S4E6: Unlearning Fatphobia

Margaux: Okay. So, all right. I'm so awkward.

Harjit: The beginnings, I feel like, are always awkward.

Margaux: I know. The transitions. Okay. Hey, everyone. Welcome to "Bundle Of Hers." This is Part 2 for the BMI and racism and BMI episode. If you didn't tune into Part 1, make sure you check that out.

Harjit and I are in the remote studio with our special guest, Isis, who's a nurse at Primary Children's and has saved my butt so many times. So make sure you check out Part 1 before tuning into this Part 2.

We finished Part 1 talking about what is health and our own experiences either personally or as providers with health and how BMI is tied to that incorrectly, and how it's flawed and harmful. But to really understand how fatphobia and white bias has become internalized in ourselves, I think it's always, for me, really important to think back on my experiences and childhood and sort of how that became the case for me and open it up to you guys.

So I don't know if either of you want to start, or I'm happy to start, just about when was the first time you were aware of your body or weight or diet culture or felt the need to be pulled into that?

Isis: I have struggled with weight my entire life. Just recently, maybe like two years ago, I jumped on the self-love journey and it has helped me grow significantly.

But if I sit down and think about it, I think it all started back in sixth grade when I was just a baby. And it saddens me to think that this has been a lifelong process. But we had some coats donated to our school and I remember being so excited to get a coat and not being able to get one because I couldn't find one that fit me. I think that's when I started being self-aware.

And like I said, I feel like it's been a lifelong process of trying to be comfortable with my body, with who I am as a person, and not let that weight or that BMI or that number define who I am as an individual.

Margaux: I have had a similar experience where, also in sixth grade, I have this very distinct memory of stepping on the scale . . . and thinking back it's like, "Why did I even have a scale in my bathroom?" I reached 100 pounds. And I don't know why or where I got that idea from, but I just felt dread and like it was the worst thing ever. I don't even know where these ideas came from or this number, the attachment to the number, but I just remember that really being a pivotal point.

From that point on, I think I never felt comfortable in my own body. I went on diets, and I even engaged in disordered eating almost to the point where I would call it eating disorder. Restricting calories to the point where I would only eat as much as I could run and burn off. So it was like net negative calories for a day. Really unhealthy things.

And I did two cycles of that, once in high school and then again in college. And even when I "lost the weight at my goal weight," whatever that meant, I was not happy. I never felt comfortable, I never felt satisfied, and then I was always starving.

And then, of course, when you restrict so extremely, the yo-yo is just as extreme the opposite way. And so these huge weights swings also were accompanied by a huge emotional toll on me. And I just never had any self-love I think until recently as well.

And like you were saying, it's so sad to think back that we were just babies in sixth grade and yet so influenced by these powerful negative ideas that shaped our lives for so long.

And as someone who works with children, I want to prevent that so much for these future generations, and I'm sure maybe that weighs on you as a mother too.

Isis: Oh, yeah. And I incredibly feel everything you just said. I don't think that there's a fad diet out there that I have not tried, because for so long, I longed to feel "normal" or healthy or beautiful. and it's really frustrating looking back on it and seeing how much I allowed for all of that to define my happiness.

And yeah, with being a mom myself, and I shared how my child is . . . she's a big girl. She's tall, she's muscular, and she does not look 10 at all. I noticed that she started having the same problems that I was having when I first started developing these issues. And that's kind of when I snapped out of it, because I never want her to struggle. I don't want any kid out there or anyone to allow what we socially think is acceptable to prevent them from being happy.

Margaux: A hundred percent.

Harjit: Can you kind of talk a little bit more about what that transition was to self-love? So you kind of said it was . . . was your daughter really the catalyst for that for you?

Isis: Yeah, for sure. So she came home one day and I could tell something had happened. We talked, and she said one of the boys in her class called her fat and ugly. It just hit me. It hit my soul. I have a really good relationship with her, and we use that as a momentum to learn how to love ourselves.

And one of the things that I've learned a lot is that whenever I talk about my weight or whenever I share with people my experiences, they're like, "But you're beautiful. But you're so pretty."

Harjit: It's always the "but."

Isis: Yes. I immediately stop people and I'm like, "Well, I didn't say I was ugly." I don't think of myself as an ugly person, and I feel like that's kind of what I used as a momentum to realize that my weight does not define who I am as a person, as a mother, as a provider.

