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Mental Note

41 - Health at Every Size with Meredith Nisbet

By Meredith Nisbet, MS, LMFT

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It’s no secret that a lot of us are uncomfortable with the shape and size of our bodies -thanks in no small part to the $72 billion dollar a year weight loss industry devoted to the thin ideal. Even most health care providers will ask patients to drop weight if their BMI is above "average." But why?

The Health at Every Size movement - HAES for short - invites us to reconsider our obsession with weight and instead focus on health behaviors. HAES principles seek to advance social justice, create an inclusive and respectful community, and support people of all sizes in finding compassionate ways to take care of themselves. But what do those principles look like in daily life?

To cut through a lot of the misinformation out there, we’ve invited Meredith Nisbet, L.M.F.T., C.E.D.S. to answer some of our most common questions when it comes to body size.

 

 

HAES Resources:
HAES Website
Database of HAES aligned businesses and medical providers

Social Media Accounts:
@thenutritiontea
@bodyimagewithbri
@colleenmwerner
@therapywithmere
Meredith Nisbet

Therapy Resources:
Eating Recovery Center (877) 850-7199
Insight Behavioral Health (877) 850-7199

Transcript

Meredith Nisbet:
What happens when we take these two variables, weight and health, and we untangle them and we say someone can pursue health, regardless of weight, regardless of weight change up or down, someone still has the inherent ability to pursue health in ways that have nothing to do with that. And what possibilities does that open up for us?

Ellie Pike:
Hello and welcome to Mental Note Podcast. Today, we'll be talking about the size of our bodies, fatness, health, and how those topics affect society. It's no secret that a lot of us are uncomfortable with the shape and size of our bodies. Thanks in no small part to the $72 billion weight loss industry. Yeah, that's a lot of money spent on creating the thin ideal. So what's so bad about fat in the first place? And how much does it truly affect a person's health? To cut through a lot of the misinformation out there we've invited Meredith Nisbet to answer some of our most common questions when it comes to body size.

Meredith Nisbet:
My name is Meredith Nisbet. I'm a licensed marriage and family therapist. I'm the supervisor of the clinical response team with Eating Recovery Center and Pathlight Mood & Anxiety Center.

Ellie Pike:
Meredith has discovered a special passion for connecting clients and healthcare providers with the fat acceptance research and principles. She's learned in the Health at Every Size community, HAES, for short,

Meredith Nisbet:
When I first got into the eating disorder community, I had never heard of Health at Every Size, and my friend and colleague, Dr. Maria Paredes was the one who first introduced me to Health at Every Size and really welcomed me into that community and helped me find community in that. And so it's become somewhat of a passion project of mine to talk with folks about health at every size, and really dig into the research and find out how we can utilize this to benefit our clinical practice and to help patients have other perspectives than maybe what they're hearing in other areas of their lives.

Ellie Pike:
HAES principals seek to advance social justice, create an inclusive and respectful community and support people of all sizes in finding compassionate ways to take care of themselves. You are listening to Mental Note Podcast. I'm Ellie Pike. If anyone is listening and just wondering is this episode for me, this episode is for you, because we're all affected by weight bias and just how culture sees it and even the medical community and how the medical community pathologizes weight. So this'll be a really interesting conversation. So stay tuned, we'll dive into more of the principles and even some of the questions that some of our listeners have about health at every size. So just for the general audience tuning in today, if you had to summarize health at every size in just two sentences, what would it mean?

Meredith Nisbet:
Yeah, so health at every size is this idea that weight does not equal health, and that we should, the research evidence-based actually indicates that we should be encouraging folks to pursue health behaviors independent of weight, and also to acknowledge the social justice aspects of oppression. So intersectional identity, including living in a larger body and how the impact of weight stigma and fatphobia, it really drastically impact folks mental and physical health. So this idea that we can pursue health behaviors and pursue health, if we choose to, without having to pursue weight loss.

