Post on 17-Mar-2018
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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