b'ing stigma-free

 

3D bodies Facts

 

Eating disorders are complex illnesses with biological, genetic, cultural and environmental components. They have the highest mortality rate of any mental disorder, yet they are consistently trivialized as being about vanity and lifestyle. The fallacies and stereotypes about eating disorders go on and on. “That’s only for white girls.” “You don’t look like you have an eating disorder.” “You’re fine, just eat something.”

Eating disorders are not choices, but serious biologically influenced illnesses.

The truth is that eating disorders affect everyone, regardless of age, ethnicity, gender, sexuality, size or economic status. They are life-threatening illnesses that can lead to bone loss, electrolyte imbalance, organ failure and death. Stigma, misconceptions and myths about eating disorders prevent people from getting the potentially life-saving treatment they need and deserve.

The stigma surrounding eating disorders is a problem in many ways. People too often suffer in silence because they are too ashamed to admit they have a problem and ask for help. Or they may not even realize that they have an eating disorder because they don’t fit the stereotype of a young, white, severely underweight teenage girl. Men, people of color and older adults have problems getting the treatment they need because those around them miss the signs. And even if the warning signs are recognized, individuals do not want to initiate the discussion because they think having an eating disorder is a sign of weakness, femininity or childishness.

Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

Even medical professionals contribute to the stigma surrounding eating disorders because of a lack of training and the many prevalent myths. Doctors may perform test after test to determine why their male patient keeps losing weight, when he clearly has an eating disorder. They may suggest that their patient loses weight, when that individual is actually struggling with a binge eating disorder. In fact, research has documented that physicians are the #2 source of weight stigma, and stigma has also been demonstrated in nurses and medical students, psychologists, dietitians and fitness professionals[1].

To fight the stigma, the largest eating disorders organizations in the country have banned together with a list of Nine Truths about Eating Disorders:

Truth #1: Many people with eating disorders look healthy, yet may be extremely ill.

Truth #2: Families are not to blame, and can be the patients’ and providers’ best allies in treatment.

Truth #3: An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.

Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights,
sexual orientations, and socioeconomic statuses.

Truth #6: Eating disorders carry an increased risk for both suicide and medical complications.

Truth #7: Genes and environment play important roles in the development of eating disorders.

Truth #8: Genes alone do not predict who will develop eating disorders.

Truth #9: Full recovery from an eating disorder is possible.

It’s important that everyone affected seeks professional help. Early detection and intervention greatly increase the chances of successful recovery, so let’s end the stigma and get the facts straight. Everyone knows someone with an eating disorder, whether they realize it or not. So, if you are concerned about yourself or a loved one, take this online screening to see if it’s time to seek help. It’s quick and confidential – remember, 3 minutes can save a life.

 

Claire Mysko_2013Claire Mysko, MA is the CEO of the National Eating Disorders Association (NEDA). To raise awareness and combat stigma, the NEDA is coordinating National Eating Disorders Awareness Week (#NEDAwareness). The goal of NEDAwareness is to put the spotlight on eating disorders and improve public understanding of their causes, dangers and treatments. Millions of people across the country suffer from eating disorders, but by increasing awareness and access to resources, we can encourage early detection and intervention. Learn more at www.nedawareness.org or call the NEDA Helpline for information and resources about eating disorders – 800.931.2237.

 

[1] Puhl, RM and Heuer, CA 2009. The stigma of obesituy: A review and update. Obesity; 17(5): 941-964. Links to this and other research about weight bias here.

Links to research about eating disorder stigma here.


 

When I was asked if I would be interested in writing this blog post I thought, “no Image of Melinda Watman, Age 3sweat.”After all, how hard could it be for someone with obesity most of her life to recount experiences of weight bias and fat shaming? Well it turns out that it isn’t as simple as it sounds. It’s easy to make a list of things that were said and looks that were given, but that seems to be just scratching the surface. What I think really matters is why these aggressive acts happen, and their ramifications.

So I started thinking about the times, places and people connected to these behaviors, and what I realized is there are different forms of bias and shaming. I think the two most obvious are the blatant “you can’t miss it” type and then the more subtle and less obvious variety. Both bring their own pain and suffering; cumulatively, they often end up defining how people with obesity perceive themselves.

I began my journey of obesity at the age of 2½, and from my earliest memories I was painfully aware that my weight was not OK. Fat shaming has no boundaries – from strangers to loved ones, hurtful behaviors are perpetuated. And my life was no exception. It was clear I was supposed to eat less than anyone else. Perhaps more importantly, I was not supposed to have the desire to eat. So, I struggled with weight and eating for as long as I can remember.

In elementary school I was first “initiated” into the fat kid world of bullying or shaming. My maiden name was Katzman and it took all of 30 seconds for one of the boys to come up with “Fatzman.” Looking back, I must have thought about this insult, and come out on the other side with the decision to simply ignore it and pretend it meant nothing to me. I also think this was the beginning of my public fight to prove I was as good as a thin person. The persona people saw was one of self-confidence, strength, determination and style. However, a lifetime of messages telling me, in one way or another, that being fat was not OK gave rise to my inner, less confident self that didn’t believe its own press. And so I lived with these two very different views of myself.

