S2E4 Food Addiction with Marci Evans, RD

Season 2 Episode 4: Food Addiction with Marci Evans, RD

Food Addiction, specifically sugar addiction, has become a hot button topic in recent years. People feel out of control around highly palatable foods and struggle to avoid over eating them. Sugar also lights up the pleasure centers of our brains, similar to drugs like cocaine and heroin. Does that mean that it, and other highly palatable foods are actually addicting? Listen to this great discussion I share with Marci Evans, RD to find out.

 

 

In this episode:

  • The research around food addiction and pleasure
  • Feeling out of control with food is definitely an issue
  • The Restrict/Binge Cycle
  • How HAES and Intuitive Eating can help reduce feelings of addiction around food
  • Yale Food Addiction Scale – is it harmful?
  • Cocaine vs Sugar and the Pleasure Centers

 

Marci Evans, RD 

Marci is a Food and Body Imager Healer®. She has dedicated her career to counseling, supervising, and teaching in the field of eating disorders. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. In addition to her group private practice and three adjunct teaching positions, Marci launched an online eating disorders training for dietitians in 2015 and co-directs a specialized eating disorder internship at Simmons College. She volunteers for a number of national eating disorder organizations including the iaedp certification committee and is serving as an eating disorder resource professional for The Academy of Nutrition and Dietetics.  She has spoken locally and nationally at numerous conferences and media outlets. She loves social media so tweet her @marciRD, follow her on Facebook and Instagram, and check out her blog at www.marciRD.com/blog.

 

If we are promoting a paradigm of abstinence or restraint or restriction, we are neurobiologically setting ourselves up, potentially, to act in a way that feels compulsive and out of control.
— Marci Evans, RD

S2E3 Weight Independent Diabetes Care with Megrette Fletcher M.Ed., RD, CDE

Is it possible to treat type 2 diabetes without weight-loss? It absolutely is. Join Megrette Fletcher M.Ed., RD, CDE and I as we explore treating type 2 diabetes in a weight independent way. Megrette has been been working in diabetes care since 1995 and has a great deal of information to share about caring for diabetic patients using effective tools that shift focus away from weight-loss. She is also the co-author of Eat What You Love, Love What You Eat with Diabetes and has authored five books for professionals. This is an interview no one will want to miss!

In this episode:

  • 8 Core Defects
  • Why weight-loss (including bariatric surgery) is not a long term solution
  • Behaviors are key to managing diabetes
  • Self care instead of weight-loss
  • Energy Balance, not Energy Deficit
  • How to encourage people to access diabetes educators
  • How weight independent treatment helps patients cope with diabetes
  • Self Compassion
  • How having a HAES trained diabetes educator can help providers better manage patients' over all health  
This fantasy around weight has lead us to a) not treat the patient with diabetes or educate people around diabetes because we spend all of our time trying to sell them on weight-loss...and then when they say...’I really want to manage my diabetes but I don’t want to lose weight’, no one knows what to do with them.
— Megrette Fletcher M.Ed., RD, CDE

 

About Megrette:

Megrette is a registered dietitian and certified diabetes educator who has worked in diabetes care since 1995. Her interest in mindful eating started in 1999 when she began meditating on a consistent basis. In 2005, she co-founded The Center for Mindful Eating, an international non-profit organization that explores the benefits of mindfulness and health. In addition to offering webinar trainings about the scientific benefits of mindfulness and health, Megrette has written five books for professionals including Diabetes Counseling and Educational Activities: Helping Clients without Harping on Weight, The Core Concepts of Mindful Eating, Discover Mindful Eating, Discover Mindful Eating for Kids and co-authored Eat What You Love, Love What You Eat with Diabetes, Michelle May MD. Megrette has recently created a Facebook group for HAES professionals, interested in diabetes care, called Weight Neutral for Diabetes Care. The group can be found by searching for WN4DC.  

