The Preserving Employee Wellness Programs Act

  • posted by Marci Anderson
  • 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 Additionally, obesity related protections under the ADA are in jeopardy; protections that need to be strengthened, not repealed.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!

21 Day Fix from a Passover Perspective

  • posted by Marci Anderson
  • Thursday, April 09, 2015

Rachel shared her blog post with me and I wanted to share it with EVERYONE as quickly as possible. She addresses a universally important topic- how we as women speak about our bodies and the damaging domino effect- that is relevant whether you celebrate Passover or not. Read it, re-read it, and share it. The original post can be found here


No More Egypt
It's a mere few hours to go before Pesach begins, and I have just spent the better part of the day cooking and cleaning and otherwise engaging in last-minute preparations. I've made a bunch of nutritious meals and snacks to get me through at least part of the week, and I've also been mentally preparing myself for the two seders ahead--spending hours around a dinner table packed with people, even when they're people I love, is not this introvert's idea of a blissfully good time. But I've worked hard to be ready for Pesach this year, and I feel prepared. I can be in the moment. I can enjoy people's company. I can stay up late and it will be fine. And, I can eat whatever I want, because I'm in a place where I can do that.

So all things considered, I'm feeling pretty good...or at least I was, until I signed onto Facebook (I know, probably a mistake) and came face-to-face with a friend's status update, which (through text and photos!) outlined her latest achievements in the "21-Day Fix." Now, this isn't a new thing--obviously, I've been seeing posts like this for 21 days--and I have tried hard to react to them in the best way I know how; mainly, I ignore them. I mean, I love this friend of mine and I am happy for her that she's feeling good in her body and all of that...but, really, enough is more than enough.

It continues to blow my mind that so many women buy into the entire concept behind the "21-Day Fix" phenomenon. First of all, ladies, are you broken? What is there to fix, really? You are fine the way you are. And if you feel you're NOT fine the way you are, might I suggest exploring that feeling a bit further and seeing what's behind it, before jumping onto the "quick-fix" bandwagon? Usually, when we feel negatively towards our bodies, it's not our physicality that needs fixing...it's our way of thinking about ourselves. How about spending 21 days working on fixing that?

Additionally, it strikes me that our culture is so acclimated to body dissatisfaction and weight-shaming that it is considered not only normal, but actually admirable, for people to continuously post intimate details and images of their workouts, diets, and attempts at body transformation on social media. I mean, it actually frightens me. What kind of social environment have we created, here? It's not helping with the whole, "female respect" thing (I acknowledge that this affects men, too, but in my experience the worst social-media offenders are overwhelmingly female). Do we actually want to be perceived as having nothing better to talk about than food, weight, and body? Do we truly want our bodies to be the first (or only?) things that other people think of when they think about us? Furthermore, can we honestly say that we want our children, students, etc. to inherit the current norm of being totally preoccupied with "fixing" our bodies? If the answer to those questions is, "no," then we have to start changing the culture in which we operate by not adding fuel to the body-shaming fire.

I recognize that this post sounds a lot like a rant, and I suppose it is...but it comes from a place of frustration with the sensation of "swimming up the cultural stream" that I so often experience in recovery. I am tired of working so hard to have an intuitive approach to eating, and a loving relationship with my body, only to have it made harder by the societal pressure to go the other way. That's one thing I wish everyone who puts their diet updates on social media would understand: that by broadcasting their "successes" with the latest diet and exercise fad, they are actually making it harder--not easier--for other women to accept their own bodies.

Luckily, though, this unfortunate experience on Facebook happened to me on Erev Pesach, and after stewing about it for a few minutes, I remembered what this entire holiday is about: freedom from our "narrow places," and liberation from whatever it is that enslaves us. At that point, I had two choices: 1) Judge myself unfavorably in comparison to this friend of mine, and consequently restrict my eating at the seders; or, 2) recognize that my recovery is about being free from all of that craziness, and therefore grant myself permission to eat what I want...and enjoy it, without guilt. I have put in my time worshipping the god of thin-and-fit, and I'm done with that. I don't have to try to manipulate my body; I get to love my body by eating normally, exercising naturally, and--yes--enjoying treats without compensating for them. It's a better, freer way of life, and I've worked hard for it. So, this Pesach, no more Egypt for me...or, I hope, for any of us. This year, may we be truly free!



Lent: Supporting or Derailing Your Health?

  • posted by Marci Anderson
  • Friday, March 27, 2015

This post is written by Sarah Patten, a registered dietitian nutritionist with Marci RD.


I hesitate to type these words for fear of jinxing what I'm about to say, but after being pummeled with blizzards for the past few months and experiencing the official snowiest winter in Boston's history, it seems as though the worst is over and that there is a hint of spring in the air. The sun feels a bit stronger, the days are a tad longer, and we've had a couple of days now where the temp feels slightly more tolerable. Things are looking up!

