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Weight and Body Imagein Youth:

Are we helping or harming?

Summer Institute Breakout Session

August 24, 2012

Vanessa Lam, RD, Healthy Attitudes Program

Kit Standish, RN MA, BCCH Day Treatment Program

Amy Candido, Kelty Peer Support Worker

Amy’s Story

Outline

• What is Weight Bias?

• Challenging beliefs about weight

• How do my beliefs affect youth?

• What can I do and say?

• Resources

• Real Life scenarios

• Summary

What is Weight Bias & Stigma?

“Stigma and bias generally refer to negative attitudes that affect our interpersonal interactions and activities in a detrimental way.”

-The Obesity Society, www.obesity.org

Source: Dr. Carrie L. Matteson. Weight Bias as an Advantage in Practice Settings? PowerPoint Feb 9, 2011 Fraser Health 2nd Annual Eating Disorders Forum

Defining BiasStigma comes in several forms, including:

• Verbal Biasridicule, teasing, insults, stereotypes, pejorative language

• Subtle and Overt Discrimination obese employee denied a position or promotion

• Physical Stigmatouching, grabbing, or other aggressive behaviours

• Other Barriers and Obstacles

Medical equipment that is too small

Chairs or seats in public venues which do not accommodate obese persons

Stores which do not carry clothing in large sizes

-The Obesity Society, www.obesity.org

Source: Dr. Carrie L. Matteson. Weight Bias as an Advantage in Practice Settings? PowerPoint Feb 9, 2011 Fraser Health 2nd Annual Eating Disorders Forum

Have a look at what you thinkPlease be honest with your self…

No one else will see your responses!!

Scoring:– For items 1, 2, 8, 9, 11, 13 & 14:

• score as 5 4 3 2 1

– Reserve scoring for items 3, 4, 5, 6, 7, 10 & 12: • score as 1 2 3 4 5

– Add up the numbers for each question to get your total score. Then divide by 14 (the number of questions).

– The range of scores is 1 – 5.

– High scores = more ‘fat phobia’

– Low scores = less ‘fat phobia’

7Source: http://imgs.sfgate.com/examiner/pictures/1999/02/16/fat-ad.jpg

Weight bias starts early

• Negative attitudes toward obese children

begin as early as preschool age children 3–5 years old

• Compared to non-overweight children, they see overweight peers as:

mean, stupid, lazy, sloppy, and less desirable playmates

Source:Cramer P, Steinwert T. Thin is good, fat is bad: How early does it begin? J Appl Dev Psycho 1998;19:429–451.B rylinski JA, Moore JC. The identification of body build stereotypes in young children. J Res Pers 1994;28:170–181.

Weight Bias at School

“Obese children aren't doing worse in school because they're not as

smart as thinner students.

They're doing worse in school because they face frequent (and

often daily) victimization and harassment from peers because

of their weight.

They are made fun of in physical education classes, mocked in

the school cafeteria, and teased on the bus.”

Sources: Krukowski RA, Smith West D, Philyaw Perez Z, Bursa Z, et al. Overweight children, weight-based teasing and academic performance. Int J Pediatr Obes. 2009; 4(4): 274-280. http://www.montanadieteticassociation.org/support-files/2011-child-nutrition.pdf

http://news.yale.edu/2011/10/11/weight-based-bullying-can-lead-adolescents-potentially-harmful-coping-strategies

“the odds of students skipping school or

reporting that their grades were harmed

because of weight-based teasing increased 5% per teasing incident.”

Source: http://news.yale.edu/2011/10/11/weight-based-bullying-can-lead-adolescents-potentially-harmful-coping-strategies

Weight Bias by Educators

• Teachers report that obese students are:– Untidy– More emotional– Less likely to succeed at work– More likely to have family problems

• Educators have lower expectations for overweight youth

Source: Weight Bias in Youth: Implications for Teachers Rebecca Puhl, Ph.D.Rudd Center for Food Policy & Obesity2007

Yale University http://www.yaleruddcenter.org/resources/upload/docs/what/bias/WeightBiasInYouth.pdf

Professional Bias

• Are we dieting?