Ellie Pike:
How would you describe the principles of Health at Every Size for someone who wants to better understand it?

Meredith Nisbet:
Yeah. There are five main principles of health at every size, so I'll just read them off and then we can go into each one. The five main principles of HAES are weight inclusivity, health enhancement, respectful care, eating for wellbeing and life enhancing movement. So the last two eating for wellbeing and life enhancing movement are also referred to as intuitive eating or joyful movement. Those are things a lot of people I've heard of before, even if they've never heard of HAES, especially intuitive eating. That's when I think the general population is a little bit more familiar with and other parts of HAES. Really the goal of HAES is for us to accept and respect diversity of bodies. So to acknowledge that for millennia bodies have come in all different shapes and sizes, larger bodies are not new, smaller bodies are not new. We've always had diversity in the ways that our bodies are built. And so we want to reject this idea that we need to either idealize or pathologize specific weights. So coming back to this really evidence-based health focused and also life focused format for health.

Ellie Pike:
So going back to the first principle of weight inclusivity, this one is like loaded, right? You're saying, we're not going to use weight as the determinant of health. A lot of studies are out there and a lot of news is out there that does equate weight with health. So what do we do with that?

Meredith Nisbet:
Yeah, absolutely. I think one of my favorite studies that I always reference when I talk to folks about Health at Every Size is a study that was done in 2012 by Matheson King and Everett. When the researchers implemented this study, they wanted to look at the association between healthy lifestyle habits, as they define those, and we'll talk about that in a second, and morbidity risk in this really large population-based sample. These researchers defined healthy habits as eating five or more fruits and vegetables daily, exercising regularly, so no specifics on that, consuming alcohol and moderation, and not smoking. And so the different thing about this study is that they stratified it by BMI. And so when they did that, we were able to see how health behaviors impact morbidity or mortality for folks with higher BMI values.

Ellie Pike:
Just want to interject and say that for those of you who may be screaming at your headphones, yes, BMI is an inherently flawed measurement. But most of the research available about the effects of body size on health utilizes it as a measurement tool. As Meredith explained to me, we've got to make the most of the research available.

Meredith Nisbet:
So if we look at this study that is analyzing does body size actually moderate health? There's a graph at the end of the study and it shows each... So it's a bar graph, and there's three bars on each piece of the graph. And so as we go across the horizontal access, it's zero to four health behaviors. So how many health behaviors do these people have? So they have zero health behaviors. And then there are three bars with three BMI categories showing mortality risk for zero health behaviors. And then it goes on one health behavior, two, three, four. And so at the very beginning with zero health behaviors, it does show that folks with higher BMI have a higher mortality risk, compared to folks with lower BMI who also have zero health behaviors.

Meredith Nisbet:
But as you move on from zero health behaviors and you implement... I mean, even starting at one, you implement one health behavior. We can see that the mortality risk drops nearly in half and brings folks with higher BMI down equal to folks of lower BMI. And as you continue to add in health behaviors, these bars continue to drop drastically and they stay almost even. And so that's all science speak for. Basically what we know after this study is that when you implement health behaviors, your health improves, which sounds kind of silly, right? You would think that that's kind of a given. But the interesting thing about this study is we see it's true, regardless of body size, weight or BMI.

Ellie Pike:
So you're saying that despite somebody's size, the more health behaviors that they brought in, and this is not related to weight loss, it's saying, okay, no matter what size you are, the more health behaviors you do it is increasing your health. It's very simple, right? But it's just not weight loss related. And it's not about, did these health behaviors actually decrease your weight to make you healthier? It's just no matter the size you are, if you include these health behaviors in your life, it makes you healthier.

Meredith Nisbet:
Right. And it's often it's phrased, especially by folks in the medical community, I don't want to pick on them too much, but it's often phrased as, if you go into the doctor and they say, "Oh, you need to lose X number of weight." They aren't necessarily asking, even before making that recommendation, if you're in a larger body, they're not necessarily saying like, "Talk to me about how you eat. Talk to me about how you move." They're just saying your BMI is X, Y, Z, and you need to lose X, Y, Z amount of weight.

