Let’s talk about the new weight loss injectables Wegovy, Ozempic and Mounjaro. We cannot ignore the timing of this medication’s popularity, while everyone continues to reckon with the impact of COVID on their lives, communities and overall health (including mental).
This month, we celebrate 10 years of Be Nourished! Our process over many of these years has been finding a language and philosophy while we unraveled our own formal training and internalized shame. Our work has been the result of deeply listening to understand what truly helps a person heal body shame and move towards a more compassionate model of caring for one’s self. This list is our reflection on what we have learned and describes the foundation of our ongoing work at Be Nourished.
1. The current wellness paradigm talks about your health like it is the “be all, end all” to your existence. Pursuing health is not a prerequisite for worthiness; nor is it a moral obligation. Healing relationship with food and body is helpful for many in a system that pathologizes human bodies and behaviors. You should not have to be “good” to be loved, respected or have access to non-stigmatizing care. Let’s not hide behind “personal responsibility” when there are enormous disparities in our health care system.
2. Weight discrimination has risen 66% in the past decade, and is just as pervasive as race and gender discrimination (Puhl and Brownell, 2006). Weight stigma impacts all of us (weight is a normative discontent, regardless of size), and this internalized oppression strongly impacts our health and well-being. We, in the HAES® community, are very concerned about the health effects of the war against “obesity”. Body loathing and shame make it difficult to care for ourselves (Tylka et al, 2014). The bottom line is nobody benefits when we see a healthy body only as a thin one.
3. The words overweight and obese pathologize certain bodies. There is no weight over which you are definitely unhealthy. These terms are defined using the criteria for the body mass index, and BMI was never intended to be a marker of an individual’s health and well-being. Stop using these terms to describe people’s bodies. Instead, try phrases like people who live in larger bodies, fat people, people at the higher end of the weight spectrum, larger bodied people, etc.
4. We, as a culture, prescribe for fat people the very behaviors we diagnose as eating disordered in thin bodies. Chew gum when you are hungry. Weigh yourself daily. Track your calories. Exercise compulsively. Just watch “The Biggest Loser” to see this in action. We must put an end to this now.
5. We wish we lived in a world that was more focused on raising competent eaters, than healthy ones. Ellyn Satter’s division of responsibility helps parents become aware of their own “food stuff” so that they keep anxiety and conflict off the table. Our current relationship with food is greatly affected by the messages we receive from adults, both at the table and beyond. We advocate for a feeding relationship that allows children to develop eating competency and grow predictably over time. If more people adopted this philosophy, we would significantly reduce the incidence of eating disorders and the harmful effects of yo-yo dieting.
6. The pursuit of health, coupled with body shame, perfectionism or a sense of righteousness, is a slippery slope to disordered eating. “Normal” eating includes flexibility. There is a new eating disorder called Orthorexia that is currently being researched and may be considered for inclusion in the next DSM. The term Orthorexia was coined by a physician when he realized that his pursuit of nutritious foods had turned into an obsession with eating correctly. The disorder is not rooted in the desire to be thin. Steven Bratman, MD, describes it as an obsessive focus on “healthy eating” with exaggerated emotional distress when food choices are perceived as unhealthy. You can read more about it here.
7. You cannot heal your relationship with food while focusing on weight loss or healthy eating. The food, nutrition and body police create too much interference, and cause people to continue to lead with their heads, completely cut off from the wisdom of the body. It is critical to put thoughts about weight and health on the back burner to create space to heal. Helping professionals need to consider a person’s history of chronic dieting and disordered eating when providing treatment and dietary recommendations, otherwise they are just exacerbating the problem, and doing more harm than good. We are fans of the mantra “Not Now.”
8. Binge eating is, more often than not, related to restrictive eating. The more restrictive you (and your thoughts) are about food, the more likely you are to binge. It is important to note that a focus on behavioral weight loss is contraindicated for people who struggle with binge eating, but is still commonly offered as a treatment option. You will not stop binge eating until you stop restricting your food in an effort to lose weight. Focusing on weight loss will not heal the eating disorder. Our colleagues and friends, Chevese Turner and Amy Pershing, have worked tirelessly to get BED recognized in the medical and eating disorder communities. They are the co-founders of the Binge Eating Disorder Association, and their website has a wealth of information for people wanting to know more about the disorder.
9. Our practice is weight-neutral. We don’t know what you are “supposed” to weigh, and neither does anyone else. One of three things will happen if you work with us: 1) you will gain weight, 2) you will lose weight, or 3) your weight will stay the same. This is a bold statement considering how many businesses promise weight loss for fear that people won’t be interested in anything but that. Even some Health at Every Size® (HAES) providers try to reign people in with the promise of weight loss. This bait and switch method is an ethical concern in the HAES community. The truth is your body has a set point, and it will do everything it can to maintain that set point weight. Only your body knows what your natural healthy weight is. Body Trust® is listening to your body, acting accordingly, and letting the body sort out the weight.
