Body Image work is life long work....

I have started writing this post multiple times.  I really wanted it to be about back to school and kids and talking about bodies but I keep getting stuck.  I haven't really had that happen before so I decided to check in and see what is up with my brain.  It's not that I am not passionate about what I was planning on writing about.  It's not that I don't think it is important because I really truly do.  And it's not that I don't think anyone would read it...because if I am going to be completely honest I think that with every post I write.  I think it is because I had an experience recently that has been eating at my brain a bit and maybe this is the place to dissect it.  I am going to be be completely honest...I have no idea how this is going to go.  And I really hope I find a point to what I am writing that someone else will find useful.

I am always reading books about body positive work, the politics of bodies and diets and pretty much anything I can get my hands on in this realm.  Recently I just finished "Landwhale" by Jes Baker (which if you have not ready you must!! So vulnerable, so amazing, so enraging) which is a memoir of living her life as a fat female.  So many components of this book were eye opening and having lived with thin privilege my whole life this book told stories that I needed to hear.  It was while I was reading this book that I had an appointment with my specialist for Crohn's disease.  I have recently started a new medication,  is a biological that I inject every 8 weeks and it treats both my Crohn's and Psoriasis.  At my appointment the doctor weighed me.  He does every 6 months and it is the only time I ever get weighed.  I don't decline because I know it is part of disease that my weight can fluctuate based on disease activity and he uses it dose my meds properly.   He made the comment that the meds must be working well as my weight has increased by 10% in 3 months.  Now as a person who spends her life wanting to eradicate fat phobia and make everyone comfortable in their bodies I was super pissed at myself for the reaction of "Seriously?!? Is that right??"  Here I am- a person that is supposed comfortable in their own body having a moment of "no..I did not gain that weight"  I- to be completely honest- don't remember much of the rest of the appointment as I was having an internal struggle with my gut reaction.  This is where I go back to "Landwhale" (READ IT!).  Jes talks about moving away from body love and body positivity to body autonomy.  Meaning that it is unrealistic to love our bodies every day, but we can work to accept that this is our only one.  We can be allowed to not like how they look  or how they are moving through the world- often times because the world is not built for all bodies- but we can learn to get through those moments.  Reinforcing that idea helped me, for a couple of different reasons.  First being that I was so pissed at myself for having any negative reaction to the comment that I was a grumpy ass for a few days.  I questioned all that I have written and said.  I noticed that my pants were tighter (noticed or projected I am not sure) and instead of telling myself to get new ones I had a couple hours (undershooting I think) of mental gymnastics of how to get my body back to what it was.  And I was disgusted with myself.  It was only when I was working on a lecture for school on self compassion that I seemed to snap out of it (not sure that is the right phrase).  My body is healing.  My body is absorbing food- all the food- for potentially the first time in years.  The psoriasis that covers 70-80% of my body is no longer visible or causing me pain.  And I was upset that my butt was bigger!  I sat here staring at my laptop wondering if I was only able to do the work I was doing because I was a "normal" clothing size.  Would or will I be brave enough to do it with a larger body- as the likelihood of my weight continue increase more is probable- or will I fall back into the depths of diet culture and rationalize my behaviour.  I can  honestly say I have never been more pissed off at myself nor have I ever questioned myself so much.  Both of which I think were good outcomes to be honest.  

I look at the work of fat activists, now these are amazing humans.  They not only put themselves out there to help others heal their relationships with their bodies they do it in a time where social media is rampant and trolls are everywhere.  The backlash they receive for merely existing is insane let alone that they live unapologetically in their bodies.  I realized that my message of "bodies need to be accepted at all sizes" is received in a different way because of my thin privilege(which is f'ed up)    This privilege has allowed me to have a voice that I am not sure I fully deserve to have.  (Yet I do believe that using my thin privilege to provide access to more marginalized voices is important and to this I will try to do more).  I want to showcase their work in a way that can bring more light to this topic and the amazing work that they do.  

The other thing that happened when I started working on this is that it became very apparent that this work is never, ever done.  Our bodies change all the time.  They age.  They get sick.  They heal.  And really as long as we have a body that means we are alive that in of itself is amazing!! Which means that one must always be doing the work on their bodies.  We must always be checking in to see what we are saying and thinking about ourselves.  And we must continue to challenge those thoughts and grow with our bodies.  My body didn't need food restriction or increased exercise.  My body needed me to say "heal from years of this disease", "do what you need to do so that I can continue to live my life".  My body needed me to say "thank you for continue to exist".  My body needed me to say "Who gives a flying fuck what you weigh!"

