Coming Home: Rescuing Our Bodies from Weight Stigma
Amy Pershing, LMSW, ACSW began her career treating the spectrum of eating and body image disorders at the Center for Eating Disorders (CED) in Ann Arbor, MI, in 1991. In 1993, she developed “Bodywise™,” a comprehensive treatment program to serve a growing population of clients coming to the center with binge eating disorder (BED). Pershing became CED’s clinical director in 1998. In 2008, Pershing and Chevese Turner, CEO and founder of Binge Eating Disorder Association (BEDA), joined forces to found Pershing Turner Centers in Annapolis, Maryland. Pershing Turner Centers treat the full spectrum of eating disorders in adults and adolescents using a multidisciplinary “whole person” treatment approach to recovery.
Pershing has pioneered an integrated approach for the treatment of BED, based on more than 25 years of clinical experience. This unique treatment approach incorporates a variety of clinical paradigms, including internal family systems (IFS), dialectical behavioral therapy (DBT), mindfulness strategies, and a range of somatic trauma techniques. Her approach also integrates intuitive eating and movement and a “health at every size” philosophy. In addition, Pershing offers training and supervision to clinicians treating BED nationwide. She has developed two- and three-day Intensives for those in recovery, as well as “Hungerwise™,” a 10-week program for ending chronic dieting and weight cycling.
Pershing lectures nationally and writes extensively on the treatment of BED and her own recovery journey for both professional and lay communities. She has been featured on numerous radio and television programs speaking about BED treatment and recovery, relapse prevention, weight stigma, and intuitive eating and movement. Pershing has also served on a variety of professional boards and currently serves as the 2013 Chair of the Binge Eating Disorder Association. She maintains a clinical practice in Ann Arbor.
“How is it possible to be happy about myself at this size?”
“There is nothing ok about cellulite, wrinkles, or age spots.”
“How is thinner not better?”
“I feel so much better about myself when I lose weight.”
“When my daughter was bullied about her weight, the school offered to get her in to see the nutritionist. They told her if she lost weight, the bullying would stop.”
“I have never been at home in my body.”
These comments are taken from various group writing exercises I have done in workshops over the years or quotes from the clients I see each week. I have an almost endless supply of these statements, gathered over the years of working with women, men and teens with binge eating disorder. For most adolescent girls and women (and increasing numbers of men), with and without an eating disorder, such comments do not seem even noteworthy. It is a given to not be at peace with our size. We would be stunned to hear someone say they felt truly at home in their body. How could they not be trying “fix” something about their weight, shape, or jeans size? Our body is an ongoing project, somehow. The state of our relationship with it is often one of war, or at best a shaky detente. The bottom line: our body is always a “work in progress”, never finished, and certainly never “good enough.” There is always money to be spent and change to be made in the cause of “looking better.”
It is a given too that our body is not principally our home, the place where we spend our lives, but in fact a billboard advertising our relative worth and value. As we see in ads all around us, the highest value is placed on being very thin, white, young, and wealthy. Girls and women, and more and more boys and men, are pitted against each other in a contest for being part of the “in-group”, and the greatest risk of rejection is being labeled as fat. Consider the latest notion of the highly prized “thigh gap”. Or note a recent comment in an interview with Abercrombie and Fitch CEO Mike Jeffries in response to why his store will not carry XL and XXL sizes: “In every school there are the cool and popular kids, and then there are the not-so-cool kids. We go after the cool kids. We go after the attractive all-American kid with a great attitude and a lot of friends. A lot of people don’t belong in our clothes, and they can’t belong. Are we exclusionary? Absolutely. That’s why we hire good-looking people in our stores. Because good-looking people attract other good-looking people, and we want to market to cool, good-looking people. We don’t market to anyone other than that.” In this comment, Jeffries says aloud the underlying message we all know well: “Only thin is cool. Only thin is good looking. Only thin is worthy of our clothes. There is no room for diversion or diversity from this ideal.” We know from considerable research that it is this orientation toward the human body, one of extreme conditionality, that lends great credibility to the voice of an eating disorder. It is much harder to fight distorted body image when the culture backs it up.