With the onset of spring comes thoughts of flowers blooming, birds chirping, and for those who observe – the lent and Easter season. Lent is the Christian season of preparation before Easter. Traditionally, it's a time to reflect prior to the Easter celebration. Not all churches observe Lent, but those that do encourage a period of “fasting, repentance, moderation, and spiritual discipline.” Though it's roots are in spirituality and religion, the forty day period of Lent has somehow transformed in our society for many people to be a time to “give up” or “deprive” oneself of something that they enjoy or feel “indulgent” around. Almost all of us have heard chatter surrounding other's Lent goals – most typically we hear about people giving up chocolate, fried food, junk food, meat, dessert, eating after 6, or maybe even snacking altogether.

How has this religious tradition morphed into an opportunity for us to create even MORE rules around food? For some, this may be a challenge they choose to embrace with the best intentions. But for others, it appears to be more of a guise to diet and restrict their intake in the name of spirituality.
All of these thoughts came to mind after meeting with one of my clients a few weeks ago, just as Lent was beginning. I have been working with this client for quite some time on healing her relationship with food, rejecting the diet mentality, giving herself unconditional permission to eat, and not basing her self worth on the number displayed on her scale. This client has made tremendous positive progress in her relationship with food and has been increasing her focus on improving her body image and the way she talks to herself. It's been a pleasure to watch her evolve along this journey, and I was blown away when she came into our session a few weeks ago reporting that upon hearing all of her friends and coworkers talk about what “bad foods” they were planning to give up for Lent, she decided to put a different spin on this period of reflection. Instead of depriving herself of the foods she enjoys, she decided to give up negative body comments and negative self talk for forty days!

I was truly inspired by hearing these words. How fabulous to spend one's energy devoted to fostering a positive body image and speaking kindly to oneself rather than creating yet another set of temporary food rules. That's not to say this new challenge has been easy. My client has continued to notice these automatic negative thoughts popping up, but with her heightened awareness, she is able to catch them and reframe them much more quickly. Through our weekly sessions since Lent began, I've heard her speak about how much more beneficial it feels to have an encouraging and supportive inner voice rather than a critical and negative internal dialog. She's hopeful that the changes she's made in self talk will remain long past the Easter holiday – a profound shift that couldn't have been accomplished by giving up something like chocolate. Although the season of Lent is approaching it's end, I would encourage all of us to learn from this example. We all deserve to speak kindly to ourselves and our bodies 365 days/year – why not start today?

What goals, for Lent or otherwise, have had a positive impact on your health?

Intuitive Eating, Obesity, Weight, and Dieting

  • posted by Marci Anderson
  • Thursday, March 12, 2015

It's National Nutrition Month and in celebration, I wanted to share some important research about Intuitive Eating, Obesity, Weight, and Dieting. Intuitive Eating shaped my life and my career so it only felt appropriate to bring it to light during National Nutrition Month. Enjoy the vlog! And below I have included the Intuitive Eating Scale-2 by Tracy Tylka to help you determine how strong of an intuitive eater you are as well as the references I used to develop my vlog. Happy and healthy eating!

Intuitive Eating Scale- 2

Directions for Participants

For each item, please circle the answer that best characterizes

your attitudes or behaviors.  For each item, the following response scale should be used: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.

1. I try to avoid certain foods high in fat, carbohydrates, or calories.

2. I find myself eating when I’m feeling emotional (e.g., anxious, depressed, sad), even when I’m not physically hungry.

3. If I am craving a certain food, I allow myself to have it.

4. I get mad at myself for eating something unhealthy.

5. I find myself eating when I am lonely, even when I’m not physically hungry.

6. I trust my body to tell me when to eat.

7. I trust my body to tell me what to eat.

8. I trust my body to tell me how much to eat.

9. I have forbidden foods that I don’t allow myself to eat.

10. I use food to help me soothe my negative emotions.

11. I find myself eating when I am stressed out, even when I’m not physically hungry.

12. I am able to cope with my negative emotions (e.g., anxiety, sadness) without turning to food for comfort.

13. When I am bored, I do NOT eat just for something to do.

14. When I am lonely, I do NOT turn to food for comfort.

15. I find other ways to cope with stress and anxiety than by eating.

16. I allow myself to eat what food I desire at the moment.

17. I do NOT follow eating rules or dieting plans that dictate what, when, and/or how much to eat.

18. Most of the time, I desire to eat nutritious foods.

19. I mostly eat foods that make my body perform efficiently (well).

20. I mostly eat foods that give my body energy and stamina.

21. I rely on my hunger signals to tell me when to eat.

22. I rely on my fullness (satiety) signals to tell me when to stop eating.

23. I trust my body to tell me when to stop eating.

Scoring Procedure

1. Reverse score Items 1, 2, 4, 5, 9, 10, and 11.

2. Total IES-2 scale score: Add together all items and divide by 23 to create an average score.

3. Unconditional Permission to Eat subscale: Add together Items 1, 3, 4, 9, 16, and 17; divide by 6 to create an average score.