I am always learning, always changing.  I only know my own lived experiences and a bit about others from my learnings.  I feel that this experience opened me up to the realization that more work needs to be done in the world and in myself.  I am not even close to where I want or need to be.  I will continue to work on myself as I hopefully assist others on their body work.  

Until next time...be  unapologetically you while I be unapologetically me

ps....for those of you living in the GTA check out the Nourished Circle Retreat, link at top of page.

The day I taught my 10 yr old about diets...

If you follow me on social media you would know that recently I posted a very excited statement that my child didn’t know what a diet was. (It was one of those "OMG look at what my kid did moments"...with her adding "that sentence is Insta worthy...you are weird," to crash me back to earth). After my fist pumping, jump screaming excitement dissipated I realized that I needed to ask a few follow up questions as well as figure out how to manage the next few years of her life now that I had essentially taught my 10 year old what a diet is (my version of diets which may or may not have included an “s” bomb in my description). 

To save the backspace button on my phone (typing this in the car as we drive to a rugby match-parental multitasking at its finest) I am going to refer to my child as E ( the younger is e- smart right?!?)   So this started a few months ago when E was learning about puberty in school, realizing I truly wanted to control the conversation about body sizes and abilities I decided to pick up Sonya Renee Taylor’s book “Celebrating your body! (And all it’s changes) (FYI E and I are going to write a review of the book when we are finished...maybe not so much a review but a gushing post about how you all need to read it.)   I chose this particular book for a few different reasons. I LOVE Taylor’s work-(have you read “The Body is not an Apology” yet?)- as well as loving the diversity of bodies depicted in the pages. So, we were reading it together, stopping anytime E had a question or wanted clarification or to say for the 100th time “ so you get hair where??” when all of a sudden she says “ we need to stop I just don’t understand” I guess my face asked “what?” because she then said “ the books says diets are not good for your body and I do not know what a diet is...so what is it anyways?”  I started to laugh. Which I can tell you that you should not laugh out loud while reading a book on puberty with your child. After dealing with her anger at me laughing (she thought it was at her) I explained that her not knowing what a diet is, is perhaps in the top 5 moments of my adult life.We proceeded to talk about diets, who might do them, has she heard anyone as school talk about diets or needing to lose weight (the answer to that was yes but she said she never wanted to talk about that so often left to go do something else hence missing the details). We had somehow managed to get through the first 10 years of life without learning anything about food manipulation. I reached over and kissed her saying “ you are perfection”. The reply “I know we all are”. In that moment. I had hope. I had hope that this generation might not be getting the same messaging about their bodies as I did. I had hope that people were becoming more aware of how they talk about their child’s body to them. E already talks about everyone’s body being different and embracing these differences. Or was this hope false because I work my ass off to be inclusive off all bodies, abilities, genders, races in all aspects of my work and personal life (and I make mistakes in this area all the time but am trying to learn and grow and show my kids that is ok)

After our talk I sat back and thought about it some more. Yes there is no body talk in the house but there has to be more.  There has to be more than that for her to not really understand what a diet is.  As I thought about it I realized that my stance on body talk has truly helped her be shielded from it.  Pretty much everyone in my life knows my views on bodies, diets and how we talk about these things.  I do think that most people in my life do not talk about their diets or body talk around me (and therefore my kids) because they know that it will end up being a conversation instead of a flippant remark.  I kinda feel like this has helped form a force field of sorts around my kids.  It's not a perfect field and I know that the dark side will likely be able to find a weak spot and weasel in at some point but for now it seems to be working to hold diet culture at bay.  It just goes to prove to me how important it is to talk about our own bodies in a neutral or positive way at home.  How important it is role model these behaviours.  

But diet culture is a shape shifting villain that rivals Thanos (my first Marvel reference??...hmmm) in strength and determination.  I know that it is every where and as they get older they will see it too.  I hope the base that we have been working to build around bodies and how we treat them will hold.  I hope that this base is safe and warm and is comfortable enough to come home to when needed.

