Episode 131 - Eating and Body Positivity

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[Music] hi everyone this is hilary mcbride i'm so excited to share with you this episode of the liturgist podcast where michael and i talked to evelyn tripple a registered dietitian and one of the creators of intuitive eating the original anti-diet approach to changing and healing our relationship with food and the way we eat before we get to the episode there are a few things i wanted to share with you this episode was recorded a little while ago so you don't hear us talking about the current events we are all experiencing in one way or the other that's important to note because the way we eat what we're eating and why have all been changing because of the global impacts of the coronavirus whether we know it or not why how and what we eat is impacted by the following things the systems within which we live our lives our jobs our abilities to access or afford food that is healthy and enjoyable our relationships and the ability to see our loved ones or even shake hands with a stranger and of course our levels of distress and the emotional reactions we're having to everything going on around us yeah i know that's true for me i think my diet i've noticed has changed during this quarantine a lot and for a lot of my life i probably would have felt some sort of should or sense of guilt that i'm not eating better right now and i probably would have actually thought that sense of guilt or shame would have helped things like if i just really felt bad and i could make healthier choices but this conversation that you're about to hear really shifted some stuff for me and really challenged me and really helped me and i'm really glad that we had it before this quarantine and that's actually one of the reasons i wanted to air this episode even though a lot of our episodes right now that are in the can uh we're waiting on because it's just totally different world now uh with covet and all of us locked up in our houses and but this particular conversation was really helpful for me and i think it will be for a lot of you as well and hopefully give us a little bit of grace for ourselves and an ability to shed some shame and some shoulds during a time that's already difficult enough without extra pressure and extra guilt lay on top of it so i hope you'll enjoy today's show it's a good one welcome to the liturgist podcast everybody our world is built with stories sometimes these stories cause suffering by pulling us apart from ourselves and each other the liturgist podcast helps people love more and suffer less by pulling apart the stories that pull us apart okay so evelyn we're having you on this podcast today because you are known around the world for your work in the intuitive eating movement and so i'm curious if you could just give us a little introduction to you and to intuitive eating yeah and as i do that introduction i want to make sure i include elise rush my co-author we're the ones that co-created this whole model over 25 years ago and to see it actually evolving into a movement you have no idea how this makes me feel so i can say to you 25 years ago it was research inspired based on the trouble we were having and how we were feeling as practitioners uh having people seeking out weight loss quote in a healthy way here these are they're smart they're successful people and they're feeling really bad about what they did what they would do with their eating and then blame themselves and we thought we're part of the problem so we went into the research to see what is a better way that we can do this we also looked at what was going on just in the everyday world hirschmann and munter had a book called overcoming overeating anyways they put this all together and created this model so it's research inspired but the cool thing that ended up happening is tracy tulka at ohio state university ended up loving the book and said hey can we measure this and who cares if you're an intuitive eater does it matter and the answer was uh hell yeah but with a lot of science and statistics that uh intuitive eaters um have better body appreciation they eat a higher variety of foods it's more protective against eating disorders they have more connection with their body and it goes on and on and on and now fast forward here we are and there's over 125 studies based on our work really showing some benefit and a study that just came out was a eight year follow-up study that showed that uh they was a famous study actually that followed adolescence from the age of 11 to 21 so it was a 10 year prospective study and what they found out is those who scored high on intuitive eating eight years later it was protective against binge eating eating disorders and other kinds of things so very encouraging stuff and i see so much suffering around this and i'm out to help end that suffering and that people can end up doing the things that are meaningful to them that makes them thrive not worrying about their identity around their eating or what their body looks like and that's might sound simple but that's a really hard thing in today's culture can you tell us for the listeners who don't know some of the principles of intuitive eating they might have heard that word thrown around a little bit but not really actually even know what that means yeah so let's let yeah let's back it up a little bit so on on a real simple level it really means that you're the boss of you only you can be the expert of your own experience your own body only you know your thoughts your feelings and your experiences and there's ten principles and on a scientific basis they're based around interceptive awareness and that is our ability to perceive physical sensations that arise within the body and that might sound boring because you're talking about having a full bladder or feeling your heart race but the thing i am so intrigued by is that every emotion has a physical sensation absolutely yeah so when you're connected to the messages of your body the our body language is physical sensation we have a powerful treasure trove to get our our needs met and so these principles work by either helping with that connection that attunement to what the messages are or the principles work by removing the obstacles the disruptors and that that comes from the mind in terms of beliefs and values and so on so that's a more broad way of looking at it and it's so funny i don't have the principles memorized because i use them differently with therapy yes when you write a book of course you need to have an order and i can certainly tell you what they all are but the one that might even matter the most right now in today's culture is to reject the diet mentality and i'll tell you it is so sneaky and it's for this reason we've just updated the book the fourth edition is coming out in june of this year 2020 and diet culture has become so sneaky you know before before i had patients coming in and saying that they knew they were on this diet or this diet and now i have a lot of patients that don't relate to the term dieting oh i don't do dieting i do a keto lifestyle or i do whole 30 and those are forms of dieting or a better way of saying it's a form of disconnecting you from your body so when you say sneaky you mean it's kind of subtle and insidious and we're getting tricked into dieting by thinking that we're being healthy or taking responsibility for our bodies but we're actually just disconnecting from ourselves i think you hit it when you said uh thinking that we're healthy because what's happening we have to