It just kind of started from there, and knowing that my child looks up to me and she mimics how I treat myself. So if I'm going to love myself, then I know that, hopefully, that will be a good example for her.

Harjit: I kind of resonate with what both of you have talked about. I think I've gone through a recent self-love journey as well, but for me, a lot of it I guess . . . I always knew I was a body from a young age.

I just remember growing up with . . . it was me and my sisters and just being girls in our family and we had a lot of just comments here and there about how our body was. I think my mom always . . . and I understand she was also socialized like this, but she always . . . We had one sister that was thinner and two of us were a little bit chubbier. We had rounder faces and stuff. So I remember growing up and I just had . . . I felt like from a super young age, I always felt like that was something that was discussed.

I am a little bit of a rebel, and so when my mom would be like, "You should eat this or don't eat this," I would like totally defy her and eat whatever I wanted.

It was always in the background, and I think because of that, I always thought I was ugly. I never changed my behavior though. I still was on the defiant route, like, "I'm going to eat everything I want. I'm going to do whatever I want," which I'm happy for my body for that because I didn't deprive myself of anything. But because of what I heard, I always thought I was ugly. I never ever thought I was a beautiful person.

I think that's the way diet culture/fatphobia impacted my life.

And then I actually had a really impactful conversation with Margaux one day. We were walking . . . I think it was Millcreek, right, Margaux?

Margaux: Yeah.

Harjit: It's a canyon here in Utah. And she was telling me a lot about her story, which was so fun to know because we had never talked about it. We've known each other for several years now. I had a conversation with her because my second year of medical school, I had gotten really sick. I had a lot of acid reflux issues. So I went on this . . . I don't love using the word diet, but I went on this diet. I changed the way I was eating, and I was eating more whole foods, like fruits and vegetables, no processed sugar. And I ended up, as a byproduct, losing weight. So even though I did it for my health, I lost weight.

And then once I had lost that weight and I had gotten so many compliments from people, like, "Oh my gosh, you're looking so pretty because you lost so much weight, X, Y, and Z," I feel like when I went to the opposite direction, that's when I started thinking about it more. And that is something that I'm constantly trying to combat now.

A lot of it is just all these signals we get in the world. Isis, the example you said of your daughter, it's like the way people talk about things. And you start associating those compliments to, "Oh, this must be the right way to do something because that's what everyone is saying," and that really messes with your head.

Margaux: I think too, Harjit, I came into the self-love and sort of realization of my internalized fatphobia maybe a year or two before med school when I was working as a yoga teacher and realizing that there are so many different body types and sizes, and yet here they all were in my class doing yoga.

I could see the beauty in each and every one of them, and I started to recognize that I wasn't offering myself that same compliment that I was giving to each of my students, and seeing each of them as a beautiful person, but I couldn't see myself as that way. So I think I started to recognize that.

But then when I met you in medical school and our meetings were around food and celebrating food and being together and having these wonderful conversations and transformative friendship all centered around food, I started to realize how negative food had been for me and how I didn't really have that cultural upbringing of food. We always ate family dinner together, but it wasn't like there was a set cultural food. It's just the American culture.

And so I saw that in you and your family, and I thought it was so powerful of a way to come together. I really wasn't allowing myself to have a good relationship with food and trying to come back to that point or establish that from the first place.

But I think it's something in medicine that we, as healthcare providers, aren't taught is that food is good. Food is fuel and food is social and needed. And we so often tell our patients, "Oh, your BMI is too high. Lose weight." But we as providers don't even know what that means, and we make food negative and I think that's so harmful.

So that's I think when I started recognizing internalized fatphobia, but I have to fight it every day. Like you were saying, there will be thoughts in my head when I'm getting dressed and the scrubs don't fit right, "I need to lose weight," and I have to catch that thought as it comes out.

Harjit: Yeah, because I am not going to allow this to take hold of me and control the way I eat or not.

Margaux, I really appreciate you bringing up that comment about food, and I kind of want to tie it into fatphobia and racism as well, because a lot of communities celebrate and find love and contentment and have exciting things around food. And I think a lot of times when we start viewing food as something as negative, you lose a lot of those moments of community as well.