4. Eating for Physical Rather Than Emotional Reasons subscale: Add together Items 2, 5, 10, 11, 12, 13, 14, and 15; divide by 8 to create an average score.

5. Reliance on Hunger and Satiety Cues subscale: Add together Items 6, 7, 8, 21, 22, and 23; divide by 6 to create an average score.

6. Body–Food Choice Congruence subscale: Add together Items 18, 19, and 20; divide by 3 to create an average score.

References

Herbert BL, Blechert J, Hautzinger M, Matthias E., Herbert C.(2013). Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index. Appetite, 70(Nov):22–30. 

Tylka TL, & Kroon Van Diest AM. (2013) The Intuitive Eating Scale-2: Item refinement and psychometric evaluation with college women and men. J Couns Psychol. Jan;60(1):137-53. 

Madden C.E., Leong, S.L., Gray A., and Horwath C.C. ( 2012). Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutrition. Mar 23:1-8.

Tylka, Tracy L. Development and psychometric evaluation of a measure of intuitive eating.J Counseling Psych;2006. 53(2), Apr:226-240.


EDAW 2015: The Invisible Eating Disorder

  • posted by Marci Anderson
  • Monday, February 23, 2015

I'm very grateful to a client of mine who agreed to write this post for Eating Disorders Awareness Week. Since this week is all about generating greater understanding and myth busting, I felt that my client's perspective and story was incredibly important to share. It's important because what she has to say is profound and also reflective of how most people live in their eating disorders. While many people believe that an eating disorder is something that is clearly visible, the truth is that most eating disorders are not outwardly obvious. If you came to my office and watched the myriad of clients who come and go, you would see a variety of ages, races, genders, shapes, and sizes. Please take the time to read what it is like for so many sufferers to feel invisible in their illness.

There were years when my eating disorder was very visible. My eyes were wide and hollow, my lips were chapped, my weight was low, my skin was pale.  At the time, I was constantly either being recommended for a higher level or care or actually in a residential treatment center or hospital.  The people in my life knew I was sick.  They were mindful of saying things that might trigger me (even though they still managed a few gems) and continually expressed their care and concern. 

Fast forward to 2015.  After a final bout of residential treatment in 2010, I am in a stronger place, certainly, in my recovery.  Pregnancy, although a tenuous time, solidified my commitment to living in a way in which my behaviors are aligned to my values.  After I had my beautiful son in 2013, a glow returned to my skin.  A light returned to my eyes.  I smiled again.  I felt joy.  And I gained weight.  Is it painful?  Yes.  Would I do it again?  Absolutely.

I had my eating disorder for 15 years.  I’ve been at a healthy, average weight for about 2 years.  And in those two years, my eating disorder has become invisible.  To friends and family, I am recovered.  To them, it seems, recovery is a magical process in which all suffering, mental and physical, is erased with a healthy weight and outwardly “normal” eating habits.  It is like those fifteen years of my life never existed. 

In some ways it is a relief to be seen, once again, as the person who has it all together.  But then, wasn’t that what led to the development of the eating disorder in the first place? It’s confusing to be seen as someone who is so strong when the vulnerabilities that led to the eating disorder are still there and are still being addressed in outpatient treatment.

A family member of mine often asks me, “Why do you still see those people,” meaning my therapist and nutritionist.  If I were to be honest, I would say that the underlying issues still remain, despite being at a normal weight.  My intense need for acceptance, my low sense of self-worth, my shame around food and my body, my issues of grief, loss, and abandonment, and all of the other myriad factors contributing to my anorexia still remain despite the fact that I eat and that I appear healthy.  But instead, I just say, “Because they help.” 

I wonder about being honest with my family and friends about where I am in my recovery.  What holds me back?  I am afraid that they won’t believe that I am still suffering, because I don’t feel like I deserve to suffer if my outside doesn’t match my inside.  I worry that my words won’t be enough.  I worry that if I said how much I am hurting inside, I would let people down.  I worry that I am not worthy of care or even of treatment because I’m so much “better” than I used to be. 

One thing I am learning in recovery is that I don’t have to share my story, my most vulnerable self, with the world. I don’t have to wear my pain like armor. I can use my words to express my pain to those few I can trust with my most authentic self. It took a long time for me to be able to put words to my experience, and I am learning that those words are precious. In many ways, it is much easier for me to use my body to express that I have a need; a need to be cared for, loved, accepted, valued, treasured. Using my words is much harder, but in the end, a far more effective way of communicating.