She is very active in the cycling community, and in 2011, her passion for biking prompted her to form the largest and top-grossing cycling team in the Tour de Cure (for diabetes) Kennebunk fundraising event. Megrette, a dog lover, passable cook, and terrible bowler, is blessed to live and laugh with her family in beautiful in New Hampshire, outside of Boston. To learn more about Megrette, please visit her website at Megrette.com or follow her on Facebook or Twitter.

Resources:

  1. 8 Core Defects
  2. Megrette's books
  3. Megrette's website
  4. Webinar for the book

Patient Experiences and Update

This episode is a bit of an experiment for the podcast. I have included the stories of three people who have had challenging experiences with medical providers due to their sizes. There is an additional story that specifically talks about medical providers showing bias around each other as well. I also included a quick update about the future of the podcast.

“Our stories are an important way for us to learn about other people and their experiences because they connect with us on a heart and soul level.”
— DeAun Nelson, ND
These secret actions of fatphobia must be called out as well as we work towards changing the medical establishment to focus on respect for every body and health at every size.
— From one of the Patient Experiences

S2E1: Interview with Dr. Jon Robison

Welcome to Season 2 of the Do No Harm Podcast! The first episode of the season is an interview with Dr. Jon Robison, a national leader in the Health At Every Size Movement for more than 2 decades.

Jon Robison holds a doctorate in health education/exercise physiology and a master of science in human nutrition from Michigan State University where he is Adjunct Assistant Professor. Dr. Robison is also Adjunct Associate Professor in The Holistic Health Care program at Western Michigan University. He has spent his career working to shift health promotion away from its traditional, biomedical, control-oriented focus, with a particular interest in why people do what they do and don’t do what they don’t do.

Jon has authored numerous articles and book chapters on a variety of health-related topics and is a frequent presenter at conferences throughout North America. He is co-author of the book, “The Spirit & Science of Holistic Health - More than Broccoli, Jogging and Bottled Water, More than Yoga, Herbs and Meditation,” a college textbook and a guidebook for practitioners who wish to incorporate holistic principles and practices into their work. This book provided the foundation for Kailo, one of the first truly holistic employee wellness programs. Kailo won prestigious awards in both Canada and The United States, and the creators lovingly claim Jon as its father.

Jon has implemented Health for Every Body® — a unique alternative to weight loss programs at the worksite in over 20 cities across the United States in the past 3 years. He is also one of the featured health professionals in the powerful documentary America The Beautiful II: The Thin Commandments and has been helping people struggling with weight- and eating-related concerns for 25 years.

His new-released book: How to Build a Thriving Culture at Work: Featuring The 7 Points of Transformation, written with co-conspirator Dr. Rosie Ward gives organizations a realistic, step-by-step blueprint to accomplish the difficult task of transforming their cultures to be healthier and more productive — “from the inside out.” The book was selected by Employee Benefit News as one of the top must reads for 2016.

As a Certified Intrinsic Coach, Jon understands that behavior is the outward manifestation of thinking and feeling – and that behavior modification approaches that focus on extrinsic motivation rarely result in sustained change and, in fact, often inhibit intrinsic motivation.

Aside from his work Jon’s passions include his wife Jerilyn, music, humor, an 11-lb living Teddy Bear named Ginger and watching his gifted son Joshua play soccer.

In this episode:

  • How Dr. Robison found HAES®
  • The research that shows that significant and sustained weight loss is not possible
  • The CDC article about Physical Activity at Every Size
  • His program Health for Every Body
  • And much more...
Do we really need more research that prejudice and stigma are health minimizing?
— Dr. Jon Robison

S1E8: Patient Empowerment through Fat Acceptance

This will be the last episode for the season and the year! I was joined by Shilo George, an activist and educator, and we talked about the importance of Fat Acceptance and Body Acceptance when it comes to individual health, and also to community health. The Fat Acceptance movement itself focuses on reducing and eliminating fat bias and fat stigma, thus improving overall health. If we are going to create better health as a society, spending time on reducing stigma is paramount.