Meredith Nisbet:
Digging in and thinking about health behaviors. I always think it's interesting to consider what it would be like for folks to go to the doctor who are in larger bodies, and to actually be met with questions and conversation. So if they want to talk about how they're eating or how they're moving and how that impacts their health, versus just a blanket, like you need to lose X amount of weight, go do that.

Ellie Pike:
I really appreciate that because I think there's a lot of people out there in the world who are like, "Okay, that sounds ideal. How do I get a health provider like that?" How does someone find a health provider who's going to be more curious about their health behaviors versus just creating a prescription based on their weight?

Meredith Nisbet:
Yeah, absolutely. I think in North Carolina, we are super lucky to have the practice Mosaic Comprehensive Care in Chapel Hill. They're in all HAES medical practice, but if you're not in North Carolina, as most of you probably are not, the Health at Every Size website has a provider locator. And if there's no one in your area, I think that you can take a little bit of a different approach, where you may have to compromise in terms of, okay, this provider may not be explicitly Health at Every Size, because that's not accessible in my area. But I still am deserving of respectful care, as one of those main pillars of HAES, right? So I'm deserving of respectful care. And what does that mean for me? Does that mean that this doctor or this clinician is willing to look at research that I provide them? Are there certain standards for the way that I want that medical appointment to go? Would I like to decline being weighed. Thinking about your values and what respectful care means for you and your body can help you ask those questions when you're seeking out providers.

Ellie Pike:
I really appreciate that. Let's hop in a little deeper to respectful care as one of the principles. And a big piece of this as really acknowledging weight bias or your own biases towards another person, and providing fair care, right? And I think this goes to the general public, to respectful relationships, not just care, where I might see someone in a larger body and if my immediate reaction is, "Oh, they're not healthy." Or, "They need to lose weight." I have weight bias, right? I have something I need to observe in myself. And so what are some ways that people can challenge their own weight stigma? And what are some of the impacts of weight stigma?

Meredith Nisbet:
Yeah, absolutely. So I think talking about impact first, so weight stigma really impacts all of us, first of all. I think that's a common misconception about HAES and weight stigma or weight bias in general, is that it only impacts people of size. I personally feel that they impact all of us. It's really important to acknowledge that people of size are of course receiving the majority of that impact, probably the worst of that impact, but to just translate this for everyone, you are in some way impacted by weight bias, whether or not you are aware of it.

Meredith Nisbet:
So this idea of the thin ideal, and all bodies need to look a certain way and move a certain way and fit a certain size of clothing. Those types of ideals that we have in society are a product of weight bias. And so kind of that societal external information then feeds the experience of folks in larger bodies. And we have tons of research that talks about medical providers spend less time with folks in larger bodies in the patient room. They are less likely to send out for diagnostic tests when they're indicated. They are more likely to perceive folks in larger bodies as lazy or unhygienic, or unintelligent, all of these negative attributes.

Meredith Nisbet:
And it doesn't just happen in the medical community. I think it's important to think about how folks in larger bodies move throughout the world. And that really are a lot of our world is not shaped or made for folks in larger bodies. So something as simple as fitting into an airplane seat or finding room to stand on public transportation, being able to sit in a booth in a restaurant, things like that, finding a chair in a medical waiting room that will fit you. I think those are things that folks who are in larger bodies don't have to think about. They can move through the world much easier. They're not worrying about, "Am I going to be able to fit in this chair? Is it too flimsy for me?" Those are things that folks in smaller bodies don't necessarily have to think about as they navigate the world. And folks in larger bodies do have to give some brain space to that just as they move throughout their day.

