Michele left a great comment over on my blog about The Self in Self-Esteem.  She asked “From this exchange it seems to me there is a strong element of “faith” to self-esteem: either you believe you are marvellous or you don’t. OR can you act/ proceed as if you believe it, and maybe it will come?”

My answer is that yes, “acting as if” can be a fantastic strategy for working on your intrinsic self-esteem (and for your health, which I’ll talk about in just a couple more paragraphs)  especially if you are having some trouble getting to the “I’m awesome just because I am” place.

I think it’s an extremely valuable exercise to imagine how your life might be different if you had the self-esteem and body image that you want.  And I would suggest considering how it would be different from your perspective, not from other people’s.  If you are hoping that a change in you will result in other people changing their behavior (ie:  My mom will be nice to me; attractive men/women will be fighting over me etc.) you’re going in the wrong direction.  This is about how you will feel, act, and react differently- not about controlling the behavior of others.

Take some time and really think about ways that you think your self-esteem might be holding you back.  How would you act differently in specific situations if you had high self-esteem?  If you have trouble picturing yourself with high self-esteem, ask your self how someone with high self-esteem would act.

Then start to act in situations the way that you would if you had the level of self-esteem that you wanted. Maybe try using a little saying like “I a person with high self-esteem”, of whatever makes sense to you.  Just say it throughout the day and picture what that would look like. A little dorky?  Maybe…but it couldn’t hurt, might help.

You can do the same thing with your health – to me that’s really what Health at Every Size is.  So many weight loss programs suggest that you do something extreme to lose weight (eat reconstituted soy protein most of the time, drastically cut calories, cut out an entire food group) and then once you’ve lost the weight they put you on what they call “maintenance”.  The reason that diets have a “maintenance” phase is that it’s not healthy to eat that way over an extended period of time.  My question is, if it’s not healthy to eat that way long term, why would I want to do it at all?  So many diets claim “this isn’t a diet, it’s a way of life” .  That’s true, but unfortunately according to the science the way of life that they are selling is:  Lose weight, gain it back during “maintenance”, feel like a failure, get back on the extreme phase of the diet, lather, rinse, repeat.

Health at Every Size suggests that we just choose behaviors that we would choose if we were healthy – eat nourishing food most of the time, enjoy the food you eat the rest of the time, move your body in ways that you enjoy.  Those healthy behaviors have the best chance of leading to a healthy body and you know that they are healthy because you can do them long term.  Healthy behaviors do not require a “maintenance phase”.

What if you just act like you were already have the health that you want right now – what things would you do differently?  Would you eat a little better?  Move a little more?

It doesn’t have to be drastic.  You do not have to be in the gym for hours a day every day, or restrict your food to be more healthy.  What if you did movement you enjoy (dance , garden, yoga, tai chi etc.) for about 30 minutes most days?  If you get busy and can’t get to it one day, don’t bother feeling guilty – since guilt won’t substitute for movement now you’re just taking a situation that’s no big deal and making a thing out of it.  Consciously choose that you’re not going to move today and then tomorrow, make a choice about moving tomorrow. The same with food.  Eat food that nourishes you most of the time.  If you’re going to eat something that you like but that isn’t so nourishing – relish it, enjoy it with no guilt.  Being guilty about eating a food doesn’t do anything positive for you so what’s the freaking point?

Seriously, if you’ve been stuck on the diet roller coaster, give this a try.  You may be very happy with the results.  If you want more information, check out Dr. Linda Bacon’s site at http://haescommunity.org/ and check out Intuitive Eating (note, I’m not affiliated with either site, nobody pays me to recommend their stuff.  I don’t know if that’s good or bad, but it’s what’s happening right now 🙂

Get good at acting as if and I bet soon it will be so.

There’s been some buzz in the fatosphere these last couple of days about a statement by Dr. Regina Benjamin, the United States Surgeon General, from about a year ago (video below) that is mostly in alignment with the principles of Health at Every Size.  She says, in part:

“…The good news is we can be healthy and fit at any size or any weight.  As America’s  family doctor I want to change the conversation from a negative one about obesity and illness to a positive one about being healthy and fit.   So let’s start with making healthy choices.  Eat nutritious foods, exercise regularly, and have fun doing it.”

I love that part.  I love that it reflects the best information that we have from scientific studies. I love that it reflects a shift from a guilt/shame/fear mentality to a paradigm where people can choose to take good care of themselves because they deserve good care and look for ways to do that that they enjoy.  I think that people take better care of things they love than of things they hate so I like that this is going in that direction, I’d love for this to trickle down to Michelle  Obama and her campaign of good intentions.

But there’s a little problem. Dr. Benjamin prefaces this statement with an introduction in which she says that obesity and being overweight “result in”  high levels of diabetes and other chronic illnesses.