 

 

A little bit about Shilo:

Shilo George is Southern Cheyenne-Arapaho and Scottish international speaker, trainer, and owner of Łush Kumtux Tumtum Consulting, which means “a great awakening of the heart and spirit” in the Chinuk Wawa trade language. She has lived her life in a body that transgresses and violates Western standards of beauty, size, sexuality, and health. Shilo interweaves cultural traditions and spirituality with an anti-oppressive and decolonizing lenses to promote healing and empowerment in herself and others in the communities she is a part of. Her workshops and presentations explore the intersections of race, sexuality, body size, and trauma (both individual and inter-generational). Shilo trains others on systems of oppression, trauma informed care, and proactive ways that businesses and organizations can create policies and environments that that promote diversity, equity, and healing. 

Shilo received her Bachelor of Science in Art Practices in 2012 and a Masters of Science in Educational Leadership and Policy with a specialization in Postsecondary Adult and Continuing Education in 2017, both from Portland State University. She was named Higher Education Student of the Year by the Oregon Indian Education Association in 2013 and in 2015 was honored with the Queer Indigenous Scholar Activist & Alumni Award by the Indigenous Nations Studies Department at Portland State University. In addition to her consulting business, Shilo works as a Parent Advocate at the Native American Youth and Family Center and is an Affiliated Adjunct Instructor of the Indigenous Nations Studies at Portland State University. She can be contacted at shilomgeorge@gmail.com. 

I will update this information when her website goes live.

 

Are we really setting fat people up to succeed or are we setting fat people up to fail?
— Shilo George

I hope that you have enjoyed season one of the Do No Harm Podcast. I will be returning on January 26, 2018 with the first episode of Season 2! Happy New Year!

 

S1 Bonus Episode: Guidelines for Medical Providers with Fat Patients

This bonus episode gave me a chance to read aloud the Guidelines for Medical Providers with Fat Patients by the National Association for the Advancement of Fat Acceptance (NAAFA). It is a follow up episode to the Promoting Health without the Scale episode because the guidelines fill in a couple of gaps and are also so well written.

S1E7: Promoting Health Without the Scale

The seventh episode of the podcast will dive into options for treating patients that do not center on weight change. Significant and permanent weight change is nearly impossible for the majority of the population, so we need to use weight independent, evidence based treatment for people of all sizes.

In this episode:

  • Defining weight neutral/weight independent and weight inclusive
  • Health at Every Size ®
  • Intuitive Eating vs Restrictive Eating
  • Well Now
  • How to move away from using weight as a determinant of health
  • Thinking beyond the individual - how society can change to support health

I would like to thank Julie Duffy Dillon for helping me come up with the title for this episode.

Music by Galynne Davis

Cover Art by Stacy Bias

 

Part of our job should not be just doing no harm, but also trying to remove the harm that’s being done outside of our offices.”
— DeAun Nelson, ND

 

Questions to Consider:

  1. How do your assessments and treatments change if they do not include weight change?
  2. How would you treat a thin patient without recommending weight loss?
  3. How can we, as individuals, help to create a society that improves everyone's health by reducing stigma.

 

Resources:

1. Bacon, L. and Aphramor, L.Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal201110:9

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10

2. Mensinger, JL et al. Appetite. 2016 Oct 1;105:364-74 https://www.ncbi.nlm.nih.gov/pubmed/27289009

3. https://lindabacon.org/_resources/resources-health-care-providers/

4. Aphramor, L. Validity of claims made in weight management research: a narrative review of dietetic articles. Nutr J. 2010; 9: 30.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916886/

5. http://lucyaphramor.com/dietitian/

6. Aamodt, S. (2016) Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. New York, NY: Penguin.

7. Bacon L, Aphramor L. Body respect: what conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX: BenBella Books; 2014.

8. Bacon, L. Health At Every Size: The Surprising Truth About Your Weight. Dallas, TX: BenBella Books; 2008.

S1E6: The Ineffectiveness of Diets

**Content Warning: We do discuss some weight and calorie numbers during the episode.

This episode covers the topic of intentional weight loss through restrictive eating or lifestyle changes. We discuss why intentional weight change does not work long term and why it can cause more harm than good for people’s health. I am joined by a guest co-host, Sumner Brooks, RD of Eating Disorder Registered Dietitians & Professionals. Her insight and knowledge were invaluable.