Ellie Pike:
Thank you so much. And I appreciate to the emphasis that this really does impact all of us, not just folks in larger bodies, and that the thin ideal, right? Like this mentality that you should be this size to be "healthy" or to look good or to be attractive, whatever those thoughts are. All of that is a result of the thin ideal. And part of that is a fear of gaining weight and a fear of living in a larger body.

Ellie Pike:
And so that in itself, as a culture, we see that everywhere. Like new year's resolutions, Super Bowl commercials, everything is tied to this in a lot of ways. And in a lot of my conversations that I have with people in the world, I often talk about how this is like such a stigma that goes under the radar, right? This is not talked about publicly in a lot of forums. And if anything, even by our government and even by our legislation, it's really just reinforced when we talk about the obesity epidemic or child obesity and the way that we see it as something to combat versus really saying like, "You know what? We have people in all sizes of bodies." And it's been that way for a long time. So instead of talking about weight as the issue, let's talk about increasing people's access to health behaviors, which really leads to the next piece I wanted to talk to you about, which was health enhancement.

Ellie Pike:
So you talked about that as really equalizing access to information and services. And I think this is really key when we talk about health behaviors, because not everyone has great access to what would mean a health behavior. So not everyone has great access to quality food, or even a grocery store within one mile. So there's a lot of implications there for those who struggle with poverty or access or don't have insurance, right? What does that look like to be an advocate in this area?

Meredith Nisbet:
Yeah, absolutely. I think getting involved locally, wherever you can, just in terms of local efforts to fund eating disorder treatment folks, or to help in food deserts or to volunteer for folks at a soup kitchen or a place where they are able to get food, if they don't have access to food. Anything that you can do on that micro individual level is fantastic.

Meredith Nisbet:
And then on a larger macro level, especially if you are a provider of any kind, thinking about how do I advocate for my clients? So how can I help them access things they may not have access to? And then also if that's not possible, if sometimes you are working with someone who you've tried to help them access things, they've tried to access things, and it's just not feasible, working with them to unpack that and understand that these external messages that are saying, "Do X, Y, Z for health. Eat X, Y, Z food." That those things are privileged inherently. That being able to follow absolutely any sort of external mandate from any external entity is a privilege in and of itself.

Meredith Nisbet:
And so breaking down those expectations and saying, "Let's look at what's accessible for you. So we're going to advocate and we're going to try to make more things accessible for you." But also, "How can we meet you where you are? How can we work with what you have? And how can we use the resources that you do have available to you to pursue health?"

Meredith Nisbet:
So, like for example, a certain specific way of eating where you have to eat these specific foods that, maybe cost more, or aren't available out of season, or aren't available in this person's neighborhood, how can you zoom in and say, "Okay, but what do you have access to? And what do you want to do?" Not what this external plan or entity thinks that you should do.

Ellie Pike:
So then the last two components are eating for wellbeing or intuitive eating, and life enhancement movement or life enhancing movement, which some people refer to as joyful movement. And I really get excited actually talking about that one. So let's jump into intuitive eating. And this really promotes flexibility. And it's talking about like paying attention to your internal cues.

Ellie Pike:
I really appreciate the caveat you provided earlier, that this is not necessarily for everyone at every stage in their life. Some people do need more of a monitored meal plan if they're actually working with a treatment team for an eating disorder. For the rest of us, a lot of people might be more ready for this part of life, right? This concept of intuitive eating and being less rigid or restrictive with the types of foods or when they eat, and really paying attention to their body's cues. So how would you intuitively... How do you actually even pay attention to your body to do that?

Meredith Nisbet:
Yeah, absolutely. So this is one of my favorite things to talk about. And it's so funny to me because I always say, we are all born knowing how to eat, right? We come out into the world knowing when we're hungry and knowing when we're full, right? So if you have an infant that is eating a formula or is being breastfed, that infant knows when they're hungry and they're going to let you know, right? And then they're going to let you know when they're done.