• Do we believe in good vs. bad foods?

• Do we loathe our bodies?

• Do we make assumptions based on the shape and size of our clients?

• Do we use the word FAT to describe bodies?

Source: Source: Health at Every Size – Webinar by Juliet Zuercher, RD, Nutrition Coordinator at Timberline Knolls

http://www.timberlineknolls.com/pdf/haes_presentation.pdf?mkt_tok=3RkMMJWWfF9wsRonva3IZKXonjHpfsX67OwrWKSg38431UFwdcjKPmjr1YIETMB0dvycMRAVFZl5nRhRF%2BKQboxJ9PBWBU6%2BVCg%3D

Why is fat so bad?

Core cultural beliefs

• Are we supporting Health or Beauty?

• Is everyone prepared to do the hard work?

Source: Health at Every Size – Webinar by Juliet Zuercher, RD, Nutrition Coordinator at Timberline Knolls

http://www.timberlineknolls.com/information/about/news/events/health-at-every-sizewebinar?mkt_tok=3RkMMJWWfF9wsRonva3PZKXonjHpfsX67OwrWKSg38431UFwdcjKPmjr1YIETMZ0dvycMRAVFZl5nRhRF%2BKQboxJ9PBWBU6%2BVCg%3D

Understanding factors causing weight-related problems: Spheres of Influence

Source: Neumark-Sztainer, Dianne. “I’m Like, So Fat!”: Helping your teen make healthy choices about eating and exercise in a

weight-obsessed world. New York, NY, Guilford Press : 2005

A closer look

Why do we keep weight stigma around?

Fat: • Lazy• Depressed

• Sick• Out of control• Loser• Bad

Thin:

• Productive

• Confident

• Healthy

• Disciplined

• Sexy

• Good

Source: http://www.nationaleatingdisorders.org/programs-events/nedawareness-materials-online-use.php#Articles

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Do my thoughts of size, weight and food matter?

No Fat Talk Video: http://www.youtube.com/watch?v=RKPaxD61lwo

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Fat is not a feeling

“Talking at the watercooler”

Your friend

I’ve gained so much weight.

I don’t know

how you stay so thin.

Your Old response

Oh my gosh, are you kidding?

I’ve gained so much weight

and way more than you.

You can’t tell because I’m

wearing black.

Your New response

You sound upset.

What’s going on that

made you think that?

Have you lost weight?

No, but I wish I could.

I keep trying but it’s pretty much hopeless

No. Nothing’s

changed. I guess I

haven’t seen you in a while.

Breaking the Fat Talk

Appreciate Behaviors & Talents

• Compliment others on

non-appearance characteristics such as:

– behaviors

– a skill or talent they have,

– an accomplishment

– or even their ability to

make other people feel welcome

Say this:

“You look

fantastic! Have you lost weight?"

"Dinner was

amazing, I always

enjoy when we can

get together and

catch up"

Instead of:

Source: http://endfattalk.org/resources/fat_talk_alternatives

Breaking the Fat Talk

Love Who You Are• Focus on non-appearance aspects about

your character or some things you love about your body and why you love them

“My arms are so flabby“

Instead of:

"I love my arms

because they

allow me to hug

my friend”

Say this:

Source: http://endfattalk.org/resources/fat_talk_alternatives

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Love your tree

Video clip from film America the Beautiful: http://www.youtube.com/watch?v=UEUsbLNAfW0

What you can do

• Accept your size.

• Embrace size diversity.

• Trust yourself.

• Focus on HEALTH not weight loss.

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Who are youth turning to for help?

