More on this book
Community
Kindle Notes & Highlights
by
Cole Kazdin
Read between
April 17 - April 20, 2023
replaying last night’s dinner in my mind like a pro athlete after a loss: What could I have done differently? How can I do better next time?
But every fifty-two minutes, someone dies as a direct result of their eating disorder.
It’s so common that scientists have named the phenomenon “normative discontent.”5 Meaning it’s considered normal for a woman to dislike her body.
Eating disorders can provide a false sense of power and control, even though the feeling around food is total absence of control.
we no longer name harmful behaviors accurately. They were rebranded while we weren’t looking. (Maybe we were exhausted from lack of carbs and didn’t notice.) “Fasting” and “intermittent fasting” are now chic terms for skipping meals and starving; “detox tea” has replaced “diuretics,” though they’re the same thing. “Cheat day” is a binge.
I still feel stress around eating, and even without retreading old eating disorder ground like starving or purging, which I no longer do, I’m still frequently preoccupied with food and what I should and shouldn’t be eating. It’s such familiar territory, I’m not fully aware of how much stress it’s causing me.
everyone at the Harvard School of Public Health, and Michael Pollan all agree on the following general health principles when it comes to what we eat: • More vegetables are always a good thing.12 • Soda is pretty much garbage.13 • Eating red meat is scientifically linked over and over and over again to higher risk of cardiovascular disease.14 • Whole grains are a better option than Cheez-Its.15 That’s it!
We cannot necessarily change our actual circumstances, but we can change how we perceive them. Stress is the silent killer that everyone knows about but few tackle.”
Food restriction causes stress. In both humans and mice, studies have found that monitoring and restricting calories prompts a stress response in the body and a rise in stress hormones, like cortisol. Reducing food restriction and therefore the resulting and well-documented mental toll, we can reduce our stress levels.
Maybe that is the true definition of healthy eating: no restrictions, no “good” foods or “bad” foods, and therefore nothing to rebel against, no losing control. Why? Because when everything is allowed, there is nothing to control. What if “eating healthily” had less to do with the food we put in our mouths and more about how we feel while we’re eating?
I’m genuinely not exactly sure what it means to “eat like a normal person.” Are there any left? I share my bed with a man who generally eats in a balanced way but also ate an entire bag of tortilla chips for dinner last night and never seems to gain a pound. That’s just the way his individual body is rigged.
As consumers have become savvier and backlash against diet culture grows, the diet industry is adapting. “They’ve co-opted the language of the body positivity movement, terms like ‘anti-diet’ and ‘we’re not about weight loss, we’re about health,’”
Your brain doesn’t care how you look. She’s trying to keep you alive despite yourself. She also has her own agenda. The brain weighs about three pounds, yet consumes up to 20 percent of our body’s calories.19 Dieting affects brain functioning, as evidenced by a series of studies in which researchers asked dieters and nondieters to complete a series of mentally challenging tasks. The dieters had more trouble focusing than the nondieters; they forgot words and sentences and reacted more slowly to stimuli.
Our bodies don’t want us to diet. The weight loss industry does.
control. If I could control my body, then by the transitive property, it stood to reason that I could control other things in my life: work, success, money, and even relationships. I felt more confident than I had in a long time,
Black teenage girls are 50 percent more likely than white teenage girls to exhibit bulimic behavior, and yet BIPOC are half as likely to be diagnosed (much less receive treatment) as their white counterparts.
The instances of diagnosing the patient with an eating disorder were significantly higher when the patient was white.4
In fact, thinness in and of itself is often viewed as a metric that things are going well. Case in point, the oft-used You look great, have you lost weight? Gaining weight, by comparison, is often perceived as external evidence that something’s gone wrong. As in, She’s really let herself go.
When the goal is weight loss (or when you say “health reasons” aloud but secretly mean weight loss), the behaviors are mentally unhealthy. Rigidity around food is a warning sign.
Is there anything you’re missing out on because your focus is on food, weight, and body?
But this—not this. I don’t like chocolate, I don’t want to eat crappy junk food. “I could eat a bag of M&M’s in one sitting,” she laughed, trying to keep it light. Yeah, no shit. She pressed. Is “bullied” too strong a word? I began, very quietly, to cry. “Look, I understand the game,” I explained. “Bring me an everything bagel, a slice of Ray’s pizza.” She wasn’t hearing me.
if a person is at a high body weight, other people’s negative attitudes toward their body may carry more health risks than the weight itself.
