Binge Eating Disorder with Amy Pershing LMSW

CW: BED, OA, Some specific amounts of food used for examples

Amy Pershing, who cowrote Binge Eating Disorder: The Journey to Recovery and Beyond with Chevese Turner, joined me on the podcast to discuss this challenging and common eating disorder that is often overlooked. Amy shares so much great information with us about BED from all sides of the disorder, having experienced it herself and recovered.

The Bodywise Program - BED Recovery Program

Hungerwise - Intuitive Eating Program

In this episode:

  • Her history around dieting and BED

  • BED - most common eating disorder

  • BED seen as a willpower issue

  • How to screen patients for EDs/BED

  • What does Binging look like?

  • How does shame affect our thoughts around binging?

  • Trauma

  • BED can manifest in any body size

  • How do you start to find help

  • Person in culture and how it affects eating disorders

  • Advocacy for patients in the world

Amy Pershing:
Amy Pershing LMSW, ACSW is the Founder of Bodywise Binge Eating Disorder Recovery Program and the Vice President of the Center for Eating Disorders in Ann Arbor. She is the co-founder of Pershing Consulting LLC, which offers training to clinicians treating BED worldwide.

Based on 30 years of clinical experience, Amy has pioneered a treatment approach for BED that is strengths-based, incorporating Internal Family Systems and somatic trauma techniques. Her approach also integrates “attuned” eating and movement and a “health at every size” philosophy. Amy is also the creator of “Hungerwise™,” a 9-week program for ending chronic dieting and weight cycling. Pershing lectures internationally and writes extensively on the treatment of BED and her own recovery journey for both professional and lay communities. She has been featured on radio, podcast, and television speaking about BED treatment and recovery, relapse prevention, weight stigma, and attuned eating and movement. She is the winner of The Binge Eating Disorder Association's 2016 Pioneer in Clinical Advocacy award, has served on a variety of professional boards, and is the Past Chair of the Binge Eating Disorder Association. Amy is the author of the book Binge Eating Disorder: The Journey to Recovery and Beyond (Routledge, 2018), and maintains her clinical practice treating BED in Ann Arbor.

“I think what recovery is…let’s get more tools in the tool box so that, if you feel that drive to go to food, you have the ability to slow down, to look at what’s really going on, and what’s really is going to ultimately allow you to feel the safest.”
— Amy Pershing, LMSW

Weight Science with Fiona Willer, AdvAPD, FHEA, MAICD

Content Warning: Discussion of Weight Loss Surgery

Fiona Willer, AdvAPD, FHEA, MAICD and PhD candidate, joins us today to discuss weight science. We talk about everything from bariatric surgery to the state of research around fatness. If you are interested in weight science, you will be interested in this episode!

Some of the topics covered:

  • Weight Loss Surgery (WLS)

  • Nutrition after WLS and development/aging

  • How WLS works

  • Fatphobia and weight stigma kills more than being fat

  • Eating/Exercise habits do not predict body size in individuals

  • Reminder of correlation vs causation and generalization vs individualization

  • Weight science research

  • Diabetes and weight loss

  • Weight loss IS and intervention

  • Ways to study weight and health that do not involve inducing weight change

  • How intention around weight affects diet quality

  • Size affirming care is beneficial to health outcomes

Ellen Maud Bennett

https://www.legacy.com/obituaries/timescolonist/obituary.aspx?n=ellen-maud-bennett&pid=189588876

Fiona Willer:

https://www.unpackingweightscience.com

https://www.fionawiller.com

https://www.healthnotdiets.com

Compassionate Care with Deb Burgard, PhD

This episode is fairly far ranging in topic and trying to pinpoint every topic was too daunting. We discuss philosophy, medicine, compassion, engaging with patients on a human level and more. Deb Burgard is such a thoughtful person who has taken a lot of time to really think about the topics surrounding not just fatness, but also social justice and how to make the world a more compassionate place. It starts with each of us individually, but I think it helps to listen to Deb and take in her joyous wisdom. I hope that you enjoy listening to her as much as I enjoyed making this episode with her.


About Deb:

Deb Burgard, PhD, FAED, is a psychologist and activist from the San Francisco Bay Area specializing in concerns about body image, eating, weight stigma, and relationships. She is also one of the founders of the Health at Every Size(r) model, the original BodyPositive.com website, and the Show Me the Data listserv, building communities where people can find each other and the resources to resist weight stigma, especially in medical and psychological treatment.  Her activism includes working with healthcare providers to integrate an understanding of the social determinants of health and creating interventions that address structural oppression and support stigma resistance.  She can be found at conferences sparking impromptu dance parties in the pool. 


