Self-Care or Self-Destruction Post-Election 2016

  • posted by Marci Evans
  • Tuesday, November 15, 2016

Regardless of whether you supported Donald Trump or not, this election has likely deeply affected you. In this video blog I share my thoughts about picking up the self-care pieces post-election 2016. Self-care is at the center of your ability to be present and effective as the kind of change agent YOU want to be. And during stressful times our best attempts at self-care can unintentionally slip into self-destruction. I encourage you to take a quick self-assessment, commit (or re-commit) to taking charge of your online media usage, and remember that we aren't able to be effective when we are trying to pour from a dry well.

What are you doing to take care of yourself post-election?

The Preserving Employee Wellness Programs Act

  • posted by Marci Evans
  • Monday, April 13, 2015

Hey Readers,

It's not often that I talk politics on this blog. But after hearing Lizabeth speak at the MEDA conference a couple of weeks ago, I realized that I needed to have her write about this very important issue. Please, please take the time to read this. And if you have experience with this issue personally or know someone who does, consider following through on the call to action at the very end. Thanks for taking the time! The remainder of this post is written Lizabeth Wesely-Casella, Founder of BingeBehavior.com.


The Preserving Employee Wellness Programs Act (PEWPA), Senate bill 620, is bad legislation that reduces employee protections and promotes discrimination within the workplace.  Though the title is deceptively innocuous, this bill allows corporations to invade personal privacy, cherry pick which employees get insurance coverage, and it allows corporations to penalize employees who find themselves unable to comply with arbitrary metrics potentially unrelated to health.

Front and center in this legislation is the fact that employee protections will be rolled back almost entirely.  The protections provided in the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) will not be available to those who challenge an Affordable Care Act (ACA) compliant wellness program because this bill strips those protections.  Practices that are currently prohibited by antidiscrimination legislation such as asking for genetic information from family members of employees and asking for mental health histories, will be allowed during program screenings should this bill pass.  Additionally, obesity related protections under the ADA are in jeopardy; protections that need to be strengthened, not repealed.  The Equal Employment Opportunity Commission (EEOC) will no longer be the guiding source for rules and regulations in these matters because this act is intended to supersede the Commission’s oversight.  

Additionally, allowing corporations to cherry pick which employees they will insure, using intrusive screening and arbitrary guidelines, the act undermines the ACA, which mandates that preexisting conditions be covered by insurance.

The driving force behind this legislation is the reality that corporate wellness programs are by definition a ‘one-size-fits-all’ answer to the question, ‘How can corporations contain health care costs across the board’?  Certainly there are some well crafted programs that address the overall health of workers, programs that cover prevention, chronic disease, mental health and are designed by treatment teams rather than human resources departments, however these programs are the exception rather than the rule.  It’s quite common that workplace wellness programs are designed and managed by human resources departments and consulting groups who benefit financially from reducing the insurance costs customarily born by the employer; also called “cost shifting”.

The ACA was originally designed to encourage voluntary wellness programs, however, S 620 distorts the spirit of the “voluntary” language by giving corporations the power to pursue cost shifting through punitive fines for noncompliance, some as costly as $4,000. These fines are a subterfuge for shifting health insurance costs onto people with chronic diseases.  For corporations, this bill is a windfall; for employees, this bill is a disaster.

For many groups of people, compliance with an employee wellness program is impossible; it is the opposite of supporting wellness.

For example, it’s estimated that nearly 15 million people in America suffer from eating disorders.  As we know, people who suffer from eating disorders come in all shapes and sizes, from frail to large bodied.  The person in the large body with binge eating disorder (BED) may not fit into the BMI guidelines of an employee wellness program and therefor be encouraged, incentivized or threatened with punitive fines if they don’t reduce their weight and size.  Eating disorders are a mental health condition so beyond the fact that being weighed and measured for compliance and being given health advice by anyone other than a medical professional or treatment team is inappropriate, these activities are likely to cause distress and have dangerous, unintended consequences.

Other examples include people who carry significant weight due to medications, health conditions or genetic predisposition.  The point being, weight metrics based health programs, influenced and administered by people without medical expertise are no supportive of health and overall wellbeing.  When implemented, programs using this model target people in large bodies and cause discrimination through fines, fees, loss of insurance, and possibly loss of employment.

Language exists within the ACA that allows employees to seek a “reasonable alternative health standard” if the wellness program goals are contraindicated for their personal health, however, research by the Obesity Action Coalition shows that a majority of employees are unaware of this language and therefore would not invoke the remedies were they needed.  S 620 scales this protection back, allowing employers to require employees seeking alternate accommodation to complete all medical requirements and request processing within 180 days, which for many people is impossible for a variety of reasons including geography, resources, expense, time off work and bureaucracy.

