PowerPoint of our presentation here

Report
Fat Studies in Mental Health
Training
AAMFT 2012
Drs. Sheila Addison & Michael Loewy
Alliant International University
With slides borrowed from
Drs. Linda Bacon, Barbara Altman Bruno, Deb Burgard, Glenn
Gaesser, Joanne Ikeda & Esther Rothblum
Activity 1
• Write 4 words or phrases that you
associate with “fat people.”
• Don’t censor yourself - write whatever
comes to mind.
Activity 2
• Write 4 words or phrases that you
associate with your own body.
• Don’t censor yourself - write whatever
comes to mind.
What exactly does “fat” look
like?
Take a moment to picture what a person
looks like who is underweight, normal
weight, overweight, obese, morbidly
obese (BMI categories).
BMI slideshow project © Kate Harding, 2007
http://www.shakesville.com/2007/09/why-bmi-is-crock-in-pictures.html
What’s my BMI? 1 & 2
What’s my BMI? 3 & 4
What’s my BMI? 5 & 6
What’s my BMI? 7 & 8
What’s my BMI? 9 & 10
What’s my BMI? 11, 12, 13
What’s my BMI? 14 & 15
What’s my BMI? 1 & 2
5’0, 130 lbs, BMI 25.4,
overweight
5’7, 170 lbs, BMI 26.6,
overweight
What’s my BMI? 3 & 4
5’6 1/2, 227 lbs, BMI 36.1, obese
5’4, 250 lbs, BMI 42.9,
morbidly obese
What’s my BMI? 5 & 6
5’7, 129 lbs, BMI 20.2, normal
6’0, 216 lbs, BMI 29.3 – overweight, 5
lbs below obese
5’4, 150 lbs, BMI 25.7, overweight
5’11, 190 lbs, BMI 26.5, overweight
What’s my BMI? 7 & 8
6’0, 135 lbs, BMI 18.3, underweight,
1 lb below normal
4’11, 120-125 lbs, BMI 24.2-25.2,
fluctuates between normal and
overweight
What’s my BMI? 9 & 10
5’7, 225 lbs, BMI 35.2 - “very
high risk” of disease
5’8, 224 lbs, BMI 34.1 - “high
risk” of disease
What’s my BMI? 11, 12, 13
5’7, 134 lbs, BMI 21,
normal
6’1, 200 lbs, BMI 26.4,
overweight
5’1 1/2, 200 lbs, BMI
37.2, obese
What’s my BMI? 14 & 15
5’7, 280 lbs, BMI 43.8,
morbidly obese
5’4, 185 lbs, BMI 31.8, obese
How did you do?
• BMI (body mass index)
is weight (in kg)
divided by height (in
meters) squared
• BMI for “overweight”
changed from 27 to 25
in 1998
• 30,500,000 people
became “overweight”
overnight
How did you do?
• BMI is not magic or even
scientific
• IT’S JUST ANOTHER
WEIGHT/HEIGHT RATIO
• 1998 change was not informed
by empirical research - the
change was effectively
arbitrary
• 2010 study - BMI poorly
predicts health
Schneider, H. J. et. al. (2010) "The Predictive Value of Different
Measures of Obesity for Incident Cardiovascular Events and
Mortality". Journal of Clinical Endocrinology & Metabolism 95
(4): 1777–85.
How fat is “fat”?
GUESS
MARIANNE’S
HEIGHT/ WEIGHT!
Marianne Kirby, co-author of “Lessons
from the Fat-o-sphere: Quit
Dieting and Declare a Truce with
Your Body”
How fat is “fat”?
How fat is “fat”?
How fat is “fat”?
Marianne says:
So why is this? Is it just that… people have no idea what certain weights look like?
I think that is a really big part of this. The guesses that most boggled my mind
were from men who said I looked like their wives and their wives weighed x
number of pounds. Those guesses were all under 200 pounds.