Resources:

Poodle Science link: https://www.youtube.com/watch?v=H89QQfXtc-k

www.bodypositive.com

BodyPositivePhD on IG, Twitter

FB group for doctors: Health At Every Size Doctors 

Weight and Health Equity with Lesley Williams, MD

I want to thank everyone for being patient with this episode getting onto the webpage so late. I know that this is the place where you can really listen to it. I have been having quite an interested few months and it looks to continue for a while. I will be doing my best!

Here is the wonderful interview I did with Dr. Lesley Williams. She does a lot of work talking to other physicians about why weight independent health care is so important to improving health outcomes!

In the episode (not in order):

How Dr. Williams got involved with HAES

Health Equity and health access

How access and respect are due to all patients, regardless of their health goals

Talking to doctors about the fear of having harmed patients unknowingly

Are there fat old people? (answer: yes)

Surgery on fat people

Why hospitals should make sure to recognize that they have fat patients

And more!

““Everyone deserves to pursue their own level of health, or lack thereof,...regardless of that pursuit, they deserve respect and access to whatever it is they need.” ”
— Lesley Williams, MD

About Dr. Williams:

Lesley Williams, MD is a Certified Eating Disorder Specialist and board certified Family Medicine physician. She received her Doctor of Medicine degree from the University of Kentucky College of Medicine and completed her Family Medicine residency training at Mayo Clinic Arizona. She has worked exclusively with eating disorders for over 15 years in the full spectrum of treatment settings. Dr. Williams recently established Williams Wellness Medical Group, an outpatient eating disorder focused medical practice in Phoenix, AZ. She is also currently the Medical Team Lead for Banner Behavioral Health Hospital in Scottsdale, AZ. Her areas of special interest and expertise include: Health Equity and Health at Every Size Advocacy. Dr. Williams is a member of the American Academy of Family Physicians. She was recently appointed to the Academy of Eating Disorders Diversity, Equity and Inclusion Committee. Due to her hard work and dedication to the field, in 2018 Dr. Williams was named as one of the Top 80 Female Eating Disorder Leaders in the United States.

lesleywilliamsmd.com

www.medicalgroup.com

Hypothalamic Amenorrhea with Nicola Rinaldi, PhD

CW: Specific calorie amounts mentioned at these points in the show:

  • 15:49:15:52

  • 17.26- 17:38

  • 46:12-46:13

Hypothalamic Amenorrhea (HA), or a lack of menstruation caused by the disfunction of the hypothalamus, affects many people in the world. It happens often when someone is under-fueling their bodies. It is a common condition with atheletes, but can affect anyone who menstruates and does not take in enough energy. While it might sound nice to not have a period, the hormones that cause menstruation affect many aspects of health and can lead to infertility if not addressed. Nicola Rinaldi, PhD has done a lot of research on HA, and experienced it herself. She now spends her time spreading the word about the causes and treatments for HA. Resources can be found on the episode page of the website: www.donoharmpodcast.orgonce the episode goes public.

In the episode:

  • Nicola's story

  • Calorie Intake in relation to menstruation

  • Calorie Intake in relation to bone density

  • PCOS vs HA

  • Using OCP to “jumpstart” menstruation (and why it doesn't work)


About Nicole: 

Dr. Nicola Rinaldi has a PhD in biology from MIT. Since experiencing hypothalamic amenorrhea (missing periods) herself, Dr. Rinaldi has been on a mission to spread awareness of the condition and how to recover. In 2016 she published the book "No Period. Now What?", updated March of 2019 to be more Health At Every Size aligned. This book is a comprehensive resource that includes much of the medical and scientific research that underlies our current understanding of the triggers for amenorrhea, what steps to take for recovery, and treatments to use for recovery and pregnancy as needed. In addition, Dr. Rinaldi performed the largest survey to date of women who likewise experienced amenorrhea, and includes results from the survey answering many of the common questions women have, such as "How long will it take to recover?" "Will I be able to get pregnant?" and "Will I resume cycling after pregnancy?". Finally, the book includes Dr. Rinaldi's own story along with those of hundreds of other women, providing hope and reassurance to women following in their footsteps. Since publishing "No Period. Now What?" Dr. Rinaldi has been on a mission to spread awareness about hypothalamic amenorrhea and recovery, appearing as a guest on dozens of podcasts, attending and presenting at industry conferences, as well as continuing to participate in ongoing academic research studies. She now also works with clients on period recovery and getting pregnant.

