States. The CDC approximates that 20 million Americans currently have HPV, with six million new infections occurring each year. (For reference, 20 million people is roughly the population of Beijing, New York state, and the entire country of Australia.) The CDC estimates that 50% of sexually active Americans (men and women) will contract HPV at some point in their lives, although the American Social Health Association thinks it’s closer to 75-80%. For women, the rates are even higher: the CDC estimates that, by the age of 50, at least 80% of women will have acquired sexually transmitted HPV.

So, if at least 50% of Americans will one day have the experience of being diagnosed with HPV, shouldn’t we be doing something to prepare them for that moment so that the bottom doesn’t drop out from under them? Shouldn’t we let them know that this is a shared experience and that they don’t have to feel so alone? Shouldn’t we be working to combat stigma at the social level so that we can reduce the emotional damage it inflicts?

Writing HPV and other STIs into television narratives is a great way to challenge and combat stigma. Especially when the character is able to make peace with the diagnosis, providing a model for the rest of us.

“All adventurous women do.”

In that one glorious sentence, Girls let us know that HPV is common and that instead of a being a sign of poor character, it’s a mark of an adventurous spirit. This one line erases the stigma and reframes HPV as something normal, even positive. “All adventurous women do” allows Lena Dunham’s character Hannah to own the diagnosis, to embrace it, to wear it as a badge of honor. And it teaches the rest of us–all of us girls who have felt the waves of shame and guilt crashing on top of us, suffocating us–that we are okay. That HPV, much like traveler’s diarrhea, is just another part of the experience of being an adventurous woman in the 21st Century.

Positive body image won’t make you fat: The case for body positive health promotion

I’m currently designing a social marketing campaign to improve body image among undergraduate women at a major university. On three different occasions, my classmates—a cohort of public health, nutrition, and health communication students in leading graduate programs—expressed concerns about my project, asking “Aren’t you worried that you’re promoting obesity?”

There seems to be a dangerous misconception in the public health community that the goals of positive body image promotion and obesity prevention are at odds. That somehow, by helping people feel better about their bodies, we will inadvertently “encourage” obesity.

But body image promotion isn’t about glorifying fatness, just like obesity prevention isn’t (or shouldn’t be) about the glorification of thinness. More accurately, body image and weight management are interconnected elements of holistic mind-body approach to health and ultimately, the public health community has more to gain by thinking of them as complementary rather than competing interests.

Obesity prevention efforts may appear to benefit from a status quo that stigmatizes fatness and worships thinness, but the evidence just doesn’t support it. We live in a culture that idolizes underweight supermodels and relegates fat actors to fart and food jokes, and yet none of it has done anything to make people healthier.

A lot of people worry—myself included—that without body dissatisfaction, we would lose our motivation to slim down. It’s an easy trap to fall into because, for many of us, negative thoughts are the only motivation to lose weight we’ve ever known. It’s scary to imagine life without our internal “fat talk”; it takes work to imagine using positive feelings as a source of motivation.

But contrary to popular belief, shame is not a good motivator. In addition to reinforcing an impossible, demoralizing standard of beauty, using fat shame as motivation will always backfire. Fear, shame, and self-disgust may prompt people to change their habits temporarily, but once they start to feel better and the bad feelings dissipate, they are bound return to old habits. Motivation-by-fat-shame doesn’t create a culture of health; it creates a culture of yo-yo dieting and January gym memberships abandoned by March.

Not only does fat shaming fail to help people get healthy, it actively hurts people, leaving maelstrom of negative body image, low self-esteem, depression, eating disorders, and other pathological eating and exercise behaviors in its wake. This is no small matter, as these conditions cause pain and suffering for millions of men and women, of all ages, all over the country and the world.

Obesity prevention efforts that reinforce the thin-ideal status quo are doomed to perpetuate a broken system where body image dissatisfaction is normative, obesity rates keep rising, and the multi-billion dollar weight loss industry capitalizes on both. But obesity prevention efforts that embrace positive body image promotion, on the other hand, have a chance to break the cycle.

Meaningful body image promotion encourages women to reject the tyrannical and reductive thin-ideal portrayed in the media, and to understand that pursuing a healthy lifestyle for its own sake is much more rewarding than obsessing about dieting and weight loss. After all, “thin” doesn’t translate to “healthy.”

For example, the Health At Every Size (HAES) movement is based on the understanding that weight does not determine health, and that exercise and good nutrition are beneficial, whether or not they result in weight loss. Instead of using BMI, HAES advocates using more specific measures, like blood pressure and cholesterol, to determine one’s health status.

Instead of relying on body dissatisfaction, HAES teaches us to draw motivation from positive sources, like the desire to explore new hobbies (yoga, archery, kickball), to achieve new goals (run a 5k, learn to surf), or to enjoy the flavor and feeling you get from nourishing your body with healthy foods. This is the kind of lifestyle change that keeps people engaged and motivated for the long haul, and it will keep us healthier, whether or not we’re overweight. Also, it’s fair to say that by letting go of the “impossible dream” of one day looking like the (photoshopped) people on the cover of magazines and by learning to accept and love our bodies as they are, we’ll be happier too.

This type of holistic approach—incorporating positive body image, mental health, physical activity, and good nutrition—is actually sustainable because it promotes an understanding of “health” as a lifelong process rather than a set of restrictions or punishments to be lifted once you reach that magic number on the scale.

We know that there are no health benefits to negative body image. So why would we limit the scope of obesity prevention to exclude the potential benefits of positive body image?

Encouraging positive body image does not “promote” obesity. Rather, it helps people let go of the shame, fear, and unsustainable weight loss behaviors that are keeping them trapped in a state of bad health.

My abortion story

I’ve been choosing abortion for 10 years, and that choice has shaped the course of my life.

Today I blogged about my abortion story on Role/Reboot:

If I got pregnant today, I would have an abortion

As a 16-year-old, I knew that if I got pregnant by accident I would have an abortion. Ten years later, I am in a completely different place—a place where I could, realistically, support and parent a child—and I would still choose abortion.

I believe in the power of telling stories. With the 80 new restrictions on abortion rights enacted by state legislatures in 2011 and more coming every day, I believe it’s especially important to tell stories about abortion and the role it plays in creating an egalitarian society that allows women, and men, to control their destinies. Until recently I felt like I didn’t have a story to tell because I haven’t had an abortion. I cannot speak to the experience of making that decision or undergoing the procedure. But I realized that I do have a story, a story that has grown with me as I matured from a 16- to 26-year-old adult who could, if I chose to, be a mom.

Continue reading at Role/Reboot.