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Presented By: Caryn Attianese, MA, NCC, LPC, CEDS
Cindy Elms, RDN
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To describe three ways weight biases are an obstacle to
emotional growth and the therapeutic relationship
To summarize ways wellness, not weight, are markers for
recovery
To discuss two methods to challenge your own weight
biases
Why are we here?
Difficult to look at self
Y Our hope for us
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Recognize
-Understanding your blind spots around weight bias
and normalize that biases are common to all
professionals
Relate
-Connecting your own personal biases to societal
beliefs that influence the therapeutic relationship
Reframe
-Changing beliefs and biases about body size and
shape
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RECOGNIZE
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Bias- “prejudice in favor of or against one thing, person, or group
compared with another, usually in a way considered to be unfair”.
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Weight Bias:
o Studies show that healthcare providers think of clients with larger
bodies as:
• non-compliant, lazy, awkward, weak-willed, dishonest, lacking in self-control,
sloppy, unsuccessful, and unintelligent
o This bias emerges from the suppositions that:
• Thin is always preferable
• Thin is always possible
• Thin people are better, happier and more acceptable people
• Often creating fears of weight gain and the loss of “thin privilege” including
those who have more socially acceptable bodies.
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Stigma- a mark of disgrace associated with a particular circumstance,
quality, or person.
Y
Weight or body stigma::
o while often applied externally, has psychological consequences when
internalized.
Y
Body Shaming- The acts of bullying, teasing, negative body language,
harsh comments, discrimination or prejudice based on a person’s body
size or weight.
o Youth are 2-3 times more likely to experience suicidal thoughts and behaviors.
o It is the stigmatizing experience itself, not the weight, which causes shame,
which contributes to adverse outcomes.
o People experiencing obesity, 3 out of 4 cope with weight bias by eating more
and resisting nutritional care.
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Discrimination: The unjust or prejudicial treatment of
different categories of people or things, especially on the
grounds of race, age, sex (or body size and shape)!
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Weight discrimination:
o Occurs more frequently than gender and age discrimination
o Two out of three adults and one out of three children are overweight
or obese
o People who are underweight and of average weight are assumed to
be more able and motivated. This assumption may prevent accurate
diagnoses and care as in the case of an eating disorder.
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“Two years ago I lost 140 pounds, and through that process
I have been both disgusted and amazed with how
differently the world, including medical professionals, treats
me. When I was morbidly obese, I felt very harshly judged by
doctors, and I often would stop going to doctors who I felt
treated me inappropriately because of my weight. Yes, I
expected my doctors to discuss my weight, but there are
ways to do it that create empathy. Now that my BMI is 21,
the weight is a non-issue, whereas before it was pretty
much all we talked about.”
- New York Times reader
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“Candidly, we go after the cool kids. We go after the
attractive all-American kid with a great attitude and a lot of
friends. A lot of people don’t belong in our clothes, and they
can’t belong.”
“Abercrombie is only interested in people with washboard
stomachs who look like they’re about to jump on a
surfboard”
-Mike Jeffries
Former CEO of Abercrombie & Fitch
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16% of employers refuse to hire obese women no matter how
qualified (Bradley, 2000)
44% of employers admitted they would use an applicants obesity
as a conditional medical grounds for not hiring (Bradley, 2000)
In elementary school, the likelihood of being bullied is 63%
higher for an obese child than a non-overweight peer (Yale Rudd
Center, 2012)
More than 69% of overweight people report having been
stigmatized by doctors. (Yale Rudd Center, 2012)
• Shorter office visits,
• Fewer referrals for return visits or other supportive treatments
• Inappropriately recommending weight loss for the presenting medical
complaint that is not related to weight.
“Psychologists ascribe more pathology,
more negative and severe symptoms, and
worse prognosis to obese patients
compared to thinner patients presenting
identical psychological profiles.”
-Yale Rudd Center, 2012
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RELATE
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Y Empathy
Y Compassionate
Y Genuineness
Y Trust
Y Respect
Y Rapport
Y Open
Y Consistent
Y Honest
Y Dependable
Y Sincere
Y Motivational
Y Safe
Y Non-Judgmental
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Counseling should provide the client with an open and safe
setting that emphasizes self-exploration and change
without the client feeling the need to censor or conform.
-When a client feels the need to meet standards of the professional’s weight
biases, they will withdraw, shut down, or become defensive.
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Therapeutic relationship is the key predictor for client
success, not necessarily the approach you use.