Resources:

Information sheet on HA, and first chapter of No Period. Now What? - free download: http://noperiod.info/HA

Information sheet on HA versus PCOS, and relevant chapter of No Period. Now What? - free download: http://noperiod.info/HAvsPCOS

New research on HA versus PCOS: http://noperiod.info/HAvsPCOS2

Time to recovery is not correlated with length of amenorrhea: http://noperiod.info/time

FB support group: http://noperiod.info/support

EBook + paperback: http://noperiod.info/book

Personal recovery/fertility support: http://noperiod.info/appointments

Book Links:

Health at Every Size

Body Respect

Body Kindness

Fast Track Trial with Louise Adams

The Fast Track Trial is a trial in Australia that is being done to determine the efficacy of intermittent fasting for weight loss in teens. My amazing guest, Louise Adams, has spent the last year actively trying to get the trial stopped because it is unethical. The connection between dieting, especially fasting, and the development of eating disorders is quite strong. This is particularly concerning in relation to young people. She has collected studies, letters of support from medical professionals and organizations in Australia, as well as over 20,000 signatures from around the world on a change.org petition opposing the trial. Unfortunately, her efforts have been unsuccessful and the trial is proceeding.

Content Warning: This episode includes information about fasting, eating disorders, weight change, and a brief discussion of normal adolescent weight gain

In this episode, we discuss:

  • A bit about who Louise is and how she started working with eating disorders and the HAES movement

  • A description of the Fast Track Trial

  • Reasons why dieting can lead to eating disorders, particularly in teens

  • How Louise has been fighting against the trial going forward

  • What risks are not being fully explained to participants

  • What the initial results of an initial study mean in practical terms

  • Who the people behind the trial are

  • And much more\

Resources:

Untrapped website

FB group for the Stop the Fast Track Trial

Parent information for the Fast Track Trial 

That Time I Was in a Child Weight Loss Study link


About Louise:

Louise Adams is a clinical psychologist, the founder of Treat Yourself Well Sydney and the creator of the UNTRAPPED online program and community. She has written two books, Mindful Moments and The Non-Diet Approach Handbook for Psychologist and Counsellors (with Fiona Willer, APD). She has been practicing in this field for more than 20 years. Louise is Vice President of Health At Every Size Australia.

She has a special interest in problematic eating, body image, and weight struggles. Louise fights to educate people about the cruel trap of dieting, which only sets us up to fail. She uses an evidence-based anti-dieting approach to empower people to achieve permanent lifestyle change.

Louise is wholly committed to the Heath At Every Size (HAES) movement, and to spreading the word about shifting our attitudes about weight and health. Louise is determined to make a difference in changing society’s perceptions about health, diets, weight loss, and bodies. Louise believes that people can approach health and happiness without attaching it to weight changes. She is for body diversity and against fat prejudice.

As well as her work with individual clients at her private practice, Louise conducts workshops and conferences for the general public and health professionals interested in changing their approach to weight issues. Louise is the host of the popular podcast All Fired Up!, and often turns up in magazines, newspapers, radio, and on television to spread her message. She blogs, she tweets, and she never shuts up about these issues!

Ethical Medicine for larger patients with Ragen Chastain

This is technically the last episode of Season 2. It was initially intended to be release in 2018, but that did not happen. I interviewed Ragen Chastain, an activist and dynamic speaker about Fat Acceptance, weight stigma in health care, and Health at Every Size®. The conversation ranged across a broad array of topics and I really recommend listening to all of it. The bit that really stood out to me is the idea that practitioners and fat people should be on the same side an asking how to break down barriers to health, including bias.

In this episode (some of the topics we cover):

  • Social Justice

  • Things providers can do

  • Weight loss intervention and what it means

  • Weight loss as a thief of credit for better health 

  • Weight loss surgery and informed consent

  • Barriers to health – we can do better

  • Sigma and health 

  • Surgeries on fat people – where I ask for surgeons to let me know what are the issues to overcome.

Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, Size Acceptance, and corporate wellness.  

Ragen's depth of knowledge about self-esteem, body image, health, and wellness, comes from a combination of her personal story of overcoming an eating disorder to become a national dance champion and marathoner, and her training as an ACE Certified Health Coach, and researcher. Her ability to combine humor with hard facts in ways that educate, motivate, and entertain, have made her a sought-after speaker on the collegiate, conference, and corporate circuits. 

Ragen has presented to employees at companies including Google Headquarters and Apple, spoken to students, faculty and staff at Dartmouth, CalTech, and Michigan State to name a few, and spoken at conferences across the world to audiences from third graders to physicians.