look at the fact that the there is a dieting industry you know and they've gotten very smart in fact there was a great op-ed piece in the new york times talking about how dieting and diet culture and wellness culture is like a virus that keeps morphing and growing with the culture and so now instead of saying here here's a diet program they'll call it a lifestyle and so some people really think they're doing something to help their body when it turns out they're increasing the risk of disconnection they're increasing the risk of eating disorders and all kinds of problematic behaviors and one thing i think that really really reinforces that is a new study just came out looking at the incidence of eating disorders and it has doubled in the last 20 years and i'm just shocked that there is no public policy outcry like what the hell is going on this has doubled if we were looking at any other health indicator people would be up in arms about this and this was a really good systematic review of 90 different studies looking at the incidents and i my perception or perspective is that because dieting and diet cultures become so normalized it's easier to hide within plain sight your eating disorder behavior appears normalized in today's culture i think it allows it to thrive sadly you know normalized and rewarded right there's i know that you know this about the moralization of food and dieting and even the fat phobia that comes in that is a part of that right when we shame fatness when we shame size different sizes there is a kind of a goodness that is supposed about people who have more tendency towards restriction or dieting or air quotes health healthy eating yeah and that's so problematic and there was a book that came out last year that really blew me away written by the academic sabrina strings and it's called fearing the black body the racial roots of fat phobia and she went line by line in history looking at media and all kinds of things since the 1600s and you can see it's a byproduct of racism and patriarchy and and just to see it line by line it was like holy moly this happened before healthcare culture got involved with all of this you know yeah yeah i bet that makes it really confusing for some people who feel like they're taking responsibility for their health and maybe there was a history of unhealthy behaviors around food or unhealthy kind of emotion regulation strategies in the home to feel like there is maybe they don't even call it dieting but there's dieting feels like a kind of empowerment and yeah they might not realize that there is a bunch of political roots to this movement that has made us fear bigger bodies yeah and that's so and that's so well said that we have to really look at the root of weight stigma and and fat phobia and you know something that happens i find really interesting when i talk about intuitive eating and when i talk about how diets really don't work that the most predictive thing for weight gain is to go on a diet there's actually a body of research and then people say to me but oh my god what about my health right and there's so much more to health than eating eating is a piece of it but it's a small piece to be honest and it's it just blows my mind because what we're talking about right now is a belief system that no matter how often i talk about these facts and the body of research i still get the question but what about my health and we can certainly get engaged in healthy sustainable behaviors that feel good and that also includes having meaningful relationships and these kinds of things and we have a big job to do right yeah so i'm hearing you say that health needs to be defined more broadly than just the quality of food that you put in your body absolutely even size or or weight yeah in fact i just read this fascinating op-ed piece in the journal of american medical association by a medical statistician at a stanford university and he said you know when he starts really taking a look at just the nutrition research when you think that there's over at least over 200 000 plants that exist that are edible and over 200 000 foods there's no way any combination of research has got that right to say there's one superpower food or that there's one food that's going to kill you and so that that's where we're at in today's culture we're in this place of this neurosis that this one bite of food's going to either kill me or cure me and we have lost the joy and the pleasure of eating and i want to bring that back right yes yeah why does the pleasure of eating matter do you think well first of all we're wired for that it's it's part of our it's part of our survival but i think if we go deeper and use a psychologist i mean i hope you would pretty much agree with this is that yes eating is a part of our our connection as well when we take a look at cultural uh uh rights of passage like marriage or how about just a birthday every year we celebrate that with food and so these are the things that have gotten lost and this is something that we've added into our book that's coming out you know back during world war ii that was when they first funded the food and nutrition board where they created all the scientists in terms of how do we feed these soldiers to fight in the army and what they also did was not well as well known is they also created a board that worked with them in tandem i forget the name of it like the human behavior board it was headed by margaret mead it was this whole idea that we're going to have food shortages and we need to change behavior and we need to consider the the sociology and the psychology of eating which is awesome but when the war ended they kept the food and nutrition board and they let go of margaret mead's uh council and that to me is is one of the beginnings of this problem that we have with nutritionism and healthism and that is when you look at just nutrients by themselves and little numbers and those kinds of things it doesn't tell the whole picture yeah we're missing the rest of it the complexity of life right the richness the relationality the emotion that comes with it one of the things that i often have people ask me in my practice when we're talking about changing relationship to food away from a diet mentality and a restriction mentality is this concern that if i'm not if i'm not preoccupied with health that somehow my size is going to get out of control and it seems that there are these these really kind of strange beliefs that we hold around eating that keep us stuck in rigidity or keep us afraid of the pleasure of food i'm wondering if you could talk about that a little bit oh that can go really deep but let's let's let's affirm and normalize this belief as not strange because i hear this coming from my patients being repeated from their physicians it's in our health care system now that drives me oh my gosh it was hard to recover before with an eating disorder from dieting but now when you have your doctors telling you to do keto or go do you know weight watchers that's a problem and so what i actually do in these situations i'll say you know it's understandable that you have that belief we have all of these forces that are here but like you were saying earlier we need to start deconstructing these belief systems and these value systems and partly also what you're kind of describing is that that really bothers me is the fear-mongering that's out there you know and it's this fear if i don't do it perfectly uh something bad is gonna happen or oh my gosh the food manufacturers are putting all these things to make us so-called addicted