 

In This Week's Episode:

  • What does “working” mean when discussing diet outcomes?

  • Physiological outcomes of intentional weight change

  • Evidence for diets is Biased

  • How restriction can lead to bingeing, disordered eating, and eating disorders

  • The detrimental effects of inevitable weight cycling

 

"If we, as health professionals, recommend to a patient to go and try to lose weight when we know that the most likely outcome is short term weight loss followed by weight gain, we are doing some harm there." 
-Sumner Brooks, RD

 


Questions to consider: (We did not get to these on the podcast itself, but they are still important)

  1. Since diets don’t work, what if we stopped recommending them to patients and started supporting them in their focus on healthy habits, which have been shown to help health regardless of size?

  2. What if we turned our focus from forcing weight change and spent our time and energy on making sure that everyone had enough, high quality food?

  3. Why are the behaviors that are diagnosed as eating disorders in thin people, prescribed to fat people?

 

Resources:

1. http://archive.wphna.org/wp-content/uploads/2016/01/2005-Mad-Science-Museum-Ancel-Keys-Starvation.pdf

2. Fothergill, Erin, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity Society Journal. 2016 August; 24(8):1612-1619

http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/full

3. Lester B. Salans, Edward S. Horton, and Ethan A. H. Sims. Experimental obesity in man: cellular character of the adipose tissue. J Clin Invest. 1971 May; 50(5): 1005-1011.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC292021/

4. Rudolph L. Leibel, M.D., Michael Rosenbaum, M.D., and Jules Hirsch, M.D. Changes in Energy Expenditure Resulting from Altered Body Weight. N Engl J Med 1995; 332:621-628

http://www.nejm.org/doi/full/10.1056/NEJM199503093321001#t=article

5. Aamodt, S. (2016) Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. New York, NY: Penguin.

6. P.A. Tataranni and E. Ravussin, “Energy metabolism and obesity.” In Handbook of Obesity Treatment, ed. TA. Wadden and A.J. Stunkard (New York: Guildford Press, 2004), 42-72.

7. J-P Montani, AK Viecelli, A Pre´vot and AG Dulloo. Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the ‘repeated overshoot’ theory. International Journal of Obesity (2006) 30, S58–S66

https://www.nature.com/articles/0803520.pdf?origin=ppub

8. L. Bacon and L Aphramor. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 2011 10:9.

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

9. Tomiyama AJ, Ahlstrom B, Mann T. Long-term effects of dieting: is weight loss related to health? Soc Pers Psychol Compass. 2013;7(12):861-877.

10. Polivy J, Herman C: Dieting and binging: A causal analysis. American Psychologist. 1985, 40: 193-204.

http://psycnet.apa.org/doiLanding?doi=10.1037%2F0003-066X.40.2.193

11. Baumeister RF, Heatherton TF: Self-regulation failure: An overview. Psychological Inquiry. 1996, 7: 1-15. 10.1207/s15327965pli0701_1.

 

Additional Material:

Mann, T. (2015) Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again. HarperCollins.

S1E5: Healthism

SHOW NOTES E005: Healthism

 

Healthism is prioritizing individual health above other things. It is also the idea that individuals have significant control over their health. It does not acknowledge that a great many things outside of an individual’s affect their health, such as oppression, war, hatred, environmental factors, and access to medical care. Ultimately, it is important to address societal inequities that affect individual health. The expectation of maintaining a certain level of health can lead to stress and unhealthy coping mechanisms. It is important to look beyond looks and support individual health as much as possible as we dismantle oppression.

 

In this episode, I will address:

  • What is healthiest?