“Even if we believe the large body is a problem, a weight loss intervention has the opposite of the intended effect about 66% of the time.”
— Ragen Chastain
“[Regarding hospitals/clinics/etc]Did you not know fat people existed [when you set up your institution] or did you not care if they got good healthcare?”
— Ragen Chastain

Dr. Nelson’s new site: www.drnelsonnd.com

Email list for those interested in the Mindfulness and Diabetes program: http://eepurl.com/gbSS9T

Mindful Health with Michelle May, MD

For the final episode of 2018, I was joined by Dr. Michelle May who talked with me about mindfulness and health, and so much more. Dr. May was trained as a general practitioner and now spends her time speaking and spreading the word about mindful eating. She has a lot of wonderful information o impart to providers and patients alike.

In this episode:

  • Dr. May's Book – Eat What you Love, Love What you Eat.

  • Holiday Eating

  • Diabetes

  • Mindful eating allows us to live our lives fully

  • Questions to ask around food

    • What do I want to eat?

    • What do I have to eat?

    • What do I need to eat?

  • Eating disorders – Binge Eating Disorder

  • Restriction and BED is highly correlated

  • Stepping away from dichotomous thinking

  • Finding enjoyable movement

    • Sometimes means lowering the bar rather than beating yourself up about what you “should” be doing

““The reason to do this [embrace mindful eating] is to free up space in your life so that you can actually live your life and so that you can find a pattern of behavior, choices, and lifestyle that is sustainable for you.””
— Michelle May, MD

Michelle May, M.D. is a recovered yoyo dieter and the founder of Am I Hungry? Mindful Eating Programs and Training that helps individuals resolve mindless and emotional eating and senseless yo-yo dieting to live the vibrant life they crave. Over 800 health and wellness professionals from 30 countries have been trained to facilitate Am I Hungry? mindful eating programs worldwide. Dr. May is also the award-winning author of the Eat What You Love, Love What You Eat book series. 

Twitter: http://www.twitter.com/eatwhatyoulove

Facebook: http://www.facebook.com/AmIHungry

LinkedIn: http://www.linkedin.com/in/amihungry

YouTube: http://www.youtube.com/c/MichelleMayMD

Press Room: http://amihungry.com/press-room/

Pinterest: http://pinterest.com/amihungry/

 

Additional Resources:

www.AmIHungry.com

10 Things Fitness Instructors (and the Media) Should Stop Saying  ( PDF version)

 Mindful Eating and Weight Loss: Setting the record straight

Eating Disorders with Jennifer Gaudiani, MD, CEDS, FAED

During this episode, Dr. Jennifer Gaudiani joined me to talk about eating disorders and her experiences with them. She recently wrote a book: Sick Enough: A Guide to the Medical Complications of Eating Disorders. She has been working with patients with eating disorders for 11 years and has also incorporated Health at Every Size and weight inclusive principles into her practice over the last few years. She has found that it has made a great deal of difference, not only in recovery, but also in identifying patients who might have otherwise had a delay in diagnosis, or not been diagnosed at all.

In this episode:

  • How Dr. G got involved with eating disorder patients and HAES,

  • How starvation affects patients’ bodies.

  • Things to be aware of as a physician who might be encountering patients with eating disorders and “atypical” eating disorders.

  • Metabolism and fertility.

“HAES works medically.”
— Jennifer Gaudiani, MD, CEDS, FAED

Something I would like to point out as well. At one point, I said something about “knowing better and doing better.” I recently found the entirety of that quote and I would like to share it because I think it is important, especially as many providers may be trying to move through guilt about causing harm through encouraging weight loss in their patients.

The important bit is to do the best you can, because we all do the best we can with what we know.

“Do the best you can until you know better. Then when you know better, do better.”
— Maya Angelou

Resource:

Sick Enough

S2E4 Food Addiction with Marci Evans, RD

Season 2 Episode 4: Food Addiction with Marci Evans, RD

Food Addiction, specifically sugar addiction, has become a hot button topic in recent years. People feel out of control around highly palatable foods and struggle to avoid over eating them. Sugar also lights up the pleasure centers of our brains, similar to drugs like cocaine and heroin. Does that mean that it, and other highly palatable foods are actually addicting? Listen to this great discussion I share with Marci Evans, RD to find out.

 

 

In this episode:

  • The research around food addiction and pleasure
  • Feeling out of control with food is definitely an issue
  • The Restrict/Binge Cycle
  • How HAES and Intuitive Eating can help reduce feelings of addiction around food
  • Yale Food Addiction Scale – is it harmful?
  • Cocaine vs Sugar and the Pleasure Centers

 

Marci Evans, RD 

Marci is a Food and Body Imager Healer®. She has dedicated her career to counseling, supervising, and teaching in the field of eating disorders. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. In addition to her group private practice and three adjunct teaching positions, Marci launched an online eating disorders training for dietitians in 2015 and co-directs a specialized eating disorder internship at Simmons College. She volunteers for a number of national eating disorder organizations including the iaedp certification committee and is serving as an eating disorder resource professional for The Academy of Nutrition and Dietetics.  She has spoken locally and nationally at numerous conferences and media outlets. She loves social media so tweet her @marciRD, follow her on Facebook and Instagram, and check out her blog at www.marciRD.com/blog.