In the meantime we have talked more about diets.  I told E what they mean and why people used them.  I talk to her about the culture and how people think that their lives will be better if they lose weight and so they pursue this dream without living their lives in the moment.  We even talked about how people use "health" to fat shame and encourage people to diet.  To which my almost 10 year old looked me straight in the eye and said...." you mean people think that you can determine someones health by looking at them??...That makes no SENSE!!"

And that is why I have hope in the future....

Until next time by Unapologetically you...while I be Unapologetically me..

Type 1 Diabetes, Body Image and Language.

One thing that became very apparent to me when I was at the Body Image Workshop in Chicago with Marci Evans and Fiona Sutherland, was just how much we (RD’s, Therapists, Humans in general) need to work body image into the discussion with clients.  This got me thinking.  Not only does it need to be part of the discussion when working with clients with eating disorders, it needs to be part of the discussion when we are talking to clients in any context.  I think body image work needs to start being considered and perhaps even implemented in various settings.  I think about how diet or wellness culture is so pervasive.  We hear body talk almost constantly everyday- whether in direct conversations, on television shows (do we even call them that anymore if they are made for Netflix random thought), on the radio, in print ads and all over every platform of social media.  That constant inundation of diet or negative body talk can only be highlighted when they get diagnosed with a disease where the body become front and centre. 

Today I want to talk about type 1 diabetes and body image.  I worked in an exclusively type 1 facility for 8 years.  I watched these amazing families work with a disease that is highly unpredictable and very scary.  I also spent those 8 years wondering if what I was teaching to help each child diagnosed survive and grow would harm their body image.  Carbohydrate counting is very important for matching insulin doses to food however this puts a huge focus on carbs.  Kids and teens (my area) could easily link the need to take an insulin shot with the intake of carbs.  No carbs-No shot.  No matter how inclusive of all foods you are as a practitioner or a parent there is still an incredible emphasis on foods.  An individual with type 1 diabetes is recommended to give their rapid acting insulin approximately 15 minutes prior to eating.  This may not seem like such a big deal to some but what we are asking this individual to do is decide how many carbohydrates they are going to eat at that meal- no more no less- (unless they want to give a second shot to cover a second plate or they are on an insulin pump which is a bit different)  In doing this we are eliminating the ability to listen to internal cues- because there could be very dire outcomes if you give insulin for carbohydrates you decide not eat.  It is just another way we are teaching them not to trust their bodies.  And if you look at it from the lens that they probably already feel that way due to having a disease where their bodies “attacked” their pancreas. 

All this and we haven’t even scratched the surface on bodies.  So this topic is going to be a mini series of blog posts that can be read individually or together-this post will be on language around bodies, followed by eating and insulin and lastly diabulimia.  There are many things I wish I could have done better or changed more for my clients in my time at the diabetes centre.  I was still navigating my way around HAES™ in an environment that was not an eating disorder facility and in retrospect wish I had done more to change the diabetes universe (realizing just recently that I still could do this)  however I do think I made some changes or planted some seeds that were helpful and I want to share them with you.  Even if you do not work in diabetes I think that this might trigger some thoughts about your own work.

Language.  If you have read this blog before you know that I am very interested in language and how it lands on the receiver.  Especially how we talk about bodies.  At diagnosis, a kid or teenager will likely lose a fairly significant amount of body weight.  This is due to the physiological effect of starvation.  The body has stopped or is not making enough insulin and therefore the individual’s glucose is not getting to the cells for energy.  This will cause the body to breakdown muscle and fat for energy and will put the body into ketosis.  Due to not having enough insulin in the body to rid the body of the ketones many people will be diagnosed with Type 1 Diabetes when they are in or close to Diabetic Ketoacidosis.  These individuals are also often dehydrated as their bodies have been working to get the glucose out of the bloodstream via urine.  Therefore increased thirst and increased urine output.  All this to say that most bodies are much smaller at diagnosis then they were even a few months ago.  And it is at this point we need to be very aware of what we are saying.