There were a lot of guesses that started out, “well, you look just like me so….” and
were totally off. But even those guesses, for the most part… were closer to the
mark than the guys using their wives’ weights.
So. Either these guys are DESPERATELY bad at a game very, VERY few people are
good at, or their wives are lying about their weight.
WHY MIGHT THAT BE?
• Shame - about what it means to be X weight
• Stigma - about what X weight looks like/means
• Distorted perceptions of self & others
What does this mean for mental
health?
• Fat shame and stigma is pervasive - research suggests
they have more health effects than actual weight
• Distorted ideas about weight and health are pervasive culture equates “thin” with “healthy” despite evidence to
the contrary
• The weight “loss” and bariatric industries sell us (and our
clients) more of these ideas every day at tremendous
financial and personal costs
• Yet most weight loss efforts do not succeed
• As clinicians, teachers, & supervisors, we are not immune
• Self-of-the-therapist: We have bodies, and weight
histories, and feelings about them, which must be
addressed.
What does this mean for mental
health?
• Our field is currently trying to get on board the “obesity
crisis” train because there is $$ to be made
– APA Task Force on Obesity
– AAMFT - Clinical Updates on bariatric surgery & Childhood
Obesity
– ACA - recommends “intensive counseling” for all obese adults and
requires insurers to pay
• Body size is a dimension of diversity; sizeism is a social
justice issue
• Our students, teachers, superviors, & clinicians badly need
training in a weight-neutral approach
• Little or nothing is offered in most mental health
programs
Fat Studies comes to mental
health
• In 2009, Alliant International University began
offering a 1-unit elective, “Fat Acceptance and
Health at Every Size,” to its PhD and PsyD
Psychology students
• Offered at the San Francisco campus as a 2-day
weekend intensive
• Students were asked to do all assigned reading
prior to class
• Based on ideas from “Fat Studies” classes taught
in other disciplines elsewhere
“A Fat Rant” - Joy Nash
CREATION OF FAT STUDIES
• Marilyn Wann, 1998
FAT STUDIES IN THE ACADEMY
• 2006 Fat and the Academy Conference,
Smith College, co-organized by Sheana
Director
THE NEW FAT STUDIES: PERFORMANCE
• Fat burlesque
• Fat cheerleaders
• Fat synchronized swimming
• …and many others
THE NEW FAT STUDIES
• “Weight discrimination will continue to
thrive so long as efforts to end it focus on
changing people’s bodies rather than
changing people’s minds.”
• Marilyn Wann
A brief history of weight research
• Early research on weight loss-1944: Ancel Keys begins
experiment
• 36 healthy young men
• 3 months 3,500 cal/day
• 6 months half rations (1750 cals), mostly whole grains and
root vegetables, a little meat and dairy; adequate
vitamins, minerals, and protein
Barbara Altman Bruno, Ph.D. 2008
A brief history of weight research
• All lost ¼ of starting weight
• Depression, lethargy, irritability, loss of libido, indifference, obsession
with food
• Two emotional breakdowns leading to leaving, another chopped off
fingertip
• Last 3 months refeeding. Men miserable despite 4,000 cal/day
Finally regained weight, less muscle and more fat
• Nine months after regain, finally regained lost muscle
Barbara Altman Bruno, Ph.D. 2008
A brief history of weight research
 E.A. Sims studies 4 college students, later groups of
prisoners trying to gain 20-30 lbs. One needed 7,000
cal/day to maintain wt. gain. All doubled normal daily
intake of food and needed 2,000 cal/day extra to
maintain extra weight.
 Lethargy, apathy.
“Essentially all of the subjects ... have lost weight ...with
the same alacrity...as that with which most of our obese
patients return to their usual and customary weight
after weight loss.”
Barbara Altman Bruno, Ph.D. 2008
- 1972: National Association to Advance Fat
Acceptance
Vivian Mayer and Judy Freespirit. Mayer presented the following
to women of LA radical therapy collective:
• Biology, not eating habits, is the main cause of fat.