Isis: Yeah. I agree 100%. Like I mentioned earlier, I'm Hispanic and every thing we do surrounds food.

Harjit: Yes. I grew up in West Valley and we had a lot of Hispanic families and I used to love it. Yes, go on though.

Isis: I live in West Valley.

Harjit: Oh, yay. West Valley is so cool.

Isis: That's so funny. But yeah, I feel like food does bring people together and it doesn't have to be a negative thing.

I recently learned about intuitive eating. Have you guys heard about intuitive eating before?

Margaux: Yes. I think this is the big post that we bonded over.

Isis: So funny.

Harjit: Can we talk about it a little bit more, Isis?

Isis: Yeah. So I'm in nurse practitioning school, and in one of my clinicals, I followed an NP in a weight management clinic. And basically, we talked about every topic that we have covered so far, but she shared this book with me that goes over into intuitive eating.

I've known for a long time that I have a bad relationship with food, and this book has just helped me change that mindset. Because like you said, our bodies need food. It's fuel. And four of the main ideas from this book that really resonated with me was to honor your hunger. I have starved myself in the past thinking that it would help me be happy, but obviously it didn't.

The second one is make peace with food, the third one is to respect your body, and the fourth one is to honor your health. And so I feel like those four main things tied into intuitive eating and have helped change my relationship with food significantly.

Margaux: I agree. I love it for all the same reasons. Also, being in pediatrics is realizing that we do have these natural cues and relationship with food from when we're born. And I think we're pretty good about getting fed according to those cues up until the time we're toddlers.

And then somehow society has decided these rigid three meals a day and ignoring cues and things like that. And so we sort of lose sight of what our body is telling us, the respect your body, listen to your body aspect.

And so a big part of it for me now is truly trying to tune in and listen. Am I craving this because I'm super stressed out and I think I just need it as a temporary thing, or will actually fuel me and make me feel better? And sort of being intentional and intuitive about eating.

I think it's such an amazing approach and program, and it's also based off of or sort of connects with the health at every size theory, which aims to improve body size diversity and acceptance in healthcare. And with the idea of everything we've been talking about, you can be any body size and be healthy.

And that's not to say that exercise doesn't have its place and not eating chocolate all day, every day isn't a good thing, but having that good relationship. If you're craving chocolate, you should eat chocolate.

And so, yeah, I love that you brought up intuitive eating and health at every size because I think those are two ways that we as medical providers can help our patients in moving forward and to change the system that is sort of is stuck on BMI. I think these two methods are really great tools for getting rid of BMI in medicine once and for all.

How we're going to do that, I don't know, but the more we talk about it, I think it's so powerful. For me, it's just recognizing and unlearning the internalized fatphobia in myself so that I don't apply that to patients. So I love that you brought that up as a way that . . . and I just think about it as a way that we can dismantle fatphobia and medicine and get rid of BMI.

Harjit: This is mean, but I'll see a chart and someone will say like "overweight" or "obese" and I change it.

Margaux: Yes. I love that.

Harjit: I'm like, "That's not going to be in my history." I'll maybe put something like . . . for example, if someone has obstructive sleep apnea, one of the risk factors might be a bigger like neck.

Margaux: Circumference.

Harjit: Yeah. So I'll just say there could be physical reasons for an obstruction, but I will never say they're obese or overweight or fat. And when I see it in other notes and I'm copying them forward for the next day, I'll take it off.

Margaux: Perfect. It's the little things that we can do.

Harjit: Really, the issue, Margaux, and I think the reason we're having this whole conversation, is we are causing, as providers, so much harm when it comes to fatphobia. We are perpetuating fatphobia. We are active participants in allowing fatphobia to persist. I think we've allowed as a community, as a medical community, to have a lot of people have psychological and social damage because of fatphobia.

And I see that a lot as a future psychiatrist and someone who's maybe practiced three months in psychiatry already. I see how much it impacts people, especially on a mental level. So then my question is, "Are you really talking about this? Is it really 'healthy' or unhealthy?" Because we're doing so much damage actually.

Margaux: I'll be honest. I didn't really know the history of BMI until I started . . . I saw one little snippet on Instagram maybe a couple months ago about the history of BMI, and then when I started looking into it, realized how it actually is racist and not valid as a tool, but yet we use and put so much weight onto it.