First, this does not reflect the scientific information that we have.  Unless there’s a study I’ve missed, no causal relationship has ever been proven between weight and disease, only correlational links have been shown.  That means that we can show that they happen at the same time, but not that one causes the other.

If we just have correlational evidence it means that it’s possible that being overweight causes disease (but we haven’t proven that in a lot of tries), or it’s possible that the diseases cause people to be overweight, or it’s possible that they are both caused by a third factor (more and more scientists are hypothesizing that it’s stress), or that they are unrelated.  If August had the most violent crimes of any month and the most ice cream eaten of any month, you wouldn’t assume that one was caused by the other.  Based on all the science I’ve seen, it’s no more likely that being overweight causes health problems.

I think the larger problem is that it seems contradictory to what she said in the first half of the video.  If we can be healthy at any weight or size then how is it possible these diseases are the “result” of being overweight or obese?

According to the American Diabetes Association website:

“Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.

Fact:  Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes.  Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.”

Still, I’m extremely happy that the Surgeon General of the United States wants to change the conversation, I’m certainly all about rolling up my sleeves and helping!

Here is the video as promised:

It seems like I meet a lot of people who don’t like themselves very much, who don’t like their bodies, who feel guilty about their weight.

Recently a couple of small studies have come out showing that in populations where there is no stigma around being fat, fat people do not have negative health outcomes.  The studies I’ve seen are too small to be statistically significant so they don’t prove anything.  But they raise an interesting question – is it possible that being under constant stress, receiving hundreds of thousands of negative messages about our bodies each year, and continuously trying and failing at dieting  could cause the negative health outcomes that are currently correlated with obesity?

In 2008 a study  looked at data for 170,577 people.  The study found that the more dissatisfied a person was with his or her weight, the more days that person indicated were “bad health days”.  Dr. Peter Muennig of Columbia University in New York City was the lead author on that paper.  He said “The obesity ‘epidemic’ might have a lot more to do with our collective preoccupation with obesity than obesity itself.  We still need to focus on healthy [eating] and [movement] as public health officials, but we need to take fatness out of the equation. Were we to stop looking at body fat as a problem, the problem may well disappear.” (emphasis added, words in brackets substitute for trigger words)

The science is all interesting but here’s my real question.  Regardless of what is true about obesity and health…  Regardless of how you feel about your current state of health…

What good does self-hatred do?

This question is neither general nor rhetorical.  I’m asking seriously:  How is disliking or hating yourself or your body helping you out?

It’s certainly an option and within your rights to dislike yourself and focus on what you don’t like about your body, to feel guilt, shame and fear about your body, your choices where health is concerned, really about anything in your life.  I’m just wondering if you feel that it’s going to help,  if you just enjoy feeling that way (and it’s cool if you do, absolutely your choice.), or if you’re just not sure how to feel any other way?

If you’re not having fun, then my next question is:  Who is in charge of how you feel about yourself?

I’m thinking it’s you – for all the reasons I listed in this post about personal responsibility.

If you are stuck in a place of body and/or self hatred, you could decide to love your body and yourself.  That doesn’t mean that it will magically happen in the next two seconds. But you could decide that no matter what it takes you are going to learn to love yourself as you are  – not 50lbs from now, not after you can run a 10k, as you are.  You deserve to love yourself and your body, no matter what your circumstances.  You and your body are totally worthy of love.

And I don’t mean some hedge-your-bets “I’m going to endeavor to try to learn to kind of accept myself even though my thighs are too big” thing.  I mean you decide that you are going to love yourself.  It may not be easy, but if you’ve already determined that self-hatred isn’t giving you the results you want, then maybe it’s time to try something radically different, even if it’s hard to do.

Once you make that decision, start looking for a path that will take you in that direction.  (Check out Love your Body More in Three Simple Steps and this post on setting boundaries for how you want to be treated for more concrete techniques).

You could do this even if you want to get more healthy, or change the size and shape of your body, or get a boob job, or whatever.  Loving yourself doesn’t mean that there aren’t different choices that you want to make about your behaviors.  But if you don’t learn to love yourself first, then based on the studies I referenced above, you could be making it that much harder to be able to get the things that you want.  Once you get to a place of loving yourself and believing that you are worthy of love and respect, in my experience it becomes much easier to make decisions that support being who you want to be.  People take better care of things they love than things they hate, and I believe that includes ourselves and our bodies.

Remember the movie “Jerry Maguire” where everyone kept yelling SHOW ME THE MONEY!!!!!!  It’s inspiring me to a similar reaction.