The bottom line is S 620 is a dangerous piece of legislation that strips employee protections, encourages weight discrimination and completely dismisses the importance of employee engagement.  If we want robust health in our workplaces, we must address how programs are designed and demand that they support job security, personal choice and individual needs.  

Call to Action

We are asking for letters describing negative experiences and outcomes related to corporate wellness programs and people with EDs of any type.

Stories of:
Discrimination,
Triggering
Failure to inform or provide "Reasonable Alternative Standard” policies
Relapse
Any other harms
These stories will be aggregated and submitted to the Administration and/or the EEOC to help inform and strengthen the employee protections that are currently in jeopard due to Senate bill 620, the Preserving Employee Wellness Programs Act. This bill proposes changes to existing employee protections that would allow employers to ask invasive medical history questions including those about mental health and genetics. Also, it would allow businesses to penalize employees who choose not to participate in the programs with fines up to $4,000.

We need your help in flooding the EEOC and humanizing the reasons why invasive questioning, wellness programs based on weight metrics, Biggest Loser style competitions and punitive fines are direct discrimination to the 15 million Americans with EDs – many of which are part of America’s workforce.

Please send your stories, or stories of how your practice has been impacted by these programs directly to Lizabeth Wesely-Casella at admin@bingebehaivior.com at your earliest possible convenience – time is of the essence.

Thank you for your prompt attention and support in this activism. Your stories matter!

Bully Calls News Anchor Fat: When it’s Worse than Bullying

  • posted by Marci Evans
  • Tuesday, October 09, 2012

The virtual world of tweeting and blogging was all a flutter when a man called news anchor Jennifer Livinston fat. Many of us applauded Jennifer's direct and powerful response. I appreciated the fact that this issue (which is pervasive in our culture) got some air time! So I posted it on my facebook page to spread the word that weight bias and bullying are NOT ok. But my dear friend and phenomenally talented writer shared her own response to this news clip that I wanted to share with my readers. Thank you Deja Earley, for sharing your thoughts.

Perhaps you’ve seen the recent video on Facebook and elsewhere, which features Jennifer Livingston—a Wisconsin news anchor—responding to an email from a viewer which criticized her appearance, specifically her weight. It’s worth watching for yourself, but, to summarize, the email calls on Livingston’s “community responsibility” as a public personality to “present and promote a healthy lifestyle” and admonishes that “obesity is one of the worst choices a person can make and one of the most dangerous habits to maintain.” In response, Jennifer Livingston called the e-mailer a “bully” and, quite rightly, said that “attacks like this are not okay.”

At first I was pleased and impressed by her response. I’m glad she didn’t “laugh off” the email, as she said she was tempted to do at first, chalking it up to a job in the public eye. But I confess I grew confused by the switch to talk of bullying. In a way, I understand it: cyber-bullying is an important contemporary issue, and one she was perhaps wise to piggyback on.

But is this bullying? It seems to me it’s worse than bullying. To call this man a bully simplifies the grave ignorance of his email, and, at least to me, doesn’t exactly match his tone. The email doesn’t ever outright call her fat, doesn’t actually mock her looks. It would be easier to dismiss if it had. Instead, it strikes me as a carefully crafted expression of concern by someone who considered themselves a responsible citizen. Was it mean-spirited? Perhaps, though it doesn’t strike me as self-aware enough to think so. In light of his clear misconceptions about the real issues of weight and obesity, this email is much more dangerous than what we’re used to thinking of as bullying, and Livingston’s response is far from adequate.

Livingston begins her response by admitting the e-mailer is “right,” that she is “overweight.” “You could call me fat,” she says. Setting aside the fact that Livingston doesn’t actually appear particularly overweight, that she’s lovely and polished and full of poise, and owning up to his label is absurd, it seems to me the next question to answer is whether or not he’s right about his main claim: that she has a “community responsibility” to “present and promote a healthy lifestyle” and the implication that her weight barred her from doing so. Livingston, surprisingly, doesn’t address this, but the answer is a resounding no. She doesn’t have a community responsibility that she’s neglecting simply by the nature of her appearance.