Type 2 diabetes, which we hear time and time again as correlated to higher weights, is also associated with weight fluctuation. Losing and regaining weight (which happens to the majority of people who diet) may elevate diabetes risk.
It’s important to note that even in a world where everyone ate kale and lentils all the time, we still all wouldn’t be the same, thin weight. There would still be people of all sizes. We’re all different. Which is not to say that weight is irrelevant to health. There are genuine health associations with higher weights (associations, not causal relationships necessarily), but it’s much more complex than only looking at weight. As long as the focus of health care, from doctors, government guidelines, insurers, and more, begins with bodies and weight, people are being set up to not only fail but
...more
The Health at Every Size (HAES) paradigm takes the position that people of all sizes can be healthy.22 Embracing the reality that we may not be able to control our weight and that overwhelming scientific evidence supports that setting out to lose weight very likely will not work, the best thing we can do for our health is to take the focus off of our weight. In part, this involves • working on liking your body as is, right now (I know, I know, but that’s why I wrote “liking” not “loving”), noting that body acceptance isn’t just about us; there is a diverse range of body types in the world;
...more
I don’t know if I know how to make an honest non–weight loss goal myself. When I say, “Eat more leafy greens! For health!” it’s an elaborate lie, even if there’s a grain of truth within. No matter how much research I do, no matter how many experts I interview, there’s a part of me, deep within, that believes that if I eat more leafy greens, my body will indicate its improved health by shedding weight.
“Healthy weight” isn’t a standard number at all. It’s what we weigh when our behaviors are healthy.
Feeling positive in your body at all times is so unrealistic in the world we live in. Also, if your self-worth is about feeling beautiful, it’s still objectifying you.”
Instead of aspiring toward another version of beauty or having something to prove, liberation is deeply personal. Accepting where we are right now (including but not limited to our appearance) as well as the world we live in. “Liberation is recognizing the systemic issues that surround us and acknowledging that perhaps we’re not able to fix them all on our own,” wrote author and activist Jes Baker.4 “Liberation is slowly learning how to become the best version of our whole selves—body included, yes. But it is no longer a requirement on our checklist of self-improvement to learn to love it.”
...more
Research has shown that female political candidates with higher body weights are seen as less dependable, less honest, and not as capable as their average-weight counterparts.10 Male candidates with higher weights, however, are actually viewed as more capable and dependable than their smaller peers. Another study, examining the concept of the “big man in the office,” found that larger men in leadership positions are viewed as more persuasive. In a good way.11
“From getting hired to getting fired. Salaries, promotional potential.” Thin women are more likely to be hired than larger women, and paid more, even when the larger person is more qualified. “It is perfectly legal,” she said.
Weight discrimination may have a stronger, negative impact on women in larger bodies, but weight stigma, negative attitudes and/or judgment about a person’s weight don’t only impact people in larger bodies—they affect most people, regardless of size.
So, OF COURSE most women feel bad about their bodies. If it’s legal to discriminate based on a person’s weight, if teen girls and women report being teased and shamed for not looking exactly like one very specific and rigid ideal of a thin body (if you’re not sure what that ideal looks like, I guess turn on your TV, open a magazine, switch on your computer?), then it makes perfect sense that we’re all kind of looking over our shoulders, comparing ourselves to others, never feeling quite physically enough, wanting to protect ourselves from additional scrutiny.
As race and sexual orientation biases decreased, weight bias increased by 40 percent. Researchers believe this increase can in part be attributed to the impression that weight is within a person’s control (whereas race and sexual orientation are not). But also, “the increasing attention to the health benefits of lower body weight and concerns about the obesity epidemic may be responsible for the increase in bias,”
While Puhl has found in her research abroad that other Western countries’ negative attitudes line up with those found in the United States, there is an American individualism, Protestant-work-ethic thing going on, too. “If you’re overweight, that means you didn’t try hard enough, you deserve what comes with that,” Puhl said, describing the logic at play. “If you’re thin, you’re doing the right thing; you will be rewarded. That kind of thinking is fundamental to the American consciousness. The media perpetuates these messages, and we don’t have policies. So if you put all of those things
...more
“To be recovered is to inhabit one’s body and to experience food and exercise in ways that are not ruled by concern over size, shape, and numbers,” she told me. “Emotions and life experiences are navigated using strategies that do not compromise one’s health or well-being.”