Smith, A., Stewart D., Peled, M., Poon, C., Saewyc, E. and the McCreary Centre Society (2009). A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver, BC: McCreary Centre Society.http://www.mcs.bc.ca/pdf/AHSIV_APictureOfHealth.pdf

Teasing & Bullying in Youth

Source: Weight Bias and Discrimination: Nature, Extent and Necessary Solutions, Rebecca Puhl, 2012

http://www.yaleruddcenter.org/resources/upload/docs/what/bias/BEDA_Presentation_%202012.pdf

Types of weight based bullying(N=1555)

Source: Weight Bias and Discrimination: Nature, Extent and Necessary Solutions, Rebecca Puhl, 2012

http://www.yaleruddcenter.org/resources/upload/docs/what/bias/BEDA_Presentation_%202012.pdf

School Locations where Teasing occurs

Source: Weight Bias and Discrimination: Nature, Extent and Necessary Solutions, Rebecca Puhl, 2012

http://www.yaleruddcenter.org/resources/upload/docs/what/bias/BEDA_Presentation_%202012.pdf

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Weight teasing affects everybody% of teens who report being teased

by their weight by their peers

Girls Boys

Underweight teens 48% 41%

Average-weight teens 21% 14%

Moderately overweight teens 31% 26%

Overweight teens 63% 58%

Newmark-Sztainer D, Falkner N, Story M, Perry C, Hannan PJ, Mulert S. Weight-teasing among adolescents: Correlations with weight status and disordered eating

behaviours. International Journal of Obesity. 2002; 26:1230131.

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Weight Teasing is close to home

Low self esteem

Suicidal thoughts

No weight teasing 16% 25%

Weight teasing by either peers or family

25% 36%

Weight teasing by both peers and family

37% 51%

Neumark-Sztainer, Dianne. “I’m Like, So Fat!”: Helping your teen make healthy choices about eating and exercise in a weight-obsessed world. New York, NY, Guilford Press : 2005

Eisenberg M, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents. Arch Pediatr Adolesc Med 2003;157:733–738.

Effects of Weight Bias

Source: Weight Bias in Youth: Implications for Teachers Rebecca Puhl, Ph.D.Rudd Center for Food Policy & Obesity2007Yale University http://www.yaleruddcenter.org/resources/upload/docs/what/bias/WeightBiasInYouth.pdf

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Why does Body Image matter?

Healthy Body Imagestems from:

• a high self-esteem

• self-confidence about looks, physical capabilities and personal worth

• a sense of connectedness to school and others

• a feeling of positive wellbeing

Body DissatisfactionIs NOT a part of normal adolescent development

= NO MOTIVATIONSource: Centre for Health Promotion, Children, Youth and Women’s Health Services. Government of Australia. Absolutely Every Body Part1: Guide for Teachers. March 2011. http://www.healthpromotion.cywhs.sa.gov.au/library/AEB_part1_teachers_guide.pdf

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> 40% of youth

don’t like the

way they LOOK

48.9 % of youth have

BEEN ON A DIET

53.7% of youth

wanted to LOSE

WEIGHT

28.9 % of youth on

average engaged in

BINGE-EATING

MacKay, L., Saewyc, E., & Smith, A. (2009). Eating disordered behaviour, body image, and BMI among adolescents in the Vancouver Coastal Health region. McCreary Centre Society

Vancouver Youth are at risk

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What you can do to support youth

• Pay attention to what you say

• Make negative weight related comments unacceptable at home and work

• Don’t laugh at weight-related jokes

• Role model non-weight focused attitudes and behaviours

Focus on HEALTH, not weight

• Look at Health as a

Value instead of Size as a Goal

Health at Every Size

http://www.haescommunity.org

Approaching the topic of disordered eating and overweight

1) Express concerns about their overall health and well-being in clear and simple language.

Some things you can say are:

“Your energy seems to be lower than usual.”

“I've noticed that you're less outgoing and more withdrawn.”

Don't comment on their weight or appearance.

Approaching the topic of disordered eating and overweight

2) Ask the student for their thoughts, feelings, and reaction. Listen.

You could ask:

"How do you feel about what I've just said?"

"Have you noticed some of the changes I've mentioned?"

