November/December 2020 Issue
Body Positivity: Overcoming Body Shame
By Rebecca Scritchfield, RDN
Today’s Dietitian
Vol. 22, No. 9, P. 22
How to Help Clients Cope in the New Year
As sure as the ball drops in Times Square every New Year’s Eve, I expect a deluge of diet advertisements offering solutions to everyone’s weight loss woes. Correspondingly, there’s an uptick in urgency on the part of clients to “do something” about their body, even when they say they don’t want to necessarily follow a diet. Almost always, they believe that changing their habits will lead to desirable changes in their appearance, and then they’d be happier.
Believing that happiness is accessible only as a result of improving one’s body, usually through weight loss, is the telltale sign that clients need tools for shame resilience more so than a meal plan and a motivating word. Shame, an intensely painful feeling of being flawed and unworthy, is more likely to be the source of destructive, hurtful behavior than a viable solution.1
When I take time to address body shame as a primary barrier to positive self-care choices, clients can heal their emotional wounds and find satisfaction in their day-to-day decisions to care for themselves. The beauty of this approach is that anyone who has a desire to be good to their body can learn to do so without predicating their happiness on weight loss. Instead, clients pivot from body criticism and send themselves much more love and compassion than ever before. This self-kindness practice exists as a matter of believing their worthiness as a human being, even when they have thoughts and feelings that something needs fixing—their body, their habits, or both.2
An important benefit of shame resilience work is that it helps clients locate the problems within the culture that has created a hierarchy of “good” and “bad” bodies, therefore excluding most folks from accessing a positive body image. This is especially true for people who experience oppression based on their race, gender identity, sexual orientation, physical ability, weight, and social class.3,4 Simply stating, “My body is not a problem, culture is,” can be a revolutionary step for people.
Dietitians can engage in helpful conversations with clients around these issues by implementing the following four strategies.
1. Ask About Their Pain
Open-ended prompts such as, “Tell me about your relationship with your body,” can reveal pain and suffering clients haven’t resolved. This insight helps you discern why they feel the way they do and validates their pain. As clients share painful experiences, demonstrate empathy by saying, “I can see why you want to lose weight right now. You don’t feel comfortable in your body. You’ve been told your whole life you’re not attractive. You get messages from culture and people you love reinforcing the ‘thin ideal,’ and it makes you feel inadequate. If you looked the way you wanted to look right now, what would you be doing to care for yourself?” Emotion-coaching dialogue like this helps clients feel seen and heard and enables them to think more clearly about meaningful actions they can take.5,6
As dietitians, it’s important to talk to clients about their pain to avoid missing something fundamentally important for their growth. Think of a tree and that its leaves and fruit represent choices to make. Clients have choices to make, whether around meal planning, scheduling exercise, or bedtimes. Clients’ choices are influenced by thoughts and feelings—the trunk of the tree. Usually, clients tell themselves, “I can’t” and “I can’t handle this,” negative stories that interfere with their decision making.2 Adverse life experiences and trauma, including historical trauma and racialized trauma, are represented by the tree’s roots, which are integral to the life and health of the tree. These life experiences influence one’s thoughts, feelings, interoceptive awareness, and emotion regulation.7 It’s not about dietitians becoming therapists. It’s about seeking the valuable wisdom of clients’ lived experiences.
2. Help Them Make Sense of Culture’s Role
In addition to discussing past life experiences connected to pain, examine the cultural factors that contribute to pain. One example of this is helping transgender or gender nonconforming clients sort out their experience as individuals trying to practice body positivity. Their pain includes a system that doesn’t offer adequate mental health support, medical care, or social acceptance. They can’t just “think positively” to erase the gender dysphoria they may feel.8 No amount of displaying fat rolls while rockin’ a bikini on Instagram makes them feel more safe in a world that carries out fatal violence against them.9 A professional resource dietitians can obtain is A Clinician’s Guide to Gender-Affirming Care: Working With Transgender and Gender Nonconforming Clients by Sand C. Chang, PhD; Anneliese A. Singh, PhD, LPC; and lore m. dickey, PhD, which offers etiquette, language, communication support, and more.10
When it comes to current cultural beliefs on dieting for intentional weight loss, dietitians should acknowledge the complex history of weight and health with clients. Let it matter less that clients have weight concerns and help them examine where it comes from beyond their upbringing. In Fearing the Black Body: The Racial Origins of Fat Phobia, author Sabrina Strings, PhD, unpacks the intersections of white supremacy, religion, and medicine that shape weight bias today.11 Research has shown that weight-related discrimination doubles the 10-year risk of high allostatic load, the negative toll on the body resulting from being forced to adapt to excessive stress, contributing to morbidity and mortality risk.12
3. Discuss and Reframe Values
Clients can feel shame about any health behavior. For example, if a client says, “I can’t believe I still don’t exercise. I’m lazy,” ask, “Do you think you’re a bad person because you have this problem?” If they say yes, help them shift away from shame by simply reframing the behavior that’s bothering them. “I’m disappointed that I’m not exercising again. I used to do it, and I wish it was easier to motivate myself.” The change in perspective isn’t subtle. It allows them to focus their attention on preparing to take action rather than staying connected to unhelpful self-loathing thoughts.2
As clients become more aware of various influences on their self-appraisal, they may realign their goals with their values. For example, a client who says, “I got to do something about this weight,” may begin to see how shame interferes with mindful self-care.13 Discuss benefits of movement, changes to eating patterns, or sleep, outside of weight loss. Encourage them to say, “I want to be the kind of person who (fill in the blank with the value) because (fill in the blank with the benefit).”