The fact that this man thinks her credibility rests so heavily on her size is a problem, and perhaps not a surprising one in light of his other misconceptions: he calls obesity “one of the worst choices a person can make” and then, confusingly, “one of the most dangerous habits to maintain.” In one sentence, he manages to imply it is a both a single overarching choice, and a habit. Which is it, Sir? For anyone who struggles with weight, it’s clear that neither is accurate. Instead, one’s weight is a product of literally thousands of choices, many of them weighed down by social pressure, shame, nutritional confusion, fear, and the parade of misleading and contradictory messages about dieting that as a culture we schizophrenically embrace. Add to that mix health issues, genetics, and body chemistry, and you have a recipe for something exponentially more complicated than a single choice, or even a habit. The research is out there now that diets don’t work, that they do more damage than good, that calories-in-calories-out is a cozy but inaccurate myth, that our bodies and our minds are much more complicatedly involved in the process of weight gain and loss than we ever thought previously. (Which is why people like Marci Anderson—trained to navigate this minefield—are so important.

This man strikes me as someone who simply hasn’t heard the real news about weight, and maybe wouldn’t understand it if he had heard it. More disturbingly, I’m confident he’s speaking for a large sector of society, a group that could have used a more meaningful message than what I think Jennifer Livingston’s response boiled down to: she seemed to say, ultimately, “You’re right, but it isn’t nice to say so.” And while it’s true that it isn’t nice to call someone fat, it’s more than not nice. A statement like this man’s is wrong because it’s ignorant, because it’s pervasively and damningly ignorant, and the message against it needs to be significantly louder and much clearer. What Jennifer Livingston has done by speaking up is a start, but she didn’t go nearly far enough.

So I'm eager to hear your thoughts! What did Jennifer do well? Where did she miss the boat in her critique? How can we change the current shift of thinking that obesity is a choice? Is it possible to spread the message that you can be both fat and fit?

**For research that supports all of the claims listed above by both myself and Deja, please see the Health at Every Size website. We're not just making this stuff up!

The War on Obesity: A War Worth Fighting?

  • posted by Marci Evans
  • Thursday, October 06, 2011
A few days after the FNCE (the American Dietetic Association’s annual conference) dust has settled, I still find my emotions riled up about the very first session I attended. John Foreyt, renowned obesity research and Linda Bacon, Health At Every Size (HAES) clinical researcher and advocate stood head to head to duke out their views on the “obesity epidemic.” John Foreyt staunchly defended his position that the war on obesity is a war worth fighting and Linda Bacon asserted that this war we are waging is ineffective, misguided, and even harmful.

I cannot escape the fact that I write this post from a very biased point of view. I simply cannot give a neutral, objective review of the debate because my feet stand so strongly in the HAES camp. I use a non-weight focused approach in my nutrition counseling and I am a certified Intuitive Eating (IE) Counselor (which means I teach my clients how to respond to internal cues of hunger/fullness rather than dieting).

So, I questioned whether to write this post at all, knowing I don’t currently have access to a recording of the debate and my memory seems to have only held on to the pieces of Dr. Foreyt’s arguments that I found uniformed, inaccurate, and downright offensive. So despite all of this, I sit here writing my two cents, which are heavily influenced by my flawed memory, passion for a non-weight focused approach to health, and personal experience in my own clinical work (and in my own life).

I cannot adequately re-cap the 90 minute debate. But I will recount my top 5 assertions that Dr. Foreyt made that I whole-heartily disagree with. If you are interested in learning more about HAES and Linda Bacon’s perspective, keep reading. I’ll share some fantastic resources at the end of the post.

Top 5 Unscientific, Unsupported, Inaccurate Assertions made by Dr. Foreyt:
1. There are no negative side effects to yo-yo dieting and weight regain (except “some bad feelings like depression for some people.”)

If Dr. Foreyt had properly done his homework, he would have known that dieting is the #1 PREDICTOR OF FUTURE WEIGHT GAIN! See here and here for two examples. And I think it’s a bit crazy for him to undermine the negative mental health consequences that are a by-product of weight cycling. Anxiety, depression, and chronic self-esteem issues are serious concerns. He treated them like nothing more than a pesky skin irritation, when in fact mental health problems are like a deadly form of cancer; challenging a person’s ability to live with a quality of life everyone deserves. We cannot minimize the effects of re-bound weight gain and mental health challenges.

2. Some of your clients will be failures and some will be successes. That’s no reason to stop trying to diet and lose weight. Just keep trying.
Whoa, hold it right there. I cannot stomach the notion that anyone I work with is a failure. But I suppose if there is only one way to measure success that might be the case. If there was a chemotherapy treatment that created more cancer than it eliminated, would we keep using it? No. So why do we keep using the same methods for weight control when the research shows that a weight-focused approach leads to more weight gain? I have learned something magical in my work. When I take the focus off the scale it allows me and my clients to work on core issues which affect body weight, food choices, and self-esteem.