Interestingly, other than the “Fatzman” thing, and being the last one picked for any sports activities, I don’t remember any other direct verbal insults. Rather, the things I remember are a bit more subtle and in many ways, much more devastating. Shopping with my very thin mother was a humiliating nightmare. First the salesperson would give a “how could you let yourself get like this” look, then bring out clothes to try with an obligatory “this should fit” comment, and finally the horror of the clothes not fitting. The inevitable trip to the “plus-size” clothing store was like a neon sign on my forehead that read, “You’re too fat to wear normal clothes.” I was never quite sure who was more mortified – my mother or me.

One summer there was fat camp, which despite the stigma associated with it, was OK. But even there the lines were drawn – there were the really fat kids, and then the rest of us. Even in an environment where you would have expected empathy, compassion and support, campers couldn’t escape the temptation to do their own version of fat shaming. To be honest, I really don’t know if I acted poorly or not – I truly hope I was kind. The other unexpected behavior was an intense competition to lose the most weight. The drive to be the “thinnest” was stronger than the desire to be supportive of others, particularly anyone who might be approaching a thin status. Basically, fat camp was a microcosm of our fat shaming society. In retrospect, it is a sad commentary on how ingrained the behaviors of weight bias are.

Fat shaming is the last bastion of public humiliation and it is considered just “good clean fun.” After all, who doesn’t like a fat joke? But there is nothing funny about being given looks of disgust when you sit down on a subway and your body spills onto the seat and person next to you. And there is nothing funny about a physician blaming your being fat as the cause for any medical concerns – not to mention the snickers heard when placing an order for food in a public place. Fat shaming definitely left its mark on me, and regardless of my weight, the residual damage is woven into who I am.

 

Image of Melinda WatmanMelinda J Watman is the President and Founder of THE F WORD FAT, dedicated to improving how the world views, perceives and acts towards those affected by obesity. Melinda creates interactive presentations to meet the specific needs of each individual, group or organization.

THE F WORD FAT was born from both professional and personal awareness of weight bias and the need to change how those with obesity are treated. Melinda is on the National Board of Advisors for the Obesity Action Coalition (OAC), chairs the OAC Weight Bias Committee and does public policy and advocacy work on the state and federal levels. She also consults to the media on obesity-related issues.

Prior to THE F WORD FAT, Melinda’s career included clinical practice, healthcare IT and entrepreneurial endeavors. She was a faculty member of the USC School of Medicine and a founder of the Mass General Hospital obstetrics service. After leaving clinical practice she worked with several Healthcare IT companies with expertise in launching innovative healthcare solutions. In addition to THE F WORD FAT, she also does consulting for healthcare startups.

Melinda is an advance practice nurse and a Certified Nurse Midwife. She received her BSN from Duke University, MSN/CNM from Medical University of South Carolina and MBA from Boston University.

www.thefwordfat.com
@mjw_thefwordfat
https://www.facebook.com/pages/The-F-WORD-FAT/356325974384053


Currently in the United States, 1/3 of youth are either overweight or obese. As rates of childhood obesity have continued to climb in recent decades, so has teasing and Image: Weight-based stigma in youthbullying of these children. Weight-based teasing and bullying is a problem that begins early in childhood and continues throughout adolescence. Youth who are obese are significantly more likely to be bullied than their thinner classmates, and among the heaviest youth, at least 60% report being teased or bullied about their weight. The research is so robust in this area, that a child’s likelihood of being teased or bullied in the future can be predicted by his or her weight status.

As a psychologist and researcher, I’ve been studying weight-based bullying and stigma for almost 15 years. Consistently, we have found in our studies (and observed in research by others) that weight-based victimization is one of the most common forms of bullying reported in the school setting.1-2 In fact, a report by the National Education Association in 2011 found that teachers across the country viewed weight-based bullying to be the most problematic form of bullying in the school setting.[3] Our studies have similarly found that both students and parents report that being overweight is the most common reason that youth are teased and bullied.1-4

As with other forms of bullying, there are many negative consequences for youth who are teased, ignored, excluded, verbally threatened and physically harassed because of their weight. Weight-based stigma has negative implications for the psychological well-being, social functioning and physical health of youth who are targeted. In addition to increased social isolation, youth who are teased or bullied about their weight are at heightened risk for depression, anxiety, low self-esteem, poor body image, suicidal ideation, unhealthy eating behaviors, avoidance of physical activity, poorer school performance and avoidance of school.[5-9] Many of these outcomes can actually reinforce additional weight gain and obesity in children.

The pervasiveness of this problem reinforces the need for effective strategies to protect students from being bullied about their weight in the school setting. One approach is to ensure that body weight and weight-based bullying are included in school-based curriculum, and treated on par with other forms of bullying. But we may also need to look more broadly at existing anti-bullying policies and laws that can help protect these vulnerable students.