to food that's a whole other topic that really gets me going and you know when you think about it as i don't know if you like to cook yourself or if you go to restaurants but when you're putting together a meal and a chef's putting together a meal you want to have it to be the tastiest that there's nothing you know demonic you know about that so and and then if you go back to our puritanical roots god forbid we have pleasure right you know but one of the things i sometimes will start i mean many times they'll start patients with this idea of aiming for satisfaction in your eating that's i think the fifth principle of intuitive eating and that's a pleasure-based principle and it's also incredibly personal like well what would satisfaction feel like to you you know what would it taste like what it would feel like and how do you want to feel when you finish and i've had many patients describe a fear that if it tastes good i'm afraid i'm not going to stop and then i'll say quite often that that is a consequence of deprivation when someone hasn't been able to eat their favorite food and they suddenly can eat that chocolate or cheesecake it becomes the last separate eating it's like oh my god i get to eat this i never know when i'm gonna have it again and so it's like i gotta get it all now while i can we see this phenomenon all the time you know yes yeah absolutely um so i have all sorts of questions that i'm probably going to circle back to at some point but i'm wondering about this this question that we are orienting our podcast around which is this why of eating and perhaps perhaps really scaling back and being reflective about how we engage with food and our relationship with fooding and eating itself and i'm curious if you have from your perspective from your research and your clinical work some insights into some of the areas where we get stuck with this and some of the things that maybe we need to know about our relationship to eating and food that would help us be healthier overall yeah and i think when we say health we have to remember it includes more than just eating it includes ours yes you know this our mental health and i think sometimes just actually let me let me just backtrack and i'm gonna i swear i'm gonna answer your question but there was this great study by paul rozen he's a psychologist i believe out of minnesota food psychologist and he did this cool study looking at four countries he looked at the united states he looked at france he looked at belgium and japan looking at the attitudes and belief systems around eating and health and what he found is that the americans worried the most about their eating and they enjoyed it the least and the french were the opposite they like revered their food less worried about their health and japan and belgium were somewhere in between and the point he made so many years ago was like 1999 is that we put so much efforts in our our policies about foods that are going to help heal us or create disease we haven't looked around the stress and the anxiety that this might be causing and this is before all the research came out on cortisol and stress and all these kinds of things i think he was really ahead of his time with that you know so that becomes an issue i think the issue i see a lot right now in my patients is this identity that i'm the good person i'm i'm the healthy one you know they why my question is why why do you need that identity to kind of elevate yourself what's missing in your life that that's what's important uh for everyone else to know that's all around you and every time you eat you know right yeah yeah and then unpacking that from there you know uh-huh yeah so the other side of this is that there might be some people who think okay instead of moralizing myself around food and feeling like i'm a superior or better person maybe more pure more clean in some way because of my eating the other people who will say things like well i why even think about it or i don't even think about it and so i'm curious about this middle road and maybe middle road isn't the best way of saying it but what is what is a maybe like a whole person healthy and i guess your language would be an intuitive eating process look like in the middle where we're not fear-based and kind of obsessive and moralizing food but also not mindless and not forgetting to be thoughtful about how we feed ourselves and what it's like to be us what feels good what's satisfying and when we've had enough yeah so basically i think what you're talking about that middle road if you will is being connected to your body to a point in terms of huh what might i need right now how do in fact here's a question i love asking people how do you feel right now and i give one or three ways to answer pleasant unpleasant or neutral so how do you feel right now pleasant unpleasant or neutral and first of all there's no wrong answer to that question second of all i consider it a universal attunement question and it's based around buddhist psychology that our mind naturally organizes a uh we label things like don't like uh just well i said don't like or neutral or indifferent about it so but if you ask that question about yourself how do i feel right now pleasant unpleasant or neutral you're connecting it's an easy question to ask and it's a question if the answer is unpleasant it's like huh what might i need right now so notice i'm not even asking you are you hungry can you rate it i'm not asking what your mood is or what you're feeling can you rate that too it's just very general and so when you realize you're feeling kind of unpleasant and that oh there might be a solution to this might i might i be hungry for example maybe i need to sit down to eat maybe maybe maybe i just need to take a break maybe i need a nap and so it's about getting curious and i find that really really kind of fun and it sounds like if i'm making some assumptions here that when you're getting curious then you're also getting information that could help you make more decisions oh my gosh yes or eating or satisfaction absolutely yeah yeah [Music] i was raised in a way that made me when i was trying to manage behavior i think a lot of us were where your body is crying out for something and the answer that we were taught is like ignore that follow the what you know to be good and true so whether that's the diet or whether that's abstaining from sex or whatever the thing is it's like make your good decision ignore the flesh or ignore the and it's an interesting flip that feels scary if that's the kind of world that you came from good point to like to go no actually listen more closely to your body because at first it feels scary like well what my body wants to do is have sex with everyone and eat all the cake and eat everything inside in the but that's just at first glance when you actually get into really listen like really pay attention yeah do you really want the whole cake like at that point after the fifth piece are you really you're listening to your body really carefully and it's still going yes i really do need more and then if the body's saying yes you know let's say after a whole cake then my question might be it's like well how do you actually really feel right now in this moment yeah and are you having any fear you're never going to have that cake again that today is just some kind of weird day out of normal uh and therefore you're disconnected actually paradoxically because there's a phenomenon that happens i call it the paradox effect of permission and that is when you know you have access to food and you can have