• Health problems of fat people are not inherently due to fat, but the
result of stress, self-hatred, and chronic dieting.
• Weight loss efforts damage health, almost never “succeed” except
temporarily, and should not be used.
• Food binges are a natural response to chronic dieting.
1972: National Association to Advance Fat
Acceptance
“The role of a radical [feminist] therapist is to help fat women
feel good about themselves as fat women and stop trying to
lose weight. To accomplish this, radical therapists should
learn and teach accurate information about fat women's
health and nutrition. They should provide emotional support
for women on binges to continue eating and stop feeling
guilty.”
WEIGHT AND INCOME - FAT IS A SOCIAL
JUSTICE ISSUE
• Fatness is highly correlated with poverty. Fatness and poverty can
often be used as synonyms
THIS IS WHAT PEOPLE ASSUME:
POVERTY --------> FATNESS
First you are poor and this causes you to become fat
BUT THIS IS WHAT SOME RESEARCH SHOWS:
FATNESS --------> POVERTY
First you are fat and this causes you to become poor
• “While there is evidence that poverty is fattening, a stronger case can
be made for the converse: fatness is impoverishing” (Glen Gaesser,
Fat Studies Reader)
Socioeconomic Status (SES)
• Consider type 2 diabetes (the disease most highly associated
with weight)
– Poverty and marginalization are much more strongly
associated with type 2 diabetes than weight.
McDermott, Soc. Sci. Med. 1998;47(9):1189
Wamala, et al., Diabetes Care. 1999;22(12):1999
WEIGHT BIAS IN EMPLOYMENT
Stereotypes of fat (150 lb) and thin (120 lb) college women applying for jobs
when the job resumé was identical:
On one resumé (sales job), college woman was rated lower on supervisory
potential, professional appearance, personal hygiene, and ability to do a
physically strenuous job when she was listed as weighing 150 lbs than
when the raters saw the IDENTICAL sales resumé but the woman was
listed as weighing 120 lbs. For self-discipline, the fatter women was rated
more positively. No effect for weight on the other resumé (service job).
Esther D. Rothblum, Carol T. Miller, & Barbara Garbutt (1988).
Stereotypes of Obese Female Job Applicants. INTERNATIONAL JOURNAL
OF EATING DISORDERS, 7, 277-283.
WEIGHT BIAS IN EMPLOYMENT
Surveyed members of NAAFA for experiences of actual fat people
Compared people who ranged in weight from very fat (50% or more
above height and weight charts) to fat (20-49% above height and
weight charts) to non-fat (19% or less above height and weight
charts) about direct job discrimination and employment-related
discrimination they had experienced.
There was a strong relationship between weight and number of
reported incidences of employment discrimination, school
victimization, concealment of weight (e.g., having a job that primarily
involved talking on the telephone), and low self-confidence.
Esther D. Rothblum, Pamela A. Brand, Carol T. Miller, & Helen A. Oetjen (1990). The Relationship Between Obesity, Employment
Discrimination, and Employment-Related Victimization. JOURNAL OF VOCATIONAL BEHAVIOR, 37, 251-266.
WEIGHT BIAS IN EMPLOYMENT
Review of weight bias literature in past decades. Fat people
are:
• Less likely to be hired
• Perceived as having undesirable traits
• More harshly disciplined on the job
• Given inferior assignments
• Paid less
• Viewed as liabilities for employee health benefits
• Fired for not losing weight
Fikkan, J., & Rothblum, E.D. (2005). Weight bias in employment. In K.D. Brownell, R.M. Puhl, & M.B. Schwartz (Eds.). Bias, stigma, discrimination,
and obesity (pp. 13-28). Guilford Publications.
LEGAL STATUS OF WEIGHT BIAS
• In the U.S., the only places with weight antidiscrimination laws are Michigan, Washington
D.C., San Francisco, Santa Cruz, and Madison, WI
• This means that in lawsuits, people have to use
other legislation such as the Americans With
Disabilities Act (ADA), sex discrimination law, etc.