The program in Sweden has reduced the overall number of hospitalizations and emergency room visits dramatically for people with eating disorders, according to Bulik. “Because they finally have agency over their own recovery,” she said. “It’s not this battle with the system. It’s finally saying, We respect you as a knowledgeable individual about your own body and your own health, and we’re going to give you a safe space to take a timeout, and then you can get back into life again.”
So she begins with asking about food preferences, how patients acquire most of their foods, what kind of budget they have, along with learning about their lifestyles and relationships. The first go-to is setting up a mechanical eating schedule: eat within an hour of waking up, then about three hours after that, then three hours after that, and so on. If someone isn’t hungry, then it’s a smoothie or something bland, like a grilled cheese. Regular eating patterns restore weight to where the body wants to be and dim down the drive to binge and/or purge. Until a person’s relationship with food is
...more
Sometimes a person appears “overweight,” and may even be overweight per the NIH guidelines (shakes fist!), but for that person, it’s actually an anorexic weight because of the extreme and harmful measures they are taking to maintain it. Hellner’s goal with patients as far as weight is concerned, is to “honor their genetic blueprint,” she told me. As far as behaviors go, are they eating with regularity, not distressed around food, not preoccupied with weight loss. “Eating just for fun or purely for enjoyment, and not always focusing on the distant health outcomes,” she said.
“No tool is going to work if it isn’t expressive, if it doesn’t let your own traits express themselves.
For example, when I indicate on the questionnaire that “determination” is a trait I’ve used negatively in the past (for losing weight), and believe I’m using positively now in my work, Hill goes further to suggest I apply it to moments of stress or crisis. If I’m upset, feeling bad about my body, for example, use determination to force myself to write about it. “To literally flip yourself to pull out some paper and start writing,” she said. Determination goes in the box. The best tools are the ones a person’s already doing. For example, if someone paints or builds furniture, perhaps they can
...more
Hill prefers the word “energy” to calories and, like dietitian Hellner, suggests that I eat every three hours, whether I’m hungry or not. I hate this idea. I tell her this. Worried it will make me obsessive over food. She gestures to the eyeglasses I’m wearing. “Do you ever think about when you put on your glasses, Cole?” She proposes that meal planning can be the same way. Corrective lenses for my little insula. Hunger-fullness correction. I just need to practice. After all, the goal isn’t losing weight. (Wait, what? Oh yeah, right.) It’s sustaining the functions of my body.
“I have to make dinner and I have to eat.” I knew this is what had to happen next. I needed nourishment to strengthen my emotional reserves. Even though I wasn’t remotely hungry and I was afraid that eating would make me gain weight that very evening. Normally, I don’t like the TV on while I’m eating, but I needed a distraction. We ate on the couch, I ate slowly, we watched Succession. One hour passed. Inhale. Exhale.
So while Beyoncé herself may define beauty ideals, she’s not immune to the pressure of living up to them, Cox noted. In other words, even Beyoncé faces pressure to “look like Beyoncé,” she said.
Joseph prepares patients for childbirth like she’s “sending folks onto the battlefield.” She tells them never to show up alone—to always have someone to advocate on their behalf. And when contractions start, she advises them to “stay outside [the hospital] for as long as you can. Walk the grounds, stay in the parking lot until the last minute, because if you bust in the door ready to go, you’re going to get better care.”
“If we had said four hundred years ago that people with blond hair and blue eyes were less valuable, trust me, they would have bad birth outcomes,” says Dr. Joia Crear-Perry, a physician and the founder and president of the National Birth Equity Collaborative. “They would be obese, they would have higher rates of poverty, we would create structures and systems that devalue them.”
“Many practitioners fear asking the hard questions,” Small told me, “the ones about racial differences and identity issues—the responses to which can help them to recognize potentially mediating factors in the development of EDs.” Mediating factors, according to Fuller and Small, like white supremacy, wealth and equity gaps, disproportionate levels of adverse childhood experiences (like sexual abuse), violence, and intergenerational trauma, the idea that historical and cultural traumas affect subsequent generations. In other words, simply living in a Black body might be enough to bring on
...more
“It can’t be treated just like, eating disorders are brain disorders,” she told me. “They’re a whole lot more. Fat phobia, food insecurity, land theft—all these factors produce stress that lead to people not having peaceful relationships with food.”
To Lucas, the relationship between food insecurity and eating disorders connects directly to the history of oppression. “The way a lot of native societies viewed their own role in the universe and themselves is tied to land,” she explained. “There’s no separation. If we want Indigenous people to heal, we’ve got to give back the land. The land is their body, their body is the land.”
What is a non–weight loss reason to exercise? I ask myself. Be honest.