 

“If we are promoting a paradigm of abstinence or restraint or restriction, we are neurobiologically setting ourselves up, potentially, to act in a way that feels compulsive and out of control.”
— Marci Evans, RD

S2E3 Weight Independent Diabetes Care with Megrette Fletcher M.Ed., RD, CDE

Is it possible to treat type 2 diabetes without weight-loss? It absolutely is. Join Megrette Fletcher M.Ed., RD, CDE and I as we explore treating type 2 diabetes in a weight independent way. Megrette has been been working in diabetes care since 1995 and has a great deal of information to share about caring for diabetic patients using effective tools that shift focus away from weight-loss. She is also the co-author of Eat What You Love, Love What You Eat with Diabetes and has authored five books for professionals. This is an interview no one will want to miss!

In this episode:

  • 8 Core Defects
  • Why weight-loss (including bariatric surgery) is not a long term solution
  • Behaviors are key to managing diabetes
  • Self care instead of weight-loss
  • Energy Balance, not Energy Deficit
  • How to encourage people to access diabetes educators
  • How weight independent treatment helps patients cope with diabetes
  • Self Compassion
  • How having a HAES trained diabetes educator can help providers better manage patients' over all health  
“This fantasy around weight has lead us to a) not treat the patient with diabetes or educate people around diabetes because we spend all of our time trying to sell them on weight-loss...and then when they say...’I really want to manage my diabetes but I don’t want to lose weight’, no one knows what to do with them.”
— Megrette Fletcher M.Ed., RD, CDE

 

About Megrette:

Megrette is a registered dietitian and certified diabetes educator who has worked in diabetes care since 1995. Her interest in mindful eating started in 1999 when she began meditating on a consistent basis. In 2005, she co-founded The Center for Mindful Eating, an international non-profit organization that explores the benefits of mindfulness and health. In addition to offering webinar trainings about the scientific benefits of mindfulness and health, Megrette has written five books for professionals including Diabetes Counseling and Educational Activities: Helping Clients without Harping on Weight, The Core Concepts of Mindful Eating, Discover Mindful Eating, Discover Mindful Eating for Kids and co-authored Eat What You Love, Love What You Eat with Diabetes, Michelle May MD. Megrette has recently created a Facebook group for HAES professionals, interested in diabetes care, called Weight Neutral for Diabetes Care. The group can be found by searching for WN4DC.  

She is very active in the cycling community, and in 2011, her passion for biking prompted her to form the largest and top-grossing cycling team in the Tour de Cure (for diabetes) Kennebunk fundraising event. Megrette, a dog lover, passable cook, and terrible bowler, is blessed to live and laugh with her family in beautiful in New Hampshire, outside of Boston. To learn more about Megrette, please visit her website at Megrette.com or follow her on Facebook or Twitter.

Resources:

  1. 8 Core Defects
  2. Megrette's books
  3. Megrette's website
  4. Webinar for the book

Patient Experiences and Update

This episode is a bit of an experiment for the podcast. I have included the stories of three people who have had challenging experiences with medical providers due to their sizes. There is an additional story that specifically talks about medical providers showing bias around each other as well. I also included a quick update about the future of the podcast.

““Our stories are an important way for us to learn about other people and their experiences because they connect with us on a heart and soul level.””
— DeAun Nelson, ND
“These secret actions of fatphobia must be called out as well as we work towards changing the medical establishment to focus on respect for every body and health at every size.”
— From one of the Patient Experiences

S2E1: Interview with Dr. Jon Robison

Welcome to Season 2 of the Do No Harm Podcast! The first episode of the season is an interview with Dr. Jon Robison, a national leader in the Health At Every Size Movement for more than 2 decades.

Jon Robison holds a doctorate in health education/exercise physiology and a master of science in human nutrition from Michigan State University where he is Adjunct Assistant Professor. Dr. Robison is also Adjunct Associate Professor in The Holistic Health Care program at Western Michigan University. He has spent his career working to shift health promotion away from its traditional, biomedical, control-oriented focus, with a particular interest in why people do what they do and don’t do what they don’t do.