THE STIGMA OF WEIGHT IN NONEMPLOYMENT SETTINGS
A large body of research has shown that fat people, esriskspecially girls
and women, are stigmatized (negatively evaluated) by:
-Children
-Adolescents
-Adults
-Health Professionals (Nutritionists, Medical Students, Physicians)
-Landlords
And the stigma of weight holds fat people responsible for their weight
Esther Rothblum (1992). The Stigma of Women's Weight: Social and Economic
Realities. FEMINISM & PSYCHOLOGY, 2, 61-73.
WHAT DO WE KNOW ABOUT THE MENTAL HEALTH EFFECTS
OF LIVING WITH STIGMA, BIAS, AND DISCRIMINATION?
STIGMA & DISCRIMINATION IS
BAD FOR MENTAL HEALTH
• Discrimination based on weight is
pervasive.
• Discrimination produces stress.
• Stress is a risk factor for disease.
• “Feeling fat” has stronger health effects
than being fat.
Puhl, et al., Int J of Obesity, 2008, 32:992.
Muennig, et al., Am J Pub Hlth, 2008, 96(9): 1662-8.
WHY CAN'T THEY JUST LOSE WEIGHT?
POOR OUTCOMES OF WEIGHT-LOSS PROGRAMS
• Meta-analysi of 50 published studies on weight loss
programs.
• Nearly all of them excluded participants who had medical
problems
• The typical participant was a white, middle-class woman
who was 48% over her average weight before treatment,
who lost 12.8 lbs during a 13-week treatment program
and then regained 4.3 lbs over the next 6.5 months
• Consider - would losing 8 pounds make anyone who is
“obese” into someone of “normal” weight?
Cogan, J., & Rothblum, E.D. (1993). Outcomes of weight loss programs. Genetic, Social and General Psychology Monographs, 118, 385-415.
Confronting the failure of obesity
“treatments”
“...the tremendous body of research
employing a great variety of
methodologies that has failed to yield
any meaningful or replicable
differences in the caloric intake or
eating patterns of the obese
compared to the nonobese.” David Garner
and Susan Wooley, Clinical Psychology Review 11, 1991, p. 748
Barbara Altman Bruno, Ph.D. 2008
Confronting the failure of obesity
“treatments”
 New England Journal of Medicine
“Losing weight: an ill-fated new year’s resolution”
Editorial: Kassirer and Angell, 1/1/98
 “Given the enormous social pressure to lose weight, one
might suppose there is clear and overwhelming evidence of
the risks of obesity and the benefits of weight loss.
Unfortunately, the data linking overweight and death, as well
as the data showing the beneficial effects of weight loss, are
limited, fragmentary, and often ambiguous.”
META-ANALYSES SHOW - 95-98% OF WEIGHT
LOSS EFFORTS FAIL
Barbara Altman Bruno, Ph.D. 2008
DIETING HURTS MENTAL
HEALTH?
• “Reinterpreting fat people as chronic
dieters puts the psychology of obesity in a
whole new light. If dieting is the crucial
variable, then the fat do not eat because
they hurt inside; rather, they hurt because
they are trying not to eat, to make their
bodies conform to social norms.”
P. 34, The Dieter's Dilemma, Bennett & Gurin 1983
RISKS OF WEIGHT LOSS
• “Obesity has health risks. But the quest for
weight loss is also a risky venture, and
those risks include injury and death from
dieting, weight loss, and attempted weight
loss.”
Berg. Health Risks of Weight Loss, 3rd Ed. 1995.