Insulin needs to be injected subcutaneously, meaning into the fat tissue.  Imagine being newly diagnosed with a disease that you do not understand but learning your medicine needs to go into fat and often times these individuals will be told that they are so tiny right now(at diagnosis) that is it hard to find a spot to give the insulin.  In a culture that praises thinness this can be viewed as the best compliment.  Being so thin that it is hard to find a spot to inject.  If a child has been living in a larger body for a while this could be seen as ultimate accomplishment.  This is where I think the language around injections needs to be considered.  I do not think that practionners should be saying “ you can put this injection anywhere you can pinch an inch” or “we will use your butt as it has some good padding” or “ see this chub right here this is a perfect spot to inject”.  I wonder if we actually teach the kids (or parents depending on the age of the kid) what the layer under their skin actually is and why it is there.  What if we got really radical and called it your adipose tissue or the layer of fat under the skin.  By using cutsey names for fat we are again increasing the power of the actual word “fat”. 

The other talking point at diagnosis is weight.  As I mentioned there is often a decrease in adipose and muscle tissue prior to diagnosis which is then followed by an increase once insulin is initiated.  Clients are then often weighed every few days to assess that the insulin is working.  This is where I think education could happen such as talk about set point theory or even something as simple as what is actually being weighed on the scale.  I have personally found many kids and teens surprised to hear that when they are being weighed after diagnosis it helps the educators see that they are becoming more hydrated and getting more muscles.  That the scale tells you nothing about you or your health most times but in this instance it tells me water and glucose are staying in your body.  For whatever reason (DIET CULTURE!!) many kids think that the only thing a scale tells you is how fat you are.  Not how much your bones weigh, or how much the poop in your colon ways (a huge hit with the 6-10yr old crowd) In full honesty, I “forgot” to weigh people quite often but if a doctor demanded a weight I was sure to educate while doing it.  And I do think this helped.  Because as I will talk about in the third part of this series people learn very quickly at diagnosis no insulin=decrease of weight.  Which can then lead to purging by omitting insulin or Diabulimia as it is often referred to. 

Just imagine all this then you now have to live with a chronic disease that requires you to inject yourself daily-often in your abdomen, buttocks or possibly legs.  Well aren’t these every teenagers favourite body parts (yes, even boys the often forgotten group when speaking about body image).  In a social media world where these body parts are glorified when thin and smooth, it can be very difficult to constantly “pinch an inch” to give insulin.  Every 3 months (standard appointment spacing where I live) the diabetes team will ask to see these “sites” and check that they are not “lumpy”.  Again, imagine how this feels.  Imagine having multiple eyes on your midsection when you are already self-conscious.  I think this is why the continued dialogue around body image is so important.  Educators should be asking how clients feel about having so much focus on certain body parts.  We should be asking how this factoring into their self-talk about their bodies.  We should be asking how their bodies are being perceived at home.  I have often wondered if because of the nature of diabetes and the fear parents have, if those living with diabetes feel like their body is never truly their own.  I wonder this because there can be so many people involved in their management. 

Finally, gold standard care for a child living with Type 1 diabetes in Canada is that they see their specialist doctor every 3 months and as part of this routine checkup they are weighed.  I have seen parents standing at the scale ready to record the weight.  I have seen doctors comment on how much a kid is up over the course of the last 3 months.  I have seen kids panic before stepping on the scale. Again to be honest I always did blind weights.  I got very good at measuring a height and a weight at the same time.  Now I wish I had pushed back a bit more and questioned why.  We as a clinic stopped weighing teenage girls as frequently but I think it should have been for all ages and all genders.  My thought behind this is, why make weight such a key thing every 3 months.  Why should it be as important as HgBA1c or a meter download.  Because it’s not.  The weight tells me nothing of kids health.  What taking a scale weight did tell me however, is how much of a focus is on weight in a particular house, but I am not sure that most people will pick up on that information.  When you see a parent panic about the weight on a scale please take that as a sign that there will likely be diet talk (or healthy lifestyle change dressed up in diet talk) in the house. 

Watching how we phrase things regarding diabetes management can go a long way to helping protect our clients from poor body image.  And if you still struggle with these ideas try it yourself.  Be a client in a clinic appointment.  Get weighed in front of the team.  Show everyone your abdomen.  Show everyone your blood sugars and let them guess on your food intake and exercise (next post!) and then rate your body image.  How do you feel?  Now image being a teenager with a changing body and a disease you struggle with.  How do you feel about yourself now?

Until next time be unapologetically you, while I be unapologetically me