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What Teachers and Counselors can do

• Refer to Guidelines For Teachers and Counselors: Helping a student with suspected disordered eating

• Inform school staff about PHN role and referral (PHN consultation form)

• Consult with Healthy Attitudes Program

Teaching Tips

Health Promotion approach

• Positive self-esteem, body image

• Media Awareness• Communication, Self-assertion

• Healthy Eating and Physical Activity

• Please use recommended and validated Teaching Resources

Avoid

• Calorie counting or weighing in class

• Discussing dieting tips or signs and symptoms of eating disorders

Teaching Tips

Choose age-appropriate activities

• Age appropriate nutrition education objectives:– K-1 – identify foods; try foods; compare shapes, colours, and

tastes

– 2-3 – classify foods into food groups; choose snacks from the food groups; identify and create balanced meals

– 4-6 – assess diets for balance; make plans to improve food choices

– 7-9 – assess diets for balance; make plans to improve food choices; problem solve

– 10-12 - assess diets for balance; make plans to improve food choices; may refine choices (eg. choosing lower fat more often)

Source: Teaching Tips for Nutrition http://www.vcha.ca/programs_services/icy/nutrition/child_youth_nutrition/_docs/binary_102475.doc

First Do No Harm – Phrasing

• Chips are bad for you

• Salad is good for you

• You shouldn’t eat cake every day

• French fries will give you heart disease

• Burgers will make you fat

• Eating soup before a meal will make you lose weight

Versus

First Do No Harm- Phrasing

Versus

• Eating from all 4 food groups gives you energy to play soccer

• Eating breakfast will help you get better grades

• Eating broccoli, salmon, yogurt and other healthy foods will help keep you from getting sick

• Eating lots of treats every day means you don’t get the vitamins you need to be active, healthy and happy

• Eating healthy fats gives you healthy skin

My personal do’s / don’t’s

• Ask permission before sharing info or ideas.

• Remain curious and use open-ended questions.

• Avoid the term ‘diet’. Use ‘eating patterns/ habits’ instead.

• Use the youth’s own knowledge of him/herself to guide ideas/ solutions (youth should be doing more talking)

• Recognize that someone of any body shape/ size may have concerns about their body.

Teaching ResourcesBeing Me K- 9 http://www.actionschoolsbc.ca/Images/Being%20Me-WEB.pdf

• module that supports existing physical activity and healthy eating frameworks and to complement Action Schools! BC’s Classroom Healthy Eating Action Resource (CHEAR)

The Student Body Grades 4 - 6/8 http://research.aboutkidshealth.ca/thestudentbody/home.asp

• a teacher training module designed to help alert teachers (and parents) to the factors that can trigger unhealthy dieting among children, and ways to prevent it

Jessie’s Legacy http://familyservices.bc.ca/professionals-a-educators/jessies-legacy

• a program of Family Services of the North Shore, provides eating disorders prevention education, resources and support for BC youth, families, educators and professionals.

• Educator Resources: http://familyservices.bc.ca/professionals-a-educators/jessies-legacy/resources-for-educators

The National Eating Disorder Information Centre (NEDIC) http://www.nedic.ca/index.shtml

• a non-profit organization that provides information and resources on eating disorders and food and weight preoccupation

Learning Activities

take 20 minutes

Questions for Discussion

• Have you witnessed weight bias by students or teachers at your school? If so, what occurred in these situations? How did you respond?

• What strategies do you think would be especially helpful to reduce weight bias at your school?

Real Life Scenario

Case # 1

John is 17 years old and wants to be an actor. He has struggled with how his body looks to others. Students tease him directly in the lunchroom and talk about “how fat he is” behind his back in class. He confides in you that the drama club teacher told him that in order to be a successful actor, he needs to lose weight.

What are the issues?

What would you be concerned about?

How would you approach this? What would you say?

What resources would you offer if any?

Case #1 Weight Stigma at School

Issue: The teacher is concerned how John’s weight could be impacting his chances at succeeding as an actor. Students are teasing John in and out of class.

