This interview was conducted by author & social commentator Melinda Tankard Reist and was first published on her blog on 15 June 2010.
BodyMatters: a health-based, not weight-based approach to eating and wellness.
One of the privileges of the cause I’m engaged in is that I get to work with some of the best women in the world. Women who are passionate, bright, engaging, outspoken and fun to be with.
Sarah and Lydia are young psychologists specialising in eating disorder treatment and prevention. While ‘picking up the pieces’ at the clinical end, they came to feel that more needed to be done to address the culturally based harms being caused to the women and girls they were treating: that what was required was a radical overturning of the negative messages directed at women. That’s why they came on board. Sarah and Lydia have been a gift to our growing movement with their evidence-based, compassionate and holistic approach. They have since launched BodyMatters Australasia, an idea whose times has well and truly come.
I thought you might like to get to know them more, so here’s my recent interview with them.
Sarah and Lydia, why did you decide to launch BodyMatters Australasia? What will BodyMatters do?
We have had the misfortune of being touched personally by clinical eating disorders and through this experience became aware of the chronic insufficiency of service and support in the Australasian region for sufferers, their family members and friends. Both of us had decided to undertake education to qualify ourselves to “make a difference” in this area. By chance we met at a conference about five years ago, and within no time began spending many days conjuring up ideas about the things we strongly believed needed to be done to eradicate the problem. Together we now have over 10 years of combined study and clinical experience within the field of disordered eating. Our qualifications extend across the disciplines of psychology, nutrition, gender studies, sexual health and public health.
Studying eating disorders made us aware of how much our culture normalizes- and actively encourages- problematic eating behaviours. We realised early on that the behaviours prescribed as solutions to those labeled ‘obese,’ were often the same behaviours we as practitioners were diagnosing in those with clinical eating disorders. It seemed rather unhelpful to view ourselves as existing in the midst of an ‘obesity epidemic;’ instead, we found it more accurate to describe what we are really experiencing as an epidemic of disordered eating. Disordered eating includes those with clinical eating disorders such as anorexia and bulimia, those who sit far above their natural body weight due to unhealthy eating practices, and also those who exist in between those extremes who experience various degrees of body shame and unhealthy weight loss practices which significantly compromises their health and wellbeing.
At the moment, estimates of disordered eating within the Australasian community are unknown. When we look at estimates suggesting that over 3 million Australians are currently ‘obese,’ we have to keep in mind that not all people who are ‘obese’ are that way because of problematic eating patterns and poor lifestyle choices. There are multiple pathways into ‘obesity,’ for example, some patients who experience bipolar disorder may find their medication leads to significant increase in weight gain. It can be very difficult for them, having to choose between sanity and fatness, largely due to social stigma and size discrimination. So statistics reflecting rates of ‘obesity’ do not accurately reflect rates of disordered eating and poor lifestyle choices. ‘Obesity’ involves a complex interaction often including the role of genetics, epigenetics, social, psychological, physiological, and environmental factors. When we look at clinical eating disorders, it is clear that a high incidence exists, with one study identifying anorexia nervosa as the third most common disease in females in Australia. Despite compelling statistics highlighting the extent of clinical eating disorders, their incidence is under reported.
The relationship between obesity and clinical eating disorders remains complex as the risk factors for clinical eating disorders include elevated body mass and dieting, rendering those who are obese or overweight at significant risk of developing clinical eating disorders if they diet for weight loss. Other research has identified overlapping risk factors for both obesity and clinical eating disorders- such as dieting, media use, body image dissatisfaction and weight-related teasing. Similarly, many people who experience obesity engage in disordered eating of sorts. Ultimately this suggests a strong, complex relationship between obesity and clinical eating disorders. Yet despite attempts to address these problems from a public health perspective, both obesity and clinical eating disorders continue to escalate.
We formed BodyMatters Australasia in recognition of the paucity of services that exist to address our current epidemic of disordered eating. At BodyMatters we provide a range of prevention and treatment services that fully integrate the spectrum of disordered eating behaviours that includes clinical eating disorders, unhealthy weight loss practices, ‘obesity,’ and body shame. Our services include counselling and treatment, education and training, advocacy and prevention, as well as consultancy. We are proud to say that soon we will be rolling out the world’s first successful long-term eating disorders prevention programme, which has been shown to reduce multiple risk factors in the development of eating disorders in teenagers, even after two years! We also operate within a health based paradigm – as opposed to a weight based paradigm – which for many people experiencing disordered eating and body shame often comes as a relief. Our approach is supported by an emerging body of research and we are particularly excited about what we are offering, given that there is currently no other clinic like BodyMatters within the Australasian region.
Ultimately our aim is to move into advocacy. Soon we hope to launch a non-profit advocacy group called BodyUnion, which will be funded in part, by BodyMatters Australasia.
In your years of clinical practice, what have you observed is having the most negative impact on young women in particular? Are these things getting worse?
Without a doubt, the bombardment of a thin ideal across a whole variety of mediums, which completely normalises what, for most, is not healthy. Of course this promotes dieting, which is the biggest risk factor for the development of disordered eating. This is further exacerbated by our fat phobic culture and scaremongering surrounding our current “obesity epidemic”, which links fatness to moral weakness such as laziness, slothfulness and greed.
We believe that when a culture actively promotes and normalises body hatred, we can expect an epidemic of disordered eating. How can people nourish and nurture their bodies in such a hostile environment? Upholding thinness as the only way to be healthy and beautiful is incredibly damaging to young women – we need to start recognising that body diversity is an issue of human rights and a range of body sizes normal within any given population. From the research it seems that women who are happiest with the way they look are more likely to commit to exercise and health-giving behaviours over time.