And like you said, Harjit, agency and autonomy for a person is so paramount and connected to their health. And then when you think about people who are oppressed by a white supremacist or colonized system that we live in, we're only adding insult to injury by using a tool that doesn't even apply to them to tell them yet another reason why . . .

Harjit: They're not okay to be who they are.

Margaux: Yeah, exactly.

Harjit: And also, I think the biggest issue I have is a lot of people will go to the doctor's office and then they'll be told that, "You're overweight, you're obese, you should lose weight, period." Okay. Can we have a discussion about that? Can we talk about our relationship with food? Can we talk about why in society I'm taught the way that I look or someone else looks is the ideal way to look? Can we have those conversations?

You cannot just give people facts. You need to complicate the conversation. I think that's where I am like, "We need to be careful the way we talk to people."

Isis: I feel like as healthcare providers, people come to us when they're most vulnerable. We have the power to educate people and guide them towards happiness, because I always associate healthiness and happiness together.

We're talking about BMI and weight, and we need to look at the whole picture. I learned recently, and it might sound silly that I just learned this, but we're so quick to judge a person by the way they look. And we initially think, "Oh, they're just lazy," or, "Oh, they just don't know how to stop eating," but there's so much more that encompasses how that person . . . their journey and why they have reached that point in their lives. We don't think about other diseases, or medication side effects, or a psychological trigger that might have happened earlier in their lives. And I think that as medical providers we really need to be aware of all those other things.

Margaux: It's so true. Unlike hypertension or diabetes, you can look at a person and you wouldn't be able to tell if they had those otherwise. Because weight is a visible characteristic, it's so easy for us to attach and diagnose and pathologize people just based on an appearance or a look.

And that's part of our socialized fatphobia, and I think it really gets beat into us in our training of a high weight equals heart disease. And you just make these quick snap judgments.

Like you said, there's so much more depth to a person beyond their weight that factors into who they are and their health and every aspect of them, and it's so important that we move away from that.

I think what's really hard is that we've been socialized by our society to be fatphobic and then even more in our training. You can make a snap judgment based on looking at someone, like you were just talking about, Isis. And I think, for me, a huge part is unlearning that internalized connection and judgment.

So one of the things I've been trying to do is follow people on Instagram that are body liberation and body liberation influencers. And two accounts come off the top of my head are @yrfatfriend and @FatLipPodcast. They both do a great job of portraying people of all sizes and doing everyday things.

And so the more I see those on my feed, the more it normalizes in my brain the connection that these are just people and I shouldn't try to pathologize or diagnose them the way that my brain has sort of been trained and socialized to do.

So that's one of the ways that I'm trying to overcome that, but it's so hard and I get caught in it. I think every day I catch myself making a judgment or noticing something and having to really catch it and tell myself, "Rewrite and reframe that behavior."

Harjit: I think that's really good advice of how you're seeing different mindsets and different images that really help you reshape the way you're thinking about something.

Another way that each one of us can really start this journey on our own is having these conversations about our personal story and our personal relationship with fatphobia, diet culture, and food. And I think once we have those conversations with ourselves, we are able to see that world in a different way and be more in tune with it.

And also, I was going to say something that reminded me of is we connect fat and food a lot, but even that connection is so complex. And like we had already discussed, food is a place where we build community. It's a way we pass on stories. It's a way we pass on cultures. It's a way we bond with each other.

And taking something so sacred and connecting it with BMI, it's actually really sad. It's actually destroying something so sacred. And I think really thinking about that is something that all of us can do together.

Margaux: I agree.

Isis: I love that.

Margaux: We should all just eat food all the time and then everybody will be happy.

Harjit: Yes. If you know me, I love food. Yay.

Well, that was a wonderful conversation. Isis, it was so amazing to hear your stories and we really loved sharing our own stories as well.

We really hope this will be a starting point or a point in someone's journey about understanding fatphobia, weight bias, and our relationship with food. I hope you will continue to have these conversations with your friends over a really, really good meal. That's what we love to do.

And continue to join us in our conversations. If you have any thoughts that you want to share, please share them @bundleofhers on Instagram. You can also go to bundleofhers.com to get any more information about our podcasts.

Thank you, everyone.

Margaux: Woo-woo. Bye.