Meredith Nisbet:
But as we get older and diet culture messaging comes into play, or family dynamics stuff comes into play, any of these external messages that really interrupt that system of feedback within our body, we have a harder time listening to what our bodies want, because there's more messaging coming in and interrupting that. So for example, I woke up this morning and really wanted a waffle for breakfast, that I was just dead set on having a waffle. And I'm out of waffles. And so I said to myself, "Okay, you can go buy more waffles and you can have a waffle for breakfast tomorrow, but we've got to work with what we have in the house today. We've got to record this podcast."

Meredith Nisbet:
And so that flexibility of intuitive eating is important as well, where a lot of folks think intuitive eating is just eating whatever you want, whenever you want. And it's really not about that. It's really about being able to honor what your body's needing. So am I hungry? How hungry am I? Am I full? How full am I? Am I wanting something crunchy? Something softer? Or something more comforting? Something spicy? Sweet? Salty? Acidy? What am I creating and meeting what your body needs. It is about that. But it's also about flexibility in terms of being able to be adaptive to the situation. So like wanting a waffle this morning, not having access to that and saying, "Okay, we're going to have some Cheerios instead."

Meredith Nisbet:
So it's not just a free for all with food. I think that's something that can be really scary to folks who are in recovery or working towards recovery from an eating disorder, the idea that they are giving themselves permission to eat anything whenever, wherever, it can be really daunting. And so focusing on, let's bring it down to this meal, so let's bring it down to breakfast. What sounds good to you for breakfast? Not what does your mom think you should eat for breakfast? What does your doctor think you should eat for breakfast? But really zooming in and saying, what do I want? What sounds good to me right now?? And then, how much do I want? How hungry am I? Is that food accessible to me? And walking through those steps, zoomed in per meal or per day, instead of getting overwhelmed with this general large picture of do whatever you want, which is really not what intuitive eating is about.

Ellie Pike:
Heads up that while this info is helpful for most folks is probably not the best starting point for someone who is actively struggling with an eating disorder. Instead, I'd encourage you to work with your treatment team and dietician to find out what's right for you. So moving on to the next piece of life enhancing movement, ah, this is great. I think about some of the clients I used to work with, where they would talk about, "Oh my gosh, exercise, just that word feels really triggering." And life enhancing movement is really talking about finding activities that bring you joy.

Ellie Pike:
And I really liked that reframe, because I think the word exercise in itself is part of diet culture and really has harmed a lot of us along the way. And it feels very rigid. And I love movement, but still the word exercise. It does make me feel like, "Oh, I have to be wearing certain clothes, and I have to sweat and I have to do it fast." But instead I really liked this concept that you can move joyfully and just find what feels good to you that day. So, Meredith, what are some of the best ways that people can just start with this concept?

Meredith Nisbet:
Yeah. Oftentimes I'll encourage clients to think about the type of movement that they did as children. For example, when I was kid, I loved to climb trees. We had this huge Dogwood tree in our front yard. And I remember as a kid just spending so much time swinging on the branches and climbing up and sitting in the tree. And you would never think of that as exercise, right? But it was a form of movement that I really enjoyed. And it was one of my biggest active activities as a kid. And now I'm not saying I'm going to go climb a tree now, but just thinking back to like, okay, I used to love swinging from a tree branch. So maybe how can I translate that into activity in adult life?

Meredith Nisbet:
So part of Health at Every Size is reconceptualizing, A, what movement means, but, B, also what your movement and health goals are, rather than the goal for exercise or for movement to be about weight loss, or about changing your body or shrinking your body in that way. How do we reframe our goals and make them actually helpful? So for me, and in my personal journey of HAES, I have found a really great active community here in Raleigh, that I'm a part of. And one of my personal movement goals is to, at some point, I don't know when, I would love to be able to do a pull-up.