If you want to make recommendations about my health and weight, you’re going to have to SHOW ME THE RESEARCH.  I want to see a statistically significant sample size, properly controlled variables, and peer reviewed proof of long-term efficacy before anyone gets to discuss my body or my health with me again. I’m tired of my side of the conversation being well researched just to be met with an eye roll and an “everybody knows” response.

There was a time when “everybody knew” the Sun revolved around the Earth.  Since “everybody knew” that, there was no need to prove or defend it with hard facts, and any attempts to disprove it through science were met with scorn – or worse- just ask Galileo.

Recently the Nutrition Journal published a review of studies used to prove that dieting works called “Validity of claims made in weight management research: a narrative review of dietetic articles”.  Here are some of the findings:

• [studies included] claims of non-specific ‘health benefits’ which are not substantiated
• It appears that beliefs about weight and health acquire a truth status so that they circulate as intuitively appealing ‘facts’, immune from scrutiny and become used, and accepted by editors, without supporting references
• Dietetic literature on weight management fails to meet the standards of evidence based medicine.
• Research in the field is characterized by speculative claims that fail to accurately represent the available data.

It is amazing to me how many studies cite an extremely low success rate (between .17% and 5%) but then assert in their conclusions that it’s still a good idea to set a weight loss goal and use the method that they just proved does not work.

This leads to a situation in which everyone from doctors to personal trainers to random strangers feel free to tell us fat people that we need to lose weight. “Everybody knows” that we are not healthy.  “Everybody knows” that if we would just eat less and exercise more we would lose weight.  “Everybody knows” it’s just a matter of willpower.

In truth, study after study has found that those things are not true.  Yet doctors keep prescribing the same things and blaming 99.83% of people for not trying hard enough. Can you imagine if Viagra only worked 5% of the time and we blamed 95% of the guys for just not trying?  It’s completely ridiculous.  But when I point this out people roll their eyes and say “everybody knows” that you can lose weight if you really try.

The best research that I am seeing says that making your goal healthy behaviors (instead of weight loss) has the best chance of producing a healthy body.  Unbelievably to me, the phrase “a goal of healthy behaviors have the best chance of producing a healthy body ” is controversial.  What the hell?

Instead we are sold the idea that eating reconstituted soy protein shakes, pudding, and bars 5 times a day will lead to a healthy body; or that restricting calories to a level that is consistent with someone suffering from Anorexia will create a healthy body. (For more about the insanity of doing unhealthy things to get “healthy” check out  “That Does Not Make Sense“).

So if you want to talk to me about my health and weight, either show me your research or shut up.  There are a lot of things in this blog that are just my opinion.  There are some things that aren’t.  This is one of those.  I went to school for this.  I read full studies, not just the abstracts. I look for factors including sample size, variables, controls, and drop-out rates.  I compare the “conclusions” section with the actual data that was collected.

That’s why when someone sees a study that concludes  “Weight loss was achieved by all compliant participants”  they can be mislead into believing that the diet was successful.  What I know is that 84% of participants dropped out, and while the other 16% did lose weight, the average weight loss was less than 2 pounds over two months and all but .17% of them gained it back by the end of the study.

If someone wants to let poorly conducted research with unsupported conclusions dictate how they live  life that’s entirely within their rights.  They’re going to have to do a lot better to convince me.

So let me channel my inner Galileo for a paragraph for two:

Based on the science, long-term weight loss is not reliably achievable by any means tested and therefore recommending it is unethical.  At best doctors should be saying, “there’s a chance you might be healthier if you were thinner but we can’t prove that, and we have no idea how you can get thinner anyway since nothing we’ve tried so far works.”

Based on the science, weight loss is nothing more than a possible (improbable, nearly impossible in the long term) side effect of healthy behaviors.  Of all options, healthy behaviors seem to have the best chance of leading to a healthy body, whether or not they lead to a thin body.

Since nobody knows what behaviors (if any) could reliably lead to a thin body it would be nice if people stopped lying to us and saying that they do.  I doubt that they will (because it’s quite lucrative) so we might want to consider no longer believing them until they show us to properly controlled, statistically significant, peer reviewed proof of long-term success. “Everybody” can “know” whatever they want but at the end of the day the Earth revolves around the Sun and there is no changing that by rolling your eyes and claiming otherwise.

Read the full nutrition review at http://www.nutritionj.com/content/9/1/30

I give talks about self-esteem and body image.  I’ve given three in the past couple of weeks.  In the talks I give a little bit of my history with eating disorders, cycle dieting and finally finding health and happiness with the Behavior Centered Health/Health at Every Size model (where healthy behaviors and not a specific weight or size are the goal).  I talk to groups for anywhere from 20 minutes to a few hours.  At the end there are two conversations that almost always happen.