-A client feeling stigmatized will not feel heard, understood, valued, or safe
in sharing private information about shameful patterns and behaviors
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Therapeutic relationship is a way to explore how to act in
outside relationships.
-Cannot happen if professionals have unchecked biases or their own
agenda, because clients will pick up on the shame of the professional.
Y
Weight bias will affect a client longer than the time they are
in your care.
-Know when to refer a client when your bias’s are negatively impacting
treatment and the client. We all have biases, so know when you are
unwilling to work through those biases.
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Psychological Consequences of Weight Bias
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Weight Bias
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Weight Stigma & Body Shaming
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Depression
Anxiety
Low SelfEsteem
Poor Body
Image
Suicidal Acts
and Thoughts
Yale Rudd Center, 2012
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Peers Teasing- wanting to be acceptable
Biggest Loser- no pain, no gain- shaming people into health
Dieting Cycle- deprivation leads to bingeing
To compare is to despair- family members
Media comparison- photo shopped and unrealistic
Loss of job/sports team participation due to weight
SHAME- the root of the eating disorder and weight bias is
shaming a person’s body and therefore pushes the need to
change who they are as a person, not just their body
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Up to 28 million Americans suffer from an eating disorder (Renfrew
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Up to 3/100 women suffer from anorexia nervosa in their lifetime
2003)
(NIMH, 2002)
Y
Up to 4/100 women have bulimia nervosa in their lifetime (NIMH,
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Up to 5/100 Americans experience binge-eating disorder in a 6month period (NIMH, 2002)
An estimated 10-15% of people with anorexia or bulimia are male
2002)
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(American Journal of Psychiatry, 1997)
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Eating Disorders have the highest mortality rate of any mental
illness (American Journal of Psychiatry, 1995)
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Y
Alcohol and other substance abuse disorders are 4 times more
common in eating disorders than in the general populations
(Harrop & Marlatt, 2010).
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As many as 50% of individuals with eating disorders (ED) abuse
alcohol or illicit drugs, compared to 9% of the general population
(National Center on Addiction and Substance Abuse at Columbia
University (CASA, 2003)
Approximately 35% of alcohol or illicit drug users have eating
disorders, compared to 3% of the general population (CASA, 2003)
Only 10% of men and women with eating disorders receive
treatment. (IJED,2002) Only 35% of people that receive treatment
for eating disorders get treatment at a specialized facility for
eating disorders (IJED,2002)
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REFRAME
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95% of weight lost during calorie restricted dieting is regained.
And 30-60% of dieters regain more than they lost.
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Weight cycling damages the heart, reduces bone mass, may
increase risk of gall stones, and disrupts serotonin function
leading to greater impulsivity and depression.
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Carbohydrate restriction inhibits the body from making it’s
natural tranquilizer GABA.
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Dieting in adolescence and childhood leads to a much greater
incidence of obesity in adulthood.
Y
Excessive exercise is praised by society but it can lead to injury,
disconnection from feelings, and is often a form of selfpunishment
Extremes in exercise can create resistance to weight loss.
Compulsive exercise interferes with relationships and overall
functionality
Avoidance of physical activity due to fear
Physical activity for health and enjoyment, not weight loss
Joyful movement creates connection between mind and body,
allowing the client to tap into hunger and fullness cues
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Weight is not a behavior and therefore not an appropriate
target for behavior modification
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WHO defines “health” as “State of complete physical,
mental and social well-being and not merely the absence of
disease and infirmity”
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Weight DOES NOT EQUAL health
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Acceptance vs Change? Acceptance is change!
(Wendy Oliver-Pyatt, MD, 2011)
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Precious Child
Body is a shell
Seeing them as a valuable, vulnerable, imperfect,
dependent, and spontaneous person
Would you criticize a child’s appearance?
Would being overweight make a child bad or unacceptable?
OR if it was a child would you think about what must be
going on for them emotionally that is contributing to the
presenting issue …same is true for the adult…FOCUS ON
THE INTERNAL AND NOT THE EXTERNAL
What were the messages in my own family of origin (spoken
or unspoken) about food, weight, and body?
What was my experience throughout my lifetime with my
own weight and body?
Do I feel better than or less than others based upon the
appearance of my body?
Do I have a foundational belief about overweight or
underweight people?
Do I believe in wellness determining health and not weight?
Do I need to seek help to work through my own weight bias
issues?
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… or He is ENOUGH!
[email protected]
[email protected]
www.EmpowermentTC.com
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