Meredith Nisbet:
So that's something that I'm working on being able to do, I'm doing a lot of strengthening and just working on flexibility. And as I'm thinking about this, I'm thinking no wonder the idea of a pull-up sounds so intriguing to me, or like such a great goal for me. If I take it back to childhood, and I think about like, I love swinging on tree ranges and climbing trees. That's kind of the adult version of that movement for me, I guess. But taking it back to basics and thinking about what did you enjoy as a kid that you didn't really think was movement? That you didn't think was exercise? What was your exercise before you had ever heard of the concept of exercise?

Meredith Nisbet:
Also thinking about what would you like your body to be able to do, rather than how would you like your body to look, is a good question. And also just trying new things. Sometimes this of joyful movement is like, what is that? What exercise, or not necessarily exercise, but what movement opportunities are available to me? Is reframing this concept that like taking a walk with your partner is also exercise. But it's when we think of it as joyful movement, that feels so much better than having to meet, like you said, the rigorous standards of what exercise is. I have to wear certain clothes. I have to do it for a certain duration. I have to exert myself this much. I have to sweat, those kinds of things.

Meredith Nisbet:
When we take those connotations out of the picture and we just focus on, what do I enjoy? What makes me feel good? I have friend who loves to longboard on a long skateboard. And that's been one of her favorite, joyful move activities. Other people really love Zumba. Just finding things that are fun that you actually want to do and have different goals, rather than just a very structured strict, you must do this because someone else says so, kind of thing, where we really bring it back into those internal cues.

Ellie Pike:
So, Meredith, I could talk to you for days, but I want to move into a lightning round of questions, because there's a lot of skepticism around Health at Every Size. And it's because it feels very counter-cultural and it's not typically what is talked about writ large. So I have some questions that you and I have brainstormed ahead of time. And these are, my previous students, when I used to teach a college class, or maybe a family member that I've heard asked the question, or maybe a client along the way. So I'm just going to ask you a couple of these questions and see how you can support the answers, because I know that our listeners are asking similar questions. One person, I remember this was a student, they asked, so you're saying that weight loss should never be the goal. Why not?

Meredith Nisbet:
Yeah. That's a great question. And arguably, maybe the most common question that I get when I talk about HAES. I think it's important to ask what the real goal is here. So even when weight loss has presented as the goal, I think that we can translate that into a different goal. So for example, if your doctor is recommending that you lose weight, some doctors may be focused on the number, but I would like to believe that our medical providers have our best interests in mind, even when they are operating in a frame of bias, right? And so being able to think about, "Okay, does this doctor believe that weight loss is going to solve the problem that I'm having?"

Meredith Nisbet:
So if my doctor believes that weight loss is going to solve the cold that I came in with, probably not. If my doctor is concerned that I'm having high blood pressure and thinks that losing weight will lower my blood pressure, I have another goal that I can translate that into. So I can say, "Okay, what are alternative ways that I can lower my blood pressure? I can control my stress better. I can be a little bit more active or find that joyful movement. I can do some meditation to, again, control, stress level." All of these things that we know do actually impact this one particular ailment, high blood pressure. The reason that weight loss should never be the goal is because we have tons of studies showing how the body responds to weight loss in the longterm.

Ellie Pike:
To kind of put a different spin on it. I actually, we had this conversation recently with someone and they're in recovery from anorexia, and they said something very unique that I think is helpful to address. So they said, "I have lots of internal biases about weight. For example, when I had anorexia, I was required to gain weight. So I'm still struggling with the idea that someone in a larger body wouldn't have the same goals of losing weight as they recover from binge eating disorder." Can you speak to that?

Meredith Nisbet:
Yeah, this is, I think, such a common thing, and I am so appreciative of this person doing this work and untangling those ideas, because it is challenging. And I think that speaks to how challenging it can be and how important it is to ask those questions and to be curious about those things. So I think the first thing that I want to address is that someone in a larger body isn't necessarily in recovery or striving for recovery, or even has a diagnosis of binge eating disorder. So it's really important to acknowledge that eating disorders impact folks of all shapes and sizes across all diagnoses. It's a really common misconception that you have a diagnosis of anorexia that you have to be very, very malnourished, have to be hospitalized and that you're not sick enough if you're not very, very ill, and in the hospital.