It is a common myth that if we shame people about their bodies (particularly about being ‘fat’), it will motivate them to adopt a healthy lifestyle. In fact the research just does not support this. What we do know is that body dissatisfaction is a significant predictor of sedentary behaviour and long term weight gain. When people are shamed about the size of their bodies, they are less likely to commit to exercise, often because they don’t want to be seen in public. Stigma and discrimination are some of the biggest predictors of mental and physical health problems, and the application of these to size is no exception.
You’ve been scathing of the current approach to ‘weight loss’ (including on my blog). Why have you taken such a hard line?
Weight loss is a multi-billion dollar industry. Currently there is much money invested in promoting a ‘thin-at-all-costs’ approach to health. About 95% of research in the field of obesity is funded by private industry – including pharmaceutical giants that stand to profit from convenient research findings. That’s a massive conflict of interest! We recently attended the inaugural Obesity Summit in Sydney where professor after professor declared ‘conflicts of interest’ with weight loss corporations before presenting their research. One prominent professor confessed that he sat on the board of Reductil, Australia’s most popular weight loss drug, so it was no surprise that his findings supported a lifetime’s prescription of diet pills to maintain weight loss!
Corporations that stand to profit from weight loss and the promotion of a thin ideal are not only funding research, but entire university departments. Take for example The Centre for Obesity Research and Education (CORE), a department of Monash University. It is funded by Allergan, Australia’s largest manufacturer of gastric banding products. Allergan also manufactures botox and implants. How unsurprising, then, that a recent research study put out by CORE found that 14 year old girls are suitable candidates for gastric banding. It seems that gastric banding is increasingly becoming a cosmetic procedure –whilst its efficacy levels are still dubious over the long term and its (often permanent) consequences minimised. CORE does not even adhere to the recommended guidelines for bariatric surgery, operating on bodies that sit far below the recommended cut-off of BMI starting levels for bariatric surgery.
It seems that there is a vested interest in promoting conflicting, confusing, and ineffective weight loss approaches to health. If you can convince people that their bodies are ‘ticking time bombs,’ abnormal, repulsive, and then sell them weight loss solutions that don’t work, you’ll be laughing your way to the bank. Many weight loss companies deliberately adopt the line “we’re not a diet” when in fact they are, and it’s clear that diets don’t work. Yet what most people are unaware of is that adopting healthy eating behaviours and healthy lifestyle approaches don’t necessarily lead to thinness or weight loss either. It is increasingly recognised that non surgical weight loss approaches carry a 98% failure rate after 2-5 years. Anyone can lose weight, but what happens after the after photo? This statistic was recognised at both The Australian New Zealand Obesity Society Conference (2009) and the inaugural Obesity Summit (2010). Surgical interventions have shown somewhat longer term weight loss sustainability but with numerous health complications – many of which are permanent. It seems that Australians today are putting in the efforts to lose weight, but the weight loss solutions are not working – and many are actually causing harm.
The problem with dieting is that it actually puts people at significant risk of weight cycling, binge-eating, and future weight gain. Weight cycling itself has been demonstrated to be significantly more harmful than maintaining a higher but steady weight. The answer to our epidemic of disordered eating requires us to encourage health-giving behaviours, rather than focus on weight. The health-based paradigm establishes health as an ongoing, multidimensional process that involves psychological, physical, intellectual, spiritual, and social aspects. Health requires us to look beyond the number on the scale. Many people have relied on Body Mass Index (BMI) to inform them as to whether or not they are healthy, but in fact the research is clear that BMI is not an accurate indicator or measure of health.
I wonder why taking a health-based rather than weight-based approach to eating and wellbeing is considered progressive? Isn’t it obvious that this would be the best approach?
You would think so! However because so much research into eating and wellbeing is compromised or biased due to funding and researchers being tied to the weight loss and pharmaceutical industries in some way, most Australians have never heard of a non weight-based approach to health. There is a significant conflict of interest in ‘obesity research.’ Some would go so far as to call the field ‘Obesity Inc.’ This is further exacerbated by research into a health-based paradigm being limited – perhaps due to academic prejudice, politics, and difficulty in obtaining research grants for independent research -resulting in limited representation of the health-based paradigm in peer reviewed journals and ultimately positioning it as an approach to be overlooked. And of course we cannot overlook the billions of dollars per year- in the diet industry, beauty industry, and even medical industry- put into maintaining a weight-based approach to eating and well being.
Are you hopeful you can replace the entrenched ‘thin ideal’ for acceptance of the fact that you can be healthy regardless of size?
It is important to recognize that the research does show that health becomes compromised at statistical extremes. People who are at the statistically extreme ends of thinness or fatness are likely to be unhealthy, regardless of the reasons that led their bodies to exist in that condition. If one’s body size is at such an extreme state that they are unable to participate in health-giving behaviours, such as going for a walk, then they are likely to experience health problems. However, having said that, the range of body sizes and weights that people can exist at and still be healthy is incredibly diverse – and not restricted to current notions of BMI.
The size- diversity movement in other parts of the world (such as the USA and the UK) has started to make progress in terms of challenging the “thin ideal.” This means challenging the idea that ‘thinness’ is the only way to be beautiful and the ultimate indication of health. This is very promising. However the Australiasian community poses some unique challenges. Firstly, there currently is no organised size diversity movement in Australia- which is one thing we hope to coordinate ourselves. There is no doubt this will be a huge undertaking with our fat phobic culture! Furthermore, the thin ideal in Asia is particularly concerning and public health interventions that are mandated by the government very much attempt to prescribe an “anorexic mindset” in the population, by attaching shame to fatness and dictating a very rigid relationship with food and exercise. Despite these challenges we are hopeful that with education and understanding, as well as a bit of coordination, there will be increased community understanding that you can indeed be healthy at your natural body weight- whatever that might be.