that cake again then for a lot of people for the first time they really get to ask huh do i really want this cake if i eat it now am i going to enjoy it because you know it's going to be there later so why eat it now and why why eat it in a way that doesn't feel good if you know you're going to have it later but then there's also this phenomenon that happens with with dieting and food restriction and that is our our mind and our body is so smart and it's wired for survival so we start thinking about food and also when emotions start to arise we start thinking about food in terms of comforting there's been a lot of research on this it doesn't make you an emotional eater your body's looking for opportunity to eat so what's interesting to me if you were to go swimming in the in the ocean out here in the pacific and a big set of waves come you dive down you go deep hold your hold your breath you come back up for air and when you take that first gasp of air that panicky breath no one calls it binge breathing no one calls it oh my god you're addicted to air oh my god you have loss of control breathing everyone knows that's a natural you know inhale for life and the same thing happens with eating actually but we label it as oh my god i'm a binge eater i'm addicted to foods like no dude you your body is surviving your cells are so so smart it's scary it feels very urgent because on a cellular level your your cells think dude's trying to kill me you know and then that scares people and they say oh i've got to do something i got to take care of this i need more rules and they get they double down and they get even stricter and then the fear happens in the mind see i can't have that cake i can't have that pie because the last time i did it i was out of control i was like no you weren't out of control it was that natural compensation and so one of the things we want to do when someone is moving into this recovery space is let's create the optimal condition so it doesn't have to feel so scary and so i don't push people into things they're not ready to do like well let's let's make sure you're nourishing your body you know how often do you connect with it how often are you feeding your body uh and let's move away from trying to fake out your body fake fake fake fullness fake hunger that's confusing and then when you have all this confusion you stop trusting yourself and that to me is profound that's a profound violation of the human spirit yeah you know well i can't help but think about everything that we were talking about when we started this conversation is the reason the cake is scary in the first place so the reason why we get afraid around the binging is the socio-cultural context that we have where we've decided somehow that food is has is bad and needs to be policed and that bigger bodies are bad that somehow there's something actually wrong about our body being a larger size i'm wondering if you can talk a little bit about what it's been like for you to do intuitive eating work and kind of have your research put forward as there's been a little bit more literacy around fat phobia mm-hmm wow i've there's so much we can do with that so i'm going to answer that on a couple of ways so i would love to hear so i've had some fat activists actually ask me evelyn why aren't people making more posts on intuitive eating on instagram and in social media why aren't they talking about intuitive eating why aren't they posting the pictures of you know desserts and the freedom you get to eat and my answer to that is because there's bigger work to be done the oppression is still here you know when you have something i i'm sure you're familiar with the term um thin privilege i wish the term was actually body privilege i find the term thin privilege throws a lot of people off there's this idea that you have to be thin but what that relates to is how culture treats you that i can go i have thin privilege i can go on to a plane and i know the seat belts are going to fit me i can go into a store and the clothing size are going to fit me i'm not going to have a stranger taking food out of my my grocery cart but someone who's in a bigger body doesn't have that thin privilege and so they're working to change policy and to change the culture there's more work to be done you know so that that becomes a really big issue and then sometimes when i'm dealing with healthcare professionals they have this idea because the policies oh my gosh the policies in healthcare that we have to change everyone's body size to be healthy does not match the research and we have to look that body diversity is a thing i sometimes call it puppy therapy with my patients we see dogs in all kinds of sizes you know we see little tiny chihuahuas and we see these big old bulldogs and no one ever says to a bulldog you gotta look like a chihuahua or you're not cool dude you know and so but we accept that diversity and we don't accept it in in human beings and when you start looking at the researches and the flaws of that like the body mass index is a horrible horrible metric i haven't met a person yet a health professional yet who says yeah that's a really good tool and yet it's used for diagnostic criteria to determine who gets health care and all kinds of things so we have a lot of work to to do here you mentioned a few things about policy there and how the research doesn't match the policy yeah i imagine in some ways you're alluding to health at every size i am actually could you tell us a little bit about that for especially for listeners who aren't familiar with that or maybe even still have internalized this idea that that a bigger body can't be healthy can you introduce us to health at every size yeah so health at every size is really it's a huge framework that has more to do than just health it has to do with social justice and this idea that regardless of what size your body is you have a right to be treated with dignity and respect and to get health care so if you're a person in a large body and you think you broke your ankle and you go see a doctor you'd like to get an x-ray and maybe to get a little bandage wrap or cast whatever it's called for not to get a lecture on oh you just need to lose weight and then your foot pain will go away and i can't tell you how often those kinds of things have happened to my patients that's a real problem so health in every size is not saying healthy at every size it means access to care at whatever size you are and that you also have the right if you choose to engage in uh health-based behaviors no matter what your size is you can still move your body you know you can do all these other kinds of things and not to be judgmental based on someone's size and withhold treatment like fertility treatment the new york times did a great future on this with virginia soul smith looking at all the awful things that go on with that so one thing that i did a while back because it was just puzzling to me because the body of research is profound how come so many people in the health care industry have this belief system when the research doesn't support it and i came across the work of carl levy he's a cardiologist and a researcher who's done a ton of research but the fact he's a practitioner i think is really cool and he described a phenomenon that was new to me but it's it's it's out there you can google it and it's called the simulvice reflex and the simulvice reflex is named after a doctor have you ever heard of dr simon vice back in i think in the okay so let me tell you a 1600s so in around that time uh women were dying in uh childbirth