50
Health Risks of Food Restriction
and Weight Loss
• Inadequate nutrient
intake
• Anemia
• Headache
• Fatigue/weakness
• Cold intolerance
• Muscle cramps
• Amenorrhea
•
•
•
•
•
•
Cardiac arrhythmias
Gallstones
High cholesterol
Decreased sex drive
Nausea
Diarrhea or
constipation
• Death
51
Psychological Risks of
Chronic Dieting
• Preoccupation with
food, eating, & weight
• Increased response to
external vs. internal
eating cues
• Mood swings
• Irritability
•
•
•
•
•
•
Poor self-image
Disordered eating
Apathy/lethargy
Narcissism
Guilt
Depression
52
Consequences of Restricting
Food Intake
• Ignore/distrust hunger and satiety
• Rely on external cues
• Develop perfectionist tendencies
• On/off diet
• Judge foods as good/bad
• Tendency to binge
53
Dieting/Weight Cycling
• Dieting increases cortisol which triggers
inflammation.
• Attempts to lose weight typically result in weight
cycling
• Weight cycling results in increased inflammation
• Inflammation is a risk factor for many diseases
• Best predicting variable for obesity is a history of
dieting - iatrogenic effect?
Tomiyama, et al., Psychosom Med, 2010; (72):1.
Strohacker, et al., Front. Biosci. 2010;E2:98
Lissner , et al., N. Engl. J. Med. 1991;324:1839
Diaz, et al., J. Community Health. Jun 2005;30(3):153
“.…Until we have better data about
the risks of being overweight and the
benefits and risks of trying to lose
weight, we should remember that the
cure for obesity may be worse than
the condition.”
Editors, New Engl. J. Med. 338, No. 1: 52-54, 1998
Basic Principles of
Health At Every Size®
1. Accepting and respecting the diversity of body shapes and
sizes.
2. Recognizing that health and well-being are multidimensional and that they include physical, social, spiritual,
occupational, emotional, and intellectual aspects.
3. Promoting all aspects of health and well-being for people of
all sizes.
4. Promoting eating in a manner which balances individual
nutritional needs, hunger, satiety, appetite, and pleasure.
5. Promoting individually appropriate, enjoyable, lifeenhancing physical activity, rather than exercise that is
focused on a goal of weight loss.
WHY IS HAES IMPORTANT?
• Diets do not work.
• There is no intervention that has been shown to be safe
and effective for the majority of people to lose weight and
maintain weight loss.
• All people deserve to enjoy the benefits of positive selfimage; attention to self-care; enjoyable, appropriately
challenging movement; mental and spiritual well-being;
and a diverse diet that meets a variety of needs. Not just
thin people, or those aspiring to become thin.
• (Many thin people are not practicing HAES either! We just
equate health with thinness.)
•
•
•
•
•
•
•
•
•
•
The things that make people
healthier are not dependent on
weight loss!
Good nutrition
Pleasurable physical activity
Social support
Restful sleep
Access to quality medical care
Meaningful work
Physical safety
A clean environment
Social justice
Freedom from stigma
HAES is an approach that
evolved from
• The critical and careful reading of thousands of research
studies;
• the clinical experience of thousands of healthcare
professionals who have grown concerned about
traditional weight-centered approaches that do not work;
• the lived experiences of thousands of people who have
tried to follow decades of advice about losing weight as a
path to health, who ended up less healthy, more
discouraged, and more at war with the very bodies they
must value enough to sustain the effort to be healthy.
Outcomes of Program Based on
HAES/Non-Diet Principles
Improved health without
harm, dependency, or
discrimination.
61
Evaluating a
Non-Diet Intervention
• Comparison of non-diet wellness program
to traditional diet program
• Randomized clinical trial with 6 month
intervention
• Measures at baseline, 3 months, 6 months,
and 1 year
Bacon et al. Int J Obes. 2002;26:854-865.