Meredith Nisbet:
Folks in larger bodies actually are underdiagnosed with restrictive eating disorders, because providers don't screen them. They assume that, A, they assume they don't have an eating disorder, but, B, if they do think they have an eating disorder, they assume it's binge eating disorder. And that's actually not accurate either. So thinking about how can we zoom out, and just be more curious about what folks are experiencing.

Meredith Nisbet:
But going back to what this question is actually asking, which is, I was required to gain weight in recovery. Why is someone else not being required to lose weight in recovery if they're in a larger body? And it really goes back to the root of, this is not about weight, even though on the surface, especially for someone with a restrictive eating disorder being required to gain weight in treatment, on the surface, it does look like it's about weight, and it's only about weight, right? All of your providers may be saying like, "Hey, we really need you to weight restore. We really need you to make sure you're completing your meal plan." All of these things. But at the root of the treatment plan, the goal is not just for someone to gain weight. The goal is for someone to become medically stable, and to gain the ability to engage in therapy. So those are two of the main goals of eating disorder treatment, help someone become medically stable, help them cease behaviors that are maladaptive and, or not working for them. And how can we help them engage better in therapy?

Meredith Nisbet:
And so those three things are true regardless of someone's body size, regardless of someone's diagnosis. And so for someone who is very malnourished, which malnourishment can occur in all body sizes, not just small body sizes, for someone who's malnourished, part of becoming medically stable is weight restoration, where for someone who is in a larger body, doesn't have a restrictive eating disorder, maybe is someone in a larger body struggling with bulemia or with binge eating disorder, or a non-restrictive necessarily eating disorder. That person isn't being required to gain weight or lose weight to become medically stable, because that's not what's making them medically unstable.

Meredith Nisbet:
So for someone who is struggling with bulemia and they're purging, purging is the medical concern there. And so there's nothing to do with weight gain or loss necessarily there for stability, it's about cessation of the purging behavior. So it's really looking at individualized, what does this person need to become medically stable, and to be able to engage in therapy.

Ellie Pike:
In the concept of Health at Every Size, we're really moving away from using the word obese and making the word fat really acceptable. And so there's a lot to this, but in simple terms, here's what someone says. So they say, "Isn't fat, a bad word. It has negative connotations in society. So I struggle with using it, even though I know that using it in a neutral and positive way would help de-stigmatize being large or being in a large body." So why use the word fat and what do you do when... This is like a scary word for a lot of people to use.

Meredith Nisbet:
In the broad sense, obese or obesity are not, and you'll hear a lot of folks refer to that as the O word. Those are words and terms that were not coined by the fat community, those are terms that were developed by the medical community. And they're rooted in BMI, because we know that BMI is inherently problematic. It was never intended to be a medical measure of health. That is part of the issue. The second part of the issue is that when that word is being weaponized against communities, so when obese or obesity are being used, as they often are, to dehumanize or pathologize body size, rather than looking solely at health, that's a big issue that the fat community takes with those words. And so I think the fat community has really embraced the word fat as a neutral descriptor. So just like we would say, this person is tall, they're short, they're old, they're young, they have brown hair, they have blonde hair, that we're adopting fat as a descriptor just like that. And kind of reclaiming that and de weaponizing that word.

Meredith Nisbet:
Fat may be something that's triggering for you. And it's perfectly okay to feel that way and to not prefer that word. I think it's a very individual choice. And so when I talk with providers about how to address this with clients or with patients, I always tell them like, here's general information about why the community at large has reclaimed or adopted this word, but also ask your clients, ask the people that you're interacting with on a daily basis, listen to the way they self identify or the way that they describe themselves. And if they don't, if you don't hear that, just ask. I think it's similar to pronouns and that the more that we normalize that the better it will be for everyone.