and uh they couldn't figure out what was going on i mean more than more than average and what was happening are some of the doctors were doing autopsies and not washing their hands and then you know working with their patients and so dr simonvice did this small experiment with hand washing and found out that hey if we wash our hands he won't kill our patients and he was met with incredulity like oh that's absurd we're gentlemen we don't kill our patients we're gentlemen we don't have to wash our hands and he was literally left out of out of medicine and it was decades later that past year came out with germ theory and so now they named the simulvice reflex after dr simonvice that when there is new data that refute the popular paradigm it's disbelieved and i think that's what we're seeing right now in medicine and healthcare that's what's going on yeah for clarity can you state the popular paradigm that is currently now yeah that health health is is is contingent on on the size of your body it is not yeah yeah and for people who who disagree are there places that you can point them to perhaps educate themselves about why that's not true for people who are who their first instinct is well obesity kills such and such number of people kind of and cite that as a statistic where can people go to sort of um kind of deconstruct some of their ideas about size oh let me think can i give you some generalities and give you some more specifics on where to go yeah please because that what you just said you know in terms of health and death and all these kinds of things those studies are based on association association's not causation so they look a group of people they see size they see death they go oh it must be the size of their bodies but we can say that with men too being male is is a higher risk factor for many types of diseases but no one's ever suggesting to go get them castrated and and so here here's the problem though this is actually a serious topic is that when these association studies are done they are missing out on big big confounders like social determinants of health like where you live like poverty like um isolation in fact there's a really big body of work showing that a big public health crisis is actually isolation in our relationships with people and then you're familiar with aces adverse childhood experiences if an adult as a child was exposed to some significant um adverse experiences that can cut their life off by 20 years they live on if they have six or more of these uh traumas they'll live to an average age of 60 versus 80. they're going to have more chronic diseases and this data is not included in all of these other factors when they're looking at weight so it's it's not this slam dunk that everyone thinks it is and one way i just i describe this to my patients it's like this it's like in the summertime more people drown and they more people drown because more people are swimming and in the summer time more people eat ice cream so it's true that eating ice creams associated with drowning it is false however that eating ice cream causes drowning it causes drowning or death and when i say that everyone laughs but that's association data and this kind of data epidemiological data what it tends to do is it just confirms whatever your belief system is whatever your bias is and that's where the real problem is so there are several big papers looking at this uh if people want to google you can google the o'hara paper looking at the paradigm shift that's needed there's if you go to the association for size diversity and health they have a lot of research published there there are big papers that came out of the australian medical research council even our own national institutes of health have had position papers on how dieting is the most predictive factor for increase of weight so if if if weight was really what we're looking at as a health outcome issue why in the world would we prescribe something that actually causes more weight gain that doesn't make any sense to me it's if it was a medication it would never be approved for a drug with the poor like the average i think i see in terms of efficacy is like it fails 95 percent of the time wow is that isn't that something yeah people don't know that and then they feel like they're a failure like i'm broken there's something wrong with me yeah yeah i think i heard i might have actually even been you in an interview say somewhere that uh the diet industry is the only thing that blames people for failing when they buy the thing that the industry is selling yeah that somehow that there is this um moral failure if i if my diet didn't succeed it's because i i am weak as opposed to seeing the the diets themselves as being ineffective and actually disrupting the goodness and the natural needs cycles capacities of our bodies you're absolutely right apparently good yeah we've said that and i'll tell you what it's a phenomenon i still see i have patients coming in and they'll say oh that diet really worked oh that diet really worked and so what i do i do a really big long history and then look at what ended up happening to their body they had rebound weight gain but in their mind because the belief system so profound they just remember that short time period where they lost weight and they don't see how their weight's been ratching it up so i show that and then i also look at what's happened to you behaviorally what's happened to your mind in terms of worrying around eating in terms of loss of control eating and all these types of things and i'll say there's a body of research that actually shows and predicts this is exactly what will happen and i have patients cry when they hear that because they've never heard that they hear diet culture very loud in the before and after pictures and oh i'm just so cool because i lost all this weight you don't hear about the loss of control eating you don't hear about the uh the weight regain and all these kinds of things you know right it breaks my heart oh my god yeah yes i'm with you i'm with you you know yeah it really strikes me as is painful when i'm listening to you talk about this because it seems like one of these things where people without being educated about the one how we're getting kind of brainwashed by diet culture and the media portrayal of i guess the glory that comes with weight loss then that that can trick us into thinking that again health is thinness in some way and what we don't realize is that even in advocating for what we think is for people's health we're actually just perpetuating some oppression around size diversity but they're i i see this constantly when people are pleading with me that perhaps my perspective on on health at every size is wrong they're saying but i actually care about those people's health and i it's because i care that i'm getting this upset at your disruption of my narrative and yet we're ignoring all of the science that says otherwise it's it's it's just it's something it's i'll tell you a phenomenon i'm also seeing especially the more i do speaking and training of healthcare professionals is they'll say their mind is blown why didn't we learn about this in grad school why don't we learn about this in our internships and sometimes i'm like why didn't you ask questions but you might not know to ask those questions and so what i see happening with a lot of people is they go through this place of cognitive dissonance that i'm presenting all this data they're reading the data and it doesn't match with what they their belief system that they were taught it doesn't