Jon has authored numerous articles and book chapters on a variety of health-related topics and is a frequent presenter at conferences throughout North America. He is co-author of the book, “The Spirit & Science of Holistic Health - More than Broccoli, Jogging and Bottled Water, More than Yoga, Herbs and Meditation,” a college textbook and a guidebook for practitioners who wish to incorporate holistic principles and practices into their work. This book provided the foundation for Kailo, one of the first truly holistic employee wellness programs. Kailo won prestigious awards in both Canada and The United States, and the creators lovingly claim Jon as its father.

Jon has implemented Health for Every Body® — a unique alternative to weight loss programs at the worksite in over 20 cities across the United States in the past 3 years. He is also one of the featured health professionals in the powerful documentary America The Beautiful II: The Thin Commandments and has been helping people struggling with weight- and eating-related concerns for 25 years.

His new-released book: How to Build a Thriving Culture at Work: Featuring The 7 Points of Transformation, written with co-conspirator Dr. Rosie Ward gives organizations a realistic, step-by-step blueprint to accomplish the difficult task of transforming their cultures to be healthier and more productive — “from the inside out.” The book was selected by Employee Benefit News as one of the top must reads for 2016.

As a Certified Intrinsic Coach, Jon understands that behavior is the outward manifestation of thinking and feeling – and that behavior modification approaches that focus on extrinsic motivation rarely result in sustained change and, in fact, often inhibit intrinsic motivation.

Aside from his work Jon’s passions include his wife Jerilyn, music, humor, an 11-lb living Teddy Bear named Ginger and watching his gifted son Joshua play soccer.

In this episode:

  • How Dr. Robison found HAES®
  • The research that shows that significant and sustained weight loss is not possible
  • The CDC article about Physical Activity at Every Size
  • His program Health for Every Body
  • And much more...
“Do we really need more research that prejudice and stigma are health minimizing?”
— Dr. Jon Robison

S1E8: Patient Empowerment through Fat Acceptance

This will be the last episode for the season and the year! I was joined by Shilo George, an activist and educator, and we talked about the importance of Fat Acceptance and Body Acceptance when it comes to individual health, and also to community health. The Fat Acceptance movement itself focuses on reducing and eliminating fat bias and fat stigma, thus improving overall health. If we are going to create better health as a society, spending time on reducing stigma is paramount.

 

 

A little bit about Shilo:

Shilo George is Southern Cheyenne-Arapaho and Scottish international speaker, trainer, and owner of Łush Kumtux Tumtum Consulting, which means “a great awakening of the heart and spirit” in the Chinuk Wawa trade language. She has lived her life in a body that transgresses and violates Western standards of beauty, size, sexuality, and health. Shilo interweaves cultural traditions and spirituality with an anti-oppressive and decolonizing lenses to promote healing and empowerment in herself and others in the communities she is a part of. Her workshops and presentations explore the intersections of race, sexuality, body size, and trauma (both individual and inter-generational). Shilo trains others on systems of oppression, trauma informed care, and proactive ways that businesses and organizations can create policies and environments that that promote diversity, equity, and healing. 

Shilo received her Bachelor of Science in Art Practices in 2012 and a Masters of Science in Educational Leadership and Policy with a specialization in Postsecondary Adult and Continuing Education in 2017, both from Portland State University. She was named Higher Education Student of the Year by the Oregon Indian Education Association in 2013 and in 2015 was honored with the Queer Indigenous Scholar Activist & Alumni Award by the Indigenous Nations Studies Department at Portland State University. In addition to her consulting business, Shilo works as a Parent Advocate at the Native American Youth and Family Center and is an Affiliated Adjunct Instructor of the Indigenous Nations Studies at Portland State University. She can be contacted at shilomgeorge@gmail.com. 

I will update this information when her website goes live.

 

“Are we really setting fat people up to succeed or are we setting fat people up to fail?”
— Shilo George

I hope that you have enjoyed season one of the Do No Harm Podcast. I will be returning on January 26, 2018 with the first episode of Season 2! Happy New Year!

 

S1 Bonus Episode: Guidelines for Medical Providers with Fat Patients

This bonus episode gave me a chance to read aloud the Guidelines for Medical Providers with Fat Patients by the National Association for the Advancement of Fat Acceptance (NAAFA). It is a follow up episode to the Promoting Health without the Scale episode because the guidelines fill in a couple of gaps and are also so well written.

S1E7: Promoting Health Without the Scale

The seventh episode of the podcast will dive into options for treating patients that do not center on weight change. Significant and permanent weight change is nearly impossible for the majority of the population, so we need to use weight independent, evidence based treatment for people of all sizes.

In this episode:

  • Defining weight neutral/weight independent and weight inclusive
  • Health at Every Size ®
  • Intuitive Eating vs Restrictive Eating
  • Well Now
  • How to move away from using weight as a determinant of health
  • Thinking beyond the individual - how society can change to support health

I would like to thank Julie Duffy Dillon for helping me come up with the title for this episode.