Conversation 1

This conversation is always interesting to me.  Someone will say to me:  “Gosh I wish I had your [self-esteem, body image, health, confidence etc.]  but I have trouble with [insert issue here].  As I’ve typically dealt with this issue before I will usually be able to say “Oh, I dealt with that and [insert solutions] helped me work through it.”  Then they will say, without hesitation, “That won’t work.”.

Ok, look.  First of all I always clarify that my methods are just my methods, other people have other methods.  What I do may not work for everyone.  However,  if I find myself wanting  a state of being that someone else has achieved and they tell me how they got it, it would not surprise me to find that it didn’t fit with what I thought would work. Mostly because if what I expected to work actually did, I wouldn’t have the problem in the first place. So I try to be open to the possibility that maybe the thing they are suggesting is worth a try.  If you don’t like where you are, you might consider trying something that doesn’t seem natural to you. If it doesn’t work you can always try something else. Your mileage may vary, but if you aren’t attempting to drive somewhere, then it might be time to learn to be at peace with your parking spot.

People ask me a lot about diet – what do I think about a vegetarian diet, Atkins, caveman, mediterranean.  What I always say is this:  Try it.  If you feel better do more of it, if you feel worse, try something else.  It has been my experience that my body knows what it needs, and that if I pay attention to it, I can learn to discern that information.  Unfortunately before I figured this out and learned to communicate with my body, I spent most of my life  with my fingers in my ears yelling “LALALALALALALA” and only pausing to tell my body what it was getting while actively ignoring the signals it was sending to me as to what it wanted.  That was not a good plan.  I like the book Intuitive Eating as a guide on this journey.  There is a bit of weight loss talk  which might be triggering for some, but if  you’re at a place of no longer feeling that you can be trusted to make food decisions for yourself I definitely recommend it.  (They don’t pay me to endorse it, I seriously doubt they even know who I am.)

Conversation 2

The second conversation is more abrasive to me.  Despite my standing in front of the group and

• talking about my journey
• explaining behavior centered health
• explaining my personal health plan
• revealing the fantastic health outcomes I’m experiencing
• explaining that  my goal is to give people an option not tell them how to live
• Acknowledging that I respect everyone’s choices as I expect mine to be respected

at the end of my presentation some whackadoodle will attempt to sell me their weight loss product.  Usually under the guise of the VFHT (Vague Future Health Threat) which always sounds something like “With your weight I’m surprised to hear that you are healthy now, but it won’t last. You’re going to have problems later”.  Or they’ll tell me that they have “vital information about my health” and then give me information gleaned from diet commercials as if I’ve somehow arrived at this stage in my life without ever having heard the claims that are made about the correlation between fat and disease.  This is often followed by them telling me their story of how weight loss changed their life and therefore will change mine.

This completely pisses me off.  First they admit that they were unable to accurately assess my current health, then they assert that I should allow them to put me in fear about my future health and buy stuff from them to solve a problem which does not currently exist. I give this a couple points for guts but none for style.

I do not discount anyone’s experience.  If someone had a goal of changing the size and shape of their body and they succeeded, I’ll be the first one throwing confetti. If they had health problems that were solved through a change in eating and/or movement that also resulted in them losing weight, I think that’s fantastic.  I’ve said five hundred million times that I am not for or against weight loss.  (Wait for it…despite my saying this clearly for the 5oo,000,001 time, someone will probably reply to this post and accuse me of hating  on people who lose weight.)

My option is about not depending on the shape and size of your body to determine your self-worth, and having quick access to true and correct information about the efficacy and likely health impacts of any path that you take for your health, wellness, weight loss etc. goals.

It’s not that I don’t think that most of these people come from a place of good intention, it’s just that I think that the inability of these people to understand that their experience is not everyone’s experience reveals a lack of emotional intelligence and maturity.  It’s like when a little kid covers his eyes and assumes that you can’t see.   If someone has found something that works for them and they want to shout that option from the rooftops to help others know it’s out there then I’m all for it.  If they want to try to get us to buy their stuff through the use of  guilt, shame, fear and unsolicited, unfounded random threats about our health, I have a problem with that and I’m going to say so.

If someone says that they are happy on their weight loss program I would never presume to tell them that they are wrong and so they should choose Health at Every Size instead.  It would be completely rude and inappropriate.  Not.  Its.  Business.

If we’re not where we want to be then we can either make peace with it, try something else, or wallow in our misery.  All three are valid choices.  They are our individual choices.  If you want to be somewhere other than where you are when it comes to your self-esteem and body image,  then may I  suggest that you’re probably going to have to do some things differently than what you would normally do.  Do some research, try some stuff.  You can always go back.  It will always be your choice.

And please, for the love of all that’s holy, don’t try to sell me your weight loss solution.  Thank you. Your friend, Ragen.