If clients lose weight over time and they’re happy about it, their feelings make sense because that’s what culture says is “good.” There’s no need for them to feel shame because they’re celebrating feeling better and their body being smaller. This is more proof of how the body oppression system works. Encourage your clients to explore how their self-care choices make them feel in a more neutral manner. Prompt them to make statements such as, “Yes, I feel better physically and emotionally. Also, I’m proud that I’m doing yoga, getting better sleep, and my anxiety has decreased.” Keep in mind that dieting usually doesn’t result in lasting weight loss or health benefits and the ethics of weight-centric public health programs have been called into question.12,14,15
4. Role-Play the Voice of Their Inner Caregiver
Another important aspect of overcoming body shame is training oneself to listen to that voice of the inner caregiver. Everyone has a vital inner caregiver. It’s like a self-parent who nurtures with compassion and kindness, and says, “It’s OK to be here right now, to make mistakes, and to struggle.”
The inner caregiver usually is a quiet voice when a client is struggling with shame. Clients may feel so disconnected from their inner caregiver’s voice that they may think they don’t have one. You can ask, “How do you think your caregiver would help you with this problem?” If they have a hard time answering this question, ask them what they’d say to a friend. Their answers never fail to reveal that they have compassion inside them. They just need help finding it, connecting to it, and strengthening it.
Clients may find the voice by writing a letter to themselves or creating short scripts for particular problems that need self-compassion. For example, a client who eats emotionally could write, “It’s OK that you soothed your feelings with food last night. It’s one way to deal with problems. What’s another choice that may comfort you or sound interesting to try?” When clients make a mistake, it’s a shame trigger. Building a strong self-compassion practice is the antidote.2
Final Thoughts
While shame is a universal human emotion, those who easily fall into shame spirals are at greater risk of anxiety and depression and will have more difficulty with the behavior change process without adequate support to process shame.16 Dietitians are natural-born helpers and uniquely positioned to assist clients in building shame resilience with practical skills and a focus on health care and social justice issues.
— Rebecca Scritchfield, RDN, is the creator and author of Body Kindness, a mindful self-care philosophy for well-being enhancement through self-compassion and shame resilience. She reaches millions through her writing, podcast, and speaking. Scritchfield trains helping professionals in using the tools of Body Kindness to help people change habits and create a better life. For more information, visit
www.BodyKindnessBook.com.
References
1. Brown B. Shame v. guilt. Brené Brown website. https://brenebrown.com/blog/2013/01/14/shame-v-guilt/. Published January 14, 2013. Accessed September 1, 2020.
2. Scritchfield R. Body Kindness: Transform Your Health From the Inside Out — and Never Say Diet Again. New York, NY: Workman Publishing Co; 2016.
3. Cherry K. What is body positivity? Verywellmind website. https://www.verywellmind.com/what-is-body-positivity-4773402. Updated February 25, 2020. Accessed September 1, 2020.
4. Matz J. 3 misconceptions about body positivity. PESI website. https://www.pesi.com/blog/details/1762/3-misconceptions-about-body-positivity. Accessed September 6, 2020.
5. Emotion-focused healthcare. Emotion-Focused Family Therapy website. https://www.emotionfocusedfamilytherapy.org/emotion-focused-healthcare/. Accessed September 8, 2020.
6. Steps of emotion coaching. Emotion-Focused Family Therapy website. https://www.emotionfocusedfamilytherapy.org/steps-of-emotion-coaching/. Accessed September 8, 2020.
7. Price CJ, Hooven C. Interoceptive awareness skills for emotion regulation: theory and approach of mindful awareness in body-oriented therapy (MABT). Front Psychol. 2018;9:798.
8. Finch SD. How can trans folks ‘do’ body positivity? Wear Your Voice website. https://wearyourvoicemag.com/trans-folks-body-positivity/. Published August 9, 2016. Accessed September 8, 2020.
9. Fatal violence against the transgender and gender non-conforming community in 2020. Human Rights Campaign website. https://www.hrc.org/resources/violence-against-the-trans-and-gender-non-conforming-community-in-2020. Accessed September 10, 2020.
10. Chang SC, Singh AA, dickey lm. A Clinician's Guide to Gender-Affirming Care: Working With Transgender & Gender Nonconforming Clients. Oakland, CA: Context Press; 2018.
11. Strings S. Fearing the Black Body: The Racial Origins of Fat Phobia. New York, NY: New York University Press; 2019.
12. Vadiveloo M, Mattei J. Perceived weight discrimination and 10-year risk of allostatic load among US adults. Ann Behav Med. 2017;51(1):94-104.
13. Mayer CH, Vanderheiden E, eds. The Bright Side of Shame: Transforming and Growing Through Practical Applications in Cultural Contexts. Cham, Switzerland: Springer International Publishing; 2019.
14. Bombak A. Obesity, health at every size, and public health policy. Am J Public Health. 2014;104(2):e60-e67.
15. Tylka TL, Annunziato RA, Burgard D, et al. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes. 2014;2014:983495.
16. Kämmerer A. The scientific underpinnings and impacts of shame. Scientific American. August 9, 2019. https://www.scientificamerican.com/article/the-scientific-underpinnings-and-impacts-of-shame/. Accessed September 11, 2020.