Music by Galynne Davis

Cover Art by Stacy Bias

 

“Part of our job should not be just doing no harm, but also trying to remove the harm that’s being done outside of our offices.””
— DeAun Nelson, ND

 

Questions to Consider:

  1. How do your assessments and treatments change if they do not include weight change?
  2. How would you treat a thin patient without recommending weight loss?
  3. How can we, as individuals, help to create a society that improves everyone's health by reducing stigma.

 

Resources:

1. Bacon, L. and Aphramor, L.Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal201110:9

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10

2. Mensinger, JL et al. Appetite. 2016 Oct 1;105:364-74 https://www.ncbi.nlm.nih.gov/pubmed/27289009

3. https://lindabacon.org/_resources/resources-health-care-providers/

4. Aphramor, L. Validity of claims made in weight management research: a narrative review of dietetic articles. Nutr J. 2010; 9: 30.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916886/

5. http://lucyaphramor.com/dietitian/

6. Aamodt, S. (2016) Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. New York, NY: Penguin.

7. Bacon L, Aphramor L. Body respect: what conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX: BenBella Books; 2014.

8. Bacon, L. Health At Every Size: The Surprising Truth About Your Weight. Dallas, TX: BenBella Books; 2008.

S1E6: The Ineffectiveness of Diets

**Content Warning: We do discuss some weight and calorie numbers during the episode.

This episode covers the topic of intentional weight loss through restrictive eating or lifestyle changes. We discuss why intentional weight change does not work long term and why it can cause more harm than good for people’s health. I am joined by a guest co-host, Sumner Brooks, RD of Eating Disorder Registered Dietitians & Professionals. Her insight and knowledge were invaluable.

 

In This Week's Episode:

  • What does “working” mean when discussing diet outcomes?

  • Physiological outcomes of intentional weight change

  • Evidence for diets is Biased

  • How restriction can lead to bingeing, disordered eating, and eating disorders

  • The detrimental effects of inevitable weight cycling

 

"If we, as health professionals, recommend to a patient to go and try to lose weight when we know that the most likely outcome is short term weight loss followed by weight gain, we are doing some harm there." 
-Sumner Brooks, RD

 


Questions to consider: (We did not get to these on the podcast itself, but they are still important)

  1. Since diets don’t work, what if we stopped recommending them to patients and started supporting them in their focus on healthy habits, which have been shown to help health regardless of size?

  2. What if we turned our focus from forcing weight change and spent our time and energy on making sure that everyone had enough, high quality food?

  3. Why are the behaviors that are diagnosed as eating disorders in thin people, prescribed to fat people?

 

Resources:

1. http://archive.wphna.org/wp-content/uploads/2016/01/2005-Mad-Science-Museum-Ancel-Keys-Starvation.pdf

2. Fothergill, Erin, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity Society Journal. 2016 August; 24(8):1612-1619

http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/full

3. Lester B. Salans, Edward S. Horton, and Ethan A. H. Sims. Experimental obesity in man: cellular character of the adipose tissue. J Clin Invest. 1971 May; 50(5): 1005-1011.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC292021/

4. Rudolph L. Leibel, M.D., Michael Rosenbaum, M.D., and Jules Hirsch, M.D. Changes in Energy Expenditure Resulting from Altered Body Weight. N Engl J Med 1995; 332:621-628

http://www.nejm.org/doi/full/10.1056/NEJM199503093321001#t=article

5. Aamodt, S. (2016) Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. New York, NY: Penguin.

6. P.A. Tataranni and E. Ravussin, “Energy metabolism and obesity.” In Handbook of Obesity Treatment, ed. TA. Wadden and A.J. Stunkard (New York: Guildford Press, 2004), 42-72.

7. J-P Montani, AK Viecelli, A Pre´vot and AG Dulloo. Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the ‘repeated overshoot’ theory. International Journal of Obesity (2006) 30, S58–S66

https://www.nature.com/articles/0803520.pdf?origin=ppub

8. L. Bacon and L Aphramor. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 2011 10:9.

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

9. Tomiyama AJ, Ahlstrom B, Mann T. Long-term effects of dieting: is weight loss related to health? Soc Pers Psychol Compass. 2013;7(12):861-877.

10. Polivy J, Herman C: Dieting and binging: A causal analysis. American Psychologist. 1985, 40: 193-204.

http://psycnet.apa.org/doiLanding?doi=10.1037%2F0003-066X.40.2.193

11. Baumeister RF, Heatherton TF: Self-regulation failure: An overview. Psychological Inquiry. 1996, 7: 1-15. 10.1207/s15327965pli0701_1.