Many (most) school districts now have anti-bullying policies in place. However, few of these policies include body weight as a characteristic that places youth at risk for bullying. Similarly, 49 states currently have school-based anti-bullying laws, but only three states (Maine, New York and New Hampshire) include body weight or physical appearance as a distinguishing characteristic. This makes it unclear whether or not students who are overweight and obese are adequately protected from weight-based bullying under existing provisions. Recently, we’ve conducted some national studies to examine parental support for policies and laws to address this issue. We found that over 75% of parents are in favor of strengthening school-based anti-bullying laws to specifically include body weight as a distinguishing characteristic and increase protections against bullying for students who are overweight, as well as efforts to promote more awareness of this problem in schools.

In addition to policies and laws to address weight-based bullying, we also need to take a hard, critical look at how the media reinforces weight stigma in our society. In all forms of media – television, film, news media, social media – weight stigma is perpetuated toward individuals who are obese by communicating negative stereotypes that they are lazy, lacking in willpower, sloppy, and gluttonous.10-11 Research examining the content of children’s media shows this to be consistently true. Stated simply, weight stigma is rarely challenged in the media, and is instead often ignored. When we consider how much media our culture consumes, it’s not surprising that studies show that children who watch more television are more likely to express weight bias toward their overweight peers.

Weight-based stigma toward youth is a societal problem in need of broad solutions. Although obesity is a particularly visible condition that is stigmatized, efforts to effectively address this problem are scarce and remain invisible. With so many youth in our country now overweight or obese, millions are vulnerable to stigma and its negative consequences. More than ever, we need to increase awareness of this problem and promote efforts to improve the quality of life of these youth.

[1] Bucchianeri MM, Eisenberg ME, Neumark-Sztainer D. Weightism, racism, classism, and sexism: shared forms of harassment in adolescents. J Adolesc Health. 2013;53(1):47-53.
2 Puhl RM, Luedicke J, Heuer C. Weight-based victimization toward overweight adolescents: Observations and reactions of peers. Journal of School Health. 2011;81(11):696-703.
3 Bradshaw CP, Waasdorp TE, O’Brennan LM, Gulemetova M. Findings from the National Education Association’s nationwide study of bullying: Teachers’ and education support professionals’ perspectives. 2011.
4 Puhl RM, Luedicke J, Depierre JA. Parental Concerns about Weight-Based Victimization in Youth. Child Obes. 2013.
5 Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Health. 2014;54(6):724-9.
6 Greenleaf C, Petrie TA, Martin SB. Relationship of weight‐based teasing and adolescents’ psychological well‐being and physical health. Journal of School Health. 2014;84(1):49-55.
[7] Haines J, Neumark-Sztainer D, Eisenberg ME, Hannan PJ. Weight teasing and disordered eating behaviors in adolescents: Longitudinal findings from Project EAT (Eating Among Teens). Pediatrics. 2006;117(2):209-15.
8 Krukowski RA, West DS, Perez AP, Bursac Z, Phillips MM, Raczynski JM. Overweight children, weight-based teasing and academic performance. International Journal of Pediatric Obesity. 2009;4(4):274-80.
[9] Puhl RM, Luedicke J. Weight-based victimization among adolescents in the school setting: Emotional reactions and coping behaviors. J Youth Adolesc. 2012;41:27-40.
[10] Latner JD, Rosewall JK, Simmonds MB. Childhood obesity stigma: association with television, videogame, and magazine exposure. Body image. 2007;4(2):147-55.
[11] Robinson T, Callister M, Jankoski T. Portrayal of body weight on children’s television sitcoms: A content analysis. Body image. 2008;5(2):141-51.

Image of Rebecca PuhlDr. Rebecca Puhl is the Deputy Director of the Rudd Center for Food Policy and Obesity at Yale University. As a Senior Research Scientist, she coordinates research and policy efforts aimed at reducing weight bias and improving the quality of life of children and adults affected by obesity. Dr. Puhl received her Ph.D. in Clinical Psychology from Yale University. She has conducted research on weight bias for 14 years and has published numerous studies on weight-based bullying in youth, weight bias in health care and the media, interventions to reduce weight bias, and the impact of weight stigma on emotional and physical health. Dr. Puhl has testified in state legislative hearings on weight bias, routinely provides expertise on this issue to State Departments of Health and national health organizations, and has developed evidence-based trainings to reduce weight bias that have been implemented in medical facilities across the country. Dr. Puhl has emerged as the leading national expert in the field of weight bias, and her research is routinely reported on in national and international media. Dr. Puhl has served on the Council of The Obesity Society, and on the Board of Directors for the Obesity Action Coalition. In 2013, she was awarded the Excellence in Policy Research Award from the National Eating Disorders Coalition. More information on Dr. Puhl’s work is available at www.yaleruddcenter.org.

To learn more about weight stigma in youth, please visit the following Rudd Center websites which provide free educational resources, videos, handouts, and more: www.yaleruddcenter.org and www.ruddrootsparents.org


 

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