Especially for women deemed “overweight” by our culture, body shame impacts thoughts, decisions, and actions of all kinds; every day, perhaps hundreds of times a day, body shame colors our internal world. In my own experience, at the height of my BED and at my top weight, I was constantly body checking, aware of how I sat, how the fabric of my sweater might reveal my stomach, wondering if my cellulite could be seen. I would never go to a beach in a swimsuit. My desire to go to a party, buy a piece of clothing in a bright color, what to allow myself to eat in public were all impacted by my beliefs about my size. While this is terrifically common, it is not normal. It is a robbery of our lives, stolen in many minutes of every day. Living in a state of shame is unnatural, damaging, and counterintuitive. It is absolutely not innate; it has to be learned. And the cultural vehicle for teaching this message is weight stigma.
Weight stigma is simply “discrimination or prejudice based on a person’s body size or weight” (BEDA, 2013). It reflects three basic assumptions; thin is always preferable (for either esthetic or health reasons), thin is always possible, and thin people are better people in some fundamental way (Pershing 2012). The impact of weight stigma is beginning to be reflected in the research. We now know for example that weight discrimination occurs more frequently than gender or age discrimination (Puhl, 2008). We know that weight discrimination reports have increased 66% in the last decade (Puhl 2009), and that obese youth who are teased about their weight are 2-3 times more likely to experience suicidal thoughts and behaviors than their peers who are not teased (Brownell, 2008). Of those with all types of eating disorders, 70% say an experience with weight-related bullying was formative in the development of the disorder (Puhl, 2008). It is the experience of weight stigma itself, not one’s actual weight, that plays a causal role in the development of eating disorders and body shame.
To challenge these notions, we must first be able to see their unnatural nature. Ask yourself if you hope your daughter or son feel about their body the way you feel about your own. Or consider this exercise I use with clients: bring to mind a close friend, someone you love and cherish. Now suppose this friend gains 30 pounds. Go into your heart and really consider this: does their place in your heart change based on this weight gain? Does who you know them to be seem altered negatively by a weight fluctuation? Conversely, does your affection for them increase if they lose weight? I think you will agree the notion is actually absurd. But it is in fact exactly the required thinking for weight stigma. And it is a notion you most likely apply to yourself without question. Does your valuing of yourself change if you gain 30 pounds? If you are impacted by weight stigma, and especially if you struggle with BED, the answer is likely yes.
Who benefits most from weight stigma? Perhaps the primary beneficiary is the $60 billion dollar per year diet and weight loss industry (2012). If we were not compelled to see our body as something to be “fixed” continuously we would not have lifetime memberships at Weight Watchers. We would not spend our money on any system with a 97% failure rate, and blame ourselves for not “sticking to the program”. We would not have a “war” on obesity, or a series of posters shaming kids about their weight. We would not have bariatric interventions covered by insurance while people must fight for coverage for eating disorders. We would not have the consistent growth in the rate of anorexia, bulimia and BED that we see annually. We would hold bullies accountable for their actions, not put the victims on diets. The word “fat” would simply be a descriptor, like “tall”, not a label that strikes shame. And perhaps most powerfully, women would not spend time or energy “diet talking” and body bashing. Imagine what else they might do.
Challenging this notion is an act of virtual revolution. How might we envision a world without weight stigma? Don’t we need stigmatizing experiences to “keep on track”? What’s wrong with shaming bad behavior? Isn’t that what we should do? Doesn’t shame motivate change? Isn’t the goal of weight loss about making people healthier? Isn’t that a reasonable goal? It seems to me we must consider the vehicle of shame as a tool for change, and see if it really makes for healthier, happier people.
There are two kinds of shame: healthy shame and toxic shame. Healthy shame allows us to live in the world with other people. It keeps us humble, and reminds us others have needs of equal importance to our own. It is the feeling we get when we have wronged someone else, and wish to make amends. It allows us to follow appropriate leaders, and experience good boundaries in relationships (to take half the space, but not more). It is at the root of compassion, for both ourselves and others, and exemplifies the very best of humanness.
Toxic shame, however, is a very different animal. Toxic shame is the result of a variety of damaging experiences, typically from our childhoods. It might be the result of trama such as sexual or physical abuse, bullying, or other significant losses. It can also be the result of not having appropriate and consistent validation for who we truly are, to feel valued and heard for what makes us unique, including our physical appearance. If these experiences are significant, we develop the belief that we are not as valuable as others, or as good as we shouldbe. We come to believe that this inferiority is innate, and we may or may not be able to “fix” what renders us of lesser value. This belief system is in fact exceptionally common, especially for women. It has made for a population of people especially vulnerable to buying into messages of shame.