Ellie Pike:
Absolutely. And so last question, and then I know we need to wrap up. So the last question I have is someone that says, "I've never thought so much about the social justice effect of stigmatizing fat bodies. How can I help?" And I love this question because there is a large component of this that really is about social justice and it is a social justice movement. So how can people help and be part of the positive change?

Meredith Nisbet:
Yes, absolutely. I get so excited when people even just start to consider other perspectives, even if you have listened to this podcast and you're like, "This makes no sense. There's no point in thinking anymore about this." I would encourage you to just be curious, do some reading if this is intriguing to you, but you're not sure, you're not sold on it. Questions to ask when you're thinking about Health at Every Size and wanting to get involved with a social justice aspect are, what assumptions do I make about a person's character, intelligence, professionalism, health status, or lifestyle behaviors that is based only on weight? What are common stereotypes about people in larger bodies that I believe to be true? And why do I believe those to be true? What are my views about the causes of higher weight? How does this impact my attitudes about size diversity? How do these biases impact the care I provide to all patients? And for folks who aren't providers listening, how do these biases impact the way that I interact with all people in the world?

Meredith Nisbet:
Another thing that folks can do to get involved is to join your local, I believe they have local chapters of ASDAH, which is A-S-D-A-H, the Association for Size Diversity and Health. You can also get involved in your local eating disorder community. A lot of them have HAES ties, not all of them, but a lot of them do. And I would encourage you to really just jump into the online community. There are tons of Instagram pages and hashtags for Health at Every Size. There are tons of great books to read, also some great podcasts on Health at Every Size nutrition. The one that comes to mind right now is called Maintenance Phase. The Instagram page, yrfatfriend, which is yrfatfriend, is a really great resource. There's tons of information on the internet. And so really just kind of seeking out the information on things that you're curious about is a great way to get involved.

Meredith Nisbet:
And then finally having conversations with folks in your personal life, if you have fat people in your life that you love, as many of us do, showing up and supporting them and not putting your bias onto them.

Ellie Pike:
Meredith, thank you so much for providing those practical tools of how we can just learn more and take the next step to understanding our own biases, and then getting involved in creating change. You are so well-spoken and so informative. So thank you so much for bringing your voice onto the podcast. And we hope to hear from me soon.

Meredith Nisbet:
Yeah. Thanks for having me.

Ellie Pike:
Awesome. Thanks, Meredith. (singing). Wow. We covered a lot in today's interview. I feel incredibly grateful to Meredith for condensing so much knowledge and research into a short podcast. Obviously you may be left with questions. You may even want to argue some of her points, and that's okay. This is just a starting point. And I really encourage you to check out the resources she talked about. We have links to the HAES website, some popular body positive social media accounts and a searchable list of HAES aligned health care providers. So check that out in our show notes.

Ellie Pike:
Mental Note Podcast is a creation of Eating Recovery Center and Pathlight Mood & Anxiety Center. If you'd like to talk to a trained therapist to see if treatment is right for you, please call them at (877) 850-7199. If you like our show, sign up for our e-newsletter and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes, it helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, and directed by Sam Pike, with the editing help on today's episode from Ian Kelsall. Till next time. (singing)

Meredith Nisbet, MS, LMFT is a Licensed Marriage and Family Therapist and member of the Clinical Response Team with Eating Recovery Center and Pathlight Behavioral Health, where she enjoys engaging with patients, families, and providers seeking admission nationwide. In addition to her work for ERC and Pathlight and in her private practice, Meredith also provides education and training on weight stigma and Health At Every Size-informed care around the country. Meredith earned her bachelor’s degree from the University of North Carolina at Chapel Hill and her master’s degree in Marriage and Family Therapy from East Carolina University; she is currently pursuing accreditation as a Certified Eating Disorder Specialist through IAEDP. Meredith resides in Raleigh, North Carolina where she spends her free time listening to true crime podcasts, practicing hot yoga, and snuggling with her dog, Mac.

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