62
Non-Diet vs. Traditional Diet
Intervention
Component
Diet
Non-Diet
Caloric restriction
Yes
No
Physical activity
Yes
Yes
Body/self acceptance
No
Yes
Internal cues (hunger/satiety)
No
Yes
Counselor facilitated
Yes
Yes
63
Selected Outcomes at One Year
Outcome
Diet
Non-Diet
Weight Change
-5.9 kg
-0.1 kg
Cholesterol
-33 mg/dl
-32 mg/dl
LDL-cholesterol
-12 mg/dl
-9 mg/dl
Triglycerides
-45 mg/dl
-41 mg/dl
Systolic BP
-8.2 mmHg
-4.5 mmHg
Dropout Rate
41%
8%
64
Conclusions at One Year
• Traditional diet approach resulted in
weight loss at 1 year; non-diet approach
did not
• Non-diet and traditional diet approaches
produced similar improvements in
metabolic fitness, psychological measures,
and eating behaviors
• Non-diet approach had significantly lower
attrition rate
65
Follow-up at Two Years
• Non-diet/HAES group:
– Maintained weight throughout
– Sustained improvement in metabolic health
indicators, activity levels, eating behaviors, and
psychological measures
• Traditional diet group:
– Weight lost at one year was regained
– Little sustained improvement
Bacon et al. J Am Diet Assoc. 2005;105:929-936.
66
Conclusions at Two Years
• Non-diet/HAES approach promotes longterm behavior change
– Traditional diet approach does not
• Size acceptance, reduction in dieting
behavior, and eating based on internal
hunger/satiety cues results in improved
health indicators
67
Review: HAES Paradigm for
Obesity Treatment
• “Initial results of the HAES-based paradigm
show some promise in offering a more
realistic and long-term approach to weight
and lifestyle.” (p. 43)
Miller and Jacob. Obes Rev. 2001;2:37-45.
68
HAES refocuses us on:
• helping people make sustainable self-care
practices a lasting feature of their day-today lives
• teaching children to treasure their bodies
and look to them for irreplaceable wisdom
about making day-to-day decisions
• transforming a culture of weight obsession
into a body positive, realistic celebration of
our human diversity.
HAES refocuses us on
educating about the health impact of weight
stigma, from
•
•
•
•
•
•
•
•
the world of fashion and advertising, to
the doctor's office, to
the adoption agency, to
the airline ticket counter, to
the job interview, to
the online dating ads, to
the clothing store, to
the "I'm so fat" chatter of your best friends.
HAES refocuses us on
getting on with our lives and
the hard, rewarding work in
front of us.
Critical Need for HAES Now!
• Well-established failure of traditional
weight loss approaches
• Physical and psychological damage from
traditional approaches
• Health improvements NOT dependent on
weight loss
72
“Do No Harm”
• Ethically, health care professionals seek
treatments that:
– Encourage autonomy
– Help, not harm
– Do not discriminate
• For successful treatment, must shift the
traditional weight paradigm
73
“Do No Harm”
• “In sum, there is little support for the notion that
diets lead to lasting weight loss or health
benefits.”
–
–
Mann, T. et al (2007) Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist 62 (3) 220233.
http://mann.bol.ucla.edu/files/Diets_don%27t_work.pdf
• So when clients ask for our support in weight loss
efforts, what are the ethical implications of
agreeing when we know they will likely fail and
have negative physical & mental health
consequences ?
“Do No Harm”
• Muenning, 2008
– “Our results raise the possibility that some of the
effects of the obesity epidemic are related to the
way we see our bodies.”
• Neumark-Sztainer, 2006
– “Adolescents using unhealthful weight-control behaviors at Time 1
increased their body mass index by about 1 unit more than
adolescents not using any . . . and were at approximately three tiems
greater risk for being overweight at time 2. . . (They) were also at
increased risk for . . . extreme weight-control behaviors such as selfinduced vomiting and use of diet pills, laxatives, and diuretics . . .”
“Do No Harm”
• Puhl and Brownell, 2006, 2007
– “More frequent exposure to stigma was related to more
attempts to cope and higher BMI. Physicians and family
members were the most frequent sources of weight bias
reported. Frequency of stigmatization was not related to
current psychological functioning . . .”