Concern: Teacher’s beliefs about weight and body shape is directing her assessment of how John will perform and his future success. The students’ behaviours are perpetuating the belief that “fat” is undesireable and that it is acceptable to tease someone for being “different”.

Approach:• Explore with John what he thinks about the teacher’s and students’ behaviours• Highlight the positive attributes and skills that John has to offer

• Explore with school staff about school culture values around diversity and acceptance of different body shapes and sizes.

• Discuss with school staff around having an anti-bullying policy that includes weight teasing and how to support students to feel safe and welcome at school

Resources:Being Me: Promoting Positive Body Image Resource

Fat Talk Alternatives re: what to sayFat Talk VideoTalking about Bullying handout

Building a Body Image Friendly School

Calm, safe, welcoming ?Laughter, friendly

chat, people being helpful to each other ?

Groups of students

gathered together in different areas of the

school ?

What does a body

image friendly school FEEL like?

What does a body

image friendly school SOUND like?

What does a body

image friendly school look like?

REFLECTION

• What is positive body image?

• What does it mean to respect EVERY BODY? For staff, students & parents

• What does it mean to be a body image friendly school?

DISCUSSION

• What do we do?

• Focus on Language

• Valuing Diversity

ACTION• What’s in place? What is needed?

Source: Australian Government, Conversation Starters for School Leaders, http://www.youth.gov.au/bodyImage/Documents/ConversationStarters_SchoolLeaders.pdf

Suggested Books

Summary

• Weight bias affects everyone & is everywhere

• Body dissatisfaction and dieting is not normal

• Accept your size and Trust yourself

• Catch, Challenge and Change your Fat Talk

• Use healthy weight language

• Focus on health not weight

• Promote acceptance of all body shapes & sizes

Body Image Friendly Checklist

Reflect about your school:

� Is there a clear policy on health and well-being which makes reference to positive body image?

� What do you think about the uniforms at your school (including sports uniforms)?� Are you happy with the food offered at the cafeteria of your school?� How well do students relate to each other at school?� Are body friendly images displayed around your local school? If so, where?

What or how does your school do:

� to provide opportunities for all students to engage in regular physical activity in a non-competitive, non-weight-loss focused, safe and secure environment?

� to promote and value the diversity of the student population?� to teach values (such as honesty, respect, empathy and inclusion)?

� to support students suffering negative body image, and/or appearance-related bullying (including cyberbullying)?

� to have opportunities for parents/carers and community leaders/operators to contribute to the health and well-being policies and programs in your school?

Source: Australian Government, Conversation Starters for Parents, http://www.youth.gov.au/bodyImage/Documents/ConversationStarters_Parents.pdf

Continuum of Food and Weight Pre-occupation

Source: Jessie’s Legacy Fact Sheet on Disordered Eating www.heretohelp.ca

Warning signs of Disordered Eating

Physical signs

• Fainting, dizziness, light headed

• Noticeable weight loss

• Pale

• Low energy

Psychological signs

• Preoccupation with body and/or weight

• Reduced concentration, memory and thinking ability

• Mood changes – withdrawn, quiet, unhappy, irritable

Behavioural signs

• Recent switch to vegetarian or vegan diet

• Skipping meals and/or won’t eat with others

• Strange eating rituals

• Drinking excessive amounts of water and/or tea

• Frequent trips to bathroom

• Decline in attendance

• Prefers standing to sitting

• Excessive exercise

• Layered, baggy clothes

Minimization of Eating Disorders

• “You can never be too rich or too thin”

• “What’s the problem - just eat!”

• “You’re not thin enough to have an eating disorder”

• “You’re too fat to have an eating disorder”

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Healthy Attitudes Program (HAP)

• youth aged 11-24 who

reside in Vancouver and are at risk of developing

eating disorders and body image disturbances

• Thursday Afternoons 2-5pm

• Referral by client, family or professional