  • How doctors can address healthism

  • Nutritionism

  • The “good fatty/bad fatty” dichotomy

  • Patient Autonomy and “non-compliance”

  • How doctors can support patients while we change society

 

“Food should be our pleasurable fuel, not our quest or destination. We’re all going to die regardless of how much quinoa we eat.
— Margaret McCartney, GP

References:

 

1. Greenhalgh, T. and Wessely, S. ‘Health for me’: a sociocultural analysis of healthism in the middle class. British Medical Bulletin. 2004:69.                       

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bmb/69/1/10.1093/bmb/ldh013/2/ldh013.pdf?Expires=1509665356&Signature=P5BApSr-FCYZlFo6J-NLnkgDSrD3Q1uxbHa2W4hheNEJ8hlSNxcoJDFyfiOqljWZ9KiCse3YdcbVeWmQgExWETImTnDk7l8ddYr1-ifvHKBm2lmOP4qhieK-0BaoMIgzyfa0vHS8juHV89BxLBY8UL3KDVKLc9bEHTpyUWA0Q39rBXn-uqHkNMgHku8ckVD5d4HtaoNeXbruzK3Cpy~FQdFl3PUojK4QwPSJB~1PxKnf-HWTxseV7z04c74HZ~bAnx4g~tM3pK~wXoOZATSF6TG-IHZ1h4WlNM7RBmWTwaEh1TjmK9TUVOmPCk5KT5FjsqPuys5OPt2B5DPv3GsrQA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

2. Crawford, R. Healthism and the Medicalization of Everyday Life. International Journal of Health Services. Pub 1980.

3. Well Now information: http://lucyaphramor.com/dietitian/about/

4. McCartney, M. Margaret McCartney: Clean eating and the cult of healthism

BMJ 2016;354:i4095. http://www.bmj.com/content/354/bmj.i4095

5. https://www.kateharding.info

 

 

 

 

S1E4: The Effect of Weight Bias on Care

*Content Warning:  If you live in a larger body (whether you are a medical professional or not), please listen with caution. If it gets too hard to hear about the depth of weight bias, please pause and come back later. Or set up to have a friend listen to the episode as well, so that you have someone to speak to about it after you listen. We believe connection and community are crucial when living with weight bias. 

 

Because weight stigma is expressed through weight bias, it is necessary to discuss and examine our own weight bias as medical professionals and medical professionals in training. There is a growing body of research showing that weight stigma has a *significant* effect on long term health, making it an important subject for medical professionals to address personally and collectively. So we will spend today’s episode diving into what weight bias is, the research, and what we can do about it.

In This Week's Episode:

  • The difference between implicit and explicit bias
  • A thought experiment considering what words come to mind to describe thin and fat people
  • How categorizing information is human nature
  • Discussion of research showing larger patients get poorer health care than thinner patients
  • Discussion of research showing medical professionals' attitudes towards fat patients
  • Overview of research about eating disorder professionals' attitudes towards larger patients
  • How the nocebo effect influences outcomes of higher weight patients

 

Race is not a risk factor.
Exposure to racism is the risk factor.
The problem is not located in people’s bodies.
— Deb Burgard, PhD

Questions to Consider:

  • Can you adequately treat larger patients when you have negative attitudes towards them?
  • Can you provide weight-inclusive or even weight-neutral care when you have an explicit bias against patients at the higher end of the weight spectrum?
  • How would you treat someone if you assumed that their size was not the cause of their condition?
  • Can you start paying attention to how your internal reactions to your larger patients may differ from those of your smaller ones?
  • Consider how do you help your patients or clients when you weigh yourself regularly, are on a diet, or dislike your own body?
  • What if how we think and talk of fatness causes more harm than the fat itself?

Resources (mentioned in this episode): 

Extra resources:

 

Thank you for joining us for Do No Harm Podcast! If you appreciated this week's episode, visit iTunes or Google Play Music, subscribe to the show, and leave a review to help us spread this very important message.

 

S1E3: The Effect of Weight Stigma on Health

Weight Stigma, and stigma in general, is an intricate and complicated subject that permeates the society we live in. We are all affected in some way by stigma, whether we are the subject of stigma, perpetrators of stigma, or both. Stigma also has a significant effect on long term health, making it an important subject for medical professionals to address personally and systemically.