3. Intuitive Eating is a cause of today’s obesity epidemic. Intuitive Eating doesn’t work.
#1 I about jumped out of my chair when Dr. Foreyt stated this. How on earth can he say that Intuitive Eating contributes to obesity when virtually no one in the US practices it?!? Not practicing Intuitive Eating is THE REASON most people struggle with food and many carry more weight than they naturally would.
#2 The principles of IE are often misconstrued or improperly applied. Dr. Foreyt, have you read the book or the research on IE? It is not eating with reckless abandon. No, quite the opposite. It is eating what you want in response to physical cues for hunger/fullness, while attending to emotional needs without using food. I cannot fathom how this can lead to increased rates of obesity.
#3Please see the IE website, where there is research showing the effectiveness of IE.

4. Dieting does work.
Unfortunately, every long-term clinical trial aimed at reducing body weight by placing clients on a specific diet that I’m aware of results in the lovely “J-Curve.” The J-Curve illustrates rapid weight loss, followed by creeping weight gain over time. The LOOK AHEAD trial, led by Dr. Foreyt is an interesting example. Like all obesity research, interventions like a healthier/reduced calorie diet and exercise protocols are given. Consequently, weight decreases but a whole slew of other parameters improve (ie blood sugar, fitness levels, cardiovascular health). What's really fascinating is that the decrease in weight is sometimes quite small, like less than 10 pounds. But the researchers always cite the improved parameters secondary to weight loss, rather than a natural consequence of eating healthier and moving more. Why the focus on weight loss?

 
Many people love to cite the National Weight Control Registry as an example of permanent/lasting weight loss. Dr. Bacon informed us that weight loss must only be maintained for 6 months in order to be added to the registry, with no clear way to have your name removed if you have re-gained your weight. Dr. Bacon shared a story of a student whose name is on the registry, but has since gained back more weight than she lost and hasn’t been able to remove her name from the list. The weight loss research we have shows the majority of lost weight gained after two years. So the National Weight Control Registry may not be a reliable measure of successful "losers."

5. It’s better to be skinny than fat.
Again, Dr. Foreyt needs to check the research because it actually shows that the life expectancy for a person who is categorically overweight but exercises regularly is longer than someone of a “normal weight” and doesn’t exercise. Having dedicated my career to working with eating disorders, I can promise that it is better to be healthy inside and out regardless of your body weight. Being thin is absolutely no guarantee than you are healthier or “better” by any standards.

Please let me make myself clear. I am an advocate for HEALTH. This means I am an advocate of:
1. Eating a balanced, nutritious diet that includes all foods
2. Eating when hungry and stopping when full MOST of the time
3. Learning to cope with emotions without using food
4. Learning to eat in a way that leaves you feeling energized and satisfied
5. Eating by your own rules and no one else’s
6. Incorporating exercise in a way that keeps your body strong (this can only be done if you are eating well first)
7. Eating guilt and stress free
8. Enjoying and finding pleasure in what you eat and how you move your body

And I believe that this is possible at any weight. I stand with Linda Bacon when she says that “fat” is not the problem, it’s the war on fat that is making us sicker and more miserable.

Finishing remarks:

My regret is that the session left a divided group more divided. If we are going to figure out how to create a nation of healthier people, those of us in the eating disorder field have got to come together and truly dialog with those in the obesity field. And until then, the war will certainly continue.


This is a controversial topic. What are your thoughts?


Linda Bacon's FNCE Handout

Validity of Claims Made in Weight Management Journals

Weight Science: Evaluating the Evidence for a Paradigm Shift


*Picture Source

Michelle Obama: Tackling Childhood Obesity

  • posted by Marci Evans
  • Monday, February 15, 2010
For those of you who listened to President Obama's State of the Union address on January 27th, you likely heard him introduce his wife's initiative to tackle childhood obesity.

Interestingly, she received some criticism for sharing her own family's story and making explicit reference to her daughter's weight.  Many eating disorder experts fear that her blatant discussion about their weight is a set-up for disordered eating and preoccupation with their weight.  I have to admit, as a nutrition therapist who specialize in counseling people with eating disorders here in Cambridge, I was unhappy to hear her reference her daughters' weight on national TV.

Despite this criticism, I felt hopeful and excited while watching her YouTube video which unveils her project "Let's Move."  I'm thrilled at the prospect of nationally prioritizing our children's eating and exercise habits.  Creating healthy kids is essential for the success and health or our nation's future.

Check out her website Let's Move and watch her video clip.  Makes me wonder what we can all be doing at a community level to help support this initiative. What do you think?