10. Change rooted in shame doesn’t stick. Using shame as motivation is like rooting yourself in quicksand. When we co-founded Be Nourished 10 years ago, our fist tag line was “change from a deeper place.” We had no idea how the meaning of this statement would take shape as we developed our approach to body trust. Shame has us hustling for our worthiness—working on our self-improvement projects in the hopes that moving closer to idealized identities will allow us to have evidence for, and believe in, our own worthiness and lovability. We say death to the constant body project so we can birth all that you already are (and always have been).
11. It is hard to take care of something you don’t like, and yet this is how most people approach their plans for change. Developing reverence for the body is part of healing. Start noticing how your body shows up for you every day, regardless of how you treat it. Can you allow yourself to take in the solemn and beautiful truth that your heart is beating just for you?
12. All of the ways we cope (and numb) are rooted in wisdom. We develop strategies to help us keep going when we need them the most. This is resilience. This is wise. When our strategies become clunky, frustrating and/or are contributing to a life that feels too small, it is time to, with gratitude, let them go.
13. Many people engaged in the fitness industry are there for cosmetic reasons. Looking fit and being fit are two completely different things. For clients who are interested in improving their health, our focus is on metabolic fitness rather than cosmetic. Research shows that fit and unfit bodies come in a variety of shapes and sizes, and that a person who is thin and unfit has a similar risk in morbidity and mortality as someone who is fat and unfit. We cannot look at someone and know how fit they are.
14. Exploring desire and moving towards pleasure is healing and life affirming. In our youth, many of us shift away from knowing what we want to responding to what the world wants from us. Esther Perel says “desire is owning the wanting and in order to own the wanting, there needs to be a self that feels deserving of the wanting.” Seeking satisfaction is different than seeking fullness. Appetite is different from hunger. Exploring these conce pts in depth, connecting to what we want, allowing for unconditional permission to eat and enjoy food, free of guilt and shame, is truly healing.
15. So much of this work is about cultivating a relationship with yourself that you want to be in, regardless of what is happening around you. How do you know that you have your own back when heartbreak, disappointment, fear and anger show up? Do you believe you have a right to feel these things? To be supported and take up space? This matters in our healing process. You need freedom to be authentic in who you are and what you feel; freedom to accept and forgive the parts of yourself you have always thought you should hide; freedom in knowing what is yours to look at and what belongs to the people around you, messy in their own lives and process.
16. The inner critic is your biggest obstacle to change. This voice is part of our development, it is needed to keep us safe when our parents are teaching us not to cross the street without looking or put our hand on the burner. But what starts as a two-way conversation, turns into an internal monologue, and our entire life can be dictated by a very, very mean voice. The truth is you have a lot of parts and voices within you. The critic may have been in the front seat, driving the car for too long. Wouldn’t it be more comfortable in the back? Tell it that fear won’t be making your decisions anymore.
17. Many health care practitioners hear us speak and want to be more body positive in their work, but feel stuck in systems that need an overhaul. The philosophy of health at every size® makes so much sense, especially after years of working in the traditional weight paradigm. Many crave a different conversation about weight and health. Advocating for compassionate, weight-inclusive care is something we can all do right now. These articles might help you find language and research to support this shift:
18. We all live in and are affected by a world with strong weight bias. We would like to see helping professionals who work with others to heal patterns of chronic dieting and disordered eating have some support and space to do their own body acceptance work. We believe we cannot take our clients further than we’ve gone. Brave conversations are needed. Healing our own body shame and practicing radical acceptance is integral to helping others do the same.
19. This movement needs you. It is time for more people to step into the skin of the fiercely body compassionate so we can all be free. How do you know this path is truly healing? Because this is what you want for your daughters and friends and sons and loved ones. Somebody needs to go first. And this is no small feat given the culture we live in. You will be reminded of this daily. The siren song of the diet and cosmetic fitness industries will continue to call. But if not now, when? If not us, then who?
20. Kindness is the way out. It really, truly is. We are pretty sure that if hating yourself into a version of yourself that you loved worked, you’d have arrived long ago. Practicing radical acceptance and self-compassion are key to healing body shame and moving towards a more sustainable model of self care. Many of our clients are concerned that they will become too passive if they are gentler with themselves. This is a common misconception about acceptance and compassion. There is a big difference between letting go and giving up. We promise you that this in not the f*ck it plan.
We’re looking forward to seeing what unfolds in the next 10 years! Thank you for traveling with us thus far.