match the policy and what happens as a healthcare practitioner has more experience usually i find around the five-year mark they're also realizing oh my god this isn't matching what my patients do either and it doesn't feel good it doesn't feel good you know yeah so we've found ourselves in this paradox where we're living these things out and we're perpetuating them with our with people around us yeah and perhaps we have these moments of insight where we realize this this isn't working how do you think change happens how do we get somewhere new culturally and maybe even individually in our relationship to understanding eating and health and and food and bodies well part of it is what you just described i sometimes call it being humbled into submission and you're you're in enough pain that i am so sick of living this way and what we haven't talked about is the food obsession that happens the i'm not even talking about patients with eating disorders i'm just talking about chronic dieting and falling patterns of you know food plans and whatnot that you go out to dinner with your partner or your friend or your kids or whoever and you're more preoccupied on oh my god what am i going to order is it fit my plan what am i going to do how am i going to do this and you've just got through missing an entire important something that that person just said your body is present but your mind has left and so it really has an impact on on quality of life so i find that when people get to that realization that this is not working that's really good news it feels awful but it's good news um the other aspect i do is that i think it's daunting this idea of changing our entire culture when you see how it is everywhere but this idea however that you know what you can change the legacy of diet culture in your family you can have your own house guidelines we can transmit our own family values our own lineage and that's that's a fascinating conversation i have a lot of my patients what is your body lineage and like what it's like well how did your mom treat her body how did your dad treat his body how about grandparents how about aunts and uncles are there gossip around people's bodies and criticisms and is there hierarchies and as we start talking about this i go oh my gosh and so when you start realizing this has come down the family tree it's pretty profound and we're talking about deconstructing a belief system here you know which is really really important and it takes time and and that's what i think is so important to allow the time for this for this learning this this unlearning basically all these things because it's shocking in the beginning you know that's where i can see your work and my work and not that it's that different but overlapping because often when people are trying to change their legacy and their families what they're realizing is i i don't actually know how to set boundaries with my mother-in-law and how she speaks or i don't know how to name hey please don't speak about bodies that way in front of my kids to my mom or my dad and now not only is the thing that's keeping me stuck all of diet culture but i don't have the skills interpersonally or in my family system and it feels like breaking a family rule to tell someone who i respect hey please don't do that anymore yeah you're absolutely right that respect and love and i don't want to hurt their feelings and this this comes up a lot and my shirt my short-term response to my patients are that grandma doesn't get a pass you know and that you have a right but but you're right it's a skill set it takes a certain amount of bandwidth and so when it comes to setting boundaries i'll say you know you get to decide do i want to put energy in this relationship and my suggestion is if you're seeing this person a lot i that would be really worth worthwhile if it's a relative you see once every five years you might just decide you know what i'm just gonna leave the conversation and you you can also do that but it takes time and practice and one of the ways that i i work with this and i'm sure i'm just repeating the stuff that you do is looking at how much pain and suffering the patient has had you know do you want your kids to have that and they'll say absolutely not and then it's like well you have the opportunity to give them this gift but it's gonna be it's gonna take setting i call it loving boundaries and it seems to be a little more received that way this is not about being mean it's about protecting your kids and you have a right to do that [Music] [Music] can you just talk a little bit more about what you mean when you say grandma doesn't get a pass because i think this might be new and really like subversive for a lot of us who were never told that and we're actually told that that you know in fact grandma does get a pass that's that's the only person who does yeah like yeah that's exactly what she gets and i realize it might sound harsh and i don't mean it that way but i get their attention i think that's probably what i'm trying to do but it's this idea they don't get a pass at your expense they can live whatever way they want to they can diet as much as they want to and make me sad but they can they have the right to do that but they don't have the right to cause you harm and what's really interesting when i start talking to the parents or the sons of daughters of the of the grandparent uh i will say things like does your mom have you ever told her how it makes you feel in terms of the shame and how much crying you've had or how much closet eating binge eating you've done because of remarks or whatnot or you don't want her seeing you want to don't want to be on the radar and they'll say no and i'll say oh then they don't have the opportunity to correct the situation if we don't if we don't teach them how are they going to know you know and then as you know there's many different ways of setting boundaries and one of the most important parts i find is not just setting the boundary my question is okay what are you going to do to maintain the boundary when they go off base because i've worked with a lot of families and i've had parents who will say wholeheartedly to support their adult kids they're still living at home for example yeah i won't make any comments on the eating i won't make comments on their bodies and they really mean it but they forget and so part of that conversation we have together is how can you politely respectfully to go back to your term uh to honor your mom and dad how can you respectfully remind them of this agreement we had it could be something as simple as putting your little hand up go remember we're not going to go there and everyone remembers um but if we don't have that in place what ends up happening is i find the patient gets pissed off oh my god my mom just totally didn't even disregarded me well did you speak up no well we're humans we're all going to make mistakes and uh so part of it is a willingness to communicate this and that takes time it takes practice it takes energy you know yes yeah i'm so glad you added in that piece then about maintaining boundaries too because sometimes we can work up all of this steam to set the boundary but we haven't thought about okay what are we going to do if it if it doesn't get held and do we have enough self-worth and enough confidence in the boundary that we set to know that that that doesn't mean the boundary was a bad one right maybe we need to revisit some things or look at the the the context or the nature of the relationship and why when i said hey this doesn't work it kept happening