Imagine then the impact of weight stigma on someone struggling with toxic shame. The message that their body will only be good enough if it conforms to a particular size and shape fits perfectly, and makes defying the cultural message that echoes their shame that much more difficult to challenge. People will continue to try anything to become acceptable, and will blame themselves for the failure to achieve it. We see that this body shaming does not motivate “good behavior.” In fact, it creates hopelessness and defiance. It is responsible for the epidemic of both yo-yo dieting and eating disorders seen in treatment centers every day.
Weight stigma messages trip people up because they feel so familiar, much like the messages at the beginning of this post. “Of course my body isn’t good enough; neither am I!” So then, how to we have a revolution? If toxic shame is at the heart of believing the messages of weight stigma that reinforce not taking good care of our bodies, how do we change? I believe there are three critical steps.
First, we gradually recognize the message of toxic body shame (and toxic shame period) for what it is: the feeling resulting from faulty childhood beliefs about our worth and value that are based on psychological damage, not on the real truth. The real truth? Your body is absolutely valuable, right this minute, without change of any kind, simply because it is your home. It is always doing its best for you, no matter what. It will be with you your whole life. And it deserves respect, care, and attention. Period. Nobody is in this psychological space all the time; we move toward it slowly. For many, psychotherapy, support groups and “bibliotherapy” are essential components of this process. There is a wound to heal; it takes work and courage to do so. And after a while, when we hear a toxic message, we know better than to buy in. We slowly free ourselves from the hook.
Second, we allow ourselves to get angry at anything that perpetuates toxic body shame and weight stigma, damaging us and those we love. And we do something to stop it. We get active, we make sure our voices are heard. We refuse to buy products that perpetuate weight stigma, or from companies that do so. We fight weight related bullying in our schools. We resist weight and diet talk, or automatically congratulating someone on weight loss. We join organizations that advocate change. We broaden our definition of “beautiful”, and see with new eyes the incredible body diversity all around us.
And finally, we move toward living in the truth: your body is your home, to be cherished, protected and honored. Its value is NOT based on adherence to some money-driven ideal. Anything we do for our appearance should be based on joy and pleasure, not shame and hate. The very best way I have discovered to move in this direction is something called “HAES”, or Health at Every Size. HAES, developed by Deb Burgard PhD and others, provides a framework for a relationship with our bodies based on compassion and respect. The basic tenets of HAES, as I use them, are as follows:
- Accept and respect the journey of your ever-changing body
- Honor that your health and well-being are multi-dimensional; they include physical, social, spiritual, occupational, emotional, and intellectual elements
- Honor the right to health and well-being for your body at the size you are right now, and at any size it may become
- Eat in a manner which balances your nutritional needs, hunger, satiety, appetite, and pleasure
- Honor your desire for appropriate, enjoyable, life-enhancing strengthening physical activity, rather than exercise that is focused on a goal of weight loss
HAES has been unfortunately misunderstood in some circles as advocating being “overweight” or ignoring health risks. In fact, quite the opposite is true. HAES invites giving the very best care to the body right now, as is. It tells us that all bodies are equally deserving of care. HAES implies that if damaging behaviors such as a binge eating disorder exist, people need proper treatment. They need to find recovery because an eating disorder is not good body and Self care, not because it leads to being fat. This difference is the revolution itself; long term change toward health (which may or may not include weight change) happens only from a place of compassion and empathy. It does not come from shaming. Shame brings fear, then perhaps rage, but never sustainable health.
I have been a BED treatment specialist for over 20 years. I have been through recovery myself. And I have been privileged to watch my clients journey through the healing process. I see their body shame slowly heal as they learn to listen to their physical needs with less judgment and fear. Body trust takes time, like any good relationship. But it happens. In the eloquent words from one client’s journal: “I’m not exactly sure how, but today I knew I was hungry. I just knew it. So I ate. Ate what sounded good (watermelon and a cookie). And there was a power there, a kind of truth. My body needed, I reacted, I felt better. I went on with life. I don’t know why for sure, but it felt like coming home. And I think I’ve been away a long time.”
And so, to those ready to begin this journey of recovery from weight stigma, welcome home.