 

Additional Material:

Mann, T. (2015) Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again. HarperCollins.

S1E5: Healthism

SHOW NOTES E005: Healthism

 

Healthism is prioritizing individual health above other things. It is also the idea that individuals have significant control over their health. It does not acknowledge that a great many things outside of an individual’s affect their health, such as oppression, war, hatred, environmental factors, and access to medical care. Ultimately, it is important to address societal inequities that affect individual health. The expectation of maintaining a certain level of health can lead to stress and unhealthy coping mechanisms. It is important to look beyond looks and support individual health as much as possible as we dismantle oppression.

 

In this episode, I will address:

  • What is healthiest?

  • How doctors can address healthism

  • Nutritionism

  • The “good fatty/bad fatty” dichotomy

  • Patient Autonomy and “non-compliance”

  • How doctors can support patients while we change society

 

““Food should be our pleasurable fuel, not our quest or destination. We’re all going to die regardless of how much quinoa we eat.”
— Margaret McCartney, GP

References:

 

1. Greenhalgh, T. and Wessely, S. ‘Health for me’: a sociocultural analysis of healthism in the middle class. British Medical Bulletin. 2004:69.                       

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bmb/69/1/10.1093/bmb/ldh013/2/ldh013.pdf?Expires=1509665356&Signature=P5BApSr-FCYZlFo6J-NLnkgDSrD3Q1uxbHa2W4hheNEJ8hlSNxcoJDFyfiOqljWZ9KiCse3YdcbVeWmQgExWETImTnDk7l8ddYr1-ifvHKBm2lmOP4qhieK-0BaoMIgzyfa0vHS8juHV89BxLBY8UL3KDVKLc9bEHTpyUWA0Q39rBXn-uqHkNMgHku8ckVD5d4HtaoNeXbruzK3Cpy~FQdFl3PUojK4QwPSJB~1PxKnf-HWTxseV7z04c74HZ~bAnx4g~tM3pK~wXoOZATSF6TG-IHZ1h4WlNM7RBmWTwaEh1TjmK9TUVOmPCk5KT5FjsqPuys5OPt2B5DPv3GsrQA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

2. Crawford, R. Healthism and the Medicalization of Everyday Life. International Journal of Health Services. Pub 1980.

3. Well Now information: http://lucyaphramor.com/dietitian/about/

4. McCartney, M. Margaret McCartney: Clean eating and the cult of healthism

BMJ 2016;354:i4095. http://www.bmj.com/content/354/bmj.i4095

5. https://www.kateharding.info

 

 

 

 

S1E4: The Effect of Weight Bias on Care

*Content Warning:  If you live in a larger body (whether you are a medical professional or not), please listen with caution. If it gets too hard to hear about the depth of weight bias, please pause and come back later. Or set up to have a friend listen to the episode as well, so that you have someone to speak to about it after you listen. We believe connection and community are crucial when living with weight bias. 

 

Because weight stigma is expressed through weight bias, it is necessary to discuss and examine our own weight bias as medical professionals and medical professionals in training. There is a growing body of research showing that weight stigma has a *significant* effect on long term health, making it an important subject for medical professionals to address personally and collectively. So we will spend today’s episode diving into what weight bias is, the research, and what we can do about it.

In This Week's Episode:

  • The difference between implicit and explicit bias
  • A thought experiment considering what words come to mind to describe thin and fat people
  • How categorizing information is human nature
  • Discussion of research showing larger patients get poorer health care than thinner patients
  • Discussion of research showing medical professionals' attitudes towards fat patients
  • Overview of research about eating disorder professionals' attitudes towards larger patients
  • How the nocebo effect influences outcomes of higher weight patients

 

“Race is not a risk factor.
Exposure to racism is the risk factor.
The problem is not located in people’s bodies. ”
— Deb Burgard, PhD

Questions to Consider:

  • Can you adequately treat larger patients when you have negative attitudes towards them?
  • Can you provide weight-inclusive or even weight-neutral care when you have an explicit bias against patients at the higher end of the weight spectrum?
  • How would you treat someone if you assumed that their size was not the cause of their condition?
  • Can you start paying attention to how your internal reactions to your larger patients may differ from those of your smaller ones?
  • Consider how do you help your patients or clients when you weigh yourself regularly, are on a diet, or dislike your own body?
  • What if how we think and talk of fatness causes more harm than the fat itself?

Resources (mentioned in this episode): 

Extra resources:

 

Thank you for joining us for Do No Harm Podcast! If you appreciated this week's episode, visit iTunes or Google Play Music, subscribe to the show, and leave a review to help us spread this very important message.