anyway right so can can i can i bring it into like a a real story real life story here because this is all amazing and you guys are very familiar with this stuff this is very new new for probably a lot of most of the listeners so i have a i have a loved one who we have we have a lot of we have a pretty fat family and one of my loved ones has some medical issues that is being she's being denied a surgery that she needs because the doctor is saying you need to lose weight first um and so the whole family is kind of on her to lose weight like come on you got to take care of your health you got to get the surgeries you gotta lose weight and so like what do you do what do you do in a scenario like that where there's right i can tell you what i would do and i and i'll tell you why i'm laughing when i say that it's completely different when it's a family member you know so i'm going to give you two things and then hillary i'm sure you've got lots to say as well uh but i talked to the healthcare provider and i tell them about the data or i put it back on them can you show me the data if this is so important this weight loss show me the data where it's sustainable and doesn't cause harm and it doesn't exist they can't show me that and i've had some people say i'd be afraid to talk to my doctor that way and i'll say but they're having a form of prejudicial aspect isn't it interesting that they'll do bypass surgery gastric bypass surgery on patients that are quite large and then suddenly change and flip oh we you know you're too big to have this other surgery and so one of the ways i also get involved too is like if we look at nip hip replacements and replacements those kind of surgeries like let's get people into physical therapy let's start having to move uh muscles that will help support the the bones when they have the surgery that they can heal and they can be a better place of ambulation and what ends up happening the the family your family might be lovingly entrenched they think that they're helping somebody not realizing it's adding shame so there's this belief system that you can just change your body just like that and in fact a paper just came out out of out of nature you know very prestigious uh scientific journal talking about weight stigma and this false narrative that weight is really easily changed and modifiable and there are so many things beyond our control and that's the problem when there are people making health policies and doing research and not using people with a lived experience of being in a fat body you know you can have a be in a fat body and have an eating disorder you know there's all kinds of things that can happen so that's a tough situation you're describing i'd be looking for a second opinion for another doctor honestly you know yeah that's so well said evelyn and that would be my that would be my other insight as i wonder if there could be another another opinion one of the things that i think is so is so painful about the way that we relate is sometimes if we're not paying attention to the emotion underneath what we're saying we're not realizing how often when we're trying to pressure other people into change it's based on our fear and instead of taking ownership of our fear we blame or control or cajole somebody into doing something different and all of this i mean this gets right back to what you were saying evelyn around intraoceptive awareness and emotion in the body and if we ourselves are not connected with our bodies it's really hard to notice if we're feeling afraid and then how could we take ownership of our fear and do something different in a dialogue with someone and so my kind if this all comes back to what we've been talking about all along and for the listeners of the podcast something that you know i'm super passionate about which is being being our bodies being in our bodies being attuned to and mindful about what we're feeling and it's just a really good strategy to know what's going on for you before you bring something up for another person oh yeah absolutely absolutely yeah that makes it for me as as i cause i used to coming from a fat family especially i've gone through lots of different diet phases and trying like extreme new ways of living and eating and in the last couple years i've let go of a lot of that but i still have a tendency to think in those ways so i have to pay attention to it but for me it's been it's something that i'm still learning is like kind of what i said earlier of reversing the instinct to leave the body to try to make a good decision instead to move into it it's a it's a hard transition to do that to go actually pay more attention so when i'm feeling like i want to go get ice cream is that really what i want like is that is that really what i want right now and if it is great let's do it yeah but sometimes that's not actually what i want i'm actually just avoiding some other thing that i don't want to look at and so i just ice cream is a nice shiny distraction for a second from what i actually want so really paying attention learning some of those signals with food how sometimes for me there they've been indicators that i do want something can i listen rather than just like actually leaving my body and ignoring the the actual desires that are there and it's a practice yeah it's a real practice you know and you know one thing i didn't mention on the on the principles we've we've slightly tweaked one of them the core principle's still the same and it has to do with coping with your emotions and the principle used to be cope with your feelings without using food and the whole merit the whole thing behind was that was to have more in your toolbox than just one way to cope but because emotional eating has been so pathologized in our culture and there's so much shame and then that shame leads to more eating and more problematic kinds of things we changed it to coping with your feelings with kindness and sometimes kindness is having that ice cream or that that cookie uh but we have to move away from this this shame and sometimes where people are in their lives is the really the best they can do so pat yourself on the back you got through that awful situation now that things are in a more calm or place stable place let's look at what we can do to get more support you know and i want to i want to stress something to hillary i do work with a lot of patients with eating disorders and of course i'm working with a psychologist or therapist so it's a team team approach here you know takes a village yeah you're uh gosh i think you're getting to something that i i just see so much in our tension with food when we are um perhaps trying to look thoughtfully at the the the stories about food and eating we were handed and maybe to evaluate if those are helpful or not as we are moving forward in our life and it seems to me that for most of us there has been this story of somebody else will tell you how to eat the food guide your parents culture that diet and so the locus of control around how you make choices moves outside your body into some other person into some other system or program and it is so much more complex and messy to ask yourself i mean as both you were saying evelyn and michael what was actually going on for me and even if i want ice cream that's okay but maybe maybe i don't want ice cream and maybe i have to figure that out and what's underneath and and how do i pay attention to myself and learn to be in myself instead of seeing and judging my body from the outside but it seems like even maybe with intuitive eating sometimes we want