– “Participants who believed that weight-based stereotypes
were true reported more frequent binge-eating and
refusal to diet. . . These findings challenge the notion that
stigma may motivate obese individuals to engage in
efforts to lose weight.”
“Do No Harm”
• Tylka , 2006
– Intuitive eating is associated with psychological well-being.
“Women who accept their bodies are more likely to eat
healthy.”
• Gailey, 2012
– “Fat women who are involved in the size-acceptance
movement tend to have a better self-image and sexual
relationships.”
• Arroyo, 2012
– The more often someone engages in “fat talk,” the lower
that person's body satisfaction and the higher the level of
depression after three weeks. "It is the act of engaging in
fat talk, rather than passively being exposed to it, that has
these negative effects.”
Research on Fat Studies in
Mental Health Training
• Qualitative study of students who have
completed the 1-unit elective course and
agreed to participate in 2-hour interviews
• Interviews are guided by the question “how
has the FA/HAES class impacted you?”
Research on Fat Studies in
Mental Health Training
• N=6 thus far; goal is for N=8-12
• Participants thus far
–
–
–
–
–
Mixture of male and female
Mixture of body sizes
Range in age from 26 to 50
All participants so far ID as White
One IDs as Latino/Hispanic
Research on Fat Studies in
Mental Health Training
• Participants have discussed
– How they chose to take the class
– Expectations/assumptions about the class and
classmates
– Memorable parts of the class
– Interactions with peers/colleagues in the class
– Awareness of their own biases about body size
– Awareness of stigma & micro-aggressions from others
Research on Fat Studies in
Mental Health Training
• Participants have discussed
– Impact of the class on their own body image
– Impact on relationships with peers
– Impact on relationships with partners/sig. others
– Impact on relationships with parents, siblings, & other
family
– Impact on relationships with friends, roommates,
partner’s friends, etc.
– Impact on perception of their clients & training sites
– Conflict over how much of an “activist” to become
Research on Fat Studies in
Mental Health Training
• Participants have NOT noted an impact of the
class on the general atmosphere at school
– Conversations in the halls/break areas
– Conversations about food, bodies, dieting when food is
brought to classes
– Fat-stigmatizing comments from faculty in other
classes
– Weight/body size generally not included in
“dimensions of diversity” conversations
– Higher-weight students have not felt comfortable
challenging privilege of lower-weight students
– Not sure how to initiate conversations with clients
Research on Fat Studies in
Mental Health Training
• Students like the class content and process
• Some wish the class were longer (more units)
• Some wish the class had a clearer connection to clinical
practice
• Some suggest that info on body size and weight stigma be
integrated into multicultural & group process classes
• Some would like a practicum option to use this info in a
concrete, direct service way
• Students feel a “gap” between research and practice, and
between the processes in the course and the overall
climate of the program
Fat Studies in MFT Training?
• Opportunities
– Another dimension of diversity/social justice,
particularly when looked at with an
intersectional lens
– Deeply relevant to a field that is over 80%
female and climbing
– Opportunities for research on FA/HAES with
families, in couple processes, looking through
intergenerational lenses
Fat Studies in MFT Training?
• Challenges
– Pressures of time/content in courses already
– Few academic resources that directly address mental
health - body size is not included in Family Life Cycle,
other multicultural/diversity texts
– Funding for research on weight is nearly all controlled
by weight “loss” & bariatric industries
– Resistance, from students & faculty - weight stigma is
still seen as “useful” and “virtuous”
Fat Studies in MFT Training?
DISCUSS:
• Look at your responses from the initial exercises.
• What do our own self-of-therapist issues on this topic look
and feel like?
– What is your personal history with dieting efforts and weight loss,
weight gain, weight cycling?
– What stereotypes and stigma do you subscribe to regarding fat
people?
– What beliefs or fears do you have about embracing Fat
Acceptance/Health at Every Size?
– What is the culture of your workplace, school, or community
regarding fatness, dieting, eating, etc.?
Questions and comments?

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