 

In this week’s episode, we will discuss the 7 Weight Stigma Myths (As outlined in Body Respect):

  • Fatness leads to decreased longevity

  • Body Mass Index (BMI) is a valuable and accurate health measure

  • Fat plays a substantive role in causing disease

  • Exercise and dietary restriction are effective weight-loss techniques

  • We have evidence that weight loss improves health

  • Health is largely determined by health behaviors

  • Science is value free

 

"The only thing anyone can accurately diagnose when looking at a fat person is their own level of weight prejudice."                                    - Marilyn Wann

 

Questions to Consider:

  1. Did you recognize your own assumptions when listening to the stigma myths?

  2. Have you experienced weight stigma?

  3. Can you start paying closer attention to language and attitudes around weight?

  4. How can you create a safer space for people who are inundated with weight stigma on a daily basis?

  5. What would happen if you considered someone’s size was not their fault?  

 

Resources:

  • Bacon L, Aphramor L. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. Dallas, TX: BenBella Books; 2014.
  • Klein S, Fontana L, Young V. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. ACC Current Journal Review. 2004;13(8). doi:10.1016/j.accreview.2004.07.105.
  • NCHHSTP Social Determinants of Health. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/socialdeterminants/faq.html. Published March 21, 2014.
  • Strohacker K, CARPENTER K.C., MCFARLIN B.K. Consequences of Weight Cycling: An Increase in Disease Risk? International Journal of Exercise Science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241770/. Published July 15, 2009.
  • Olson MB, Kelsey SF, Bittner V, Reis SE, Reichek N, Handberg EM, Merz CN (2000). Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect. Journal of the American College of Cardiology 36: 1565–1571.    
  • Who's fat? New definition adopted. CNN. http://www.cnn.com/HEALTH/9806/17/weight.guidelines/. Published June 17, 1998. 
  • T. A. Wadden, Obesity (Silver Spring). 2006 May; 14(5): 737–752. (Look AHEAD)

Thank you for joining us for Do No Harm Podcast. If you appreciated this week’s episode, visit iTunes or Google Play Music, subscribe to the show, and leave a review to help us spread this very important message!

S1E2: Should There be a War on Obesity?

*Disclaimer: We will be using the terms “overweight” and “obese” for this episode, because they are the medical terms currently being used. Therefore they have specific definitions. We find them offensive when used to describe people and will normally use the terms larger/smaller bodied, or fat/thin throughout the podcast.

*We unfortunately had technical difficulties with this episode, and we have published a re-edited version. Thank you so much for your patience while we are learning!*

 

The “War on Obesity” has been raging for decades. Just like many similar wars, such as drugs and terrorism, it has a very nebulous enemy and never really has an end. These types of “wars” rarely accomplish their stated objective. This war is attacking ordinary, law-abiding citizens who happen to be traveling around in bodies that are larger than whatever society has deemed “appropriate”. From babies to the elderly, no one who is fat is truly safe from this war, nor are those who fear becoming fat.

In This Week’s Episode:

  • The history of the Body Mass Index

  • Questions about the process that lowered BMI standards by the NIH in 1998

  • There are many determinants of health and weight is a small component.

  • Risks of pursuing weight loss to increase health

  • Dangers of assuming thin people are healthy

  • Dangers of assuming larger people are unhealthy

  • Inability to eradicate fatness from a population

  • Compassionate care providers not recognizing the damage caused by fighting “obesity”

“How would we ever get on board with prescribing for fat people what we diagnose as eating disordered in thing people?
— Deb Burgard, Food Psych Podcast, Episode #117

S1E1: Introduction

Get to know co-hosts, DeAun Nelson who is a naturopathic physician and Sarah Thompson who is a MS candidate and Body Trust® Advocate candidate. We introduce our topic of what's possible in health care when we shift our focus off of weight and why it is important to each of us.