someone to hand us a checklist where we can say oh eating for sadness not okay but eating for joy yes okay or something like that and really what we're trying to do here is get to know ourselves yeah it's really one else who can help us do that or no one else who can do that for us well and that's a good point and that's something i like to stress is the work that i do i'm kind of more like a tour guide that actually and if i'm doing a good if i'm doing a good job you know you are the expert of your body you might not feel that way right now but as the tour guide i'm going to point out some nice rights and it's up to you to decide do i want to take that ride and you take that ride it's like hmm would i do that again maybe yeah and maybe i would do it a different way so i'm just i'm guiding you and one of the things i like to do in that guidance is look at what's been working for you i just had a patient today i saw and things are going really well i go what did you do to create that i don't know i did what you said i don't know it was more than what i said because i want to i want them to have the power and to see that they've been doing this and as she started really looking through and deconstructing oh i did this i took care of my needs i gave myself permission to eat all these other kinds of things so it's kind of profound yeah sometimes it feels like we we think of our bodies as dumb like blocks of meat a lot of times they're our bodies are the things that know how to heal themselves and how to grow their bones and how to like turn food into body like that's that's a good point oh my god brian the body is genius hey body what do you need the body note the body knows it's so smart and it's your home for the rest of your life you know and it's it's the house of all of our whatever you want to call it your your magic your spirit your life force your consciousness your soul whatever you connect to and you're so much more than a body and so part of it's also moving away from that identity that we have a body but you're more than a body to move away from the objectification you know would you go so far as to say that eating and maybe in eating intuitively could be a spiritual practice you know what i really think so and if elise was here i know she would say so but i completely agree and you know i'll tell you i used to be uncomfortable with this phrase i'm going to tell you but i'm not anymore because i see it so much and people say that intuitive eating is life-changing and i've had that feedback over and over again unsolicited and i think what happens is as you come back home to yourself to your smart body and as you start trusting the basics of your body it transfers over into other areas of your life where you're trusting your decision making you're trusting your path and all these kinds of things there's a deep healing that ends up happening that's incredibly profound and you know when we look at even just down on the scientific level intuitive eating is more than the absence of an eating disorder it's it's thriving it's life appreciation it's it's doing what is you want to do and you have the energy and the bandwidth to do it because you're not starving yourself or withholding food you know yeah so can i say something else because sometimes when people hear this they start feeling guilty that they they're they like healthy uh food what they would call healthy food and so one of the things i want to really stress is that when it comes to the on your health with gentle nutrition intuitive eating is non-denominational meaning you can eat the way that you like to uh you don't have to apologize or tell me why you're in the mood for a salad i had a patient crying about that she goes i really wanted a salad but i was afraid it'd be like i'm going down diet culture it's like no if it's what you really wanted that's that's the gift of that you get to the point you don't have to explain and you're just deeply rooted in yourself you know yeah and so what this is is it becomes just another way this is a different we don't have to live in diet culture we're here and we're ready to help you you know yeah there's a way out sign me up right right i if someone was to come to you and had never heard about intuitive eating would there be a couple practices i know you'd mentioned the principles before but maybe some tangible things maybe things you've alluded to before that would help a person begin to start thinking about eating intuitively yeah i mean really it's ironic one of the first steps i do is a middle step but it's that satisfaction factor i was telling you about earlier because if you think about it it's not satisfying ultimately to under eat ultimately it's not satisfying to overeat so in a way you're kind of integrating hunger and fullness without getting there i've had some patients inadvertently try to turn intuitive eating into a diet like i have to eat precisely when i'm hungry and i have to stop precisely when i felt like no our bodies this amazing thing it adjusts and and so on so i would start with that and noticing how it feels and noticing about how would it feel to really know that you're the expert of your body you're the boss of your body nobody can tell you how you feel only you know that and when you get to that point when that becomes your personal truth it doesn't matter what diet is flying around it's not going to affect you in that way and it's ultimate liberation is what that is you know wow questions i i feel great i think this is great powerful this is a yeah this is like hitting me for my family circumstances especially right now i'm actually thrilled to hear that it's it's profoundly powerful you can you well michael's sitting here and he can see my box of tissues and i can't tell you how many tissues i go through in a week because patients cry like i can't believe i'm crying over this but your relationship to your food and your body is so profound uh often this is the first place they've started talking about those things you know yeah in a socio-cultural context where there is like we've talked about thin privilege or body privilege to to bump up against that and decide to say actually i'm going to listen to myself and what i need and trust that my body is good and trust that actually my body is good regardless of what size i'm at really is disruptive and is a kind of resistance it is a resistance like one kind of body is a way to have a good body and that means something about your value as a human [Music] it is the resistance yeah it's a disrupter yeah yeah i love it food is spirituality food is activism food as yes food as love and trust pleasure it's so many things isn't it yeah don't mess with my food don't tell me how to eat and when you look back at it too i mean when people start doing that that's messing with your autonomy and we all want no one likes to be told what to do right yeah yeah so it's about living authentically what do i really want right now what my body really wants what sounds good you know yeah at a really fundamental physical level yeah yeah pretty powerful yeah without judgment or moralization or shame yeah yeah thank you you're welcome wow thank you so much you're welcome this is really cool yay likewise by the way nice and deep yeah thanks for listening everybody this episode was edited by teja slayer haydn we'd love to invite you deeper into the liturgists community we do weekly online gatherings and there's zoom meetings and extra podcasts meditations and all sorts of stuff check all of that out at the liturgists.com love to see you this sunday peace